Radiological predictors of surgical intervention and hospital outcomes in paediatric subperiosteal orbital abscess: A 10-year cohort study and decision tool

Abstract

Importance

Paediatric subperiosteal orbital abscess (SPOA) is a serious complication of sinusitis. Unclear radiological criteria risk unnecessary or delayed surgery, prolonging hospitalisation.

Design and measures

Retrospective cohort study of 117 children with computed tomography (CT)-confirmed SPOA at an Australian quaternary children's hospital (2015–2025). Patients were grouped by treatment (surgery vs non-surgical) and, for surgical cases, by time from CT to operation (≤24 h, ≤48 h, >48 h).

Results

Of 117 patients, 70 underwent surgery. Surgical patients had significantly larger median abscess volumes (1.03 mL [IQR 0.70–1.57] vs 0.14 mL [0.08–0.26]), proptosis (4.8 mm vs 2.3 mm; both p < 0.001), and bony erosion (52.9 % vs 31.9 %; p = 0.04). Abscess volume was an independent predictor in multivariable analysis (OR 1.99 per 0.1 mL, p < 0.001). Logistic regression using abscess volume predicted surgical need (AUC = 0.96), with 94.3 % sensitivity and 89.4 % specificity. Median hospital length of stay (LOS) was significantly longer in surgical patients (4.95 days [IQR 3.89–6.48] vs 3.92 days [IQR 2.93–5.05]; p < 0.001) attributable to surgery >48 h (5.09 days [4.77–6.42], p < 0.001). Complications occurred in 34 % of surgical vs 17 % of non-surgical patients (p = 0.04), driven by surgical-only events; rates of shared complications were similar, and no permanent vision loss occurred.

Conclusion

Abscess volume independently predicts surgical need in paediatric SPOA. The logistic model achieved high discrimination, with timely surgery avoiding excess LOS. Wider use of this tool may promote consistent management and improve outcomes.