Preseptal cellulitis versus orbital spectrum disease in children: Early predictors and impact on hospital costs.

Authors

Esmanur Demir, Nevin Hatipoglu, Emine E Sari, Sadik S Hatipoglu

Published in

International journal of pediatric otorhinolaryngology. Volume 207. Pages 112924. Jul 08, 2026. Epub Jul 08, 2026.

Abstract

Periorbital infections in children encompass a clinical spectrum from preseptal cellulitis (PC) to orbital spectrum disease (OSD), with markedly different management requirements and outcomes. The economic consequences of this distinction remain poorly characterized.
To identify independent predictors of orbital involvement in children presenting with periorbital infection, and to quantify the impact of disease severity on hospital costs across five expenditure categories.
This retrospective cohort study included 219 pediatric patients managed at a tertiary center between 2016 and 2022. Patients were classified as PC (n = 177) or OSD (n = 42) using the modified Chandler Classification. Clinical, laboratory, radiological, and detailed cost data were collected. Multivariable logistic regression was used to identify independent predictors of OSD and of high-cost hospitalization.
OSD patients were significantly older (median 7.5 vs. 5.0 years, p < 0.001), presented more frequently with pain, fever, and presenting symptom count ≥3, and had higher rates of extensive sinus involvement (54.8% vs. 20.3%, p < 0.001). C-reactive protein (CRP) and neutrophil counts were markedly elevated in OSD, while lymphocyte counts were significantly lower (median 2.6 vs. 4.0 × 10³/μL, p < 0.001). Four variables independently predicted OSD: presenting symptom count ≥3 (adjusted OR [aOR] 4.90), extensive sinus involvement (aOR 3.01), age (aOR 1.12 per year), and CRP (aOR 1.09 per 10 mg/L); model AUC was 0.825. Median total cost was 8.3-fold higher in OSD than PC (USD 140.3 vs. 16.9, p < 0.001). OSD, sinusitis, and elevated CRP independently predicted high-cost hospitalization.
Age, presenting symptom count, extensive sinus involvement, and CRP assessed during the initial diagnostic evaluation support early identification of children at risk for orbital involvement. Although lymphopenia was associated with orbital spectrum disease on univariate analysis, it was not retained as an independent predictor in the final multivariable model; its potential clinical utility should be considered exploratory and warrants further investigation in larger prospective studies. Orbital involvement is associated with substantially higher hospital costs, driven primarily by service and medication expenditures.

PMID:
42424680
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.

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