Background Due to limited evidence to guide management of periorbital cellulitis (POC), we surveyed current practice and assessed quality and consistency of local clinical practice guidelines (CPGs) to highlight future research priorities. Methods A web-based survey was sent to a designated emergency physician (who clinically assesses children) at Paediatric Emergency Research United Kingdom and Ireland (PERUKI) sites between 23 November 2018 to 22 January 2019. A nominated site lead offered one response as a department-wide perspective on admission, severity assessment, treatment, disposition and specialty consultation request. Sites shared their CPG. These were compared using a standardised data collection tool, and quality assessed using Standardised Reporting Practice Guidelines in Healthcare (RIGHT) criteria. Survey responses were also compared against CPG recommendations. Results 83% (49/59) institutions invited submitted an individual survey response. 67% of responding sites had a CPG and 63% (31/49) submitted these. CPG quality was poor (mean 6.7/35 RIGHT criteria). 21 different severity markers were identified across CPGs. Most CPGS recommend investigations for severe disease, yet 23% (7/31) advise blood culture universally. 90% of CPGs advise discharge with oral antibiotics for milder cases, yet 86% of respondents reported departmental admission of all patients with POC. Nearly all respondents included proptosis, systemically unwell and visual disturbance as indications for admission but differed regarding importance of other signs. Conclusions We demonstrated variation in practice across the PERUKI network in assessment of severity and management of POC. CPGs vary in recommendations, and clinical practice appears to differ from CPGs. Guidelines were generally of poor quality when compared against RIGHT standards. Data are available on reasonable request. Any further data required may be made available via request to the corresponding author.

中文翻译：

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儿童眶周和眼眶蜂窝织炎：对急诊医生的调查和整个 PERUKI 网络临床实践指南的分析


背景由于指导眶周蜂窝织炎（POC）治疗的证据有限，我们调查了当前的实践并评估了当地临床实践指南（CPG）的质量和一致性，以突出未来的研究重点。方法 2018 年 11 月 23 日至 2019 年 1 月 22 日期间，向英国和爱尔兰儿科急诊研究 (PERUKI) 站点的指定急诊医生（对儿童进行临床评估）发送了一份基于网络的调查。指定站点负责人作为部门提供了一份答复- 对入院、严重程度评估、治疗、处置和专业咨询请求的广泛视角。网站分享了他们的 CPG。使用标准化数据收集工具对这些数据进行比较，并使用医疗保健标准化报告实践指南 (RIGHT) 标准评估质量。调查回复也与 CPG 的建议进行了比较。结果 83% (49/59) 受邀机构提交了个人调查回复。 67% 的回复网站拥有 CPG，并且 63% (31/49) 提交了这些内容。 CPG 质量较差（平均 6.7/35 RIGHT 标准）。在 CPG 中确定了 21 种不同的严重程度标记。大多数 CPGS 建议对严重疾病进行检查，但 23% (7/31) 建议普遍进行血培养。 90% 的 CPG 建议对较轻的病例使用口服抗生素出院，但 86% 的受访者报告所有 POC 患者均已入院。几乎所有受访者都将眼球突出、全身不适和视力障碍作为入院指征，但对其他体征的重要性存在不同看法。结论 我们证明了整个 PERUKI 网络在评估 POC 严重性和管理方面的实践差异。 CPG 的建议各不相同，临床实践似乎也与 CPG 不同。 与正确的标准相比，指南的质量通常很差。可根据合理要求提供数据。任何所需的进一步数据可通过向相应作者提出请求来提供。