A report by Mahalingam-Dhingra et al1 offers an enlightening perspective on the relationship between epidemiologic factors and use trends in pediatric patients with orbital infections, with important implications for clinical care and preferred practice guidelines. The implications of this work will be important to optimize the triage and management of such patients. Analysis of the Kids' Inpatient Database, published by the Agency for Healthcare Research and Quality, demonstrated that older age, the presence of diplopia, and hospital admission via the emergency department predict the likelihood of surgical intervention in cases of patients with pediatric orbital infections. In general, these findings are consistent with previous reports indicating an increased likelihood of polymicrobial infections requiring surgical management in older children.2
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