Appropriateness of Diagnosis and Management for Otitis Media With Effusion in Pediatric Urgent Care Clinics.
Document Type
Article
Publication Date
6-1-2023
Identifier
DOI: 10.1097/PEC.0000000000002954
Abstract
BACKGROUND: Otitis media with effusion (OME)'s clinical presentation is often confused with acute otitis media (AOM) by clinicians. Despite OME guidelines recommending watchful waiting with no antibiotics, rates of antibiotic use remain elevated. The aim of this study was to determine the clinician diagnosis validity and the rates of antibiotics prescribed among pediatric OME patients evaluated in 3 urgent care clinics within a pediatric health care system.
METHODS: We retrospectively reviewed a random sample of encounters for children aged 0 to 18 years with a billing diagnosis of OME in 2019. We recorded clinical symptoms, antibiotic prescribed, and the clinicians' diagnosis. We used the American Academy of Pediatrics guidelines to assign an AOM diagnosis and compared those with the clinicians' final diagnoses using Pearson χ 2 .
RESULTS: Of the 912 eligible charts, clinicians' final diagnoses were as follows: AOM for 271 (29.7%) patients, OME for 638 (70.0%) patients, and no ear pathology for 3 (0.3%) patients. Antibiotics were prescribed for 519 (56.9%) patients; of those, only 242 (46.6%) had a final clinician diagnosis of AOM. Antibiotic prescribing rates were higher when a clinician diagnosed AOM compared with OME (89.3% vs 43.2%; P < 0.001). Per American Academy of Pediatrics guidelines, up to 273 (29.9%) patients qualified for an AOM diagnosis, but those were not the same as those diagnosed with AOM by clinicians ( P < 0.001).
CONCLUSIONS: When evaluating children with a billing diagnosis of OME, a third fit a diagnosis of AOM. Clinicians commonly misdiagnosed AOM, but also prescribed antibiotics to almost half of those they diagnose with OME.
Journal Title
Pediatric emergency care
Volume
39
Issue
6
First Page
390
Last Page
392
MeSH Keywords
Child; Humans; Infant; Otitis Media with Effusion; Retrospective Studies; Otitis Media; Anti-Bacterial Agents; Delivery of Health Care; Acute Disease
Keywords
Otitis Media with Effusion; Retrospective Studies; Otitis Media; Anti-Bacterial Agents; Delivery of Health Care; Acute Disease
Recommended Citation
Wyly DR, DeSchepper A, Nedved A, Lee BR, El Feghaly RE. Appropriateness of Diagnosis and Management for Otitis Media With Effusion in Pediatric Urgent Care Clinics. Pediatr Emerg Care. 2023;39(6):390-392. doi:10.1097/PEC.0000000000002954
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