Presenter Status
Resident/Psychology Intern
Abstract Type
Research
Primary Mentor
Dr. Rana El Feghaly MD MSCI
Start Date
11-5-2021 11:30 AM
End Date
11-5-2021 1:30 PM
Presentation Type
Poster Presentation
Description
Background: Otitis media with effusion (OME)’s clinical presentation is often confused with acute otitis media (AOM) by providers. Despite OME guidelines recommending watchful waiting with no antibiotics, rates of antibiotic use remain elevated. In our pediatric urgent care clinics (UCCs), an estimated 50% of patients diagnosed with OME receive antibiotic prescriptions.
Objectives/Goal: To determine the provider diagnosis validity and the rates of antibiotics prescribed among pediatric OME patients evaluated in 3 UCCs within a pediatric healthcare system.
Methods/Design: We randomly selected 75% of encounters for children age 0-18 years who had a billing diagnosis of OME in 2019. Charts were reviewed retrospectively and the onset and degree of otalgia, presence of middle ear effusion (MEE), bulging and erythema of the tympanic membrane (TM), otorrhea, antibiotic prescribed, and the providers’ diagnosis were recorded. The American Academy of Pediatrics (AAP) guidelines were used to assign an AOM diagnosis using strict and liberal criteria listed in table 1. Providers’ final diagnoses was compared to diagnosis by AAP guidelines. We compared rates of diagnoses and rates of antibiotics prescribed among the 3 locations using Pearson’s chi square.
Results: A total of 957 charts were reviewed. We excluded 45 (4.7%) charts due to a concomitant diagnosis that may require antibiotics. Of the 912 eligible charts, providers’ final diagnoses were: 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 provider diagnosis of AOM. Antibiotic prescribing rates were similar between patients with provider diagnosis of AOM and OME (52.8% vs. 58.9%; p =0.086). Applying the liberal AAP criteria, 273 (29.9%) patients qualified for an AOM diagnosis, but the patients qualifying were not the same as those diagnosed by providers (p
Conclusions: When evaluating children with a billing diagnosis of OME, 30% fit a diagnosis of AOM, using liberal AAP criteria. Antibiotic prescribing rates were similar between patients with provider diagnosis of AOM and OME. This data will be used to develop antibiotic stewardship projects for UCCs
MeSH Keywords
OME; OME treatment; AOM diagnosis
Additional Files
Diagnosis and Management of Otitis Media with Effusion in Pediatr.pdf (199 kB)Abstract
Included in
Bacterial Infections and Mycoses Commons, Diagnosis Commons, Higher Education and Teaching Commons, Infectious Disease Commons, Pediatrics Commons
Diagnosis and Management of Otitis Media with Effusion in Pediatric Urgent Care Clinics
Background: Otitis media with effusion (OME)’s clinical presentation is often confused with acute otitis media (AOM) by providers. Despite OME guidelines recommending watchful waiting with no antibiotics, rates of antibiotic use remain elevated. In our pediatric urgent care clinics (UCCs), an estimated 50% of patients diagnosed with OME receive antibiotic prescriptions.
Objectives/Goal: To determine the provider diagnosis validity and the rates of antibiotics prescribed among pediatric OME patients evaluated in 3 UCCs within a pediatric healthcare system.
Methods/Design: We randomly selected 75% of encounters for children age 0-18 years who had a billing diagnosis of OME in 2019. Charts were reviewed retrospectively and the onset and degree of otalgia, presence of middle ear effusion (MEE), bulging and erythema of the tympanic membrane (TM), otorrhea, antibiotic prescribed, and the providers’ diagnosis were recorded. The American Academy of Pediatrics (AAP) guidelines were used to assign an AOM diagnosis using strict and liberal criteria listed in table 1. Providers’ final diagnoses was compared to diagnosis by AAP guidelines. We compared rates of diagnoses and rates of antibiotics prescribed among the 3 locations using Pearson’s chi square.
Results: A total of 957 charts were reviewed. We excluded 45 (4.7%) charts due to a concomitant diagnosis that may require antibiotics. Of the 912 eligible charts, providers’ final diagnoses were: 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 provider diagnosis of AOM. Antibiotic prescribing rates were similar between patients with provider diagnosis of AOM and OME (52.8% vs. 58.9%; p =0.086). Applying the liberal AAP criteria, 273 (29.9%) patients qualified for an AOM diagnosis, but the patients qualifying were not the same as those diagnosed by providers (p
Conclusions: When evaluating children with a billing diagnosis of OME, 30% fit a diagnosis of AOM, using liberal AAP criteria. Antibiotic prescribing rates were similar between patients with provider diagnosis of AOM and OME. This data will be used to develop antibiotic stewardship projects for UCCs
