Acute otitis media in children presenting to the emergency department: Is it diagnosed and managed appropriately? Is it diagnosed and managed appropriately?

Niroshan Balasundaram, Dung Phan, Daniel Mazzoni, Elliot Duong, Amy Sweeny, Chris Del Mar, Gerben Keijzers

Research output: Contribution to journalArticleResearchpeer-review

Abstract

AIM: To describe the diagnostic and management practice in children with acute otitis media (AOM) presenting to the emergency department (ED) and compare diagnosis and management against existing guidelines.

METHODS: We performed a retrospective descriptive cohort study of patients ≤15 years of age who presented to two EDs in Southeast Queensland between January 2016 and June 2017 with an ED diagnosis of AOM. Likelihood of diagnosis was based on medical records and classified as likely, possible or unlikely using paediatric practice guidelines. Appropriateness of antibiotics prescription was classified using the National Antibiotic Prescribing Survey, which takes into account adherence to the Australian Therapeutic Guidelines. Each medical record was extracted by two blinded reviewers, and discrepancies were resolved by consensus or arbitration.

RESULTS: Of the 305 patients included for analysis, 87% had a likely or possible diagnosis of AOM. Otalgia was the presenting complaint in 75%. Standard otoscopy was the routine method for tympanic membrane visualisation, and 70% had abnormal tympanic membrane findings. Almost two-thirds (62%) of all children were prescribed antibiotics. Antibiotic appropriateness could be ascertained for 286 patients (94%). A total of 39% received inappropriate antibiotic management for AOM. The majority of patients received analgesia in the form of paracetamol and/or ibuprofen.

CONCLUSIONS: ED clinicians make the diagnosis of AOM fairly accurately, although better assessment of the tympanic membrane by tympanometry and/or pneumatic otoscopy may improve accuracy. More than one-third of patients are prescribed antibiotics inappropriately. Our data can inform knowledge translation and education strategies to ensure the correct evidence-based management of this condition.

Original languageEnglish
Number of pages9
JournalJournal of Paediatrics and Child Health
DOIs
Publication statusE-pub ahead of print - 20 Feb 2019

Fingerprint

Otitis Media
Hospital Emergency Service
Anti-Bacterial Agents
Tympanic Membrane
Otoscopy
Medical Records
Earache
Guidelines
Acoustic Impedance Tests
Queensland
Translational Medical Research
Ibuprofen
Practice Management
Negotiating
Acetaminophen
Practice Guidelines
Analgesia
Prescriptions
Consensus
Cohort Studies

Cite this

@article{8f4bde58814f4b92800166749cb7e653,
title = "Acute otitis media in children presenting to the emergency department: Is it diagnosed and managed appropriately?: Is it diagnosed and managed appropriately?",
abstract = "AIM: To describe the diagnostic and management practice in children with acute otitis media (AOM) presenting to the emergency department (ED) and compare diagnosis and management against existing guidelines.METHODS: We performed a retrospective descriptive cohort study of patients ≤15 years of age who presented to two EDs in Southeast Queensland between January 2016 and June 2017 with an ED diagnosis of AOM. Likelihood of diagnosis was based on medical records and classified as likely, possible or unlikely using paediatric practice guidelines. Appropriateness of antibiotics prescription was classified using the National Antibiotic Prescribing Survey, which takes into account adherence to the Australian Therapeutic Guidelines. Each medical record was extracted by two blinded reviewers, and discrepancies were resolved by consensus or arbitration.RESULTS: Of the 305 patients included for analysis, 87{\%} had a likely or possible diagnosis of AOM. Otalgia was the presenting complaint in 75{\%}. Standard otoscopy was the routine method for tympanic membrane visualisation, and 70{\%} had abnormal tympanic membrane findings. Almost two-thirds (62{\%}) of all children were prescribed antibiotics. Antibiotic appropriateness could be ascertained for 286 patients (94{\%}). A total of 39{\%} received inappropriate antibiotic management for AOM. The majority of patients received analgesia in the form of paracetamol and/or ibuprofen.CONCLUSIONS: ED clinicians make the diagnosis of AOM fairly accurately, although better assessment of the tympanic membrane by tympanometry and/or pneumatic otoscopy may improve accuracy. More than one-third of patients are prescribed antibiotics inappropriately. Our data can inform knowledge translation and education strategies to ensure the correct evidence-based management of this condition.",
author = "Niroshan Balasundaram and Dung Phan and Daniel Mazzoni and Elliot Duong and Amy Sweeny and {Del Mar}, Chris and Gerben Keijzers",
note = "{\circledC} 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).",
year = "2019",
month = "2",
day = "20",
doi = "10.1111/jpc.14414",
language = "English",
journal = "Australian Paediatric Journal",
issn = "1034-4810",
publisher = "Blackwell Publishing Asia",

}

Acute otitis media in children presenting to the emergency department: Is it diagnosed and managed appropriately? Is it diagnosed and managed appropriately? / Balasundaram, Niroshan; Phan, Dung; Mazzoni, Daniel; Duong, Elliot; Sweeny, Amy; Del Mar, Chris; Keijzers, Gerben.

In: Journal of Paediatrics and Child Health, 20.02.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Acute otitis media in children presenting to the emergency department: Is it diagnosed and managed appropriately?

T2 - Is it diagnosed and managed appropriately?

AU - Balasundaram, Niroshan

AU - Phan, Dung

AU - Mazzoni, Daniel

AU - Duong, Elliot

AU - Sweeny, Amy

AU - Del Mar, Chris

AU - Keijzers, Gerben

N1 - © 2019 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

PY - 2019/2/20

Y1 - 2019/2/20

N2 - AIM: To describe the diagnostic and management practice in children with acute otitis media (AOM) presenting to the emergency department (ED) and compare diagnosis and management against existing guidelines.METHODS: We performed a retrospective descriptive cohort study of patients ≤15 years of age who presented to two EDs in Southeast Queensland between January 2016 and June 2017 with an ED diagnosis of AOM. Likelihood of diagnosis was based on medical records and classified as likely, possible or unlikely using paediatric practice guidelines. Appropriateness of antibiotics prescription was classified using the National Antibiotic Prescribing Survey, which takes into account adherence to the Australian Therapeutic Guidelines. Each medical record was extracted by two blinded reviewers, and discrepancies were resolved by consensus or arbitration.RESULTS: Of the 305 patients included for analysis, 87% had a likely or possible diagnosis of AOM. Otalgia was the presenting complaint in 75%. Standard otoscopy was the routine method for tympanic membrane visualisation, and 70% had abnormal tympanic membrane findings. Almost two-thirds (62%) of all children were prescribed antibiotics. Antibiotic appropriateness could be ascertained for 286 patients (94%). A total of 39% received inappropriate antibiotic management for AOM. The majority of patients received analgesia in the form of paracetamol and/or ibuprofen.CONCLUSIONS: ED clinicians make the diagnosis of AOM fairly accurately, although better assessment of the tympanic membrane by tympanometry and/or pneumatic otoscopy may improve accuracy. More than one-third of patients are prescribed antibiotics inappropriately. Our data can inform knowledge translation and education strategies to ensure the correct evidence-based management of this condition.

AB - AIM: To describe the diagnostic and management practice in children with acute otitis media (AOM) presenting to the emergency department (ED) and compare diagnosis and management against existing guidelines.METHODS: We performed a retrospective descriptive cohort study of patients ≤15 years of age who presented to two EDs in Southeast Queensland between January 2016 and June 2017 with an ED diagnosis of AOM. Likelihood of diagnosis was based on medical records and classified as likely, possible or unlikely using paediatric practice guidelines. Appropriateness of antibiotics prescription was classified using the National Antibiotic Prescribing Survey, which takes into account adherence to the Australian Therapeutic Guidelines. Each medical record was extracted by two blinded reviewers, and discrepancies were resolved by consensus or arbitration.RESULTS: Of the 305 patients included for analysis, 87% had a likely or possible diagnosis of AOM. Otalgia was the presenting complaint in 75%. Standard otoscopy was the routine method for tympanic membrane visualisation, and 70% had abnormal tympanic membrane findings. Almost two-thirds (62%) of all children were prescribed antibiotics. Antibiotic appropriateness could be ascertained for 286 patients (94%). A total of 39% received inappropriate antibiotic management for AOM. The majority of patients received analgesia in the form of paracetamol and/or ibuprofen.CONCLUSIONS: ED clinicians make the diagnosis of AOM fairly accurately, although better assessment of the tympanic membrane by tympanometry and/or pneumatic otoscopy may improve accuracy. More than one-third of patients are prescribed antibiotics inappropriately. Our data can inform knowledge translation and education strategies to ensure the correct evidence-based management of this condition.

UR - http://www.scopus.com/inward/record.url?scp=85061901188&partnerID=8YFLogxK

U2 - 10.1111/jpc.14414

DO - 10.1111/jpc.14414

M3 - Article

JO - Australian Paediatric Journal

JF - Australian Paediatric Journal

SN - 1034-4810

ER -