Friedman Norman R, McCormick David P, Pittman Carmen, Chonmaitree Tasnee, Teichgraeber Davis C, Uchida Tatsuo, Baldwin Constance D, Saeed Kokab A
Departments of Pediatrics, University of Colorado, Denver, CO, USA.
Pediatr Infect Dis J. 2006 Feb;25(2):101-7. doi: 10.1097/01.inf.0000199290.73333.89.
Watchful waiting management of nonsevere acute otitis media (AOM) can reduce the use of antibiotics, but it requires a reliable means of assessing clinical severity.
We present the development of a pocket AOM card with which the clinician can rapidly assess total AOM severity.
DESIGN/METHODS: The components of the pocket card consisted of a faces scale, to assess parent perception of severity, and a standard set of tympanic membrane photographs, with which the pediatrician can grade the severity of tympanic membrane inflammation. The components of the pocket card were tested for validity, reliability and responsiveness with the use of data from parents, pediatricians and pediatric otolaryngologists.
Instruments were assessed for concurrent correlation, sequence validity and reliability against previously published questionnaires with the use of Spearman correlation. Responsiveness was calculated with the use of enrollment, day 12 and day 30 data from a randomized clinical trial.
The components of the pocket AOM card demonstrated excellent sequence validity, concurrent correlation and reliability (r = 0.58-0.99). Total AOM card severity, consisting of the sum of the 2 scales, demonstrated better responsiveness to change than any of the scales taken individually.
The AOM card combines a parent assessment of symptoms and the clinician assessment of the tympanic membrane to provide an assessment of total AOM severity that can be used to facilitate shared decision making between parent and clinician. The combined score of the AOM card was more responsive to change than any of the instruments used alone. The AOM card provides a useful tool for teaching and research.
对非重度急性中耳炎（AOM）进行观察等待管理可减少抗生素的使用，但这需要一种可靠的评估临床严重程度的方法。
我们展示了一种袖珍AOM卡片的开发，临床医生可使用该卡片快速评估AOM的总体严重程度。
设计/方法：袖珍卡片的组成部分包括一个面部表情量表，用于评估家长对严重程度的感知，以及一组标准的鼓膜照片，儿科医生可据此对鼓膜炎症的严重程度进行分级。利用来自家长、儿科医生和儿科耳鼻喉科医生的数据，对袖珍卡片的组成部分进行了有效性、可靠性和反应性测试。
使用Spearman相关性分析，将这些工具与先前发表的问卷进行同时相关性、序列有效性和可靠性评估。利用一项随机临床试验的入组、第12天和第30天的数据计算反应性。
袖珍AOM卡片的组成部分显示出优异的序列有效性、同时相关性和可靠性（r = 0.58 - 0.99）。由两个量表之和组成的AOM卡片总体严重程度，对变化的反应性比任何一个单独的量表都要好。
AOM卡片结合了家长对症状的评估和临床医生对鼓膜的评估，以提供AOM总体严重程度的评估，可用于促进家长和临床医生之间的共同决策。AOM卡片的综合评分对变化的反应性比任何单独使用的工具都要好。AOM卡片为教学和研究提供了一个有用的工具。
