Gunasekera Hasantha, Knox Stephanie, Morris Peter, Britt Helena, McIntyre Peter, Craig Jonathan C
Centre for Kidney Research, The Children's Hospital, Westmead, Sydney, Australia.
Pediatr Infect Dis J. 2007 Aug;26(8):689-92. doi: 10.1097/INF.0b013e3180621177.
Indigenous children have the highest reported prevalence and severity of otitis media in the world, but whether their clinical management varies accordingly is unknown.
Using a representative Australia-wide cluster survey of consecutive primary healthcare consultations, we compared practitioners' investigation, treatment, and referral practices for otitis media in indigenous and nonindigenous children (0-18 years), after adjusting for clustering.
Over 8 years (1998-2006), 7991 practitioners managed 141,693 problems during 119,503 consultations with children, including 2856 (2%) with indigenous children. Ear problems were the fourth most common problems managed overall, with otitis media seen more commonly in indigenous than in nonindigenous children (10% versus 7% consultations, P < 0.001). Indigenous children were significantly more likely to have severe otitis media (chronic and/or suppurative and/or perforation, 8% versus 2%, P < 0.001); discharging ears (4% versus 0.1%, P < 0.001); ear swabs [4%, 95% confidence interval (CI): 2%-6% versus 0.8%, 95% CI: 0.6%-0.9%]; and topical eardrops administered (11%, 95% CI: 7%-15% versus 5%, 95% CI: 4%-5%); but not more likely to receive oral antibiotics (72% versus 76%); have ear syringing (1% versus 0.2%); be referred to an otolaryngologist (6% versus 3%) or audiologist (2% versus 1%); all P > 0.05.
In the Australian primary healthcare setting, indigenous children are 5 times more likely to be diagnosed with severe otitis media than nonindigenous children, but reported management is not substantially different, which is inconsistent with established national guidelines. This spectrum-management discordance may contribute to continued worse outcomes for indigenous children with otitis media.
据报告，世界范围内原住民儿童中耳炎的患病率和严重程度最高，但他们的临床治疗是否因此而有所不同尚不清楚。
我们采用一项具有代表性的全澳大利亚连续初级医疗咨询整群调查，对原住民和非原住民儿童（0 - 18岁）中耳炎的从业者调查、治疗和转诊做法进行了比较，并对聚类情况进行了校正。
在8年期间（1998 - 2006年），7991名从业者在119,503次儿童咨询中处理了141,693个问题，其中包括2856例（2%）原住民儿童的问题。耳部问题是总体处理的第四大常见问题，中耳炎在原住民儿童中比在非原住民儿童中更常见（咨询次数分别为10%和7%，P < 0.001）。原住民儿童患严重中耳炎（慢性和/或化脓性和/或穿孔，分别为8%和2%，P < 0.001）、耳部流脓（分别为4%和0.1%，P < 0.001）、耳部拭子检查[4%，95%置信区间（CI）：2% - 6%对0.8%，95% CI：0.6% - 0.9%]以及使用局部滴耳剂（分别为11%，95% CI：7% - 15%对5%，95% CI：4% - 5%）的可能性显著更高；但接受口服抗生素治疗的可能性没有更高（分别为72%和76%）；进行耳部冲洗的可能性（分别为1%和0.2%）；被转诊至耳鼻喉科医生（分别为6%和3%）或听力学家（分别为2%和1%）的可能性；所有P > 0.05。
在澳大利亚初级医疗环境中，原住民儿童被诊断患有严重中耳炎的可能性是非原住民儿童的5倍，但报告的治疗情况没有实质性差异，这与既定的国家指南不一致。这种治疗差异可能导致原住民中耳炎儿童的病情持续恶化。
