The Alfred Hospital, Melbourne, Victoria, Australia.
Princess Alexandra Hospital, Brisbane, Queensland, Australia.
J Paediatr Child Health. 2019 Nov;55(11):1335-1343. doi: 10.1111/jpc.14414. Epub 2019 Feb 20.
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.
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.
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.
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.
描述急诊科就诊的急性中耳炎（AOM）患儿的诊断和治疗方法，并与现有指南进行比较。
我们对 2016 年 1 月至 2017 年 6 月在昆士兰州东南部两家急诊科就诊的≤15 岁患儿进行了回顾性描述性队列研究，其急诊科诊断为 AOM。根据病历，采用儿科临床实践指南对诊断可能性进行分类，分为很可能、可能或不太可能。根据国家抗生素处方调查，结合对澳大利亚治疗指南的遵守情况，对抗生素处方的适当性进行分类。两名盲法审查员提取了每一份病历，通过协商或仲裁解决分歧。
在纳入分析的 305 例患者中，87%的患者诊断为 AOM 的可能性很大或可能。耳痛是最常见的主诉症状（75%）。标准耳镜检查是鼓膜可视化的常规方法，70%的患者鼓膜检查异常。将近三分之二（62%）的儿童开了抗生素。可确定 286 例（94%）儿童的抗生素使用是否恰当。共有 39%的儿童接受了不恰当的 AOM 抗生素治疗。大多数患者接受对乙酰氨基酚和/或布洛芬等形式的镇痛治疗。
急诊科临床医生对 AOM 的诊断相当准确，尽管通过鼓室压测量和/或气动耳镜检查更好地评估鼓膜可能会提高准确性。超过三分之一的患者接受了不适当的抗生素治疗。我们的数据可以为知识转化和教育策略提供信息，以确保正确的基于证据的管理。
