Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, U.S.A.
Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine Health, New York, New York, U.S.A.
Laryngoscope. 2021 Jun;131(6):1266-1270. doi: 10.1002/lary.29202. Epub 2020 Oct 26.
OBJECTIVES/HYPOTHESIS: The American Academy of Otolaryngology-Head and Neck Surgery has published clinical practice guidelines (CPGs) to guide management of common otolaryngologic (ENT) conditions. While these CPGs have been disseminated within specialty journals, many patients' first presentation of certain ENT complaints is to primary and acute care settings, including the emergency department (ED). It is less clear whether practice in these settings is concordant with specialty CPGs.
Retrospective cohort study.
A retrospective review of medical records was performed at an academic tertiary care center with ED diagnoses of 1) Bell's palsy/facial weakness (BP) or 2) acute otitis externa (AOE) from May 2014-June 2018. Individual chart abstraction was performed for all encounters with these diagnoses for the purpose of assessing providers' adherence to CPGs.
During the study period, 224 patients were diagnosed with BP and 465 patients were diagnosed with AOE. Of the patients diagnosed with BP, 94% (n = 211/224) were prescribed oral steroids, concordant with guidelines, while 36% of these patients received head computed tomography (CT) scans and 43% received laboratory tests, counter to the guidelines. For those with a diagnosis of AOE, 28.6% received topical antibiotics only as primary treatment (n = 133/465) in accordance with guidelines while systemic antibiotics were prescribed in 42.2% (n = 196/465) discordant with the guidelines and 29.2% received both topical and systemic antibiotics (n = 136/465).
CPGs developed by subspecialty societies provide evidence-based recommendations for the care of patients with particular conditions, but may not be disseminated broadly outside of the specialty. Further research is required to understand the reasons behind divergent management of such conditions.
3 Laryngoscope, 131:1266-1270, 2021.
目的/假设：美国耳鼻喉科学会发布了临床实践指南（CPG），以指导常见耳鼻喉（ENT）疾病的管理。虽然这些 CPG 已在专业期刊上发表，但许多患者首次出现某些 ENT 投诉是在初级和急性护理环境中，包括急诊部（ED）。在这些环境中实践是否与专业 CPG 一致尚不清楚。
回顾性队列研究。
在一家学术性三级护理中心进行了回顾性病历审查，ED 诊断为 1）贝尔麻痹/面部无力（BP）或 2）急性外耳炎（AOE），时间为 2014 年 5 月至 2018 年 6 月。对所有这些诊断的就诊记录进行了单独的图表摘录，目的是评估提供者对 CPG 的遵守情况。
在研究期间，224 名患者被诊断为 BP，465 名患者被诊断为 AOE。在被诊断为 BP 的患者中，94%（n=211/224）接受了口服类固醇治疗，符合指南，而其中 36%接受了头部计算机断层扫描（CT）检查，43%接受了实验室检查，与指南相悖。对于那些被诊断为 AOE 的患者，28.6%（n=133/465）接受了仅局部抗生素的初始治疗，符合指南，而 42.2%（n=196/465）接受了系统抗生素治疗，与指南不符，29.2%（n=136/465）接受了局部和系统抗生素治疗。
由亚专业学会制定的 CPG 为特定疾病患者的护理提供了循证建议，但可能在专业之外没有广泛传播。需要进一步研究以了解这种情况下管理差异的原因。
3 Laryngoscope，131：1266-1270，2021。
