Cleere Eoin F, Crotty Thomas J, Lang John, Young Orla, Keogh Ivan J
Department of Otolaryngology Head and Neck Surgery, Galway University Hospital, Galway, Ireland.
Department of Otolaryngology Head and Neck Surgery, Galway University Hospital, Galway, Ireland.
Int J Pediatr Otorhinolaryngol. 2023 Jan;164:111395. doi: 10.1016/j.ijporl.2022.111395. Epub 2022 Nov 18.
This study aimed to improve local management of paediatric otitis media using the 2022 American-Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) Clinical Practice Guideline for Tympanostomy Tubes in Children.
A SQUIRE 2.0 compliant quality improvement study was carried out within the outpatient department of our otolaryngology tertiary referral centre. Local outpatient management of paediatric otitis media was compared to the AAO-HNS guidelines, specifically focussing on the decision to offer tympanostomy tubes. Following initial audit of practice, an educational session was performed within the otolaryngology department and local practice was subsequently re-evaluated.
Overall, 88 children were included (46 pre-intervention and 42 post-intervention) with a mean age of 7.6 years (range 1-12 years). Sixty-four (72.7%) children presented with suspected otitis media with effusion. The remainder presented with recurrent or persistent acute otitis media (24/88, 27.3%). Twenty-six children were offered tympanostomy tubes (29.5%). Initial evaluation of practice identified that the decision to offer tympanostomy tubes was guideline appropriate in 76.1% of children (35/46). This significantly improved following an educational session (40/42, 95.2%, p = 0.02). The reasons for non-guideline compliance included: otitis media with effusion <3 months, no evidence of middle ear fluid and patients meeting criteria for tympanostomy tube insertion not being offered.
A focussed educational intervention may improve local adherence to guidelines in the management of paediatric otitis media. Continued re-evaluation of local practice is essential in order to ensure children are managed in accordance with the guidelines.
本研究旨在利用2022年美国耳鼻咽喉头颈外科学会（AAO-HNS）儿童鼓膜置管临床实践指南改善小儿中耳炎的局部管理。
在我们的三级耳鼻咽喉科转诊中心门诊部开展了一项符合SQUIRE 2.0标准的质量改进研究。将小儿中耳炎的局部门诊管理与AAO-HNS指南进行比较，特别关注提供鼓膜置管的决定。在对实践进行初步审核后，在耳鼻咽喉科开展了一次教育活动，随后对当地实践进行了重新评估。
总共纳入了88名儿童（干预前46名，干预后42名），平均年龄7.6岁（范围1-12岁）。64名（72.7%）儿童表现为疑似分泌性中耳炎。其余儿童表现为复发性或持续性急性中耳炎（24/88，27.3%）。26名儿童接受了鼓膜置管（29.5%）。实践的初步评估发现，在76.1%的儿童（35/46）中，提供鼓膜置管的决定符合指南。在一次教育活动后，这一比例显著提高（40/42，95.2%，p = 0.02）。不符合指南的原因包括：分泌性中耳炎病程<3个月、无中耳积液证据以及未为符合鼓膜置管标准的患者提供置管。
有针对性的教育干预可能会提高小儿中耳炎管理中当地对指南的遵循程度。持续重新评估当地实践对于确保儿童按照指南进行管理至关重要。
