From the Division of Urgent Care, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO.
School of Medicine, University of Missouri-Kansas City, Kansas City, MO.
Pediatr Emerg Care. 2023 Jun 1;39(6):390-392. doi: 10.1097/PEC.0000000000002954.
Otitis media with effusion (OME)'s clinical presentation is often confused with acute otitis media (AOM) by clinicians. Despite OME guidelines recommending watchful waiting with no antibiotics, rates of antibiotic use remain elevated. The aim of this study was to determine the clinician diagnosis validity and the rates of antibiotics prescribed among pediatric OME patients evaluated in 3 urgent care clinics within a pediatric health care system.
We retrospectively reviewed a random sample of encounters for children aged 0 to 18 years with a billing diagnosis of OME in 2019. We recorded clinical symptoms, antibiotic prescribed, and the clinicians' diagnosis. We used the American Academy of Pediatrics guidelines to assign an AOM diagnosis and compared those with the clinicians' final diagnoses using Pearson χ 2 .
Of the 912 eligible charts, clinicians' final diagnoses were as follows: AOM for 271 (29.7%) patients, OME for 638 (70.0%) patients, and no ear pathology for 3 (0.3%) patients. Antibiotics were prescribed for 519 (56.9%) patients; of those, only 242 (46.6%) had a final clinician diagnosis of AOM. Antibiotic prescribing rates were higher when a clinician diagnosed AOM compared with OME (89.3% vs 43.2%; P < 0.001). Per American Academy of Pediatrics guidelines, up to 273 (29.9%) patients qualified for an AOM diagnosis, but those were not the same as those diagnosed with AOM by clinicians ( P < 0.001).
When evaluating children with a billing diagnosis of OME, a third fit a diagnosis of AOM. Clinicians commonly misdiagnosed AOM, but also prescribed antibiotics to almost half of those they diagnose with OME.
中耳炎伴积液（OME）的临床表现常被临床医生误诊为急性中耳炎（AOM）。尽管 OME 指南建议密切观察等待，不使用抗生素，但抗生素的使用仍居高不下。本研究旨在确定儿科保健系统内 3 家急诊诊所评估的小儿 OME 患者的临床医生诊断的准确性和抗生素处方率。
我们回顾性分析了 2019 年在一家儿科保健系统内就诊的年龄在 0 至 18 岁之间、以 OME 为计费诊断的随机抽样患者的就诊记录。我们记录了临床症状、处方的抗生素和临床医生的诊断。我们使用美国儿科学会的指南来分配 AOM 诊断，并使用 Pearson χ 2 比较这些诊断与临床医生的最终诊断。
在 912 份符合条件的病历中，临床医生的最终诊断如下：AOM 患者 271 例（29.7%），OME 患者 638 例（70.0%），无耳部病理患者 3 例（0.3%）。519 例患者（56.9%）开具了抗生素；其中只有 242 例（46.6%）临床医生的最终诊断为 AOM。与 OME 相比，当临床医生诊断为 AOM 时，抗生素的处方率更高（89.3%比 43.2%；P < 0.001）。根据美国儿科学会的指南，多达 273 例（29.9%）患者符合 AOM 诊断标准，但这些患者与临床医生诊断为 AOM 的患者并不相同（P < 0.001）。
当评估以 OME 计费诊断的儿童时，三分之一的患者符合 AOM 诊断。临床医生常误诊为 AOM，但也给近一半他们诊断为 OME 的患者开了抗生素。
