Variation in rates of diagnosis of acute otitis media.

Over 13 weeks during two periods in 1978 the diagnostic rate for acute otitis media was monitored among febrile children (aged one to five years) in the emergency room of a large children's hospital. Of the total 228 eligible children, 53 (23 percent) were diagnosed as having otitis media. The observed variation in the weekly diagnostic rates was significantly (p < .005) greater than that expected if the diagnosis rate were a constant 23 percent. Temporal variation in diagnostic rates was largely attributable to differences among individual providers and independent of level of training. For junior residents short-term learning, within the seven-week emergency room rotation, contributed significantly to the week-to-week temporal variation in diagnostic rates for acute otitis media.