Bergus G R, Lofgren M M
Department of Family Medicine, University of Iowa, Iowa City, IA 52242, USA.
J Fam Pract. 1998 Apr;46(4):304-10.
The two most frequently used options to reduce the occurrence of acute otitis media (AOM) are tympanostomy tubes and prophylactic antibiotics. The goal of this study was to create a decision model to identify which intervention, if any, is preferred from the perspective of parents with young children.
We developed a decision analysis model based on probabilities obtained from the literature and outcome disutilities obtained by interviewing parents. These parameters were placed into the model along with the anticipated number of episodes of AOM a child was expected to have in the coming year without intervention. Sensitivity analyses were performed on the effectiveness of the interventions, the disutilities (burdens associated with specific outcomes or interventions) associated with the interventions, and the characteristics of AOM episodes that the child would experience without any intervention.
Thirty-seven parents with young children were interviewed for this project. The preferred intervention for a child was sensitive to the number of episodes of AOM the child was anticipated to have in the coming year, the percentage of these episodes predicted to be severe, and how parents rated tympanostomy tubes compared with prophylactic antibiotics. In our base case of four episodes of AOM in the coming year (two mild episodes and two severe episodes), we found that tympanostomy tubes resulted in the best average outcome. Under different patient conditions, however, the preferred strategy could be either the use of prophylactic antibiotics or watchful waiting.
In our base case, the model suggested that tympanostomy tubes were preferable to prophylactic antibiotics. However, there is no single preferred preventive intervention for all children with recurrent AOM because of variation in the character of infections and the values parents give to the potential outcomes.
减少急性中耳炎（AOM）发生的两种最常用方法是鼓膜置管和预防性使用抗生素。本研究的目的是创建一个决策模型，以确定从幼儿家长的角度来看，哪种干预措施（如果有的话）是更可取的。
我们基于从文献中获得的概率以及通过采访家长获得的结果负效用，开发了一个决策分析模型。这些参数与预计在未来一年中未经干预的情况下儿童预计会发生的AOM发作次数一起放入模型中。对干预措施的有效性、与干预措施相关的负效用（与特定结果或干预措施相关的负担）以及儿童在无任何干预情况下会经历的AOM发作特征进行了敏感性分析。
本项目采访了37位有幼儿的家长。对孩子而言，首选的干预措施对预计孩子在未来一年中AOM发作的次数、预计这些发作中严重发作的百分比以及家长对鼓膜置管与预防性使用抗生素的评价敏感。在我们的基础案例中，预计来年有4次AOM发作（2次轻度发作和2次重度发作），我们发现鼓膜置管导致了最佳的平均结果。然而，在不同的患者情况下，首选策略可能是预防性使用抗生素或观察等待。
在我们的基础案例中，模型表明鼓膜置管比预防性使用抗生素更可取。然而，对于所有复发性AOM儿童，没有单一的首选预防干预措施，因为感染特征和家长对潜在结果的重视程度存在差异。
