scholarly journals 1473. Guideline Adherence in Pediatric Ambulatory Visits for Acute Otitis Media

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S738-S738
Author(s):  
Joshua C Herigon ◽  
Sarah Mousseau ◽  
Amir Kimia ◽  
Jonathan Hatoun ◽  
Louis Vernacchio
Keyword(s):  
Otitis Media ◽  
Watchful Waiting ◽  
Treatment Guidelines ◽  
Medical Condition ◽  
Acute Otitis Media ◽  
Antibiotic Use ◽  
The United States ◽  
Chronic Medical Condition ◽  
Cross Sectional ◽  
Strict Adherence

Abstract Background Acute otitis media (AOM) is the most common pediatric outpatient condition treated with antibiotics in the United States. Over 30% of children receive inappropriate antibiotics for AOM, contributing to increasing antimicrobial resistance and unnecessary adverse events. Strict adherence to diagnostic and treatment guidelines has been proposed by the American Academy of Pediatrics (AAP) Committee on Infectious Diseases as one strategy to combat inappropriate antibiotic use. Our objective was to describe adherence to the 2013 AAP guidelines on AOM. Methods We performed a cross-sectional study on a random sample of visit notes for patients 3 to 59 months old diagnosed with otitis media based on ICD-10-CM codes (H65, H66, H67) and treated with antibiotics between 9/1/2017 and 8/31/2018 in an association of pediatric practices across Massachusetts. Children with tympanostomy tubes or a chronic medical condition increasing their risk for AOM were excluded. Based on the 2013 AAP diagnostic criteria, tympanic membrane exam descriptions were reviewed and classified as describing AOM or not. Antibiotic choices were classified as appropriate or inappropriate. Notes were then labeled as “fully adherent” (exam consistent with AOM and appropriate antibiotic choice), “partially adherent” (exam inconsistent with AOM or inappropriate antibiotic choice), and “non-adherent” (exam inconsistent with AOM and inappropriate antibiotic choice). Results Three hundred and ninety-four visit notes from 39 different practices were analyzed. One hundred and sixty-six notes (42%) were “fully adherent” to the AAP guidelines, 183 (46%) were “partially adherent” and 45 (11%) were “non-adherent” (Figure 1). In the “partially adherent” and “non-adherent” groups combined, exams were inappropriate in 179 notes (45.4%) and antibiotic choice was inappropriate in 94 notes (23.9%). Cefdinir was the most frequent inappropriate antibiotic (44/94, 46.8%) (Table 1). “Watchful waiting” occurred in only 7% (16/229) of eligible cases. Figure 1. Breakdown of encounters by adherence type Table 1. Cross-table of indicated and prescribed antibiotics Conclusion Our analysis of independent pediatric practices showed moderate adherence to the AAP guidelines for AOM. Substantial room exists for improvement in diagnosing and treating AOM in young children, especially regarding the potential for watchful waiting. Disclosures All Authors: No reported disclosures

scholarly journals 1362. Antibiotic Prescribing for Acute Otitis Media in Commercially Insured Pediatric Patients in the United States

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S692-S692
Author(s):  
Nicole Smolinski ◽  
Patrick Antonelli ◽  
Almut Winterstein
Keyword(s):  
Otitis Media ◽  
Pediatric Patients ◽  
Watchful Waiting ◽  
Acute Otitis Media ◽  
The United States ◽  
Primary Diagnosis ◽  
Outpatient Setting ◽  
Pediatric Care ◽  
Antibiotic Prescribing ◽  
Gradual Change

Abstract Background Overprescribing of antibiotics to treat conditions that are self-limiting and do not always require antibiotics is a well-recognized concern in pediatric care. The 2013 American Academy of Pediatrics (AAP) acute otitis media (AOM) guidelines reinforced previous recommendations regarding watchful waiting for three days among patients with non-recurrent uncomplicated AOM and provided more explicit diagnostic criteria. Methods We conducted a retrospective cohort study using the IBM Marketscan Commercial Claims Research Databases (2008-2018). Pediatric patients 1 to 12 years old were included. We required a primary diagnosis of AOM in an outpatient setting, without AOM or other complicated ear infections within 6 months prior and no other acute infections in the 2 weeks prior to or 1 week after AOM diagnosis. Patients were classified as treated (pharmacy dispensing record of antibiotics within 3 days of diagnosis) or watchful waiting (no treatment or treatment after > 3 days). We used segmented linear regression to examine changes in treatment proportions across the study period. Results We identified 2,640,920 pediatric AOM episodes, of which 2,033,697 (77.0%) were treated within 3 days. The majority of episodes were treated with amoxicillin (51.3%), followed by amoxicillin/clavulanate (15.3%) and cephalosporins (22.0%). Among episodes in the watchful waiting group, 18,793 (3.1%) filled a prescription within 4-7 days of diagnosis. Most patients saw a pediatrician (62.7%). A larger proportion of otolaryngologists adopted watchful waiting approaches compared to other physician types. There was no difference in chronic conditions or regional variation between the two groups. There was no immediate (p=0.31) or gradual change in treatment proportion (p=0.49) after release of the 2013 guidelines. Conclusion Most pediatric patients continue to be treated with antibiotics within three days of AOM diagnosis, reflecting no impact of the 2013 AAP guidelines. Physician specialty but not patient characteristics appear to determine treatment approaches. Disclosures Nicole Smolinski, PharMD, Nothing to disclose

scholarly journals Diagnostic Accuracy, Prescription Behavior, and Watchful Waiting Efficacy for Pediatric Acute Otitis Media

2018 ◽  
Vol 58 (1) ◽  
pp. 60-65 ◽  
Author(s):  
David L. Brinker ◽  
Erina L. MacGeorge ◽  
Nicole Hackman
Keyword(s):  
Physical Examination ◽  
Otitis Media ◽  
Chart Review ◽  
Watchful Waiting ◽  
Acute Otitis Media ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Central Pennsylvania ◽  
Current Guidelines ◽  
Prescription Behavior

Current guidelines recommend “watchful waiting” (WW) as an alternative to immediate antibiotic treatment. Continued high rates of antibiotic use suggest that WW may be underutilized. We conducted a retrospective chart review of 474 pediatric acute otitis media (AOM) cases at a clinic in central Pennsylvania. We assessed physical examination findings, diagnostic behavior, WW utilization, prescription writing, and filling in cases of pediatric AOM to evaluate the underutilization of WW. We evaluate diagnostic consistency with published guidelines and rates of antibiotic prescription resulting from misdiagnosis. We report WW instructions and compliance, and prescription filling behaviors. Fifty percent of AOM diagnoses in this sample were not supported by physical examination findings. The majority of these AOM diagnoses received antibiotic prescriptions, suggesting that unsupported diagnoses translated to injudicious prescribing. WW instructions corresponded to 57% fewer filled prescriptions and longer fill delay. We discuss the implications and recommendations to improve antibiotic stewardship.

scholarly journals Relative Humidity Affects Acute Otitis Media Visits of Preschool Children to the Emergency Department

2021 ◽  
pp. 014556132110091
Author(s):  
Ying-Fang Jiang ◽  
Wen-Wei Luo ◽  
Xin Zhang ◽  
Dong-Dong Ren ◽  
Yi-Bo Huang
Keyword(s):  
Emergency Department ◽  
Preschool Children ◽  
Relative Humidity ◽  
Otitis Media ◽  
Meteorological Factors ◽  
Acute Otitis Media ◽  
Emergency Department Visits ◽  
Preschool Age ◽  
School Age Children ◽  
Cross Sectional

Objective: The associations between climate variables and diseases such as respiratory infections, influenza, pediatric seizure, and gastroenteritis have been long appreciated. Infection is the main reason for acute otitis media (AOM) incidence. However, few previous studies explored the correlation between climatic parameters and AOM infections. The most important meteorological factors, temperature, relative humidity, and fine particulate matter (PM2.5), were included in this study. We studied the relationship between these meteorological factors and the AOM visits. Materials and Methods: It was a retrospective cross-sectional study. A linear correlation and a linear regression model were used to explore the AOM visits and meteorological factors. Results: A total of 7075 emergency department visits for AOM were identified. Relative humidity was found an independent risk factor for the AOM visits in preschool children (regression coefficient = −10.841<0, P = .039 < .05), but not in infants and school-age children. Average temperature and PM2.5 were not correlated with AOM visits. Conclusion: Humidity may have a significant inverse impact on the incidence of AOM in preschool-age children.

scholarly journals Antibiotics versus placebo or watchful waiting for acute otitis media: a meta-analysis of randomized controlled trials

2009 ◽  
Vol 64 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Evridiki K. Vouloumanou ◽  
Drosos E. Karageorgopoulos ◽  
Maria S. Kazantzi ◽  
Anastasios M. Kapaskelis ◽  
Matthew E. Falagas
Keyword(s):  
Randomized Controlled Trials ◽  
Otitis Media ◽  
Watchful Waiting ◽  
Meta Analysis ◽  
Acute Otitis Media ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals Psychosocial Outcomes in Adult Survivors of Retinoblastoma

2015 ◽  
Vol 33 (31) ◽  
pp. 3608-3614 ◽  
Author(s):  
Jennifer S. Ford ◽  
Joanne F. Chou ◽  
Charles A. Sklar ◽  
Kevin C. Oeffinger ◽  
Danielle Novetsky Friedman ◽  
...  
Keyword(s):  
Traumatic Stress ◽  
Medical Condition ◽  
Cancer Recurrence ◽  
Psychosocial Outcomes ◽  
The United States ◽  
Fear Of Cancer Recurrence ◽  
Chronic Medical Condition ◽  
Post Traumatic Stress ◽  
Stress Symptoms ◽  
Post Traumatic

Purpose Survival rates for individuals diagnosed with retinoblastoma (RB) exceed 95% in the United States; however, little is known about the long-term psychosocial outcomes of these survivors. Patients and Methods Adult RB survivors, diagnosed from 1932 to 1994 and treated in New York, completed a comprehensive questionnaire adapted from the Childhood Cancer Survivor Study (CCSS), by mail or telephone. Psychosocial outcomes included psychological distress, anxiety, depression, somatization, fear of cancer recurrence, satisfaction with facial appearance, post-traumatic growth, and post-traumatic stress symptoms; noncancer CCSS siblings served as a comparison group. Results A total of 470 RB survivors (53.6% with bilateral RB; 52.1% female) and 2,820 CCSS siblings were 43.3 (standard deviation [SD], 11) years and 33.2 (SD, 8.4) years old at the time of study, respectively. After adjusting for sociodemographic factors, RB survivors did not have significantly higher rates of depression, somatization, distress, or anxiety compared with CCSS siblings. Although RB survivors were more likely to report post-traumatic stress symptoms of avoidance and/or hyperarousal (both P < .01), only five (1.1%) of 470 met criteria for post-traumatic stress disorder. Among survivors, having a chronic medical condition did not increase the likelihood of psychological problems. Bilateral RB survivors were more likely than unilateral RB survivors to experience fears of cancer recurrence (P < .01) and worry about their children being diagnosed with RB (P < .01). However, bilateral RB survivors were no more likely to report depression, anxiety, or somatic complaints than unilateral survivors. Conclusion Most RB survivors do not have poorer psychosocial functioning compared with a noncancer sample. In addition, bilateral and unilateral RB survivors seem similar with respect to their psychological symptoms.

scholarly journals Particular matter influences the incidence of acute otitis media in children

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mina Park ◽  
Jiyeon Han ◽  
Jiwon Park ◽  
Myoung-jin Jang ◽  
Moo Kyun Park
Keyword(s):  
Air Pollution ◽  
Otitis Media ◽  
Demographic Data ◽  
Age Groups ◽  
Acute Otitis Media ◽  
Antibiotic Use ◽  
Claim Data ◽  
Environmental Research ◽  
Main Component ◽  
The Relationship

AbstractParticulate matter (PM) is the main component of air pollution. Children are vulnerable to PM and acute otitis media (AOM), which is one of the most common diseases in children. However, studies on the relationship between AOM in children and PM are rare and their results are inconsistent. The aim of this study is to investigate the effect of PM on AOM in children on the basis of the Korea National Health Insurance service (NHIS) claims data. NHIS claim data from 2008 to 2015 was used to identify outpatient visits, antibiotic use to treat AOM, and demographic data. This data was combined with the data on PM2.5 (≤ 2.5 μm) and PM10 (≤ 10 μm according to its aerodynamic diameter) level extracted from air pollution data from Korean National Institute of Environmental Research for 16 administrative regions. The children with AOM were divided into three age groups (< 2, 2–4, 5–10 years). Generalized linear Poisson regression model was used to estimate the association between AOM and PM using daily counts of AOM and daily mean PM concentrations. It was adjusted to temperature, wind, humidity, season, year, age, and region. With an increase in PM2.5 of 10 μg/m3, the relative risk of OM increased by 4.5% in children under 2 years of age. The effect of PM2.5 was strongest influence on the day of exposure. The exposure to PM10 was related to the incidence of AOM on the day of exposure and the following seven days in all three age groups. The PM concentrations did not strongly affect either AOM duration or the use of antibiotics to cure AOM. The RR in the each lag day after exposure to PM10 was diverse according to the age groups. Regardless of PM size and children’s age, the PM levels are positively related to the incidence of AOM. Both PM2.5 and PM10 have the most adverse effects on children under 2 years of age and on the day of exposure.

Sign in / Sign up

Export Citation Format

Share Document