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Published on: February 5, 2019
Development of a practical tool for assessing the severity of acute otitis media
Norman R Friedman1, David P McCormick, Carmen Pittman
1Departments of Pediatrics, University of Colorado, Denver, CO, USA.
Insights
A new pocket card helps clinicians quickly assess acute otitis media (AOM) severity by combining parent and doctor evaluations. This tool aids in shared decision-making and reduces unnecessary antibiotic use.
Area of Science:
- Pediatrics
- Otolaryngology
- Clinical Assessment Tools
Background:
- Watchful waiting for acute otitis media (AOM) requires accurate severity assessment to minimize antibiotic use.
- Current methods may lack reliability in determining AOM clinical severity.
Purpose of the Study:
- To develop and validate a pocket AOM card for rapid and reliable assessment of acute otitis media severity.
- To integrate parent and clinician perspectives into a unified severity score.
Main Methods:
- Developed a pocket card with a parent-reported faces scale and clinician-graded tympanic membrane photographs.
- Assessed validity, reliability, and responsiveness using data from parents, pediatricians, and otolaryngologists.
- Utilized Spearman correlation and data from a randomized clinical trial for analysis.
Main Results:
- The pocket AOM card components showed excellent validity, correlation, and reliability (r = 0.58-0.99).
- The total AOM card severity score demonstrated superior responsiveness to change compared to individual components.
- Combined parent and clinician assessments proved more effective than single measures.
Conclusions:
- The AOM card effectively combines subjective and objective measures for a comprehensive severity assessment.
- It serves as a valuable tool for facilitating shared decision-making in AOM management.
- The AOM card is a useful resource for clinical practice, teaching, and research.
Background:
Watchful waiting management of nonsevere acute otitis media (AOM) can reduce the use of antibiotics, but it requires a reliable means of assessing clinical severity.
Objective:
We present the development of a pocket AOM card with which the clinician can rapidly assess total AOM severity.
Design/Methods:
The components of the pocket card consisted of a faces scale, to assess parent perception of severity, and a standard set of tympanic membrane photographs, with which the pediatrician can grade the severity of tympanic membrane inflammation. The components of the pocket card were tested for validity, reliability and responsiveness with the use of data from parents, pediatricians and pediatric otolaryngologists.
Statistics:
Instruments were assessed for concurrent correlation, sequence validity and reliability against previously published questionnaires with the use of Spearman correlation. Responsiveness was calculated with the use of enrollment, day 12 and day 30 data from a randomized clinical trial.
Results:
The components of the pocket AOM card demonstrated excellent sequence validity, concurrent correlation and reliability (r = 0.58-0.99). Total AOM card severity, consisting of the sum of the 2 scales, demonstrated better responsiveness to change than any of the scales taken individually.
Conclusions:
The AOM card combines a parent assessment of symptoms and the clinician assessment of the tympanic membrane to provide an assessment of total AOM severity that can be used to facilitate shared decision making between parent and clinician. The combined score of the AOM card was more responsive to change than any of the instruments used alone. The AOM card provides a useful tool for teaching and research.
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