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Evaluating children with otitis media for bacteremia or urinary tract infection
Daniel Yawman1, Patrick Mahar, Aaron Blumkin
1Department of Pediatrics and Emergency Medicine, University of Rochester Medical Center and Rochester General Hospital, Box 238 1425 Portland Avenue, Rochester, NY 14621, USA.
Insights
Clinicians rarely test young children with acute otitis media (AOM) for bacteremia or urinary tract infections (UTI). This is true even for febrile infants, indicating a need for improved diagnostic practices in emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Healthcare Quality Improvement
Background:
- Acute otitis media (AOM) is a common pediatric diagnosis.
- Clinical guidelines do not consistently address concurrent bacteremia or urinary tract infection (UTI) evaluation in young children with AOM.
- Current practices for investigating these co-infections in emergency settings are not well-defined.
Purpose of the Study:
- To determine the frequency of bacteremia and UTI investigations in young children diagnosed with AOM.
- To identify circumstances influencing the likelihood of such investigations.
- To assess testing patterns across different age groups and fever severities.
Main Methods:
- Analysis of the 2001-2004 National Hospital Ambulatory Medical Care Survey (NHAMCS)-Emergency Department dataset.
- Inclusion of 2-36 month old patients diagnosed with AOM.
- Examination of laboratory testing rates, including complete blood count (CBC), blood culture, urinalysis, and urine culture.
Main Results:
- AOM was diagnosed in 17% of emergency department visits for children aged 2-36 months.
- Laboratory testing for bacteremia or UTI was infrequent (9% for any test).
- Testing rates did not significantly differ by age group (2-6, 6-12, 12-36 months) or for moderate fever (≥38.0°C).
- Higher fever (≥39.0°C) increased the likelihood of all tests except urine investigation.
Conclusions:
- Diagnostic workup for bacteremia or UTI is not routine in young children with AOM presenting to emergency departments.
- Testing practices remain low even in febrile infants, suggesting a gap in adherence to comprehensive diagnostic evaluation.
- Further research and guideline refinement may be needed to optimize care for pediatric AOM patients.
Abstract:
Background. It is unclear if clinicians evaluate for concurrent bacteremia or UTI in young patients diagnosed with acute otitis media (AOM). Objectives. To describe how often, and under which circumstances, emergency providers investigate for bacteremia or UTI in 2-36 month olds with AOM. Methods. Cases of AOM were analyzed from the 2001-2004 National Hospital Ambulatory Medical Care Survey (NHAMCS)-Emergency Department dataset. Results. AOM was diagnosed in 17% of the 10,847 recorded visits of 2-36 month olds. Of these visits, laboratory testing included: CBC: 7%, Blood culture: 4%, urinalysis or urine culture: 5%, and any of these tests: 9%. Rates of testing for 2-6 month olds with temperature ≥ 38.0 (CBC: 13%, blood culture: 9%, urinalysis or urine culture: 7%, any of the tests: 14%) were not significantly different from testing of patients aged 6-12 months, or 12-36 months (all P > .1). Patients with temperature of ≥39.0 were more likely to have all tests, with the exception of urine investigation, than patients with temperature between 38.0 and 38.9. Conclusions. 17% of 2-36 month old patients seen in the emergency department are diagnosed with AOM. Investigating for bacteremia or UTI in these patients is not routine, even in febrile infants.
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