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Selecting infants with OM that need referral and further assessment: creating a case-finding instrument
W Lok1, M N Chenault, L J C Anteunis
1Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. w.lok@asz.nl
Insights
A new OM score helps identify children needing surgical treatment. This tool aids in selecting infants with otitis media (OM) for further assessment and potential surgical intervention, improving care pathways.
Area of Science:
- Pediatric Otolaryngology
- Evidence-Based Medicine
- Health Services Research
Background:
- Otitis media (OM) is frequently treated surgically in Dutch children.
- Recent evidence questions the necessity of surgical intervention for uncomplicated OM.
- A subgroup of infants with OM requires specialized assessment and treatment.
Purpose of the Study:
- To explore the utility of known and presumed risk factors for OM.
- To develop an instrument for selecting and routing infants with OM for further care.
- To predict the need for surgical treatment in children with otitis media.
Main Methods:
- Two-stage questionnaire study involving 6531 children at 9 months and their parents at 21 months.
- Univariate and multivariable regression analyses to identify predictors of surgical treatment.
- Receiver Operating Characteristic (ROC) curve analysis to determine predictive model performance.
Main Results:
- Univariate analysis identified 10 significant predictors for surgical treatment of OM.
- Multivariable regression yielded a predictive model with an ROC curve area of 0.801.
- An OM score was developed based on estimated risk factor coefficients.
Conclusions:
- The developed OM scoring sheet shows promise in predicting the need for surgical treatment.
- This tool can aid clinicians in identifying children who may benefit from further assessment and surgical intervention.
- The OM score may enhance decision-making for otitis media management in infants.
Objective:
In the Netherlands, many children are surgically treated for OM. Recent publications question the need for surgical treatment in common uncomplicated OM, although there is certainly a subgroup of infants that do need further assessment and possible treatment. The present study explores the possibility of using known and presumed risk factors for OM as an instrument for selecting and routing an infant with OM to further care.
Methods:
Two questionnaires were used. A questionnaire embracing a wide range of OM-related factors was sent to 6531 children aged nine months that were routinely invited for the hearing screen at nine months. In a second stage, a structured history questionnaire regarding ear and/or hearing problems, subsequent referral and/or treatment, was sent to all parents of children at age 21 months, responding to the first questionnaire. Univariate analysis was performed for identification of potential predictors for surgical treatment of OM for the whole sample as well as for 4 different subsets. Multivariable regression analysis with stepwise backward deletion was applied to arrive at a model for optimal prediction of tube insertion. A ROC (receiver operating characteristic) curve and the accompanying sensitivity and specificity values were analyzed to determine cut off values.
Results:
Univariate analysis found 10 items predicting surgical treatment for OM. Multivariable regression analysis resulted in a model with a ROC curve having an area of 0.801 and estimated coefficients for risk factors which were used to calculate a OM-score for each case.
Conclusion:
The developed scoring sheet, e.g., to be used in combination with physical examinations and/or tympanometry looks promising as a predictor for those children that might benefit from further assessment and eventually surgically treatment for OM.
