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Use of symptoms and risk factors to predict acute otitis media in infants
David P McCormick1, Kristofer Jennings2, Linda C Ede1
1Department of Pediatrics, University of Texas Medical Branch at Galveston, TX, USA.
Insights
Predicting acute otitis media (AOM) in infants with upper respiratory tract infections (URI) is challenging. Symptom severity and specific risk factors like daycare attendance can help identify infants at higher risk for AOM.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Infants and children with upper respiratory tract infections (URI) frequently develop acute otitis media (AOM).
- Younger infants present with less specific symptoms compared to older children, complicating diagnosis.
- Identifying predictive factors for AOM in infants is crucial for timely intervention.
Purpose of the Study:
- To assess the utility of various symptoms and risk factors in predicting AOM in infants.
- To develop a predictive model for AOM in infants experiencing URI.
Main Methods:
- Prospective follow-up of healthy infants from birth to one year of age.
- Enrollment of infants presenting with URI symptoms, with parental reporting of symptom severity.
- Clinical diagnosis of concurrent AOM by an investigator, and analysis of risk factors and symptom scores.
Main Results:
- A combination of five symptoms (fever, earache, poor feeding, restless sleep, irritability) showed a statistical association with AOM prediction (P=0.006).
- A multivariable model (J-Score) incorporating daycare attendance, age, cough severity, and earache severity demonstrated strong predictive capability for AOM (P<0.001) with 95% specificity.
- Both predictive methods exhibited relatively low sensitivity for AOM detection.
Conclusions:
- Symptom severity during URI in the first year of life is significantly linked to concurrent AOM.
- Daycare attendance, earache presence/severity, and cough severity enhance the correlation for AOM prediction.
- These findings may aid in identifying infants at increased risk for developing AOM.
Objectives:
Infants and children with upper respiratory tract infection (URI) often have concurrent acute otitis media (AOM). Young infants have fewer specific symptoms than older children. The purpose of this study was to evaluate the usefulness of symptoms and other risk factors in predicting the presence of AOM in infants.
Methods:
Healthy infants, age less than four weeks, were enrolled and followed prospectively for up to age one year. Infants were scheduled for a research visit when their parents noted the onset of symptoms. At each URI visit, parents first reported the severity of symptoms. An investigator then diagnosed the presence or absence of concurrent AOM. Risk factors and symptom scores for infants with and without AOM were studied.
Results:
Infants (N=193, mean age at first URI 3.9±2.5 months) experienced 360 URI episodes and 63 AOM events. Symptoms consisting of fever, earache, poor feeding, restless sleep, and irritability together (ETG-5) were statistically associated with the prediction of AOM (P=0.006). A multiple variable statistical model (J-Score) that included day care attendance, age, severity of cough and earache best predicted AOM (P<0.001), with 95% specificity. Both ETG-5 and J-score yielded relatively low sensitivity for AOM prediction.
Conclusions:
In infants with URI in the first year of life, severity of symptoms was significantly associated with concurrent AOM. Daycare attendance, presence and severity of earache and cough added to better correlation. These observations may have clinical application in identification of infants at risk for AOM.
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