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Current management and referral patterns of pediatricians for acute otitis media
Shivani Shah-Becker1, Michele M Carr2
1Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
Insights
Pediatrician practices for acute otitis media (AOM) often diverge from 2013 American Academy of Pediatrics guidelines. This highlights a need for better alignment in AOM management and referral patterns.
Area of Science:
- Pediatrics
- Otolaryngology
- Evidence-based Medicine
Background:
- The American Academy of Pediatrics (AAP) established clinical guidelines for acute otitis media (AOM) management in 2013.
- Current pediatrician practices may not fully align with these evidence-based recommendations.
Purpose of the Study:
- To evaluate current pediatrician practices regarding AOM diagnosis and treatment.
- To compare these practices against the 2013 AAP AOM clinical practice guidelines.
Main Methods:
- A survey was distributed to 196 practicing pediatricians concerning AOM management.
- Responses were analyzed using Chi-square and ANOVA statistical tests.
Main Results:
- A 38% survey response rate was achieved, with most respondents in non-academic group practices and extensive clinical experience.
- Significant variations exist in diagnostic tool usage (pneumatic otoscopy/tympanometry) and treatment approaches (observation vs. antibiotics) for AOM.
- Referral patterns for recurrent AOM to Otolaryngology were reported by 75% of pediatricians.
Conclusions:
- Pediatrician practices for AOM diagnosis, treatment, and referral do not consistently follow the 2013 AAP guidelines.
- Otolaryngologists should be aware of these practice variations as they can influence patient management and referrals.
Objective:
The American Academy of Pediatrics (AAP) has published an evidence-based clinical practice guideline for the management of acute otitis media (AOM), most recently revised in 2013. This study aims to assess current practice patterns and how they compare to the published guideline.
Methods:
An 11 question survey addressing topics included in the 2013 AAP AOM guidelines was mailed to 196 practicing pediatricians. Statistical analysis was performed using Chi-square and ANOVA testing.
Results:
76 (38%) completed surveys were returned. 75% of respondents were in group practice (non-academic) and 83% were in practice 11 years or more. 93% were members of the AAP. 46% of responding pediatricians use pneumatic otoscopy and/or tympanometry at least once a day to aid in the diagnosis of AOM, while 28% never do. 15% of respondents would choose close observation over antibiotics in a child under the age of 2 years with unilateral non-severe AOM while 50% would choose close observation in a child over age 2. 75% would make a referral to Otolaryngology for recurrent AOM. No significant differences were noted in responses based on practice type, years in practice, or Otolaryngology experience during residency training.
Conclusions:
Current pediatrician practice and referral patterns for AOM are not consistent with 2013 Guidelines from the AAP. As consulting surgeons, Otolaryngologists should have knowledge of management protocols in related specialties that can have an impact on their practice.
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