Specialists' adherence to guidelines on tympanostomy tube insertion

Area of Science:

• Pediatric Otolaryngology
• Evidence-Based Medicine
• Health Services Research

Background:

• Tympanostomy tube (TT) insertion is a common procedure in Denmark for children with otitis media (OM).
• Assessing adherence to the 2015 national clinical guideline (NCG) for TT insertion is crucial for optimizing pediatric ear care.
• Electronic patient-reported outcome (ePRO) data offers a valuable tool for evaluating clinical practice adherence.

Purpose of the Study:

• To evaluate the adherence of Danish Ear, Nose, and Throat (ENT) specialists to the 2015 NCG for first-time TT insertion in children aged 0-5 years with OM.
• To assess the utility of ePRO data in monitoring adherence to national clinical guidelines.

Main Methods:

• Retrospective analysis of data from the Danish ENT Specialists Organisation (DØNHO) database for 1,495 children (0-5 years) with OM undergoing first-time TT insertion.
• Utilized pre-operative ePRO questionnaires to gather information on symptom duration and acute otitis media (AOM) episodes.
• Defined NCG adherence based on criteria for symptom duration (≥3 months) and recurrent AOM (RAOM: ≥3 episodes/6 months or ≥4 episodes/12 months).

Main Results:

• 91.0% of parents reported symptom duration of ≥3 months and/or RAOM within 6-12 months, meeting NCG adherence criteria.
• A small percentage (4.6%) did not meet recommended criteria, reporting <3 months symptom duration with few AOM episodes.
• 4.4% of parents were undecided regarding symptom duration or AOM episode counts.

Conclusions:

• Danish ENT specialists demonstrate high adherence to the 2015 NCG regarding symptom duration and RAOM for TT insertion in young children.
• ePRO data is an effective method for assessing adherence to clinical guidelines in pediatric otolaryngology practice.