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Are Management Practices for Pediatric Uncomplicated Acute Otitis Media Different on Weekends Versus Weekdays?
Eyal Schneider1,2, Maor Pichadze2,3, Shir Avraham2
1From the Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
Insights
Acute otitis media (AOM) care in children was guideline-adherent, irrespective of visit timing or physician supervision. This study found no evidence of a "weekend effect" on AOM management quality in the pediatric emergency department.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Disease Management
- Healthcare Quality Improvement
Background:
- Acute otitis media (AOM) is a frequent pediatric diagnosis and a primary driver of antibiotic prescriptions.
- The "weekend effect," characterized by reduced care quality due to decreased senior physician supervision outside standard hours, is a recognized concern in pediatric healthcare.
- The impact of the weekend effect on the management of acute otitis media has not been previously investigated.
Purpose of the Study:
- To investigate the potential impact of the "weekend effect" on the quality of acute otitis media (AOM) management in a pediatric emergency department.
- To assess whether AOM treatment appropriateness varies based on visit timing (weekday vs. after-hours) and physician supervision levels.
Main Methods:
- A retrospective cross-sectional study analyzed data from 288 children (6 months to 10 years) diagnosed with uncomplicated AOM.
- Treatment appropriateness was evaluated against the 2023 Israeli AOM guidelines.
- Care optimality was categorized by visit timing and attending physician presence: Level 0 (weekday, attending), Level 1 (after-hours, attending), and Level 2 (after-hours, no attending).
Main Results:
- Weekend and weekday patient groups were clinically and demographically similar.
- Attending physician presence was significantly higher during weekdays (82.8%) compared to after-hours (55.6%).
- Overall guideline-appropriate treatment was 72.9%, with amoxicillin as the preferred first-line antibiotic; no significant differences in appropriateness were observed across visit times or care optimality levels.
Conclusions:
- Acute otitis media management adhered to guidelines consistently, regardless of visit timing or physician supervision intensity.
- The study did not identify a "weekend effect" influencing the quality of AOM care.
- Findings suggest robust clinical practice standardization within the pediatric emergency department, supporting current protocols as a model for consistent AOM care.
Background:
Acute otitis media (AOM) is a leading cause of antibiotic prescriptions in children. The "weekend effect"-reduced care quality outside standard hours due to lower senior supervision-has been reported for various pediatric conditions, but its impact on AOM management remains unexplored.
Methods:
We conducted a retrospective cross-sectional study of children aged 6 months to 10 years diagnosed with uncomplicated AOM in a secondary academic pediatric emergency department (PED) between 2017 and 2024. Treatment appropriateness was assessed against the 2023 Israeli AOM guidelines. Care optimality was stratified by visit timing and physician seniority into 3 levels: level 0 (weekday, attending present), level 1 (after-hours, attending present) and level 2 (after-hours, no attending).
Results:
Of 288 children included, weekend and weekday visitors were clinically and demographically comparable. The presence of attending physicians was significantly higher on weekdays (82.8% vs. 55.6%, P < 0.001). Guideline-appropriate treatment was achieved in 72.9% of cases overall, with amoxicillin as the first-line chosen antibiotic therapy. No significant differences in treatment appropriateness were found between weekend and weekday visits, nor across care optimality levels (P = 0.363), indicating that physician supervision level did not influence guideline adherence.
Conclusions:
AOM management was guideline-adherent regardless of visit timing or physician supervision level, with no weekend effect identified. These findings suggest effective standardization of clinical practice in our pediatric emergency department and support maintaining current protocols as a model for consistent AOM care in emergency settings.
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