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Referral and management patterns for paediatric otorrhoea across primary and secondary care: a multicentre
Elliot Heward1, Alexander Collingwood2, Farah Jeffry3
1https://ror.org/027m9bs27University of Manchester School of Biological Science, UK.
Insights
Otorrhoea in children is common, with 10.9% of pediatric ENT referrals presenting with ear discharge. Management varies, highlighting a need for standardized care pathways to improve outcomes for children with otorrhoea.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Public Health
Background:
- Middle ear infections are prevalent in children, potentially causing hearing loss due to otorrhoea (ear discharge).
- Timely management is crucial to prevent long-term developmental repercussions.
- Current referral patterns and management strategies for pediatric otorrhoea are not well-documented.
Purpose of the Study:
- To determine the frequency and characteristics of pediatric otorrhoea referrals from UK primary care to secondary care Ear, Nose, and Throat (ENT) services.
- To analyze referral urgency based on hearing loss status.
Main Methods:
- A cohort of 2,100 pediatric ENT referrals (ages 0-16) from primary care to two English hospital trusts in 2023 was analyzed.
- Data on children with otorrhoea were extracted, and chi-squared tests compared referral urgency between those with and without hearing loss.
Main Results:
- Otorrhoea was present in 10.9% (228 children) of pediatric ENT referrals, with a mean age of 6.4 years.
- The most common referral duration was over 3-6 months (21.1%).
- No significant difference in referral urgency was observed for children with hearing loss compared to those without (28.1% vs. 29.4%, p=0.832). Primary care predominantly used oral antibiotics, while secondary care favored topical treatments.
Conclusions:
- Children with otorrhoea represent a substantial portion of pediatric ENT referrals in the UK.
- Heterogeneous management approaches in primary and secondary care may contribute to treatment failures.
- Standardized management pathways are recommended for children with otorrhoea to ensure timely and effective care.
Aim:
To determine the frequency and nature of referrals for children with acute or chronic otorrhoea from primary care to secondary care ENT services in the UK.
Background:
Middle ear infections in children are common; if the ear drum bursts discharge leaks out (otorrhoea). This causes hearing loss during a critical developmental period. Managing these children in an appropriate time frame to prevent disease repercussions is vital. There is currently no evidence demonstrating referral patterns and management strategies across primary and secondary care services.
Method:
Children with otorrhoea were identified amongst a cohort of 2,100 paediatric ENT (age 0-16 years) referrals from primary care at two secondary care hospital trusts in England in 2023. Chi-squared statistical analysis was performed to compare referral urgency for those with or without hearing loss.
Findings:
Of the paediatric ENT referrals, 228 (10.9%) had otorrhoea (mean age: 6.4 years, female: n = 110). The most frequent symptom duration at time of referral was >3-6 months (21.1%). Children with hearing loss were not referred more urgently compared to those without reported hearing loss (28.1% vs. 29.4%, p = 0.832). Antibiotic use in primary care was predominantly using oral antibiotics compared to topical antibiotics in secondary care. This study has shown that children with otorrhoea make up a significant proportion of paediatric referrals to the ENT secondary care services in the UK. Current management is heterogenous and could contribute to treatment failure. Standardized management pathways for these patients should be formulated.
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