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¿Este niño tiene otitis media aguda?
Russell Rothman1, Thomas Owens, David L Simel
1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn 37232, USA. russell.rothman@vanderbilt.edu
JAMA
|September 25, 2003
Resumen
El diagnóstico preciso de la otitis media aguda (AOM) en los niños se basa en los resultados específicos del examen físico. Un tímpano nublado, abultado o inmóvil en la otoscopia neumática son indicadores clave para la OMA.
Área de la Ciencia:
- Medicina Pediátrica La medicina pediátrica es una especialidad de la medicina pediátrica.
- La otorrinolaringología otorrinolaringología.
- Estudios de precisión de diagnóstico Estudios de precisión de diagnóstico.
Sus antecedentes:
- La otitis media aguda (OAM) es una enfermedad pediátrica frecuente.
- El diagnóstico preciso de la OMA es crucial para un manejo y seguimiento adecuados.
Objetivo del estudio:
- Revisar sistemáticamente la literatura sobre la precisión diagnóstica de la historia clínica del paciente y el examen físico para la OMA en niños.
- Para determinar la precisión y exactitud de varios síntomas y signos en el diagnóstico de AOM.
Principales métodos:
- Buscado MEDLINE y bibliografías para estudios en inglés (1966-2002) sobre la precisión del diagnóstico AOM.
- Se incluyeron estudios con datos originales sobre la historia clínica o el examen físico para la OMA en niños.
- Relaciones de probabilidad calculadas (LR) para los síntomas y signos, ajustando el sesgo cuando sea necesario.
Principales resultados:
- El dolor de oído es el síntoma más útil (LR positivo, 3.0-7.3).
- Las membranas timpánicas turbias (ajustadas LR, 34), abultadas (ajustadas LR, 51) o inmóviles (ajustadas LR, 31) son muy indicativas de AOM.
- Las membranas timpánicas claramente rojas son útiles (LR ajustado, 8.4), mientras que el color normal sugiere la ausencia de AOM (LR ajustado, 0.2).
Conclusiones:
- A pesar de las limitaciones del estudio, los hallazgos físicos específicos son más valiosos para el diagnóstico de la OMA.
- Las membranas timpánicas turbias, abultadas o inmóviles son los indicadores más fuertes.
- El eritema de la membrana timpánica también es una señal útil, con un color normal que hace que la OMA sea menos probable.
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