May 2012

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Background: Acute otitis media (AOM) is one of the most common presenting pediatric complaints accounting for a large proportion of antibiotic prescriptions. Current guidelines for AOM strongly recommend the use of analgesics and observation without antibiotics for mild to moderate cases of AOM, yet few studies have described their use. This study is the first to identify predictor variables for use of analgesics and observation. Methods: A retrospective chart review of 600 charts was conducted from ambulatory clinic and pediatric emergency department (PED) records in an academic, tertiary care center for children ages 6 months to 12 years diagnosed with AOM between June 2008 and June 2010. Charts were assessed for recommendations for analgesics/antipyretics (A/A), use of observation (prior to antibiotic use) and hypothesized predictor variables. Results: The mean age of the study cohort was 40.6 months. Recommendations of A/A use following the visit were significantly higher in the PED compared to the ambulatory clinic (86.7% vs. 60.7%, p<0.001). Observation was recommended in 37.8% of all visits. Patients with recommended use of observation received post-visit A/A recommendations more often than those prescribed antibiotics immediately (OR 2.11: 95% CI 1.36-3.28). The absence of fussiness (p=0.03), fever (p<0.001), and tympanic membrane bulging (p<0.001) were all independently associated with the use of observation. Conclusion: A/A were more often given in conjunction with observation compared to immediate antibiotic use. Overall the frequencies of use of observation and A/A were higher than previously reported. Further prospective analyses are necessary to confirm these findings.




School of Medicine



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