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Observation Option for Acute Otitis Media in the Emergency Department

Fischer, Thomas MD; Singer, Adam J. MD; Chale, Stuart MD

doi: 10.1097/PEC.0b013e3181b91ff0
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Objectives: The objective of our study was to evaluate the efficacy of the observation option for the treatment of acute otitis media (AOM) in the emergency department (ED).

Methods: The study was designed as a prospective case series. It was conducted in a suburban academic emergency department, with pediatric patients 2 years or older as participants.

Interventions and outcomes: The patient population consisted of children 2 years or older with conditions diagnosed as AOM. Patients were excluded if they had a history of any potentially immunocompromising conditions or a history of recurrent AOM. Patients were treated with ibuprofen or acetaminophen in the ED. The parents were given a prescription for antibiotics but were asked not to fill the prescription immediately. Parents were contacted by phone for follow-up.

Results: One hundred forty-four patients were enrolled in the study. One hundred five (73%) recovered uneventfully without ever requiring antibiotics. Thirty-nine patients were treated with antibiotics. Of the 39 patients who were started on antibiotics, 11 patients had at least 1 episode of vomiting or diarrhea, and 5 of these patients had their antibiotic changed because of it.

Conclusions: Our study demonstrates that the observation option as defined by the New York Otitis Project Committee can be safely implemented in the ED and prevented the administration of antibiotics in more than 70% of the patients in our group. This suggests that if the observation option became the standard of care for the treatment of AOM, antibiotic administration for this disease could be significantly reduced.

From the Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, NY.

Reprints: Thomas Fischer, MD, Department of Emergency Medicine, University Hospital at Stony Brook, Stony Brook, NY 11794 (e-mail: tomfxf@optonline.net).

Presented in part at the Society for Academic Emergency Medicine, San Francisco, CA, May 2006.

© 2009 Lippincott Williams & Wilkins, Inc.