1473. Guideline Adherence in Pediatric Ambulatory Visits for Acute Otitis Media
Notice bibliographique
Résumé
Abstract Background Acute otitis media (AOM) is the most common pediatric outpatient condition treated with antibiotics in the United States. Over 30% of children receive inappropriate antibiotics for AOM, contributing to increasing antimicrobial resistance and unnecessary adverse events. Strict adherence to diagnostic and treatment guidelines has been proposed by the American Academy of Pediatrics (AAP) Committee on Infectious Diseases as one strategy to combat inappropriate antibiotic use. Our objective was to describe adherence to the 2013 AAP guidelines on AOM. Methods We performed a cross-sectional study on a random sample of visit notes for patients 3 to 59 months old diagnosed with otitis media based on ICD-10-CM codes (H65, H66, H67) and treated with antibiotics between 9/1/2017 and 8/31/2018 in an association of pediatric practices across Massachusetts. Children with tympanostomy tubes or a chronic medical condition increasing their risk for AOM were excluded. Based on the 2013 AAP diagnostic criteria, tympanic membrane exam descriptions were reviewed and classified as describing AOM or not. Antibiotic choices were classified as appropriate or inappropriate. Notes were then labeled as “fully adherent” (exam consistent with AOM and appropriate antibiotic choice), “partially adherent” (exam inconsistent with AOM or inappropriate antibiotic choice), and “non-adherent” (exam inconsistent with AOM and inappropriate antibiotic choice). Results Three hundred and ninety-four visit notes from 39 different practices were analyzed. One hundred and sixty-six notes (42%) were “fully adherent” to the AAP guidelines, 183 (46%) were “partially adherent” and 45 (11%) were “non-adherent” (Figure 1). In the “partially adherent” and “non-adherent” groups combined, exams were inappropriate in 179 notes (45.4%) and antibiotic choice was inappropriate in 94 notes (23.9%). Cefdinir was the most frequent inappropriate antibiotic (44/94, 46.8%) (Table 1). “Watchful waiting” occurred in only 7% (16/229) of eligible cases. Figure 1. Breakdown of encounters by adherence type Table 1. Cross-table of indicated and prescribed antibiotics Conclusion Our analysis of independent pediatric practices showed moderate adherence to the AAP guidelines for AOM. Substantial room exists for improvement in diagnosing and treating AOM in young children, especially regarding the potential for watchful waiting. Disclosures All Authors: No reported disclosures
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».