171. Retrospective Review of Management of Acute Otitis Media in a Canadian Pediatric Emergency Department
Bibliographic record
Abstract
Abstract Background Acute Otitis Media (AOM) is a leading cause of antibiotic prescription in children. Watchful waiting is the preferred strategy for AOM management for mildly ill children ≥ 2-years-old however current clinical practice varies. This study aims to compare published AOM guidelines by the Canadian Pediatric Society (CPS) with clinical practice in a Canadian academic tertiary care emergency department (ED). Methods We performed a retrospective review on AOM ED visits at the Children’s Hospital of Eastern Ontario (CHEO) from 1/2021 to 12/2021. Measures of non-adherence to the CPS AOM guideline were defined as follows: missed opportunity for watchful waiting, diagnostic criteria absent or not recorded, prolonged duration of treatment, lack of immediate treatment, and inappropriate agent. Additionally we explored if guideline-discordant antibiotic prescribing practices differ by geographic locale (rural vs non-rural as determined by postal code) and preferred language. The postal code was linked to a Material and Social Deprivation Index (MSDI) from INSPQ as a proxy for socio-economic status. Results 442 patients were included (Table 1). 66.5% patients met criteria of non-adherence (Table 2). 41.9% patients received antibiotics despite being categorized as mildly ill. 29.6% patients received antibiotics, despite having no/undocumented middle ear effusion or bulging tympanic membrane. 6.6% received longer duration of antibiotics (10 days) despite lack of complications such as perforation. 4.1% received non-penicillin antibiotics as first-line treatment. 1.4% received parachute prescriptions despite being categorized as severely ill. After controlling for language and rurality, the odds of being in any non-adherence group were not higher for patients in higher deprivation quintiles compared to those in the lowest deprivation quintile (Figure 1, 2).Figure 1.Distribution of Material Deprivation Quintiles by Non-adherence Type Conclusion 2/3rd of ED patients met criteria of guideline non-adherence. Material deprivation was not a predictor of non-adherence. The two domains of watchful waiting and applying diagnostic criteria can serve as specific benchmarks to improve antibiotic prescribing practices in ED settings. Pragmatic management of AOM using current guidelines may be biased towards immediate treatment rather than timely follow-up.Figure 2.Odds ratio of any non-adherence for material deprivation quintile adjusted for language and rurality Disclosures All Authors: No reported disclosures
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.010 | 0.016 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".