07 Overdiagnosis of acute otitis media: A call to action
Bibliographic record
Abstract
Abstract Background The pressing scarcity of healthcare resources and access to primary care makes accuracy of clinical diagnoses in children paramount; unneeded treatments incorrectly prompt parents to seek medical attention again when similar symptoms recur in the future. Acute otitis media (AOM) is a prime example, where overdiagnosis leads to unnecessary antibiotics, unneeded healthcare visits during viral infections, and potentially after repeated misdiagnoses, unnecessary myringotomy tubes. Objectives The variety of findings observable during otoscopy and difficulty performing this exam in children likely contributes to overdiagnosis. The Canadian Paediatric Society (CPS) has published guidelines on the diagnosis of AOM, requiring both middle ear inflammation and an effusion. However, no study has determined which otoscopy findings on-the-ground physicians use to diagnose AOM, and whether lack of adherence to guidelines contributes to overdiagnosis. Design/Methods In this single-centre, multi-site retrospective chart review, we determined the rate of adherence to CPS AOM diagnosis guidelines for children presenting to adult and paediatric emergency departments (EDs) from September 2021 to August 2022 based on documented otoscopy findings in patient charts. Results For 177 cases of non-perforated AOM for which antibiotics were prescribed and contained a documented physical exam, only 109 (61.6%) had otoscopy findings consistent with CPS criteria. Fifty-seven cases (32.8%) had documented middle ear inflammation without effusion, and 9 cases (5.1%) were diagnosed with AOM despite the tympanic membrane not being visualized. Figure 1 shows the frequency of documented tympanic membrane findings. Notably, only 98 cases (55.4%) documented the presence (n=94) or absence (n=4) of bulging. Figure 2 shows guideline adherence by location, clinician type, and age, with significantly higher adherence in the paediatric ED, by learners, and in older patients. Conclusion This study highlights that AOM is overdiagnosed, perhaps related to lack of adherence to diagnosis guidelines. Simplification of guidelines, such as explicitly requiring a bulging tympanic membrane, may improve diagnostic accuracy. Additionally, a CPS working group focused on identifying and addressing factors contributing to the overdiagnosis of paediatric conditions commonly diagnosed in community settings would be crucial in reducing healthcare resource overuse. The authors of this abstract would be eager to contribute to this effort.Figure 1.Number of cases for which each listed tympanic membrane finding was documented in the patient chart. Figure 2.Percentage of cases meeting diagnostic criteria by location of diagnosis, clinician type, and age.
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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 | 0.021 | 0.064 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.004 | 0.006 |
| Insufficient payload (model declined to judge) | 0.003 | 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".