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Does this child have acute otitis media?

Publication ,  Journal Article
Rothman, R; Owens, T; Simel, DL
Published in: JAMA
September 24, 2003

CONTEXT: Acute otitis media (AOM) is one of the most common problems in pediatrics. An accurate diagnosis of AOM can guide proper treatment and follow-up. OBJECTIVE: To systematically review the literature regarding precision and accuracy of history taking and physical examination in diagnosing AOM in children. DATA SOURCES: We searched MEDLINE for English-language articles published from 1966 through May 2002. Bibliographies of retrieved articles and textbooks were also searched. STUDY SELECTION: We located studies with original data on the precision or accuracy of history or physical examination for AOM in children. Of 397 references initially identified, 6 met inclusion criteria for analysis. DATA EXTRACTION: Two authors independently reviewed and abstracted data to calculate likelihood ratios (LRs) for symptoms and signs. DATA SYNTHESIS: Four studies of symptoms used clinical diagnosis as the criterion standard and were limited by incorporation bias. Ear pain is the most useful symptom (positive LRs, 3.0-7.3); fever, upper respiratory tract symptoms, and irritability are less useful. One study of clinical signs used tympanocentesis as the criterion standard, and we adjusted the results to correct for verification bias. A cloudy (adjusted LR, 34; 95% confidence interval [CI], 28-42), bulging (adjusted LR, 51; 95% CI, 36-73), or distinctly immobile (adjusted LR, 31; 95% CI, 26-37) tympanic membrane on pneumatic otoscopy are the most useful signs for detecting AOM. A distinctly red tympanic membrane is also helpful (adjusted LR, 8.4; 95% CI, 6.7-11) whereas a normal color makes AOM much less likely (adjusted LR, 0.2; 95% CI, 0.19-0.21). CONCLUSIONS: Although many of the studies included in this analysis are limited by bias, a cloudy, bulging, or clearly immobile tympanic membrane is most helpful for detecting AOM. The degree of erythema may also be useful since a normal color makes otitis media unlikely whereas a distinctly red tympanic membrane increases the likelihood significantly.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

September 24, 2003

Volume

290

Issue

12

Start / End Page

1633 / 1640

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Physical Examination
  • Otitis Media
  • Medical History Taking
  • Infant
  • Humans
  • General & Internal Medicine
  • Child, Preschool
  • Acute Disease
  • 42 Health sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Rothman, R., Owens, T., & Simel, D. L. (2003). Does this child have acute otitis media? JAMA, 290(12), 1633–1640. https://doi.org/10.1001/jama.290.12.1633
Rothman, Russell, Thomas Owens, and David L. Simel. “Does this child have acute otitis media?JAMA 290, no. 12 (September 24, 2003): 1633–40. https://doi.org/10.1001/jama.290.12.1633.
Rothman R, Owens T, Simel DL. Does this child have acute otitis media? JAMA. 2003 Sep 24;290(12):1633–40.
Rothman, Russell, et al. “Does this child have acute otitis media?JAMA, vol. 290, no. 12, Sept. 2003, pp. 1633–40. Pubmed, doi:10.1001/jama.290.12.1633.
Rothman R, Owens T, Simel DL. Does this child have acute otitis media? JAMA. 2003 Sep 24;290(12):1633–1640.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

September 24, 2003

Volume

290

Issue

12

Start / End Page

1633 / 1640

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Physical Examination
  • Otitis Media
  • Medical History Taking
  • Infant
  • Humans
  • General & Internal Medicine
  • Child, Preschool
  • Acute Disease
  • 42 Health sciences