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Child/Adolescent Health

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A simple pocket card that assesses the symptoms and severity of a child's acute ear infection can aid treatment decisions

The majority of children with acute otitis media (AOM, ear infection) recover without antibiotics if their symptoms are managed. This "watchful waiting" approach is safe and effective but parents need to be educated because some parents expect an antibiotic whenever their child is diagnosed with AOM. A pocket AOM card can help facilitate shared decisionmaking between parents and clinicians. The AOM card combines a parent assessment of the child's symptoms (using a scale of facial expressions) and the clinician's assessment of the severity of tympanic membrane (ear drum) inflammation to assess total AOM severity.

Researchers, supported in part by the Agency for Healthcare Research and Quality (HS10613), developed the card to identify children who are candidates for watchful waiting by stratifying a child's AOM severity. The card includes a parent-friendly AOM faces scale (AOM-FS), with facial expressions ranging from a broadly smiling child with no problem (1) to a slightly frowning child with a moderate problem (4) to a crying child with an extreme problem (7). It also includes a more objective otoscopy scale (the OS-8), which grades the tympanic membrane and middle ear appearance as seen during otoscopy (examination of the tympanic membrane with a lighted instrument) on a scale of 0 to 8.

For example, based on the AOM card, a screaming child with a red but mobile tympanic membrane (OS-8 grade 1) should not be diagnosed with AOM. Similarly, a child who has an OS-8 grade 4 ear but is asymptomatic does not have AOM. After considering AOM severity, the child's age, and presence or absence of other risk factors, the clinician and parent can make a shared decision regarding the treatment plan. The AOM card can also be used to improve the diagnostic skills of medical students and residents.

See "Development of a practical tool for assessing the severity of acute otitis media," by Norman R. Friedman, M.D., David P. McCormick, M.D., Carmen Pittman, B.A., and others, in the February 2006 Pediatric Infectious Disease Journal 25(2), pp. 101-107.

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