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Otitis externa - what is the problem with getting it right? A mixed-methods study in primary and secondary care. The Journal of Laryngology & Otology 2021; 136:486-491. [PMID: 34819190 DOI: 10.1017/s0022215121003649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Taufique Z, Timen M, Swartz JL, Friedmann DR. Adherence to Subspecialty Guidelines in the Emergency Department. Laryngoscope 2020; 131:1266-1270. [PMID: 33103763 DOI: 10.1002/lary.29202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/21/2020] [Accepted: 10/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS The American Academy of Otolaryngology-Head and Neck Surgery has published clinical practice guidelines (CPGs) to guide management of common otolaryngologic (ENT) conditions. While these CPGs have been disseminated within specialty journals, many patients' first presentation of certain ENT complaints is to primary and acute care settings, including the emergency department (ED). It is less clear whether practice in these settings is concordant with specialty CPGs. STUDY DESIGN Retrospective cohort study. METHODS A retrospective review of medical records was performed at an academic tertiary care center with ED diagnoses of 1) Bell's palsy/facial weakness (BP) or 2) acute otitis externa (AOE) from May 2014-June 2018. Individual chart abstraction was performed for all encounters with these diagnoses for the purpose of assessing providers' adherence to CPGs. RESULTS During the study period, 224 patients were diagnosed with BP and 465 patients were diagnosed with AOE. Of the patients diagnosed with BP, 94% (n = 211/224) were prescribed oral steroids, concordant with guidelines, while 36% of these patients received head computed tomography (CT) scans and 43% received laboratory tests, counter to the guidelines. For those with a diagnosis of AOE, 28.6% received topical antibiotics only as primary treatment (n = 133/465) in accordance with guidelines while systemic antibiotics were prescribed in 42.2% (n = 196/465) discordant with the guidelines and 29.2% received both topical and systemic antibiotics (n = 136/465). CONCLUSIONS CPGs developed by subspecialty societies provide evidence-based recommendations for the care of patients with particular conditions, but may not be disseminated broadly outside of the specialty. Further research is required to understand the reasons behind divergent management of such conditions. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1266-1270, 2021.
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Affiliation(s)
- Zahrah Taufique
- Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, U.S.A.,Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine Health, New York, New York, U.S.A
| | - Micah Timen
- Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, U.S.A.,Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine Health, New York, New York, U.S.A
| | - Jordan L Swartz
- Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, U.S.A.,Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine Health, New York, New York, U.S.A
| | - David R Friedmann
- Department of Otolaryngology - Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York, U.S.A.,Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine Health, New York, New York, U.S.A
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Selwyn DM, Lau A. When to refer: Validating the Evidence-based Acute Otitis Externa Referral Score (EARS). Our experience of 287 cases of otitis externa in primary care. Clin Otolaryngol 2019; 44:475-479. [PMID: 30786146 DOI: 10.1111/coa.13320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/04/2019] [Accepted: 02/15/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Andrew Lau
- Mersey ENT Research Collaborative (MERC), Liverpool, UK.,Royal Liverpool Hospital, Liverpool, UK
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Use of Systemic Antibiotics for Acute Otitis Externa: Impact of a Clinical Practice Guideline. Otol Neurotol 2018; 39:1088-1094. [DOI: 10.1097/mao.0000000000001955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zanichelli V, Monnier AA, Gyssens IC, Adriaenssens N, Versporten A, Pulcini C, Le Maréchal M, Tebano G, Vlahović-Palčevski V, Stanić Benić M, Milanič R, Harbarth S, Hulscher ME, Huttner B. Variation in antibiotic use among and within different settings: a systematic review. J Antimicrob Chemother 2018; 73:vi17-vi29. [PMID: 29878219 PMCID: PMC5989604 DOI: 10.1093/jac/dky115] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Variation in antibiotic use may reflect inappropriate use. We aimed to systematically describe the variation in measures for antibiotic use among settings or providers. This study was conducted as part of the innovative medicines initiative (IMI)-funded international project DRIVE-AB. Methods We searched for studies published in MEDLINE from January 2004 to January 2015 reporting variation in measures for systemic antibiotic use (e.g. DDDs) in inpatient and outpatient settings. The ratio between a study's reported maximum and minimum values of a given measure [maximum:minimum ratio (MMR)] was calculated as a measure of variation. Similar measures were grouped into categories and when possible the overall median ratio and IQR were calculated. Results One hundred and forty-three studies were included, of which 85 (59.4%) were conducted in Europe and 12 (8.4%) in low- to middle-income countries. Most studies described the variation in the quantity of antibiotic use in the inpatient setting (81/143, 56.6%), especially among hospitals (41/81, 50.6%). The most frequent measure was DDDs with different denominators, reported in 23/81 (28.4%) inpatient studies and in 28/62 (45.2%) outpatient studies. For this measure, we found a median MMR of 3.7 (IQR 2.6-5.0) in 4 studies reporting antibiotic use in ICUs in DDDs/1000 patient-days and a median MMR of 2.3 (IQR 1.5-3.2) in 18 studies reporting outpatient antibiotic use in DDDs/1000 inhabitant-days. Substantial variation was also identified in other measures. Conclusions Our review confirms the large variation in antibiotic use even across similar settings and providers. Data from low- and middle-income countries are under-represented. Further studies should try to better elucidate reasons for the observed variation to facilitate interventions that reduce unwarranted practice variation. In addition, the heterogeneity of reported measures clearly shows that there is need for standardization.
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Affiliation(s)
- Veronica Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Céline Pulcini
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
- Université de Lorraine, APEMAC, F-54000 Nancy, France
| | | | | | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
- University of Rijeka, Medical Faculty, Rijeka, Croatia
| | - Mirjana Stanić Benić
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
| | | | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benedikt Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Adam EA, Collier SA, Fullerton KE, Gargano JW, Beach MJ. Prevalence and direct costs of emergency department visits and hospitalizations for selected diseases that can be transmitted by water, United States. JOURNAL OF WATER AND HEALTH 2017; 15:673-683. [PMID: 29040071 DOI: 10.2166/wh.2017.083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
National emergency department (ED) visit prevalence and costs for selected diseases that can be transmitted by water were estimated using large healthcare databases (acute otitis externa, campylobacteriosis, cryptosporidiosis, Escherichia coli infection, free-living ameba infection, giardiasis, hepatitis A virus (HAV) infection, Legionnaires' disease, nontuberculous mycobacterial (NTM) infection, Pseudomonas-related pneumonia or septicemia, salmonellosis, shigellosis, and vibriosis or cholera). An estimated 477,000 annual ED visits (95% CI: 459,000-494,000) were documented, with 21% (n = 101,000, 95% CI: 97,000-105,000) resulting in immediate hospital admission. The remaining 376,000 annual treat-and-release ED visits (95% CI: 361,000-390,000) resulted in $194 million in annual direct costs. Most treat-and-release ED visits (97%) and costs ($178 million/year) were associated with acute otitis externa. HAV ($5.5 million), NTM ($2.3 million), and salmonellosis ($2.2 million) were associated with next highest total costs. Cryptosporidiosis ($2,035), campylobacteriosis ($1,783), and NTM ($1,709) had the highest mean costs per treat-and-release ED visit. Overall, the annual hospitalization and treat-and-release ED visit costs associated with the selected diseases totaled $3.8 billion. As most of these diseases are not solely transmitted by water, an attribution process is needed as a next step to determine the proportion of these visits and costs attributable to waterborne transmission.
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Affiliation(s)
- E A Adam
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - S A Collier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - K E Fullerton
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - J W Gargano
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
| | - M J Beach
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, USA E-mail:
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Kozin ED, Sethi RKV, Remenschneider AK, Kaplan AB, Del Portal DA, Gray ST, Shrime MG, Lee DJ. Epidemiology of otologic diagnoses in United States emergency departments. Laryngoscope 2015; 125:1926-33. [PMID: 25702897 DOI: 10.1002/lary.25197] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/31/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES/HYPOTHESIS Otologic complaints may place a significant burden on emergency departments (EDs) in the United States; however, few studies have comprehensively examined this discrete patient population. We aimed to identify utilization of EDs by patients with primary otologic complaints. STUDY DESIGN Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011. METHODS The NEDS database was queried for patient encounters with a primary otologic diagnosis based on International Classification of Diseases, Ninth Revision codes (380-389). Weighted estimates for demographics, diagnostic characteristics, socioeconomic status, and trends over time were extracted. Predictors of mortality and admission were determined by multivariable logistic regression. RESULTS A weighted total of 8,611,282 visits between 2009 and 2011 were attributed to otologic diagnoses, representing 2.21% of all ED visits. Stratified by patient age, otologic diagnoses encompassed 1.01% and 6.79% of all adult and pediatric ED visits, respectively. The majority of patients were treated and released (98.17%). The average age of patients presenting with an otologic complaint was 17.9 years (standard error = 0.23). Overall, 62.7% of patients who presented with an otologic complaint were 0 to 17 years old. The most common diagnoses among all age groups included otitis media not otherwise specified (NOS) (60.6%), infected otitis externa NOS (11.8%), and otalgia NOS (6.8%). CONCLUSIONS We provide a comprehensive overview of otologic complaints that are an overlooked diagnostic category in public health research. NEDS data demonstrate a significant number of visits related to otologic complaints, especially in the pediatric population, that are nonemergent. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Elliott D Kozin
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Rosh K V Sethi
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Aaron K Remenschneider
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | | | - Daniel A Del Portal
- Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Stacey T Gray
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
| | - Mark G Shrime
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Harvard Interfaculty Initiative in Health Policy, Cambridge, Massachusetts, U.S.A
| | - Daniel J Lee
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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Wade TJ, Sams EA, Beach MJ, Collier SA, Dufour AP. The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study. Environ Health 2013; 12:67. [PMID: 23962340 PMCID: PMC3765573 DOI: 10.1186/1476-069x-12-67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/19/2013] [Indexed: 05/26/2023]
Abstract
BACKGROUND Earaches and outer ear infections are commonly associated with swimming. In this study, we estimated the excess risk and health burden of earaches due to swimming in natural fresh and marine waters using results from a survey of over 50,000 beachgoers at nine beaches across the United States. METHODS Prospective cohort studies were conducted at four freshwater and five marine sites in the United States and Puerto Rico. Beach visitors were enrolled on summer weekends and holidays. Ten to twelve days after the beach visit, respondents answered questions about health symptoms, including earaches or ear infections experienced since the beach visit. Economic and physical burdens were also obtained. Fixed slope, random intercept (beach site) multivariate logistic regression models were used to estimate the relationship between head immersion swimming exposure and earaches. Model results were used to calculate excess risk for earaches attributable to swimming. RESULTS The overall incidence of self-reported earache was 1.6% in the 10-12 days after the beach visit. Earaches were more frequent in head immersion swimmers compared to non-swimmers for all beach sites and age groups. Earaches were unassociated with water sample measures of fecal contamination and turbidity. After adjustment for covariates, we calculated 7.12 excess earaches among head immersion swimmers per 1,000 swimming events. Twenty-four percent of those with earache reported missing their regular activities; 28% visited a doctor; 4% visited the emergency room; and 31% and 40% used prescription and non-prescription medications, respectively. CONCLUSIONS There are at least 128 million swimming events in natural waters annually. Such frequent exposures could result in 900,000 excess earaches, 260,000 visits to the doctor, 39,900 visits to the emergency room, nearly $4 million dollars in out-of-pocket expenditures on prescription and over-the-counter medications, and close to 75,000 hours of clinician time. More accurate estimates of swimming exposure are needed to improve population burden and associated cost estimates.
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Affiliation(s)
- Timothy J Wade
- Office of Research and Development, United States Environmental Protection Agency, Chapel Hill, NC, USA
| | - Elizabeth A Sams
- Office of Research and Development, United States Environmental Protection Agency, Chapel Hill, NC, USA
| | - Michael J Beach
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah A Collier
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alfred P Dufour
- Office of Research and Development, United States Environmental Protection Agency, Cincinnati, OH, USA
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