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儿科急诊护理中中耳炎治疗指数在不同地点和社会人口学群体中的差异

Variation in Otitis Media Treatment Index by Location and Sociodemographic Groups in Pediatric Urgent Cares.

临床研究耳科IF 2.5Q1

文献信息

PMID42755025
原文在 PubMed 查看原文 ↗
发表日期2026
作者Amanda C Nedved
查看其他 11 位作者

Louis Vernacchio；Brian R Lee；Luis E Sainz；Jonathan Hatoun；Laura B Patane；Matthew P Kronman；Adam L Hersh；Victoria Parente；Rana F Hamdy；Rana E El Feghaly；On Behalf Of The Reducing Differences In Urgent Care Encounters For Antibiotic Choice ReDUCE Antibiotic Choice Quality Improvement Collaborative

作者单位Department of Pediatrics, Children's Mercy, Kansas City, MO, USA.
查看其他 10 条单位信息

Department of Pediatrics, University of Missouri Kansas City, Kansas City, MO, USA.；Pediatric Physicians' Organization at Children's, Wellesley Hills, MA, USA.；Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.；Department of Pediatrics, Harvard Medical School, Boston, MA, USA.；Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.；Seattle Children's Hospital, Seattle, WA, USA.；Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.；Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.；Department of Pediatrics, Children's National Hospital, Washington, DC, USA.；Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

期刊Journal of the Pediatric Infectious Diseases Society
SCI 分区Q1
IF2.5
研究类型临床研究 · 临床
所属专科耳科

中文摘要

背景： 抗生素使用往往由过度诊断驱动。中耳炎是儿科中开具抗生素最常见的诊断。中耳炎治疗指数（OMTI）衡量的是急性呼吸道感染（ARI）中诊断为中耳炎（OM）并开具抗生素处方的比例。我们探讨了来自全国儿科急诊护理（PUC）质量改进（QI）协作组在不同地点和患者特征方面的OMTI差异。
方法： 这项二次分析纳入了来自6个医疗组织的24个PUC中心，代表美国全部4个地区。我们分析了2022年4月至2024年10月期间年龄为6-59个月、诊断为ARI的患者的就诊记录。我们计算了OMTI，其定义为诊断为OM并开具抗生素处方的ARI就诊次数除以协作组及每个PUC中心的所有ARI就诊次数。我们考察了年龄、种族和支付方类型方面的变异性。
结果： 在456,748次ARI就诊中，总体OMTI指数为35.8%（n=163,686），各中心范围为9%至50%。西部地区的OMTI最低（28.4%），而东北部和中西部的OMTI最高（40.1%和40.8%）。拥有商业保险的患者OMTI（37.5%）高于其他支付方类型。白人患者的OMTI最高（38.7%），高于其他种族。OMTI在6个月龄后稳步上升，在13个月龄时达到峰值40.9%，随后稳步下降至59个月龄时的33.5%。
结论： OMTI在PUC地点和患者亚组之间存在显著差异，提示PUC中OM诊断和抗生素处方实践不一致。使用OMTI作为基准可以识别面临OM过度诊断和抗生素过度使用风险的人群，并可能有助于发现诊断管理干预和PUC中更适当抗生素处方的机会。

英文摘要

BACKGROUND: Antibiotic use is often driven by overdiagnosis. Otitis media is the most common diagnosis for which antibiotics are prescribed in pediatrics. Otitis Media Treatment Index (OMTI) measures the proportion of acute respiratory infections (ARIs) that have a diagnosis of otitis media (OM) and an antibiotic prescription. We explored variation in OMTI from our national pediatric urgent care (PUC) quality improvement (QI) collaborative across sites and by patient characteristics.
METHODS: This secondary analysis included 24 PUC centers from 6 healthcare organizations representing all 4 regions of the United States. We analyzed encounters of patients aged 6-59 months with diagnoses of ARIs from April 2022 to October 2024. We calculated OMTI defined as the number of ARI encounters with OM diagnosis and antibiotic prescribed divided by all ARI encounters for the collaborative and each PUC center. We examined variability across age, race, and payor type.
RESULTS: Among 456,748 ARI encounters, the overall OMTI index was 35.8% (n=163,686), with ranges from 9 to 50% across centers. The West region had the lowest OMTI (28.4%) while the Northeast and Midwest had the highest OMTIs (40.1% and 40.8%). Patient with commercial insurance had a higher OMTI (37.5%) than other payor types. White patients had the highest OMTI (38.7%) compared to other races. OMTI steadily increased between 6 months of age, peaking at 40.9% at 13 months, and then steadily decreased to 33.5% at 59 months.
CONCLUSIONS: OMTI varied substantially by PUC site and patient subgroups suggesting inconsistent OM diagnosis and antibiotic prescribing practices in PUCs. Using OMTI as a benchmark could identify populations at risk of OM overdiagnosis and antibiotic overuse and may help identify opportunities for diagnostic stewardship interventions and more appropriate antibiotic prescribing in PUC.