Our study describes how often pediatric emergency department practitioners evaluate for bacteremia or urinary tract infection (UTI) in patients between the ages of 2-36 months diagnosed with acute otitis media (AOM). A large-scale descriptive study of practice patterns had not been previously published. What was known prior to the study was that AOM is common, and these patients are often febrile. It is also common to investigate for bacteremia or UTI in young children with fever.

The background of this study came from an emergency department clinical encounter in which an emergency medicine resident presented a case of a 5 month old with an acute otitis media (AOM) and fever to 39.6 Celsius. The question became, "in a young febrile patient with AOM, who you were planning on treating as an outpatient, is it common to evaluate for concurrent bacteremia or UTI?"

We utilized the 2001-2004 National Hospital Ambulatory Medical Care Survey (NHAMCS)-Emergency Department dataset of emergency department visits in the US. We reviewed the records of patients diagnosed with AOM who were discharged from the emergency department to home.

The main findings were that nearly one-fifth of all 2-36 month old patients presenting to emergency departments were diagnosed with AOM. Investigating for bacteremia or UTI was not common in this study population, even in febrile infants. It is important to note that what can't be concluded is whether or not laboratory tests should be done; this study merely describes if clinicians evaluate for these occult infections.

The study was limited by the fact that at the time of publication these data were obtained from 6-9 years prior. It is conceivable that more recent data may have showed different results. However, these years were utilized because the data was obtained similarly during these four years, and all essential data fields were available for analyses. We also were interested in reviewing data after the introduction of the pneumococcal conjugate vaccine in 2000. The other important limitation is that we are unaware of the culture results, these data only note if these tests were obtained.

The question that is still left unknown is how many young children who are diagnosed and treated for AOM also have an undiagnosed UTI or bacteremia? Also, if there are young patients with an undiagnosed UTI, what are the consequences of having this occult infection treated with antibiotics aimed at treating AOM?

Daniel Yawman, MD, MPH, FAAP as part of Beyond the Abstract on UroToday. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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