Development of a practical tool for assessing the severity of acute otitis media.
BACKGROUND
Watchful waiting management of nonsevere acute otitis media (AOM) can reduce the use of antibiotics, but it requires a reliable means of assessing clinical severity.


OBJECTIVE
We present the development of a pocket AOM card with which the clinician can rapidly assess total AOM severity.


METHODS
The components of the pocket card consisted of a faces scale, to assess parent perception of severity, and a standard set of tympanic membrane photographs, with which the pediatrician can grade the severity of tympanic membrane inflammation. The components of the pocket card were tested for validity, reliability and responsiveness with the use of data from parents, pediatricians and pediatric otolaryngologists.


METHODS
Instruments were assessed for concurrent correlation, sequence validity and reliability against previously published questionnaires with the use of Spearman correlation. Responsiveness was calculated with the use of enrollment, day 12 and day 30 data from a randomized clinical trial.


RESULTS
The components of the pocket AOM card demonstrated excellent sequence validity, concurrent correlation and reliability (r = 0.58-0.99). Total AOM card severity, consisting of the sum of the 2 scales, demonstrated better responsiveness to change than any of the scales taken individually.


CONCLUSIONS
The AOM card combines a parent assessment of symptoms and the clinician assessment of the tympanic membrane to provide an assessment of total AOM severity that can be used to facilitate shared decision making between parent and clinician. The combined score of the AOM card was more responsive to change than any of the instruments used alone. The AOM card provides a useful tool for teaching and research.
Friedman
Norman R
NR
Departments of Pediatrics, University of Colorado, Denver, CO, USA.
McCormick
David P
DP
Pittman
Carmen
C
Chonmaitree
Tasnee
T
Teichgraeber
Davis C
DC
Uchida
Tatsuo
T
Baldwin
Constance D
CD
Saeed
Kokab A
KA
D000208:Acute Disease; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003939:Diagnostic Techniques, Otological / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D010290:Parents / Q000523:psychology; D012720:Severity of Illness Index; D014432:Tympanic Membrane / Q000503:physiopathology