Predictors of pain and/or fever at 3 to 7 days for children with acute otitis media not treated initially with antibiotics: a meta-analysis of individual patient data.
OBJECTIVE
The goal was to determine the predictors of a prolonged course for children with acute otitis media.


METHODS
A meta-analysis of data with the observation groups of 6 randomized, controlled trials was performed. Participants were 824 children, 6 months to 12 years of age, with acute otitis media. The primary outcome was a prolonged course of acute otitis media, which was defined as fever and/or pain at 3 to 7 days.


RESULTS
Of the 824 included children, 303 had pain and/or fever at 3 to 7 days. Independent predictors of a prolonged course were age of < 2 years and bilateral acute otitis media. The absolute risk of pain and/or fever at 3 to 7 days for children < 2 years of age with bilateral acute otitis media (20% of all children) was 55%, and that for children > or = 2 years of age with unilateral acute otitis media (47% of all children) was 25%.


CONCLUSIONS
The risk of a prolonged course was 2 times higher for children < 2 years of age with bilateral acute otitis media than for children > or = 2 years of age with unilateral acute otitis media. Clinicians can use these features (ie, age of < 2 years and bilateral acute otitis media) to inform parents more explicitly about the expected course of their child's otitis media and to explain which features should prompt parents to contact their clinician for reexamination of the child.
Rovers
Maroeska M
MM
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, PO Box 85060, 3508 AB Utrecht, The Netherlands. m.rovers@umcutrecht.nl
Glasziou
Paul
P
Appelman
Cees L
CL
Burke
Peter
P
McCormick
David P
DP
Damoiseaux
Roger A
RA
Little
Paul
P
Le Saux
Nicole
N
Hoes
Arno W
AW
D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005334:Fever / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000150:complications* / Q000188:drug therapy; D010146:Pain / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors
D000900:Anti-Bacterial Agents