title: Evaluating children with otitis media for bacteremia or urinary tract infection.
abstract: Background. It is unclear if clinicians evaluate for concurrent bacteremia or UTI in young patients diagnosed with acute otitis media (AOM). Objectives. To describe how often, and under which circumstances, emergency providers investigate for bacteremia or UTI in 2-36 month olds with AOM. Methods. Cases of AOM were analyzed from the 2001-2004 National Hospital Ambulatory Medical Care Survey (NHAMCS)-Emergency Department dataset. Results. AOM was diagnosed in 17% of the 10,847 recorded visits of 2-36 month olds. Of these visits, laboratory testing included: CBC: 7%, Blood culture: 4%, urinalysis or urine culture: 5%, and any of these tests: 9%. Rates of testing for 2-6 month olds with temperature ≥ 38.0 (CBC: 13%, blood culture: 9%, urinalysis or urine culture: 7%, any of the tests: 14%) were not significantly different from testing of patients aged 6-12 months, or 12-36 months (all P > .1). Patients with temperature of ≥39.0 were more likely to have all tests, with the exception of urine investigation, than patients with temperature between 38.0 and 38.9. Conclusions. 17% of 2-36 month old patients seen in the emergency department are diagnosed with AOM. Investigating for bacteremia or UTI in these patients is not routine, even in febrile infants.
authors.affiliation: Department of Pediatrics and Emergency Medicine, University of Rochester Medical Center and Rochester General Hospital, Box 238 1425 Portland Avenue, Rochester, NY 14621, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Yawman
authors.forename: Patrick
authors.initials: P
authors.lastname: Mahar
authors.forename: Aaron
authors.initials: A
authors.lastname: Blumkin
authors.forename: Gregory
authors.initials: G
authors.lastname: Conners
references.citation: Pediatr Infect Dis J. 2007 Sep;26(9):771-7
references.pmid: 17721369
references.citation: Pediatrics. 1998 Aug;102(2):e16
references.pmid: 9685461
references.citation: Clin Infect Dis. 2006 Apr 1;42(7):907-14
references.pmid: 16511752
references.citation: Clin Infect Dis. 2007 Jun 15;44(12):1569-76
references.pmid: 17516400
references.citation: Pediatrics. 2006 May;117(5):1695-701
references.pmid: 16651326
references.citation: Acad Emerg Med. 2007 Dec;14(12):1172-5
references.pmid: 18045893
references.citation: Ann Emerg Med. 1998 Jun;31(6):679-87
references.pmid: 9624306
references.citation: Eur J Clin Microbiol Infect Dis. 2003 Sep;22(9):519-24
references.pmid: 12938004
references.citation: Pediatrics. 2000 Nov;106(5):977-82
references.pmid: 11061763
references.citation: N Engl J Med. 2003 May 1;348(18):1737-46
references.pmid: 12724479
references.citation: Pediatrics. 1991 May;87(5):670-4
references.pmid: 2020512
references.citation: Pediatr Infect Dis J. 2004 Jun;23(6):485-9
references.pmid: 15194827
references.citation: Pediatr Infect Dis J. 2005 Apr;24(4):320-3
references.pmid: 15818291
references.citation: Pediatrics. 2008 Feb;121(2):253-60
references.pmid: 18245415
references.citation: Infect Dis Clin North Am. 2005 Sep;19(3):629-45
references.pmid: 16102653
references.citation: Pediatrics. 1991 Jan;87(1):48-53
references.pmid: 1984618
references.citation: Pediatr Infect Dis J. 2003 Jan;22(1):10-6
references.pmid: 12544402
references.citation: Arch Pediatr Adolesc Med. 2004 Jul;158(7):671-5
references.pmid: 15237067
references.citation: Int J Pediatr Otorhinolaryngol. 2005 Mar;69(3):361-6
references.pmid: 15733595
references.citation: N Engl J Med. 2001 Feb 8;344(6):403-9
references.pmid: 11172176
references.citation: Pediatrics. 2004 May;113(5):1451-65
references.pmid: 15121972