title: Burden of acute otitis media in primary care pediatrics in Italy: a secondary data analysis from the Pedianet database.
abstract: BACKGROUND
  The incidence of acute otitis media (AOM) vary from country to country. Geographical variations together with differences in study designs, reporting and settings play a role. We assessed the incidence of AOM in Italian children seen by primary care paediatricians (PCPs), and described the methods used to diagnose the disease.
  
  
  METHODS
  This secondary data analysis from the Pedianet database considered children aged 0-6 years between 01/2003 and 12/2007. The AOM episodes were identified and validated by means of patient diaries. Incidence rates/100 person-years (PY) were calculated for total AOM and for single or recurrent AOM.
  
  
  RESULTS
  The 92,373 children (52.1% males) were followed up for a total of 227,361 PY: 23,039 (24.9%) presented 38,241 episodes of AOM (94.6% single episodes and 5.4% recurrent episodes). The total incidence rate of AOM in the 5-year period was 16.8 episodes per 100 PY (95% CI: 16.7-16.9), including single AOM (15.9 episodes per 100 PY; 95% CI: 15.7-16.1) and recurrent AOM (0.9 episodes per 100 PY; 95% CI: 0.9-0.9). There was a slight and continuously negative trend decrease over time (annual percent change -4.6%; 95%CI: -5.3, -3.9%). The AOM incidence rate varied with age, peaking in children aged 3 to 4 years (22.2 episodes per 100 PY; 95% CI 21.8-22.7). The vast majority of the AOM episodes (36,842/38,241, 96.3%) were diagnosed using a static otoscope; a pneumatic otoscope was used in only 3.7%.
  
  
  CONCLUSIONS
  Our data fill a gap in our knowledge of the incidence of AOM in Italy, and indicate that AOM represents a considerable burden for the Italian PCP system. Educational programmes concerning the diagnosis of AOM are needed, as are further studies to monitor the incidence in relation to the introduction of wider pneumococcal conjugate vaccines.
authors.affiliation: Department of Pathophysiology and Transplantation, University of Milan, and Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy. paola.marchisio@unimi.it
authors.forename: Paola
authors.initials: P
authors.lastname: Marchisio
authors.forename: Luigi
authors.initials: L
authors.lastname: Cantarutti
authors.forename: Miriam
authors.initials: M
authors.lastname: Sturkenboom
authors.forename: Silvia
authors.initials: S
authors.lastname: Girotto
authors.forename: Gino
authors.initials: G
authors.lastname: Picelli
authors.forename: Daniele
authors.initials: D
authors.lastname: Dona
authors.forename: Antonio
authors.initials: A
authors.lastname: Scamarcia
authors.forename: Marco
authors.initials: M
authors.lastname: Villa
authors.forename: Carlo
authors.initials: C
authors.lastname: Giaquinto
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D015233:Models, Statistical; D010033:Otitis Media / Q000175:diagnosis / Q000453:epidemiology*; D038781:Otoscopy; D016012:Poisson Distribution; D011320:Primary Health Care; D012008:Recurrence; D012189:Retrospective Studies