title: Use of symptoms and risk factors to predict acute otitis media in infants.
abstract: OBJECTIVE
  Infants and children with upper respiratory tract infection (URI) often have concurrent acute otitis media (AOM). Young infants have fewer specific symptoms than older children. The purpose of this study was to evaluate the usefulness of symptoms and other risk factors in predicting the presence of AOM in infants.
  
  
  METHODS
  Healthy infants, age less than four weeks, were enrolled and followed prospectively for up to age one year. Infants were scheduled for a research visit when their parents noted the onset of symptoms. At each URI visit, parents first reported the severity of symptoms. An investigator then diagnosed the presence or absence of concurrent AOM. Risk factors and symptom scores for infants with and without AOM were studied.
  
  
  RESULTS
  Infants (N=193, mean age at first URI 3.9±2.5 months) experienced 360 URI episodes and 63 AOM events. Symptoms consisting of fever, earache, poor feeding, restless sleep, and irritability together (ETG-5) were statistically associated with the prediction of AOM (P=0.006). A multiple variable statistical model (J-Score) that included day care attendance, age, severity of cough and earache best predicted AOM (P<0.001), with 95% specificity. Both ETG-5 and J-score yielded relatively low sensitivity for AOM prediction.
  
  
  CONCLUSIONS
  In infants with URI in the first year of life, severity of symptoms was significantly associated with concurrent AOM. Daycare attendance, presence and severity of earache and cough added to better correlation. These observations may have clinical application in identification of infants at risk for AOM.
authors.affiliation: Department of Pediatrics, University of Texas Medical Branch at Galveston, TX, USA. Electronic address: dpmccorm@utmb.edu.
authors.forename: David P
authors.initials: DP
authors.lastname: McCormick
authors.affiliation: Department of Preventive Medicine and Community Health, University of Texas Medical Branch at Galveston, TX, USA. Electronic address: krjennin@utmb.edu.
authors.forename: Kristofer
authors.initials: K
authors.lastname: Jennings
authors.affiliation: Department of Pediatrics, University of Texas Medical Branch at Galveston, TX, USA. Electronic address: lcede@utmb.edu.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Ede
authors.affiliation: Department of Pediatrics, University of Texas Medical Branch at Galveston, TX, USA. Electronic address: pedroenrique1971@gmail.com.
authors.forename: Pedro
authors.initials: P
authors.lastname: Alvarez-Fernandez
authors.affiliation: Department of Pediatrics, University of Texas Medical Branch at Galveston, TX, USA. Electronic address: jpatel@utmb.edu.
authors.forename: Janak
authors.initials: J
authors.lastname: Patel
authors.affiliation: Department of Pediatrics, University of Texas Medical Branch at Galveston, TX, USA; Department of Pathology, University of Texas Medical Branch at Galveston, TX, USA. Electronic address: tchonmai@utmb.edu.
authors.forename: Tasnee
authors.initials: T
authors.lastname: Chonmaitree
mesh_terms: D000208:Acute Disease; D004433:Earache / Q000175:diagnosis; D001068:Feeding and Eating Disorders / Q000175:diagnosis; D005260:Female; D005334:Fever / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010033:Otitis Media / Q000175:diagnosis* / Q000382:microbiology; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000382:microbiology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000175:diagnosis
keywords: Acute otitis media; Child; Diagnosis; Infant; Respiratory infection; Symptoms
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