title: Management of Pediatric Acute Mastoiditis in Israel: Nationwide Survey Among Otorhinolaryngologists and Emergency Pediatricians.
abstract: BACKGROUND
  Acute mastoiditis (AM) is a medical emergency that mandates prompt diagnosis and treatment. Nevertheless, its management often differs between otorhinolaryngologists (ORLs) and pediatricians (PEDs) working in emergency departments. We sought to characterize the similarities and differences between management protocols of these 2 disciplines.
  
  
  METHODS
  A voluntary electronic questionnaire, including 17 items pertaining to pediatric AM management, was sent to all the 20 otorhinolaryngology and their corresponding pediatric emergency departments nationwide. Each department sent 1 filled out questionnaire. The response rate was 100%.
  
  
  RESULTS
  Eighteen (90%) ORLs are notified when a child with suspected AM arrives. Medical history collected by both disciplines was similar-previous otologic history (100%), previous antibiotic use (100%), and pneumococcal conjugate vaccination status (60%)-whereas acute otitis media risk factors were more important to PEDs (13 [65%] PEDs, 10 [50%] ORLs). According to 85% to 90% of ORLs and PEDs, imaging was not mandatory upon admission. According to 14 (70%) PEDs and 16 (80%) ORLs, imaging was overall performed in less than 50% of patients during hospitalization. Intravenous ceftriaxone and cefuroxime were the most common first-line antibiotic treatments (8 [40%] ORLs, 10 [50%] PEDs), with a mean treatment duration of 7 to 10 days. Eighteen (90%) of the ORLs, compared with 15 (75%) PEDs, reported that myringotomy (with or without ventilating tube insertion) was performed upon diagnosis (P = 0.05).
  
  
  CONCLUSIONS
  The management of pediatric AM is generally similar by both disciplines. The use of imaging studies is mild-moderate. We call for a national registry and encourage the publication of guidelines.
authors.affiliation: From the Sackler Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Tel Aviv University, Holon.
authors.forename: Sharon Ovnat
authors.initials: SO
authors.lastname: Tamir
authors.affiliation: Sackler Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University, Zerifin.
authors.forename: Tal
authors.initials: T
authors.lastname: Marom
authors.affiliation: Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem.
authors.forename: David
authors.initials: D
authors.lastname: Rekhtman
authors.affiliation: Technion-Bruce Rappaport Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery, Bnai Zion Medical Center, Haifa, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Luntz
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000379:methods / Q000706:statistics & numerical data; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008417:Mastoiditis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D008876:Middle Ear Ventilation / Q000379:methods / Q000706:statistics & numerical data; D000072220:Otolaryngologists / Q000706:statistics & numerical data*; D000072143:Pediatricians / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents