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Clinical characteristics of New York City children who received tympanostomy tubes in 2002.
Pediatrics 2008; 121(1):e24-33Ped

Abstract

OBJECTIVE

Tympanostomy tube insertion is the most common procedure that requires general anesthesia for children in the United States. We report on the clinical characteristics of a cohort of New York City children who received tympanostomy tubes in 2002.

METHODS

This retrospective cohort study included all 1046 children who received tubes in 2002 in any of 5 New York City area hospitals. We analyzed clinical data for all 682 (65%) children for whom we were able to abstract data for the preceding year from all of 3 sources: hospital, pediatrician, and otolaryngologist medical charts.

RESULTS

Mean age was 3.8 years, 57% were male, and 74% had private insurance. More than 25% of children had received tubes previously. The stated reason for surgery was otitis media with effusion for 60.4% of children, recurrent acute otitis media for 20.7%, and eustachian tube dysfunction for 10.6%. Children with recurrent acute otitis media averaged 3.1 +/- 0.2 episodes (median: 3.0) in the previous year; those with otitis media with effusion averaged effusions that were 29 +/- 1.7 days long (median: 16 days) at surgery. Twenty-five percent of children had bilateral effusions of >42 days' duration at surgery. Despite a clinical practice guideline for otitis media with effusion that recommends withholding tympanostomy tubes for otherwise healthy children until a bilateral effusion is at least 3 to 4 months old, 50% of children had surgery without having had 3 months of effusion cumulatively during the year before surgery.

CONCLUSIONS

The clinical characteristics of children who received tympanostomy tubes varied widely. Many children with otitis media with effusion had shorter durations of effusions than are generally recommended before surgery. The extent of variation in treating this familiar condition with limited treatment options suggests both the importance and the difficulty of managing common practice in accordance with clinical practice guidelines.

Authors+Show Affiliations

Department of Health Policy, Mount Sinai School of Medicine, One Gustave L. Levy Pl, Box 1077, New York, NY 10029, USA. salomeh.keyhani@mountsinai.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18166541

Citation

Keyhani, Salomeh, et al. "Clinical Characteristics of New York City Children Who Received Tympanostomy Tubes in 2002." Pediatrics, vol. 121, no. 1, 2008, pp. e24-33.
Keyhani S, Kleinman LC, Rothschild M, et al. Clinical characteristics of New York City children who received tympanostomy tubes in 2002. Pediatrics. 2008;121(1):e24-33.
Keyhani, S., Kleinman, L. C., Rothschild, M., Bernstein, J. M., Anderson, R., Simon, M., & Chassin, M. (2008). Clinical characteristics of New York City children who received tympanostomy tubes in 2002. Pediatrics, 121(1), pp. e24-33. doi:10.1542/peds.2007-0623.
Keyhani S, et al. Clinical Characteristics of New York City Children Who Received Tympanostomy Tubes in 2002. Pediatrics. 2008;121(1):e24-33. PubMed PMID: 18166541.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics of New York City children who received tympanostomy tubes in 2002. AU - Keyhani,Salomeh, AU - Kleinman,Lawrence C, AU - Rothschild,Michael, AU - Bernstein,Joseph M, AU - Anderson,Rebecca, AU - Simon,Melissa, AU - Chassin,Mark, PY - 2008/1/2/pubmed PY - 2008/2/6/medline PY - 2008/1/2/entrez SP - e24 EP - 33 JF - Pediatrics JO - Pediatrics VL - 121 IS - 1 N2 - OBJECTIVE: Tympanostomy tube insertion is the most common procedure that requires general anesthesia for children in the United States. We report on the clinical characteristics of a cohort of New York City children who received tympanostomy tubes in 2002. METHODS: This retrospective cohort study included all 1046 children who received tubes in 2002 in any of 5 New York City area hospitals. We analyzed clinical data for all 682 (65%) children for whom we were able to abstract data for the preceding year from all of 3 sources: hospital, pediatrician, and otolaryngologist medical charts. RESULTS: Mean age was 3.8 years, 57% were male, and 74% had private insurance. More than 25% of children had received tubes previously. The stated reason for surgery was otitis media with effusion for 60.4% of children, recurrent acute otitis media for 20.7%, and eustachian tube dysfunction for 10.6%. Children with recurrent acute otitis media averaged 3.1 +/- 0.2 episodes (median: 3.0) in the previous year; those with otitis media with effusion averaged effusions that were 29 +/- 1.7 days long (median: 16 days) at surgery. Twenty-five percent of children had bilateral effusions of >42 days' duration at surgery. Despite a clinical practice guideline for otitis media with effusion that recommends withholding tympanostomy tubes for otherwise healthy children until a bilateral effusion is at least 3 to 4 months old, 50% of children had surgery without having had 3 months of effusion cumulatively during the year before surgery. CONCLUSIONS: The clinical characteristics of children who received tympanostomy tubes varied widely. Many children with otitis media with effusion had shorter durations of effusions than are generally recommended before surgery. The extent of variation in treating this familiar condition with limited treatment options suggests both the importance and the difficulty of managing common practice in accordance with clinical practice guidelines. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/18166541/Clinical_characteristics_of_New_York_City_children_who_received_tympanostomy_tubes_in_2002_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=18166541 DB - PRIME DP - Unbound Medicine ER -