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Intranasal Steroid Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement.
Otolaryngol Head Neck Surg. 2017 08; 157(2):289-296.OH

Abstract

Objectives Our objectives were (1) to assess patterns of intranasal steroid administration when otitis media with effusion (OME) has been diagnosed in children, (2) to investigate whether usage varies according to visit setting, and (3) to determine if practice gaps are such that quality improvement could be tracked. Study Design Cross-sectional analysis of an administrative database. Subjects and Methods National Ambulatory and Hospital Ambulatory Medical Care Surveys, 2005 to 2012; univariate, multivariate, and stratified analyses of intranasal steroid usage were performed. The primary outcome was intranasal steroid administration, and the primary predictor was a diagnosis of OME. The impact of location of service was also analyzed. Results Data representing 1,943,177,903 visits demonstrated that intranasal steroids were administered in 10.0% of visits in which OME was diagnosed, in comparison to 3.5% of visits in which OME was not diagnosed (univariate odds ratio, 3.07; 95% confidence interval [CI], 1.85-5.08; P < .001). After adjusting for age, sex, race/ethnicity, and other confounding conditions, multivariate analysis demonstrated that OME remained associated with an increase in intranasal steroid usage (odds ratio, 3.58; 95% CI, 1.60-8.01; P = .002). This practice pattern was more prevalent in the ambulatory office setting (risk difference 6.6%, P < .001) and less seen in a hospital-based office or emergency department. Conclusion Despite randomized controlled trials showing a lack of efficacy for isolated OME, nasal steroids continue to be used in treating children with OME in the United States. Related quality improvement opportunities to prevent usage of an ineffective treatment exist.

Authors+Show Affiliations

1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.2 Department of Otolaryngology, Oregon Health and Science University, Portland, Oregon, USA.3 Department of Otolaryngology, Hospital Universitari de la Vall d'Hebron, Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.4 Department of Otolaryngology, SUNY Downstate Medical Center, New York, New York, USA.5 School of Medicine, Emory University, Atlanta, Georgia, USA.1 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28535109

Citation

Wang, David E., et al. "Intranasal Steroid Use for Otitis Media With Effusion: Ongoing Opportunities for Quality Improvement." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 157, no. 2, 2017, pp. 289-296.
Wang DE, Lam DJ, Bellmunt AM, et al. Intranasal Steroid Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement. Otolaryngol Head Neck Surg. 2017;157(2):289-296.
Wang, D. E., Lam, D. J., Bellmunt, A. M., Rosenfeld, R. M., Ikeda, A. K., & Shin, J. J. (2017). Intranasal Steroid Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 157(2), 289-296. https://doi.org/10.1177/0194599817703046
Wang DE, et al. Intranasal Steroid Use for Otitis Media With Effusion: Ongoing Opportunities for Quality Improvement. Otolaryngol Head Neck Surg. 2017;157(2):289-296. PubMed PMID: 28535109.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intranasal Steroid Use for Otitis Media with Effusion: Ongoing Opportunities for Quality Improvement. AU - Wang,David E, AU - Lam,Derek J, AU - Bellmunt,Angela M, AU - Rosenfeld,Richard M, AU - Ikeda,Allison K, AU - Shin,Jennifer J, Y1 - 2017/05/23/ PY - 2017/5/24/pubmed PY - 2017/9/12/medline PY - 2017/5/24/entrez KW - adenoid hypertrophy KW - allergic rhinitis KW - clinical practice guideline KW - database KW - intranasal steroid KW - otitis media with effusion KW - otolaryngology KW - practice patterns KW - quality improvement SP - 289 EP - 296 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 157 IS - 2 N2 - Objectives Our objectives were (1) to assess patterns of intranasal steroid administration when otitis media with effusion (OME) has been diagnosed in children, (2) to investigate whether usage varies according to visit setting, and (3) to determine if practice gaps are such that quality improvement could be tracked. Study Design Cross-sectional analysis of an administrative database. Subjects and Methods National Ambulatory and Hospital Ambulatory Medical Care Surveys, 2005 to 2012; univariate, multivariate, and stratified analyses of intranasal steroid usage were performed. The primary outcome was intranasal steroid administration, and the primary predictor was a diagnosis of OME. The impact of location of service was also analyzed. Results Data representing 1,943,177,903 visits demonstrated that intranasal steroids were administered in 10.0% of visits in which OME was diagnosed, in comparison to 3.5% of visits in which OME was not diagnosed (univariate odds ratio, 3.07; 95% confidence interval [CI], 1.85-5.08; P < .001). After adjusting for age, sex, race/ethnicity, and other confounding conditions, multivariate analysis demonstrated that OME remained associated with an increase in intranasal steroid usage (odds ratio, 3.58; 95% CI, 1.60-8.01; P = .002). This practice pattern was more prevalent in the ambulatory office setting (risk difference 6.6%, P < .001) and less seen in a hospital-based office or emergency department. Conclusion Despite randomized controlled trials showing a lack of efficacy for isolated OME, nasal steroids continue to be used in treating children with OME in the United States. Related quality improvement opportunities to prevent usage of an ineffective treatment exist. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/28535109/Intranasal_Steroid_Use_for_Otitis_Media_with_Effusion:_Ongoing_Opportunities_for_Quality_Improvement_ L2 - https://journals.sagepub.com/doi/10.1177/0194599817703046?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -