SGEM#278: Seen Your Video for Acute Otitis Media Discharge Instructions?

Date: December 13th, 2019 Reference: Belisle et al. Video discharge instructions for acute otitis media in children: a randomized controlled open-label trial. AEM December 2019 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. Case: An 18-month-old, previously healthy female presents to the emergency department with 24 hours of fever. The past few days the parents note there has been some rhinorrhea and cough. She looks well, immunizations are up to date and her examination reveals right sided acute otitis media (AOM). When discussing discharge instructions for her AOM, you wonder whether having the parents watch a video will be more beneficial for the child’s symptoms, rather than giving the parents oral instructions with a paper handout. Dr. Chris Bond Background: AOM is the second most commonly diagnosed illness in children and the most common indication for antibiotic prescription [1-2]. There are significant costs associated with AOM and parents often bring their children to health care providers for evaluation of pain and fever [3-4]. More than one third of children experience pain, fever or both three to seven days following treatment, and nearly seventy-five percent of parents identify pain and disturbed sleep as the most important sources of AOM related burden [5-6]. There is significant parental uncertainty regarding treatment of AOM and less than 30% of US parents receive instructions on appropriate analgesia for their children [7-8]. Discharge instruction complexity and inadequate comprehension is associated with medication errors, suboptimal post-discharge care and unnecessary recidivism [9-12]. Medication errors can be reduced using standardized discharge instructions, and parents prefer these to verbal summaries [13-15]. Video discharge instructions have been shown to be preferred over paper instructions in many pediatric presentations, however no study has explored the effectiveness of video instructions for AOM [16-17]. Clinical Question: Are video discharge instructions superior to a paper handout with respect to the Acute Otitis Media – Symptom Severity Score (AOM-SOS)? Reference: Belisle et al. Video discharge instructions for acute otitis media in children: a randomized controlled open-label trial. AEM December 2019 Population: Parents of children age 6 months to 17 years with a chief complaint of otalgia in the setting of URTI and where the treating physician was at least 50% certain of a clinical diagnosis if AOM. Diagnostic certainty was on a 100mm visual analog scale based on the physicians’ rate of color photos of AOM. Excluded: Parents who were not the primary care provider, had poor English proficiency, lacked internet or telephone access, and whose children had: a pre-existing diagnosis of AOM (<72 hours old); other concomitant diagnoses (pneumonia, urinary tract infection, gastroenteritis, sinusitis, or any other condition requiring antibiotics and/or hospital admission); tympanostomy tubes; acute tympanic membrane perforation. Intervention: Video discharge instructions Comparison: Paper-based discharge instructions identical to the video discharge instructions Outcome: Primary Outcome: AOM Severity of Symptom (AOM-SOS) score on day three post-discharge. Secondary Outcomes: Knowledge questionnaire scores, parental satisfaction with the intervention, number of days of missed school or daycare (child) and work (parent), proportion of children with at least one return visit to a healthcare provider, and proportion of children who received analgesia. Dr. Naveen Poonai This is an SGEMHOP episode which means we have the lead author on the show.  Dr. Naveen Poonai is a Paediatric Emergency Medicine physician at the Children’s Hospital, London Health Sciences Centre,