Overuse of tympanostomy tubes in New York metropolitan area: evidence from five hospital cohort.
Overuse of tympanostomy tubes in New York metropolitan area: evidence from five hospital cohort.
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DOI：
10.1136/bmj.a1607
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发表时间：
2008-10-03
影响因子：
105.7
通讯作者：
Chassin, Mark
中科院分区：
文献类型：
--
作者：
Keyhani, Salomeh;Kleinman, Lawrence C.;Rothschild, Michael;Bernstein, Joseph M.;Anderson, Rebecca;Chassin, Mark
目的 将 2002 年中耳炎儿童鼓膜置管术与两套专家指南的建议进行比较。设计回顾性队列研究。制定与五家不同医院相关的纽约都会区实践。参与者 1046 名儿童中的 682 名在五家医院接受了鼓膜造口管，可以获取医院、初级保健医生和耳鼻喉科医生的图表。结果 平均年龄为 3.8 岁。平均而言，患有急性中耳炎的儿童在手术前一年内感染次数少于四次。患有渗出性中耳炎的儿童在手术时连续渗出少于30天。与建议的一致性非常低：30.3% (n=207) 的所有鼓膜切开术符合本研究制定的明确标准，7.5% (n=13) 符合美国儿科学会、美国家庭医学会和美国耳鼻喉头颈外科学会 1994 年指南。之前接受过鼓膜造口管手术、正在进行伴随手术或患有“危险状况”的儿童更有可能出现不一致。结论 根据明确的标准，在美国最大和人口最多的大都市地区，绝大多数鼓膜造口管插入都是不合适的，并且根据两个指南都不推荐。无论当前的做法是否代表了手术的严重过度使用，还是指南的限制过于严格，指南与实践之间持续存在的差异对于儿童或有兴趣改善医疗保健的人们来说都不会有好处。
Objectives To compare tympanostomy tube insertion for children with otitis media in 2002 with the recommendations of two sets of expert guidelines. Design Retrospective cohort study. Setting New York metropolitan area practices associated with five diverse hospitals. Participants 682 of 1046 children who received tympanostomy tubes in the five hospitals for whom charts from the hospital, primary care physician, and otolaryngologist could be accessed. Results The mean age was 3.8 years. On average, children with acute otitis media had fewer than four infections in the year before surgery. Children with otitis media with effusion had less than 30 consecutive days of effusion at the time of surgery. Concordance with recommendations was very low: 30.3% (n=207) of all tympanostomies were concordant with the explicit criteria developed for this study and 7.5% (n=13) with the 1994 guideline from the American Academy of Pediatrics, American Academy of Family Medicine, and American Academy of Otolaryngology—Head and Neck Surgery. Children who had previously had tympanostomy tube surgery, who were having a concomitant procedure, or who had “at risk conditions” were more likely to be discordant. Conclusions A significant majority of tympanostomy tube insertions in the largest and most populous metropolitan area in the United States were inappropriate according to the explicit criteria and not recommended according to both guidelines. Regardless of whether current practice represents a substantial overuse of surgery or the guidelines are overly restrictive, the persistent discrepancy between guidelines and practice cannot be good for children or for people interested in improving their health care.
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影响因子：
2.1
作者：
MAW, AR;BAWDEN, R
通讯作者：
BAWDEN, R
影响因子：
158.5
作者：
Paradise, Jack L.;Feldman, Heidi M.;Pelham, William E., Jr.
通讯作者：
Pelham, William E., Jr.
影响因子：
--
作者：
Rosenfeld, RM;Bhaya, MH;Smith, RJH
通讯作者：
Smith, RJH
影响因子：
120.7
作者：
KLEINMAN, LC;KOSECOFF, J;BROOK, RH
通讯作者：
BROOK, RH
影响因子：
17.3
作者：
BLACK, N
通讯作者：
BLACK, N