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PEDIATRICS Vol. 108 No. 2 August 2001, pp. 248-254

Evidence Assessment of Management of Acute Otitis Media: II. Research Gaps and Priorities for Future Research

Received Aug 22, 2000; accepted Nov 21, 2000.

Linda S. Chan*, Dagger , Glenn S. TakataDagger , §, Paul Shekelleparallel , #, Sally C. Morton#, , Wilbert MasonDagger , **, and S. Michael MarcyDagger Dagger

From the * Division of Biostatistics and Outcomes Assessment, Los Angeles County-University of Southern California Medical Center, Los Angeles, California; Dagger  Center for Pediatric Health Outcomes Research, Department of Pediatrics, University of Southern California, Los Angeles, California; § Division of General Pediatrics, Childrens Hospital Los Angeles, Los Angeles, California; parallel  Health Services Research and Development Service, Greater Los Angeles Veterans Affair Healthcare System, Los Angeles, California;  Statistics Group, RAND, Santa Monica, California; # Southern California Evidence-Based Practice Center, RAND, Santa Monica, California; ** Division of Infectious Diseases, Childrens Hospital Los Angeles, Los Angeles, California; and Dagger Dagger  Department of Pediatrics, Southern California Kaiser-Permanente Health Care Program, Panorama City, California.

Objectives.  To report research gaps and priorities of future research identified during an evidence assessment process on the management of acute otitis media (AOM).

Methods.  A conceptual framework for management of AOM was developed to guide the evidence assessment. An 11-member technical expert panel guided the selection of key questions, prioritization of influencing factors, development of scope, definition of AOM, and search strategy through polling processes and conference calls. Quality of clinical trials was evaluated using established scales. Outcome measures were abstracted from each study.

Results.  A total of 3461 titles and abstracts were screened, and 760 full-length articles were reviewed. Of the 760 articles, 80 studies addressed the key questions. In defining AOM, 42 (52.5%) of the 80 studies included the middle-ear effusion component, only 2 (2.5%) included the rapid onset component, and 26 (32.5%) included the signs/symptoms of inflammation component. None of the 80 studies used all 3 components. Of the 74 controlled trials, 39 (53%) were of acceptable quality (Jadad score of 3 or higher). The technical experts did not agree in the ranking of the importance of the 41 influencing factors (Kendall's coefficient of concordance was 0.0022). Another poll also indicated diverse opinions of the experts on the importance of 7 key questions derived from the conceptual framework (Kendall coefficient of concordance is 0.21). Furthermore, our review found that the type and definition of outcome measure varied.

Conclusions.  Despite the large body of literature on AOM, its quality is uneven and its findings are not generalizable. Future research should try to answer all key questions and investigate all risk factors in well-designed, scientific studies.  Key words:  otitis media, children, future research.




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