Community Pediatric Acceptability Study Open Access

Wilcox, Katherine (2015)

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Ear infections cause increased health expenditures and antimicrobial prescriptions in children. Optimal diagnosis requires visualization of the eardrum. Interpretation of an otoscopic examination is limited by an individual's assessment that cannot be seen by anyone other than the person holding the otoscope. Physicians often advise parents to wait and watch for symptoms to abate before giving antibiotics, known as watchful waiting. An attachment employing the technology and light source of a smartphone to capture images of the ear canal and eardrum allows for documentation and sharing of images. We conducted an observational crossover study of patients aged 0.5 to 18 years with symptoms suggestive of an otic source, including discomfort, fever, rhinorrhea, cough, or otalgia. Six participating physicians were randomized to use the smartphone or conventional otoscope for the first study month, and changed to the opposite device for the next month, alternating between devices for 4 months. Parents of children examined with the smartphone otoscope were shown images taken during the exam. All participating parents completed a baseline assessment within one day of the initial examination, an interim visit questionnaire for any follow-up visits during that month, and a follow up assessment 30 days later. Of 337 eligible patients, 75 (22%) were enrolled, 7 (2%) completed interim questionnaires, and 62 (18%), completed both baseline and follow up questionnaires. Thirty (48%) were prescribed an antibiotic at baseline assessment. Odds of receiving a prescription were lower with the smartphone otoscope compared to the conventional otoscope (OR = 0.24, P = 0.05). There was no significant difference in the total number of parents who waited > 24 hours to fill their child's antibiotic prescription or in the completion rates of antimicrobial course by otoscope device. Thirty-four (94%) of 36 parents of children examined with the smartphone reported that images of their child's ear helped them to understand management of their child's ear infection. Results of our single center study suggest that a smartphone otoscope is acceptable to parents and shared visualization by parents and clinicians of the otic examination may improve the ability to optimally manage otitis media.

Table of Contents

Background 1

Methods 5

Results 9

Discussion 13

References 15

Tables 17

Figures and Figure Legends 19

Appendices 24

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