Background Thirty percent of children with acute otitis media (AOM) experience symptoms < 7 days after initiating treatment, highlighting the importance of comprehensive discharge instructions. Methods We randomized caregivers of children 6 months to 17 years presenting to the emergency department (ED) with AOM to discharge instructions using a video on management of pain and fever to a paper handout. The primary outcome was the AOM Severity of Symptom (AOM‐SOS) score at 72 hours postdischarge. Secondary outcomes included caregiver knowledge (10‐item survey), absenteeism, recidivism, and satisfaction (5‐item Likert scale). Results A total of 219 caregivers were randomized and 149 completed the 72‐hour follow‐up (72 paper and 77 video). The median (IQR) AOM‐SOS score for the video was significantly lower than paper, even after adjusting for preintervention AOM‐SOS score and medication at home (8 [7–11] vs. 10 [7–13], respectively; p = 0.004). There were no significant differences between video and paper in mean (±SD) knowledge score (9.2 [±1.3] vs. 8.8 [±1.8], respectively; p = 0.07), mean (±SD) number of children that returned to a health care provider (8/77 vs. 10/72, respectively; p = 0.49), mean (±SD) number of daycare/school days missed by child (1.2 [±1.5] vs. 1.1 [±2.1], respectively; p = 0.62), mean (±SD) number of workdays missed by caregiver (0.5 [±1] vs. 0.8 [±2], respectively; p = 0.05), or median (IQR) satisfaction score (5 [4–5] vs. 5 [4–5], respectively; p = 0.3). Conclusions Video discharge instructions in the ED are associated with less perceived AOM symptomatology compared to a paper handout.
Management strategies to address Intracranial Pressure and Cerebral perfusion pressure, the use of oxygenation and ventilation strategies, temperature, correction of metabolic abnormalities and seizure care are discussed.
BACKGROUND Pain, the most identifiable feature of acute otitis media (AOM), is undertreated with 30% of children ≤ 2 years experiencing pain, fever, or both for up to 7 days, highlighting the importance of effective caregiver education. OBJECTIVES We sought to determine if video discharge instructions were associated with improved symptomatology, functional outcomes, and knowledge compared to a paper handout. DESIGN/METHODS We conducted a randomized controlled superiority trial comparing video discharge instructions (Easy Sketch Pro3TM) on management of pain and fever to a paper handout detailing the same. We included primary caregivers of children 6 months to 5 years presenting to the emergency department (ED) with a clinical diagnosis of AOM. The primary outcome was symptomatology using the Acute Otitis Media Severity of Symptom (AOM SOS) score between 48 and 72 hours. The 7-item self-report AOM-SOS is scored from 0 to 13 with a higher score indicating more symptomatology. Secondary outcomes included knowledge gain using a 10-item survey, days of daycare/school/work missed, and recidivism. RESULTS A total of 219 caregivers were randomized and 149 completed the 72-hour follow-up (72 paper and 77 video). Participants were primarily mothers (175/219, 79.9%); 136/219 (62.1%) completed post-secondary education and 147/219 (67.1%) had previously cared for a child with AOM. Children included 107/219 (48.6%) females with an overall mean (SD) age of 2.9 (2.8) years. Caregivers did not offer analgesia to 41/219 (18.7%) of children. The median (IQR) AOM-SOS score in the video group was significantly lower than the paper group, even after adjusting for pre-intervention AOM-SOS and medication (analgesics and antibiotics) given by caregivers [8 (7,11) versus 10 (7,13), respectively, p = 0.004]. There were no significant differences between video and paper in the mean (SD) number of correct answers given on the post-intervention survey [9.2 (1.3) versus 8.8 (1.8), respectively, p = 0.07], mean (SD) number of children that returned to a health provider [8/77 versus 10/72, respectively, p = 0.49), mean (SD) number of daycare/school missed by child [1.2 (1.5) versus 1.1 (2.1), respectively, p = 0.62, mean (SD) number of work missed by caregiver [0.5 (1) versus 0.8 (2), respectively, p = 0.05]. CONCLUSION Children of caregivers with AOM who received a five-minute video detailing the identification and management of pain and fever experienced less symptomatology compared to a paper handout. Our findings suggest that video discharge instructions in the ED are effective for caregiver education and should be used routinely.
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