Epidemiology of otologic diagnoses inUnitedStates emergency departments

Abstract

Objective Otologic complaints may place a significant burden on emergency departments (EDs) in the United States; however, few studies have comprehensively examined this discrete patient population. We aim to identify utilization of EDs by patients with primary otologic complaints. Study Design Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011. Methods The NEDS database was queried for patient encounters with a primary otologic diagnosis based on ICD9 codes (380–389). Weighted estimates for demographic, diagnostic characteristics, SES, and trends over time were extracted. Predictors of mortality and admission were determined by multivariable logistic regression. Results A weighted total of 8,611,282 visits between 2009 and 2011 were attributed to otologic diagnoses, representing 2.21% of all ED visits. Stratified by patient age, otologic diagnoses encompassed 1.01% and 6.79% of all adult and pediatric ED visits, respectively. The majority of patients were treated and released (98.17%). The average age of patients presenting with an otologic complaint was 17.9 years (Standard Error [SE] = 0.23). Overall, 62.7% of patients that presented with an otologic complaint were 0–17 years old. The most common diagnoses among all age groups included otitis media NOS (60.6%), infected otitis externa NOS (11.8%), and otalgia NOS (6.8%). Conclusions We provide a comprehensive overview of otologic complaints that are an overlooked diagnostic category in public health research. NEDS data demonstrates significant number of visits related to otologic complaints, especially in the pediatric population, that are non-emergent.

Referral patterns from emergency department to otolaryngology clinic

“…The most frequent discrepancy was patients diagnosed with acute otitis media in the ED later being diagnosed as acute otitis externa in the otolaryngology clinic, accounting for 10% of all patients who received different diagnoses. As otitis externa is one of the most common diagnoses in our analysis and other studies, we believe this represents a significant opportunity for improvement in patient care . As stated in the AAO‐HNS clinical practice guidelines for acute otitis externa, clinicians should make every effort to distinguish otitis externa from other causes of otalgia, otorrhea, and inflammation .…”

“…Patients with otologic conditions predominated our cohort. These have been previously investigated in the literature due to their high economic burden . An analysis of large US healthcare databases estimated that in 2011, ED visits for dizziness and vertigo cost $4 billion, with 40% of patients having imaging studies performed compared to only 9% in 1995 .…”

“…These have been previously investigated in the literature due to their high economic burden. 8,9 An analysis of large US healthcare databases estimated that in 2011, ED visits for dizziness and vertigo cost $4 billion, with 40% of patients having imaging studies performed compared to only 9% in 1995. 8 Another recent study demonstrated that almost half of patients seen at a large health system's ED for vertigo received CT imaging, but only 0.74% of studies identified clinically significant pathology.…”

“…This problem has significant relevance to otolaryngology–head and neck surgery, as common ear, nose, and throat (ENT) complaints such as chronic dizziness, ear problems, nasal obstruction, and sore throat are the reason for substantial numbers of ED visits. In 2011, it has been estimated that diagnoses such as dizziness and vertigo and otitis media and eustachian tube disorders accounted for almost 4 million and 2 million ED visits, respectively . The overwhelming number of ENT‐related ED visits has spawned the creation of otolaryngology‐specific EDs to address this high demand for services .…”

“…In 2011, it has been estimated that diagnoses such as dizziness and vertigo and otitis media and eustachian tube disorders accounted for almost 4 million and 2 million ED visits, respectively. [7][8][9] The overwhelming number of ENTrelated ED visits has spawned the creation of otolaryngology-specific EDs to address this high demand for services. [10][11][12][13] Although these appear to be a costbeneficial method for addressing acute ENT complaints, can offload a sizeable number of general ED visits, and even augment residency education, staffing is a potential challenge and they have not yet become commonplace.…”