A health records review of 396 children ≥2 years discharged from a tertiary pediatric ED with an acute otitis media (AOM) diagnosis in 2021, measuring adherence to the Canadian Pediatric Society (CPS) guidelines for AOM diagnosis and management, including watchful waiting use and antibiotic prescribing practices.
Guideline non-adherence occurred in 62.6% (248/396) of encounters. Watchful waiting was used in only 22% (48/214) of eligible mildly ill cases — 78% (166/214) received unnecessary prescriptions. Diagnostic criteria were absent in 21.5% (85/396) of charts; prolonged antibiotic courses occurred in 6.6% (26/396); and 4.3% (17/396) received non-penicillin first-line antibiotics.
- Single tertiary pediatric ED limits generalizability to community or primary care settings. - Retrospective chart review may underestimate true guideline adherence if clinical reasoning was not fully documented. - Sociodemographic subgroups (language, rurality, deprivation index) were too small for meaningful association analysis.
Most eligible children with mild AOM in this ED received antibiotics when watchful waiting was the guideline-recommended approach — target this gap with structured stewardship prompts at point of prescribing. Ensuring diagnostic criteria are documented before prescribing is an equally important, low-effort quality lever.
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