Physicians' Diagnostic Judgments and Treatment Decisions for Acute Otitis Media in Children

Physicians' diagnoses of acute otitis media (AOM) and their treatment choices were investigated using judgment and decision-making analyses. Thirty-two pediatricians in the Albany, New York, area provided probability judgments of the presence of AOM and made treatment decisions for 32 patient v...

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Bibliographic Details
Published in:Medical decision making 1998-04, Vol.18 (2), p.149-162
Main Authors: González-Vallejo, Claudia, Sorum, Paul C., Stewart, Thomas R., Chessare, John B., Mumpower, Jeryl L.
Format: Article
Language:English
Subjects:
Acute Disease
Anti-Bacterial Agents - economics
Anti-Bacterial Agents - therapeutic use
Child, Preschool
Decision Support Techniques
Drug Costs
Female
Humans
Infant
Judgment
Linear Models
Male
Medical History Taking
Otitis Media - diagnosis
Otitis Media - drug therapy
Patient Selection
Pediatrics
Physical Examination
Physicians - psychology
Probability
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Summary:Physicians' diagnoses of acute otitis media (AOM) and their treatment choices were investigated using judgment and decision-making analyses. Thirty-two pediatricians in the Albany, New York, area provided probability judgments of the presence of AOM and made treatment decisions for 32 patient vignettes, each described in terms of historical and examination variables. Their probability judgments were well predicted by linear combinations of the patient variables (R2s ranged from 0.76 to 0.97). Information about the observed condition of the eardrum proved to be most critical to the physicians' diagnoses. They demonstrated good levels of agreement on diagnoses. They varied, however, in their tendencies to treat with amoxicillin rather than another antibiotic. Case vagueness was related to the rate of antibiotic treatment. The rate of antibiotic treatment was higher for vague than for non-vague cases when the mean judged probability of AOM was low. In combination, the findings highlight the importance of performing and interpreting ear examinations and the role that consistent training may have in improving management of AOM.
ISSN:0272-989X
1552-681X
DOI:10.1177/0272989X9801800203