Pediatric Emergency Department Smartphone Otoscope Study (PED-Oto)

Not Applicable

Completed

Brief Summary: Acute otitis media (AOM), defined as acute inflammation in the middle ear, is a leading cause of health encounters and antimicrobial prescriptions in children worldwide. Diagnosis of AOM is often dependent on a brief view of the tympanic membrane in an uncooperative child's ear canal. As a consequence, AOM may be inappropriately diagnosed when visualization of the tympanic membrane (ear drum) is not optimal. Improved methods for visualizing the tympanic membrane including capturing still images and recording video of the ear exam would be beneficial in the diagnosis and management of otic complaints, including acute and chronic otitis media. Use of a smartphone otoscope has the potential to optimize clinician ability to manage otic complaints, visualize the tympanic membrane, and support antimicrobial stewardship. This study will be conducted as a randomized control study in two affiliated children's hospital emergency departments. Twenty volunteer clinicians will be randomly assigned to use either a smartphone otoscope or a conventional otoscope for all otic examinations for a 6-month period.

Detailed Description: A smartphone otoscope (CellScope-Oto) is a pocket size attachment that employs the technology and light source of a smartphone to capture reproducible images of the ear canal and tympanic membrane. Previous studies with this device demonstrated that images taken with both the smartphone otoscope and a camera-fitted conventional analogue otoscope were equivalent with respect to image quality and that the smartphone otoscope was acceptable as an educational and diagnostic tool to health professional students. A pilot study with a similar design to this study conducted in two offices of an ambulatory pediatric clinic demonstrated a trend toward decreased antimicrobial prescription filling among families whose children were examined with the smartphone otoscope compared to those who were examined with a conventional otoscope. To further assess this trend, this study proposes an evaluation of the impact of device use on antimicrobial prescribing for children with an otic complaint in a pediatric emergency department (PED) setting. This study will enroll 20 clinicians for the 6-month study period; 10 who will be randomly assigned to use a smartphone otoscope for the 6-month study period and 10 who will be assigned to use a conventional otoscope for all otoscopic exams. Data will be abstracted via retrospective review of the electronic medical record of encounters in with an otoscopic exam was performed as part of the diagnostic evaluation.

Recruitment & Eligibility

Inclusion Criteria

Participants must be a pediatric emergency care clinicians providing care at an emergency department a participating children's hospital
Willing to agree to random assignment to either a smartphone otoscope device or a conventional otoscope device for the 6-month study period
Willing to log patient encounters that included the an otoscopic examination for non-traumatic indication for each shift
Willing to document and report episodes of care in which the assigned otoscopic device could not be used on a study-eligible otoscopic examination
Willing to complete an end of study assessment, if assigned to use the smartphone otoscope

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Smartphone otoscope	Smartphone otoscope	Participating clinicians randomized to the smartphone otoscope study arm will use a smartphone otoscope for all otic (ear) examinations for a 6-month period.
Conventional otoscope	Conventional otoscope	Participating clinicians randomized to the conventional otoscope study arm will use a conventional otoscope for all otic (ear) examinations for a 6-month period.

Primary Outcome Measures

Name	Time	Method
Number of Antibiotic Prescriptions	Month 6	The number of emergency department encounters where antibiotics were prescribed to treat acute otitis media (AOM) are presented here. Information about antimicrobial prescriptions were found in the medical records of children receiving an otoscopic exam by a participating clinician.

Secondary Outcome Measures

Name	Time	Method
Number of Diagnoses of Otitis Externa	Month 6	The number of emergency department encounters where a diagnosis of otitis externa was made is presented here. Information about the diagnosis of otitis externa was found in the medical records of children receiving an otoscopic exam by a participating clinician.
Number of Diagnoses of Acute Otitis Media (AOM)	Month 6	The number of emergency department encounters where a diagnosis of acute otitis media (AOM) was made is presented here. Information about the diagnosis of AOM was found in the medical records of children receiving an otoscopic exam by a participating clinician.
Clinician Acceptability of the Smartphone Otoscopic Device	Month 6	Clinicians randomized to use the smartphone otoscopic device completed a survey to assess the acceptability of this device compared to the historical use of a conventional otoscope. The survey, developed specifically for this study, asked clinicians to report on their preference for using the smartphone otoscope over the conventional otoscope, whether the device increased their ability to diagnose AOM, and the perceived impact on antibiotic prescribing.

Locations (2): Children's Healthcare of Atlanta at Hughes Spalding
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Atlanta, Georgia, United States
Children's Healthcare of Atlanta at Egleston
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Atlanta, Georgia, United States