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1、EffectofAntibioticsforOtitisMediaonMastoiditisinChildren:ARetrospectiveCohortStudyUsingtheUnitedKingdomGeneralPracticeResearchDatabasePediatricResidents’JournalClubFebruary5,2009SaraSzkolaPaulaLouiseThompson,RuthE.Gilbert,PaulF.Long,SoniaSaxena,MikeSharl
2、and,andIanChiKeiWong Pediatrics2009;123:424-430BackgroundOtitismediaisthemainreasonchildrenvisittheirdoctorintheUKThoughmostcasesofotitismediaareself-limiting,rarelychildrencangoontodevelopcomplicationssuchasmastoiditisAntibioticprescriptionsforotitismed
3、iahavedecreasedinrecentyears,andotherstudieshavedocumentedaconcurrentincreaseinhospitaladmissions(1,2,3)Thisstudyaimedtodetermineifthisisacausalrelationshipbetweendecreasedantibioticuseandincreasedcomplications(ie,mastoiditis),orifitisduetochangesin“acce
4、sstoservices,referralpatternsandcodingofroutinedata”Thatis,doesitmakesensetogiveantibioticsforotitismediaforthepurposeofpreventingmastoiditis?StudyDesignDataweredrawnfromtheGeneralPracticeResearchDatabase,adatabasethatdrawsfrompracticesallovertheUKandinc
5、ludesinformationonallactivepatientsChildrenaged3monthsto15yearswhowereinthisdatabasefrom1990-2006wereincluded2exclusions:childrenwhoweren’twith“uptostandard”practice(MDnotrecordingalldata),and“temporarilyregistered”children(ie,1visittodifferentMDthanthei
6、rown)StudyDesignContinuedDataAnalysisAgespecificincidencerates(alongwithcalendar-yearspecificincidencerates)formastoiditiswithandwithoutotitismediawerecalculatedper1000childyearsatriskIncidencerateswerealsocalculatedforotitismediaandforantibiotic-prescri
7、bingforotitismediaThentheycalculatedtherelativeriskofchildrenwithotitismediadevelopingmastoiditiswithandwithoutantibiotctreatmentWhatareallthesestatistics?Incidencerateper1000childrenyearsmeansthenumberofnewcasesperunitofperson-timeatrisk.Thatis….Ifthein
8、cidentrateis10per1000childrenyears,theninapopulationof1000children,10wouldbeexpectedtodevelopotitismediain1year.Ifyouobservedthepopulationfor2yearsinsteadof1,then20wouldbeexpectedtodevelopotitismedia(youdividethenumberofca
