Key Action Statement Profile: KAS 1A
| Aggregate evidence quality | Grade B |
| Benefits | • Identify a population of children most likely to benefit from intervention. |
| • Avoid unnecessary treatment of those without highly certain AOM. | |
| • Promote consistency in diagnosis. | |
| Risks, harms, cost | May miss AOM that presents with a combination of mild bulging, intense erythema, or otalgia that may not necessarily represent less severe disease and may also benefit from intervention. |
| Benefits-harms assessment | Preponderance of benefit. |
| Value judgments | Identification of a population of children with highly certain AOM is beneficial. Accurate, specific diagnosis is helpful to the individual patient. Modification of current behavior of overdiagnosis is a goal. Increased specificity is preferred even as sensitivity is lowered. |
| Intentional vagueness | By using stringent diagnostic criteria, the TM appearance of less severe illness that might be early AOM has not been addressed. |
| Role of patient preferences | None |
| Exclusions | None |
| Strength | Recommendation |
| Notes | Tympanocentesis studies confirm that using these diagnostic findings leads to high levels of isolation of pathogenic bacteria. Evidence is extrapolated from treatment studies that included tympanocentesis. |
| Aggregate evidence quality | Grade B |
| Benefits | • Identify a population of children most likely to benefit from intervention. |
| • Avoid unnecessary treatment of those without highly certain AOM. | |
| • Promote consistency in diagnosis. | |
| Risks, harms, cost | May miss AOM that presents with a combination of mild bulging, intense erythema, or otalgia that may not necessarily represent less severe disease and may also benefit from intervention. |
| Benefits-harms assessment | Preponderance of benefit. |
| Value judgments | Identification of a population of children with highly certain AOM is beneficial. Accurate, specific diagnosis is helpful to the individual patient. Modification of current behavior of overdiagnosis is a goal. Increased specificity is preferred even as sensitivity is lowered. |
| Intentional vagueness | By using stringent diagnostic criteria, the TM appearance of less severe illness that might be early AOM has not been addressed. |
| Role of patient preferences | None |
| Exclusions | None |
| Strength | Recommendation |
| Notes | Tympanocentesis studies confirm that using these diagnostic findings leads to high levels of isolation of pathogenic bacteria. Evidence is extrapolated from treatment studies that included tympanocentesis. |