Adherence to Clinical Practice Guidelines for Pediatric Acute Otitis Media Management in the Emergency Department: A Retrospective Review of 2903 Cases at Hospital Universitario San Ignacio, Bogotá, Colombia (2016-2019)

Abstract

Introduction: Acute otitis media (AOM) is one of the leading causes of pediatric emergency department visits and antibiotic prescriptions. Despite the availability of clinical practice guidelines (CPGs), diagnostic difficulties and low adherence to recommendations persist, contributing to overdiagnosis and unnecessary antimicrobial use. Objective: to evaluate adherence to national clinical practice guidelines for the diagnosis and management of AOM in pediatric patients treated in the emergency department of a high-complexity hospital in Bogotá, Colombia. Methods: A retrospective, descriptive observational study was conducted based on the review of electronic medical records. Adherence to diagnostic criteria, use of diagnostic tools such as pneumatic otoscopy, appropriateness of antibiotic prescribing, and compliance with therapeutic recommendations, including watchful waiting, were assessed. Results: only 56,2% of cases met the diagnostic criteria established by the guidelines. Antibiotics were prescribed in 96,8% of patients; however, only 54,9% had a clear indication for antibacterial therapy. Watchful waiting and documentation of pneumatic otoscopy use were infrequent. Conclusions: A significant gap exists between clinical practice guideline recommendations and real-world management, characterized by diagnostic inaccuracy and antibiotic overprescription. Strategies aimed at strengthening clinical training, optimizing the use of diagnostic tools, and promoting rational antimicrobial use are needed.