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Acad Emerg Med. 2019 Nov 19. doi: 10.1111/acem.13839. [Epub ahead of print]

Video Discharge Instructions for Acute Otitis Media in Children: A Randomized Controlled Open-label Trial.

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From the, Department of Pediatrics, Division of Paediatric Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario.
the, Department of Pediatrics, Division of Paediatric Emergency Medicine, University of Alberta, Edmonton, Alberta.
Women and Children's Health Research Institute, Edmonton, Alberta.
the, Children's Health Research Institute, London Health Sciences Centre, London, Ontario.
and the, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.



Thirty percent of children with acute otitis media (AOM) experience symptoms < 7 days after initiating treatment, highlighting the importance of comprehensive discharge instructions.


We randomized caregivers of children 6 months to 17 years presenting to the emergency department (ED) with AOM to discharge instructions using a video on management of pain and fever to a paper handout. The primary outcome was the AOM Severity of Symptom (AOM-SOS) score at 72 hours postdischarge. Secondary outcomes included caregiver knowledge (10-item survey), absenteeism, recidivism, and satisfaction (5-item Likert scale).


A total of 219 caregivers were randomized and 149 completed the 72-hour follow-up (72 paper and 77 video). The median (IQR) AOM-SOS score for the video was significantly lower than paper, even after adjusting for preintervention AOM-SOS score and medication at home (8 [7-11] vs. 10 [7-13], respectively; p = 0.004). There were no significant differences between video and paper in mean (±SD) knowledge score (9.2 [±1.3] vs. 8.8 [±1.8], respectively; p = 0.07), mean (±SD) number of children that returned to a health care provider (8/77 vs. 10/72, respectively; p = 0.49), mean (±SD) number of daycare/school days missed by child (1.2 [±1.5] vs. 1.1 [±2.1], respectively; p = 0.62), mean (±SD) number of workdays missed by caregiver (0.5 [±1] vs. 0.8 [±2], respectively; p = 0.05), or median (IQR) satisfaction score (5 [4-5] vs. 5 [4-5], respectively; p = 0.3).


Video discharge instructions in the ED are associated with less perceived AOM symptomatology compared to a paper handout.


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