Time to Presentation for Acute Otitis Media During the COVID-19 Pandemic

Background: Delays in acute care for diabetic ketoacidosis, appendicitis and malignancy resulted in more severe initial presentations for these problems during the COVID-19 pandemic. It is unknown whether the pandemic also caused delays in care for more common problems such as pediatric acute otitis media (AOM). Delays in presentation for AOM may have secondarily resulted in decreased delayed prescribing or watchful waiting (WW). We hypothesized that there was a greater time to presentation for AOM in 2020 (during the pandemic) with an increased percentage of patients presenting outside of the delayed antibiotic prescribing window compared to those who presented in 2019 (pre-pandemic).

Methods: This is a retrospective secondary analysis of data collected for a national quality improvement project across 24 institutions with free-standing pediatric urgent care sites conducted in calendar years 2019 and 2020. 2020 data collection began after the pandemic was declared in the US. We included all submitted records with a diagnosis of AOM. Records were excluded if they had a co-diagnosis for which an antibiotic is almost always required. The primary outcome compared the median time to presentation measured in days between 2019 and 2020 using the Wilcoxon rank-sum test. Pearson’s chi-square test was used to compare categorical factors between 2019 and 2020.

Results: Our analysis included 1,983 and 402 encounters diagnosed with AOM in 2019 and 2020. There was no significant difference in time to presentation for AOM between 2019 and 2020 (p=0.761). Similarly, the rate of delayed antibiotic prescriptions for eligible encounters was not different (p=0.419). Among patients without associated fever, the median time to presentation was shorter in 2019 compared to 2020, (2 days vs 3 days, p=0.02). However, when fever was present, the directionality was changed (3 days in 2019 and 2 days in 2020 p=0.04).

Conclusion: Despite a growing body of evidence of delayed pediatric care during the COVID-19 pandemic, there was no difference in time to presentation, albeit many fewer diagnoses, for AOM in a national pediatric urgent care database. Both time periods had a median time to presentation of 2 days; however, children with fever had a shorter time to presentation during the pandemic. Only a small percentage of AOM encounters were eligible for delayed antibiotics due to presentation after 2 days of symptoms.