Resident Physician University of California, San Diego San Diego, California
Introduction: Otitis media (OM) is one of the most common pediatric illnesses. Patients with recurrent or chronic OM may require tympanostomy tubes (TT). Untreated acute OM can result in serious complications. In 2020, the novel coronavirus (SARS-CoV-2) resulted in schools and businesses closing across the United States. The goal of this study is to identify whether OM and TT rates in the US during 2020 differ from prior years through intervention analysis. Secondary outcomes included OM, TT, and complication rates of OM by region and month.
Methods: Patient data was queried from the Pediatric Health Information System® (PHIS) database utilizing the International Classification of Disease (ICD) 9/10 codes as well as the Current Procedural Terminology (CPT) codes from 2015 to 2020. Hospital systems that had no data for all years queried were excluded. Demographic and clinical data included age, sex, insurance, and encounter type. State-sanctioned “stay-at-home” order dates were verified. Statistical analysis included descriptive statistics, statistical hypothesis testing and predictive modeling (ARIMA).
Results: A total of 37 centers reported patient data during the study period, representing all 5 regions of the US. The difference between the predicted and actual number of OM and TT for April/2020 was 14136 (predicted 16758, actual 2622) and 6820 (predicted 7879, actual 1059) respectively. The largest differences by month started in April/2020 and lasted at least until the last month studied (December/2020). The proportion of complications per cases of OM was higher during the lockdown (0.3% versus 0.2%, p <0.001), however, the monthly average number of complications was reduced (3 versus 8, p <0.006).
Conclusion: There was a significant decrease in total OM, TT, and complication rates during the stay-at-home mandates. This decrease may be related to reduced viral disease exposure and suggests a potential treatment adjunct for children with recurrent OM. The increased proportion of complications may be due to hesitancy of parents/patients to present to a provider for OM during pandemic restrictions. Alternatively, this hesitancy may also be a contributor to the reduced rates of OM and TT. Both scenarios speak to the impact of social distancing measures and offering appropriate access to care to all patients.