BACKGROUND AND OBJECTIVES Updated guidelines continue to support watchful waiting as an option for uncomplicated acute otitis media (AOM) and provide explicit diagnostic criteria. To determine treatment prevalence and associated determinants of watchful waiting for AOM in commercially insured pediatric patients. METHODS This was a retrospective cohort study using IBM Marketscan Commercial Claims Databases (2005 to 2019) of patients 1 to 12 years old with AOM, without otitis-related complications within 6 months prior, with no tympanostomy tubes, and no other infections around index diagnosis of AOM. We examined monthly antibiotic treatment prevalence (defined as pharmacy dispensing within 3 days of AOM diagnosis) and used multivariable logistic regression models to examine determinants of watchful waiting. RESULTS Among 2 176 617 AOM episodes, 77.8% were treated within 3 days. Whereas some clinical characteristics were moderate determinants for watchful waiting, clinician antibiotic prescribing volume and specialty were strong determinants. Low-volume antibiotic prescribers (≥80% of AOM episodes managed with watchful waiting) had 11.61 (95% confidence interval 10.66-12.64) higher odds of using watchful waiting for the index AOM episode than high-volume antibiotic prescribers (≥80% treated). Otolaryngologists were more likely to adopt watchful waiting (odds ratio 5.45, 95% CI 5.21-5.70) than pediatricians, whereas other specialties deferred more commonly to antibiotics. CONCLUSIONS Adoption of watchful waiting for management of uncomplicated, nonrecurrent AOM was limited and stagnant across the study period and driven by clinician rather than patient factors. Future work should assess motivators for prescribing and evaluate patient outcomes among clinicians who generally prefer versus reject watchful waiting approaches to guide clinical decision-making.

中文翻译：

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注意等待急性中耳炎。

背景和目的 更新后的指南继续支持将观察等待作为无并发症急性中耳炎 (AOM) 的一种选择，并提供了明确的诊断标准。确定商业保险儿科患者的治疗流行率和观察等待 AOM 的相关决定因素。方法 这是一项回顾性队列研究，使用 IBM Marketscan 商业索赔数据库（2005 年至 2019 年）对 1 至 12 岁患有 AOM 的患者进行研究，这些患者在前 6 个月内没有中耳炎相关并发症，没有鼓膜置管术，并且在指数诊断期间没有其他感染奥姆。我们检查了每月抗生素治疗流行率（定义为 AOM 诊断后 3 天内的药房配药），并使用多变量逻辑回归模型检查观察等待的决定因素。结果 在 2 176 617 个 AOM 情节中，77.8% 的患者在 3 天内接受了治疗。虽然一些临床特征是观察等待的适度决定因素，但临床医生抗生素处方量和专业是强决定因素。低用量抗生素处方者（≥80% 的 AOM 事件通过观察等待进行管理）使用观察等待指数 AOM 事件的几率比高用量抗生素处方者（≥80% 接受治疗). 与儿科医生相比，耳鼻喉科医生更可能采用观察等待（比值比 5.45，95% CI 5.21-5.70），而其他专科更普遍地推迟抗生素治疗。结论 在整个研究期间，对不复杂、非复发性 AOM 的观察等待管理的采用是有限的和停滞的，并且是由临床医生而不是患者因素驱动的。