Most ED Visits for Otologic Complaints are Non-Emergencies

How are emergency departments (EDs) in the United States utilized by patients with primary otologic complaints?

Background: Otologic complaints are commonly treated in the ED setting. The Patient Protection and Affordable Care Act aims to insure a greater number of Americans, and this influx will likely contribute to an additional strain on EDs. Although not all ED patients with otologic complaints will require complex management, it is vital to understand the extent of otologic disease evaluated in the ED setting.

Study design: Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011, published by the Healthcare Cost and Utilization Project and sponsored by the Agency for Healthcare Research and Quality.

Setting: Department of Otology and Laryngology, Harvard Medical School, Boston.

Synopsis: Out of a weighted total of 388,904,009 ED visits, 8,611,282 visits were attributed to a primary otologic diagnosis, representing 2.21% of all ED visits. The majority of patients were treated and released. Overall, 62.7% of patients with an otologic complaint were zero to 17 years old, and a slightly greater number were women.

The most common diagnoses among all age groups included otitis media not otherwise specified (NOS), infected otitis external NOS, and otalgia NOS. The most common pediatric diagnoses were suppurative or unspecified otitis media, external ear disorders, and other ear disorders. The most common adult diagnoses were suppurative or unspecified otitis media, external ear disorders, vertiginous syndromes, and other ear disorders. The most common diagnoses resulting in admission included benign paroxysmal vertigo, labyrinthitis, otitis media NOS, and vestibular neuronitis.

Older patients, those in a larger metropolitan area, and those with Medicare were more likely to be admitted. The mean charge for ED diagnosis and treatment was $793.35. Limitations include a possible underestimation of otologic diagnoses associated with other presentations, a limited ability to account for unknown confounders, and independent code reviewer biases

Bottom line: NEDS data demonstrate a significant number of visits related to otologic complaints, especially in the pediatric population, that are nonemergent in nature.

Citation: Kozin ED, Sethi RKV, Remenschneider AK, Kaplan AB, del Portal DA, Gray, ST, Shrime MG, Lee DJ. Epidemiology of otologic diagnoses in United States emergency departments. Laryngoscope. 2015;125:1926-1933.