TY - JOUR T1 - About half of children under age 3 whose parents suspected acute otitis media do not have the diagnosis; restless sleep, ear rubbing, crying, irritability and fever are not predictive JF - Evidence Based Medicine JO - Evid Based Med SP - 186 LP - 187 DO - 10.1136/ebm1129 VL - 15 IS - 6 AU - Eugene Leibovitz Y1 - 2010/12/01 UR - http://ebm.bmj.com/content/15/6/186.abstract N2 - Commentary on: Laine MK, Tähtinen PA, Ruuskanen O, et al. Symptoms or symptom-based scores cannot predict acute otitis media at otitis-prone age. Pediatrics 2010;125:e1154–61.OpenUrlAbstract/FREE Full Text The American Academy of Pediatrics clinical practice guideline for acute otitis media (AOM) was published in 2004 in order to help physicians to make an accurate acute diagnosis.1 According to these guidelines, presence of middle ear effusion and signs and symptoms of middle ear inflammation, together with a history of acute onset, are required for diagnosis and evaluation of disease severity. In clinical trials, AOM symptoms have been used for evaluation of disease severity in order to assign patients to different treatment groups (including ‘watchful waiting’) and follow-up. A clinical/otological severity score measuring patient temperature, irritability, redness of tympanic membrane and bulging was able to discern between bacterial and non-bacterial aetiology (at diagnosis) and … ER -