The effectiveness of video discharge instructions for acute otitis media in children: a randomized controlled trial

Purpose 30% of children with acute otitis media (AOM) experience symptoms up to 7 days into the illness, highlighting the importance of comprehensive ED discharge instructions. We sought to determine if video discharge instructions associated with improved symptomatology compared to a paper handout. Methods We conducted a randomized, controlled, open-label, superiority trial comparing ED discharge instructions using a novel 5-minute video (Easy Sketch Pro3TM) on management of pain and fever to a paper handout, the standard of care, covering the same. We included caregivers of children 6 months to 17 years presenting to the ED with AOM. The primary outcome was the Acute Otitis Media Severity of Symptom (AOM SOS) score at 72 hours post-discharge. Secondary outcomes included a caregiver knowledge survey, days of daycare, school, or work missed, recidivism, and caregiver satisfaction using a 5-item Likert scale. The primary outcome was analyzed by intention to treat using ordinal logistic regression adjusted for pre-intervention AOM-SOS score and analgesic/antibiotic use at home. P-values < 5% were deemed statistically significant. Results 219 caregivers were randomized and 149 completed the 72-hour follow-up (72 paper and 77 video). The median (IQR) AOM-SOS score for the video was significantly lower than paper, even after adjusting for pre-intervention AOM-SOS score and medication at home [8 (7,11) versus 10 (7,13), respectively, p = 0.004]. There were no significant differences between video and paper in the mean (SD) survey score [9.2 (1.3) versus 8.8 (1.8), respectively, p = 0.07], mean (SD) number of children that returned to a health care provider [8/77 versus 10/72, respectively, p = 0.49], mean (SD) number of daycare/school days missed [1.2 (1.5) versus 1.1 (2.1), respectively, p = 0.62], mean (SD) number of workdays missed by caregiver [0.5 (1) versus 0.8 (2), respectively, p = 0.05], median (IQR) satisfaction scores [5 (4,5) versus 5 (4,5), respectively, p = 0.3], or the number of children receiving an analgesic at home following discharge [87/110 (79.1) versus 87/109 (79.8%), respectively, p = 1]. Conclusions Video discharge instructions in the ED are associated with less AOM symptomatology compared to a paper handout and should be used routinely for caregivers of children with AOM. Future work should explore approaches to reducing absenteeism.