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Key Action Statement Profile: KAS 1A

Aggregate evidence quality Grade B 
Benefits • Identify a population of children most likely to benefit from intervention. 
• Avoid unnecessary treatment of those without highly certain AOM. 
• Promote consistency in diagnosis. 
Risks, harms, cost May miss AOM that presents with a combination of mild bulging, intense erythema, or otalgia that may not necessarily represent less severe disease and may also benefit from intervention. 
Benefits-harms assessment Preponderance of benefit. 
Value judgments Identification of a population of children with highly certain AOM is beneficial. Accurate, specific diagnosis is helpful to the individual patient. Modification of current behavior of overdiagnosis is a goal. Increased specificity is preferred even as sensitivity is lowered. 
Intentional vagueness By using stringent diagnostic criteria, the TM appearance of less severe illness that might be early AOM has not been addressed. 
Role of patient preferences None 
Exclusions None 
Strength Recommendation 
Notes Tympanocentesis studies confirm that using these diagnostic findings leads to high levels of isolation of pathogenic bacteria. Evidence is extrapolated from treatment studies that included tympanocentesis. 
Aggregate evidence quality Grade B 
Benefits • Identify a population of children most likely to benefit from intervention. 
• Avoid unnecessary treatment of those without highly certain AOM. 
• Promote consistency in diagnosis. 
Risks, harms, cost May miss AOM that presents with a combination of mild bulging, intense erythema, or otalgia that may not necessarily represent less severe disease and may also benefit from intervention. 
Benefits-harms assessment Preponderance of benefit. 
Value judgments Identification of a population of children with highly certain AOM is beneficial. Accurate, specific diagnosis is helpful to the individual patient. Modification of current behavior of overdiagnosis is a goal. Increased specificity is preferred even as sensitivity is lowered. 
Intentional vagueness By using stringent diagnostic criteria, the TM appearance of less severe illness that might be early AOM has not been addressed. 
Role of patient preferences None 
Exclusions None 
Strength Recommendation 
Notes Tympanocentesis studies confirm that using these diagnostic findings leads to high levels of isolation of pathogenic bacteria. Evidence is extrapolated from treatment studies that included tympanocentesis. 
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