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aao_hnsf_ssnhl-00245 | aao_hnsf_ssnhl | 46-year-old patient with unilateral acute hearing loss starting 12 hours ago. Tuning fork exam suggests sensorineural loss. No vertigo, imbalance, focal weakness, or severe headache is reported. Associated tinnitus is present. Mild nasal congestion is noted. Patient is calm.
What is the recommended management at this ... | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 12, "unilateral": true}, "distractor_params": {"age_years": 46, "anxiety": false, "mild_congestion": true, "tinnitus": true}} | Onset: 12 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
idsa_abrs_rx-00555 | idsa_abrs_rx | 51-year-old patient with sinus symptoms for 12 days. Severe onset with high fever and purulent nasal discharge. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Reports a mild cough. Notes some fatigue.
... | {"decisive_params": {"double_worsening": false, "duration_days": 12, "severe_onset": true}, "distractor_params": {"age_years": 51, "fatigue": true, "mild_cough": true, "seasonal_allergies": false}} | Duration: 12 days; Severe onset: yes; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Persistent symptoms for at least 10 days meets IDSA criteria for ABRS antibiotics. | [
"duration_ge_10",
"severe_onset"
] | v0.3-action-first |
aao_hnsf_ssnhl-00445 | aao_hnsf_ssnhl | 48-year-old patient with unilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. On exam, there is new focal neurologic deficit. Reports new imbalance with difficulty walking. Associated tinnitus is present. Mild nasal congestion is noted. Patient is calm.
How would you manag... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 24, "unilateral": true}, "distractor_params": {"age_years": 48, "anxiety": false, "mild_congestion": true, "tinnitus": true}} | Onset: 24 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
aao_hnsf_ssnhl-00287 | aao_hnsf_ssnhl | 34-year-old patient with unilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. Reports new severe vertigo with gait instability. On exam, there is new focal neurologic deficit. Associated tinnitus is present. Mild nasal congestion is noted. Patient is calm.
How would you ma... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 24, "unilateral": true}, "distractor_params": {"age_years": 34, "anxiety": false, "mild_congestion": true, "tinnitus": true}} | Onset: 24 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
idsa_abrs_rx-00587 | idsa_abrs_rx | 53-year-old patient with sinus symptoms for 4 days. Severe onset with high fever and purulent nasal discharge. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Denies cough. Notes some fat... | {"decisive_params": {"double_worsening": true, "duration_days": 4, "severe_onset": true}, "distractor_params": {"age_years": 53, "fatigue": true, "mild_cough": false, "seasonal_allergies": true}} | Duration: 4 days; Severe onset: yes; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Severe onset with high fever/purulence meets IDSA criteria for ABRS antibiotics. | [
"severe_onset",
"double_worsening"
] | v0.3-action-first |
aap_aom_rx-00652 | aap_aom_rx | 11-month-old child presents with ear pain in the left ear. Symptoms include mild ear discomfort without high fever. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. Attends daycare... | {"decisive_params": {"age_months": 11, "bilateral": false, "otorrhea": false, "severe": false}, "distractor_params": {"daycare": true, "parent_preference": "Family is open to antibiotics if needed.", "rhinorrhea": true, "viral_uri": true}} | Age: 11 months; Otorrhea: no; Severe: no; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Observation/watchful waiting with analgesia and close follow-up; start antibiotics if worsening or no improvement.", "label": "watchful_waiting"}] | No otorrhea/severe symptoms and not bilateral under 24 months, so observation is appropriate. | [
"watchful_waiting"
] | v0.3-action-first |
aao_hnsf_ssnhl-00084 | aao_hnsf_ssnhl | 55-year-old patient with unilateral acute hearing loss starting 36 hours ago. Tuning fork exam suggests sensorineural loss. Reports new severe vertigo with gait instability. Associated tinnitus is present. No significant nasal congestion. Patient is anxious about the symptoms.
What is the recommended management at thi... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 36, "unilateral": true}, "distractor_params": {"age_years": 55, "anxiety": true, "mild_congestion": false, "tinnitus": true}} | Onset: 36 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
aap_aom_rx-00025 | aap_aom_rx | 33-month-old child presents with ear pain in the both ears. Symptoms include mild ear discomfort without high fever. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. No significant rhinorrhea. Does not att... | {"decisive_params": {"age_months": 33, "bilateral": true, "otorrhea": true, "severe": false}, "distractor_params": {"daycare": false, "parent_preference": "Parent would like a clear plan.", "rhinorrhea": false, "viral_uri": true}} | Age: 33 months; Otorrhea: yes; Severe: no; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea"
] | v0.3-action-first |
idsa_abrs_rx-00001 | idsa_abrs_rx | 35-year-old patient with sinus symptoms for 7 days. No high fever or severe purulence at onset. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Reports a mild cough. Energy level is other... | {"decisive_params": {"double_worsening": true, "duration_days": 7, "severe_onset": false}, "distractor_params": {"age_years": 35, "fatigue": false, "mild_cough": true, "seasonal_allergies": true}} | Duration: 7 days; Severe onset: no; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Double-worsening after initial improvement meets IDSA criteria for ABRS antibiotics. | [
"double_worsening"
] | v0.3-action-first |
aao_hnsf_ssnhl-00362 | aao_hnsf_ssnhl | 32-year-old patient with unilateral acute hearing loss starting 36 hours ago. Tuning fork exam suggests sensorineural loss. On exam, there is new focal neurologic deficit. Reports new imbalance with difficulty walking. Associated tinnitus is present. No significant nasal congestion. Patient is calm.
What is the best n... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 36, "unilateral": true}, "distractor_params": {"age_years": 32, "anxiety": false, "mild_congestion": false, "tinnitus": true}} | Onset: 36 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
idsa_abrs_rx-00007 | idsa_abrs_rx | 40-year-old patient with sinus symptoms for 9 days. No high fever or severe purulence at onset. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Denies cough. Notes some fatigue.
What is the recommended... | {"decisive_params": {"double_worsening": false, "duration_days": 9, "severe_onset": false}, "distractor_params": {"age_years": 40, "fatigue": true, "mild_cough": false, "seasonal_allergies": false}} | Duration: 9 days; Severe onset: no; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Supportive care/symptomatic management; no antibiotics at this time.", "label": "supportive_care"}] | Symptoms do not meet persistent, severe-onset, or double-worsening criteria; supportive care is advised. | [
"supportive_only"
] | v0.3-action-first |
aap_aom_rx-00307 | aap_aom_rx | 35-month-old child presents with ear pain in the both ears. Symptoms include mild ear discomfort without high fever. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. Mild rhinorrhea is present. Does not attend daycare. Fami... | {"decisive_params": {"age_months": 35, "bilateral": true, "otorrhea": false, "severe": false}, "distractor_params": {"daycare": false, "parent_preference": "Family is open to antibiotics if needed.", "rhinorrhea": true, "viral_uri": false}} | Age: 35 months; Otorrhea: no; Severe: no; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Observation/watchful waiting with analgesia and close follow-up; start antibiotics if worsening or no improvement.", "label": "watchful_waiting"}] | No otorrhea/severe symptoms and not bilateral under 24 months, so observation is appropriate. | [
"watchful_waiting"
] | v0.3-action-first |
idsa_abrs_rx-00339 | idsa_abrs_rx | 31-year-old patient with sinus symptoms for 3 days. Severe onset with high fever and purulent nasal discharge. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Reports a mild cough. Notes ... | {"decisive_params": {"double_worsening": true, "duration_days": 3, "severe_onset": true}, "distractor_params": {"age_years": 31, "fatigue": true, "mild_cough": true, "seasonal_allergies": true}} | Duration: 3 days; Severe onset: yes; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Severe onset with high fever/purulence meets IDSA criteria for ABRS antibiotics. | [
"severe_onset",
"double_worsening"
] | v0.3-action-first |
aap_aom_rx-00352 | aap_aom_rx | 27-month-old child presents with ear pain in the left ear. Symptoms include mild ear discomfort without high fever. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. Mild rhinorrhea is present. Does not attend daycare. Fa... | {"decisive_params": {"age_months": 27, "bilateral": false, "otorrhea": true, "severe": false}, "distractor_params": {"daycare": false, "parent_preference": "Family is open to antibiotics if needed.", "rhinorrhea": true, "viral_uri": false}} | Age: 27 months; Otorrhea: yes; Severe: no; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea"
] | v0.3-action-first |
aao_hnsf_ssnhl-00118 | aao_hnsf_ssnhl | 35-year-old patient with unilateral acute hearing loss starting 12 hours ago. Tuning fork exam suggests sensorineural loss. No vertigo, imbalance, focal weakness, or severe headache is reported. Associated tinnitus is present. Mild nasal congestion is noted. Patient is calm.
What is the best next step in management? | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 12, "unilateral": true}, "distractor_params": {"age_years": 35, "anxiety": false, "mild_congestion": true, "tinnitus": true}} | Onset: 12 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
idsa_abrs_rx-00371 | idsa_abrs_rx | 31-year-old patient with sinus symptoms for 9 days. No high fever or severe purulence at onset. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Denies cough. Notes some fatigue.
How wou... | {"decisive_params": {"double_worsening": true, "duration_days": 9, "severe_onset": false}, "distractor_params": {"age_years": 31, "fatigue": true, "mild_cough": false, "seasonal_allergies": false}} | Duration: 9 days; Severe onset: no; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Double-worsening after initial improvement meets IDSA criteria for ABRS antibiotics. | [
"double_worsening"
] | v0.3-action-first |
aap_aom_rx-00249 | aap_aom_rx | 35-month-old child presents with ear pain in the right ear. Symptoms include fever to 39.4°C with moderate to severe otalgia. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. Atten... | {"decisive_params": {"age_months": 35, "bilateral": false, "otorrhea": false, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Parent would like a clear plan.", "rhinorrhea": true, "viral_uri": true}} | Age: 35 months; Otorrhea: no; Severe: yes; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Severe AOM symptoms support immediate antibiotics per AAP guidance. | [
"severe"
] | v0.3-action-first |
idsa_abrs_rx-00085 | idsa_abrs_rx | 45-year-old patient with sinus symptoms for 5 days. No high fever or severe purulence at onset. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Denies cough. Notes some fatigue.
What is ... | {"decisive_params": {"double_worsening": true, "duration_days": 5, "severe_onset": false}, "distractor_params": {"age_years": 45, "fatigue": true, "mild_cough": false, "seasonal_allergies": true}} | Duration: 5 days; Severe onset: no; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Double-worsening after initial improvement meets IDSA criteria for ABRS antibiotics. | [
"double_worsening"
] | v0.3-action-first |
idsa_abrs_rx-00013 | idsa_abrs_rx | 48-year-old patient with sinus symptoms for 12 days. No high fever or severe purulence at onset. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Reports a mild cough. Notes some fatigue.
What is the re... | {"decisive_params": {"double_worsening": false, "duration_days": 12, "severe_onset": false}, "distractor_params": {"age_years": 48, "fatigue": true, "mild_cough": true, "seasonal_allergies": false}} | Duration: 12 days; Severe onset: no; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Persistent symptoms for at least 10 days meets IDSA criteria for ABRS antibiotics. | [
"duration_ge_10"
] | v0.3-action-first |
aao_hnsf_ssnhl-00621 | aao_hnsf_ssnhl | 33-year-old patient with bilateral acute hearing loss starting 12 hours ago. Tuning fork exam suggests sensorineural loss. On exam, there is new focal neurologic deficit. Reports new imbalance with difficulty walking. No tinnitus. Mild nasal congestion is noted. Patient is calm.
What is the best next step in managemen... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 12, "unilateral": false}, "distractor_params": {"age_years": 33, "anxiety": false, "mild_congestion": true, "tinnitus": false}} | Onset: 12 hours; Unilateral: no; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
idsa_abrs_rx-00493 | idsa_abrs_rx | 48-year-old patient with sinus symptoms for 9 days. Severe onset with high fever and purulent nasal discharge. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Reports a mild cough. Energy level is other... | {"decisive_params": {"double_worsening": false, "duration_days": 9, "severe_onset": true}, "distractor_params": {"age_years": 48, "fatigue": false, "mild_cough": true, "seasonal_allergies": false}} | Duration: 9 days; Severe onset: yes; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Severe onset with high fever/purulence meets IDSA criteria for ABRS antibiotics. | [
"severe_onset"
] | v0.3-action-first |
aap_aom_rx-00543 | aap_aom_rx | 36-month-old child presents with ear pain in the both ears. Symptoms include mild ear discomfort without high fever. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. Mild rhinorrhea is present. Attends daycare. Parent would... | {"decisive_params": {"age_months": 36, "bilateral": true, "otorrhea": false, "severe": false}, "distractor_params": {"daycare": true, "parent_preference": "Parent would like a clear plan.", "rhinorrhea": true, "viral_uri": false}} | Age: 36 months; Otorrhea: no; Severe: no; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Observation/watchful waiting with analgesia and close follow-up; start antibiotics if worsening or no improvement.", "label": "watchful_waiting"}] | No otorrhea/severe symptoms and not bilateral under 24 months, so observation is appropriate. | [
"watchful_waiting"
] | v0.3-action-first |
idsa_abrs_rx-00167 | idsa_abrs_rx | 42-year-old patient with sinus symptoms for 7 days. Severe onset with high fever and purulent nasal discharge. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Reports a mild cough. Energy level is otherw... | {"decisive_params": {"double_worsening": false, "duration_days": 7, "severe_onset": true}, "distractor_params": {"age_years": 42, "fatigue": false, "mild_cough": true, "seasonal_allergies": true}} | Duration: 7 days; Severe onset: yes; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Severe onset with high fever/purulence meets IDSA criteria for ABRS antibiotics. | [
"severe_onset"
] | v0.3-action-first |
aap_aom_rx-00355 | aap_aom_rx | 57-month-old child presents with ear pain in the both ears. Symptoms include fever to 39.4°C with moderate to severe otalgia. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. At... | {"decisive_params": {"age_months": 57, "bilateral": true, "otorrhea": true, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": true, "viral_uri": true}} | Age: 57 months; Otorrhea: yes; Severe: yes; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea",
"severe"
] | v0.3-action-first |
aao_hnsf_ssnhl-00041 | aao_hnsf_ssnhl | 36-year-old patient with unilateral acute hearing loss starting 12 hours ago. Tuning fork exam suggests sensorineural loss. Denies dizziness/vertigo and any focal neurologic symptoms. No tinnitus. No significant nasal congestion. Patient is anxious about the symptoms.
What is the recommended management at this point? | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 12, "unilateral": true}, "distractor_params": {"age_years": 36, "anxiety": true, "mild_congestion": false, "tinnitus": false}} | Onset: 12 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
aap_aom_rx-00568 | aap_aom_rx | 36-month-old child presents with ear pain in the both ears. Symptoms include fever to 39.4°C with moderate to severe otalgia. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. No significant rhinorrhea. Does not attend da... | {"decisive_params": {"age_months": 36, "bilateral": true, "otorrhea": true, "severe": true}, "distractor_params": {"daycare": false, "parent_preference": "Parent would like a clear plan.", "rhinorrhea": false, "viral_uri": false}} | Age: 36 months; Otorrhea: yes; Severe: yes; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea",
"severe"
] | v0.3-action-first |
aao_hnsf_ssnhl-00242 | aao_hnsf_ssnhl | 69-year-old patient with unilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. Denies dizziness/vertigo and any focal neurologic symptoms. Associated tinnitus is present. No significant nasal congestion. Patient is calm.
What is the recommended management at this point? | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 24, "unilateral": true}, "distractor_params": {"age_years": 69, "anxiety": false, "mild_congestion": false, "tinnitus": true}} | Onset: 24 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
aap_aom_rx-00222 | aap_aom_rx | 41-month-old child presents with ear pain in the left ear. Symptoms include mild ear discomfort without high fever. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. Does not att... | {"decisive_params": {"age_months": 41, "bilateral": false, "otorrhea": true, "severe": false}, "distractor_params": {"daycare": false, "parent_preference": "Family is open to antibiotics if needed.", "rhinorrhea": true, "viral_uri": true}} | Age: 41 months; Otorrhea: yes; Severe: no; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea"
] | v0.3-action-first |
idsa_abrs_rx-00405 | idsa_abrs_rx | 65-year-old patient with sinus symptoms for 7 days. Severe onset with high fever and purulent nasal discharge. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Denies cough. Notes some fa... | {"decisive_params": {"double_worsening": true, "duration_days": 7, "severe_onset": true}, "distractor_params": {"age_years": 65, "fatigue": true, "mild_cough": false, "seasonal_allergies": false}} | Duration: 7 days; Severe onset: yes; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Severe onset with high fever/purulence meets IDSA criteria for ABRS antibiotics. | [
"severe_onset",
"double_worsening"
] | v0.3-action-first |
aap_aom_rx-00084 | aap_aom_rx | 59-month-old child presents with ear pain in the right ear. Symptoms include mild ear discomfort without high fever. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. Mild rhinorrhea is present. Does not attend daycare. P... | {"decisive_params": {"age_months": 59, "bilateral": false, "otorrhea": true, "severe": false}, "distractor_params": {"daycare": false, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": true, "viral_uri": false}} | Age: 59 months; Otorrhea: yes; Severe: no; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea"
] | v0.3-action-first |
aao_hnsf_ssnhl-00143 | aao_hnsf_ssnhl | 52-year-old patient with unilateral acute hearing loss starting 12 hours ago. Tuning fork exam suggests sensorineural loss. No vertigo, imbalance, focal weakness, or severe headache is reported. Associated tinnitus is present. No significant nasal congestion. Patient is calm.
What is the best next step in management? | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 12, "unilateral": true}, "distractor_params": {"age_years": 52, "anxiety": false, "mild_congestion": false, "tinnitus": true}} | Onset: 12 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
aao_hnsf_ssnhl-00535 | aao_hnsf_ssnhl | 55-year-old patient with bilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. Reports new severe vertigo with gait instability. On exam, there is new focal neurologic deficit. Associated tinnitus is present. Mild nasal congestion is noted. Patient is calm.
What is the recom... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 24, "unilateral": false}, "distractor_params": {"age_years": 55, "anxiety": false, "mild_congestion": true, "tinnitus": true}} | Onset: 24 hours; Unilateral: no; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
idsa_abrs_rx-00015 | idsa_abrs_rx | 55-year-old patient with sinus symptoms for 6 days. Severe onset with high fever and purulent nasal discharge. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Denies cough. Energy level is otherwise norm... | {"decisive_params": {"double_worsening": false, "duration_days": 6, "severe_onset": true}, "distractor_params": {"age_years": 55, "fatigue": false, "mild_cough": false, "seasonal_allergies": true}} | Duration: 6 days; Severe onset: yes; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Severe onset with high fever/purulence meets IDSA criteria for ABRS antibiotics. | [
"severe_onset"
] | v0.3-action-first |
aao_hnsf_ssnhl-00604 | aao_hnsf_ssnhl | 32-year-old patient with unilateral acute hearing loss starting 6 hours ago. Tuning fork exam suggests sensorineural loss. Reports new severe vertigo with gait instability. On exam, there is new focal neurologic deficit. No tinnitus. Mild nasal congestion is noted. Patient is anxious about the symptoms.
What is the re... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 6, "unilateral": true}, "distractor_params": {"age_years": 32, "anxiety": true, "mild_congestion": true, "tinnitus": false}} | Onset: 6 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
idsa_abrs_rx-00266 | idsa_abrs_rx | 65-year-old patient with sinus symptoms for 7 days. Severe onset with high fever and purulent nasal discharge. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Reports a mild cough. Energ... | {"decisive_params": {"double_worsening": true, "duration_days": 7, "severe_onset": true}, "distractor_params": {"age_years": 65, "fatigue": false, "mild_cough": true, "seasonal_allergies": false}} | Duration: 7 days; Severe onset: yes; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Severe onset with high fever/purulence meets IDSA criteria for ABRS antibiotics. | [
"severe_onset",
"double_worsening"
] | v0.3-action-first |
aap_aom_rx-00216 | aap_aom_rx | 16-month-old child presents with ear pain in the left ear. Symptoms include mild ear discomfort without high fever. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. Mild rhinorrhea is present. Attends daycare. Parent pre... | {"decisive_params": {"age_months": 16, "bilateral": false, "otorrhea": true, "severe": false}, "distractor_params": {"daycare": true, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": true, "viral_uri": false}} | Age: 16 months; Otorrhea: yes; Severe: no; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea"
] | v0.3-action-first |
idsa_abrs_rx-00362 | idsa_abrs_rx | 65-year-old patient with sinus symptoms for 10 days. No high fever or severe purulence at onset. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Denies cough. Notes some fatigue.
How wou... | {"decisive_params": {"double_worsening": true, "duration_days": 10, "severe_onset": false}, "distractor_params": {"age_years": 65, "fatigue": true, "mild_cough": false, "seasonal_allergies": true}} | Duration: 10 days; Severe onset: no; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Persistent symptoms for at least 10 days meets IDSA criteria for ABRS antibiotics. | [
"duration_ge_10",
"double_worsening"
] | v0.3-action-first |
aap_aom_rx-00432 | aap_aom_rx | 41-month-old child presents with ear pain in the left ear. Symptoms include fever to 39.4°C with moderate to severe otalgia. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. No significant rhinorrhea. Attends daycare. Paren... | {"decisive_params": {"age_months": 41, "bilateral": false, "otorrhea": false, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Parent would like a clear plan.", "rhinorrhea": false, "viral_uri": false}} | Age: 41 months; Otorrhea: no; Severe: yes; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Severe AOM symptoms support immediate antibiotics per AAP guidance. | [
"severe"
] | v0.3-action-first |
aao_hnsf_ssnhl-00296 | aao_hnsf_ssnhl | 33-year-old patient with unilateral acute hearing loss starting 12 hours ago. Tuning fork exam suggests sensorineural loss. Reports new imbalance with difficulty walking. On exam, there is mild facial weakness. Associated tinnitus is present. No significant nasal congestion. Patient is calm.
How would you manage this ... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 12, "unilateral": true}, "distractor_params": {"age_years": 33, "anxiety": false, "mild_congestion": false, "tinnitus": true}} | Onset: 12 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
aap_aom_rx-00170 | aap_aom_rx | 34-month-old child presents with ear pain in the left ear. Symptoms include fever to 39.4°C with moderate to severe otalgia. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. No significant rhinorrhea. Does not attend day... | {"decisive_params": {"age_months": 34, "bilateral": false, "otorrhea": true, "severe": true}, "distractor_params": {"daycare": false, "parent_preference": "Parent would like a clear plan.", "rhinorrhea": false, "viral_uri": false}} | Age: 34 months; Otorrhea: yes; Severe: yes; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea",
"severe"
] | v0.3-action-first |
aao_hnsf_ssnhl-00149 | aao_hnsf_ssnhl | 41-year-old patient with unilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. Denies dizziness/vertigo and any focal neurologic symptoms. No tinnitus. No significant nasal congestion. Patient is calm.
What is the recommended management at this point? | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 24, "unilateral": true}, "distractor_params": {"age_years": 41, "anxiety": false, "mild_congestion": false, "tinnitus": false}} | Onset: 24 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
idsa_abrs_rx-00443 | idsa_abrs_rx | 19-year-old patient with sinus symptoms for 14 days. Severe onset with high fever and purulent nasal discharge. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Denies cough. Notes some fa... | {"decisive_params": {"double_worsening": true, "duration_days": 14, "severe_onset": true}, "distractor_params": {"age_years": 19, "fatigue": true, "mild_cough": false, "seasonal_allergies": true}} | Duration: 14 days; Severe onset: yes; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Persistent symptoms for at least 10 days meets IDSA criteria for ABRS antibiotics. | [
"duration_ge_10",
"severe_onset",
"double_worsening"
] | v0.3-action-first |
aao_hnsf_ssnhl-00044 | aao_hnsf_ssnhl | 64-year-old patient with unilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. Denies vertigo, imbalance, facial weakness, severe headache, or other neurologic symptoms. No tinnitus. No significant nasal congestion. Patient is anxious about the symptoms.
What is the best ne... | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 24, "unilateral": true}, "distractor_params": {"age_years": 64, "anxiety": true, "mild_congestion": false, "tinnitus": false}} | Onset: 24 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
idsa_abrs_rx-00245 | idsa_abrs_rx | 54-year-old patient with sinus symptoms for 4 days. No high fever or severe purulence at onset. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Denies cough. Energy level is otherwise normal.
How would... | {"decisive_params": {"double_worsening": false, "duration_days": 4, "severe_onset": false}, "distractor_params": {"age_years": 54, "fatigue": false, "mild_cough": false, "seasonal_allergies": false}} | Duration: 4 days; Severe onset: no; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Supportive care/symptomatic management; no antibiotics at this time.", "label": "supportive_care"}] | Symptoms do not meet persistent, severe-onset, or double-worsening criteria; supportive care is advised. | [
"supportive_only"
] | v0.3-action-first |
idsa_abrs_rx-00529 | idsa_abrs_rx | 38-year-old patient with sinus symptoms for 14 days. Severe onset with high fever and purulent nasal discharge. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Reports a mild cough. Ener... | {"decisive_params": {"double_worsening": true, "duration_days": 14, "severe_onset": true}, "distractor_params": {"age_years": 38, "fatigue": false, "mild_cough": true, "seasonal_allergies": false}} | Duration: 14 days; Severe onset: yes; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Persistent symptoms for at least 10 days meets IDSA criteria for ABRS antibiotics. | [
"duration_ge_10",
"severe_onset",
"double_worsening"
] | v0.3-action-first |
aap_aom_rx-00623 | aap_aom_rx | 26-month-old child presents with ear pain in the both ears. Symptoms include fever to 39.4°C with moderate to severe otalgia. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. No significant rhinorrhea. Attends daycare. Fami... | {"decisive_params": {"age_months": 26, "bilateral": true, "otorrhea": false, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Family is open to antibiotics if needed.", "rhinorrhea": false, "viral_uri": false}} | Age: 26 months; Otorrhea: no; Severe: yes; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Severe AOM symptoms support immediate antibiotics per AAP guidance. | [
"severe"
] | v0.3-action-first |
aap_aom_rx-00311 | aap_aom_rx | 48-month-old child presents with ear pain in the both ears. Symptoms include fever to 39.4°C with moderate to severe otalgia. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. Do... | {"decisive_params": {"age_months": 48, "bilateral": true, "otorrhea": true, "severe": true}, "distractor_params": {"daycare": false, "parent_preference": "Parent would like a clear plan.", "rhinorrhea": true, "viral_uri": true}} | Age: 48 months; Otorrhea: yes; Severe: yes; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea",
"severe"
] | v0.3-action-first |
aao_hnsf_ssnhl-00090 | aao_hnsf_ssnhl | 70-year-old patient with unilateral acute hearing loss starting 12 hours ago. Tuning fork exam suggests sensorineural loss. On exam, there is mild facial weakness. Reports new imbalance with difficulty walking. No tinnitus. No significant nasal congestion. Patient is calm.
How would you manage this patient now? | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 12, "unilateral": true}, "distractor_params": {"age_years": 70, "anxiety": false, "mild_congestion": false, "tinnitus": false}} | Onset: 12 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
aao_hnsf_ssnhl-00284 | aao_hnsf_ssnhl | 51-year-old patient with unilateral acute hearing loss starting 48 hours ago. Tuning fork exam suggests sensorineural loss. Denies vertigo, imbalance, facial weakness, severe headache, or other neurologic symptoms. No tinnitus. Mild nasal congestion is noted. Patient is calm.
How would you manage this patient now? | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 48, "unilateral": true}, "distractor_params": {"age_years": 51, "anxiety": false, "mild_congestion": true, "tinnitus": false}} | Onset: 48 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
aap_aom_rx-00018 | aap_aom_rx | 13-month-old child presents with ear pain in the both ears. Symptoms include fever to 39.4°C with moderate to severe otalgia. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. No significant rhinorrhea. Does not attend dayca... | {"decisive_params": {"age_months": 13, "bilateral": true, "otorrhea": false, "severe": true}, "distractor_params": {"daycare": false, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": false, "viral_uri": false}} | Age: 13 months; Otorrhea: no; Severe: yes; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Severe AOM symptoms support immediate antibiotics per AAP guidance. | [
"severe",
"bilateral_lt24"
] | v0.3-action-first |
aao_hnsf_ssnhl-00332 | aao_hnsf_ssnhl | 36-year-old patient with unilateral acute hearing loss starting 48 hours ago. Tuning fork exam suggests sensorineural loss. No vertigo, imbalance, focal weakness, or severe headache is reported. Associated tinnitus is present. No significant nasal congestion. Patient is calm.
What is the recommended management at this... | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 48, "unilateral": true}, "distractor_params": {"age_years": 36, "anxiety": false, "mild_congestion": false, "tinnitus": true}} | Onset: 48 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
idsa_abrs_rx-00665 | idsa_abrs_rx | 57-year-old patient with sinus symptoms for 5 days. No high fever or severe purulence at onset. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Reports a mild cough. Energy level is othe... | {"decisive_params": {"double_worsening": true, "duration_days": 5, "severe_onset": false}, "distractor_params": {"age_years": 57, "fatigue": false, "mild_cough": true, "seasonal_allergies": false}} | Duration: 5 days; Severe onset: no; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Double-worsening after initial improvement meets IDSA criteria for ABRS antibiotics. | [
"double_worsening"
] | v0.3-action-first |
aap_aom_rx-00470 | aap_aom_rx | 30-month-old child presents with ear pain in the left ear. Symptoms include mild ear discomfort without high fever. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. Mild rhinorrhea is present. Attends daycare. Parent prefer... | {"decisive_params": {"age_months": 30, "bilateral": false, "otorrhea": false, "severe": false}, "distractor_params": {"daycare": true, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": true, "viral_uri": false}} | Age: 30 months; Otorrhea: no; Severe: no; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Observation/watchful waiting with analgesia and close follow-up; start antibiotics if worsening or no improvement.", "label": "watchful_waiting"}] | No otorrhea/severe symptoms and not bilateral under 24 months, so observation is appropriate. | [
"watchful_waiting"
] | v0.3-action-first |
idsa_abrs_rx-00135 | idsa_abrs_rx | 19-year-old patient with sinus symptoms for 14 days. Severe onset with high fever and purulent nasal discharge. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Reports a mild cough. Energy level is othe... | {"decisive_params": {"double_worsening": false, "duration_days": 14, "severe_onset": true}, "distractor_params": {"age_years": 19, "fatigue": false, "mild_cough": true, "seasonal_allergies": false}} | Duration: 14 days; Severe onset: yes; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Persistent symptoms for at least 10 days meets IDSA criteria for ABRS antibiotics. | [
"duration_ge_10",
"severe_onset"
] | v0.3-action-first |
aao_hnsf_ssnhl-00241 | aao_hnsf_ssnhl | 37-year-old patient with bilateral acute hearing loss starting 36 hours ago. Tuning fork exam suggests sensorineural loss. On exam, there is new focal neurologic deficit. Associated tinnitus is present. No significant nasal congestion. Patient is calm.
What is the recommended management at this point? | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 36, "unilateral": false}, "distractor_params": {"age_years": 37, "anxiety": false, "mild_congestion": false, "tinnitus": true}} | Onset: 36 hours; Unilateral: no; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
aao_hnsf_ssnhl-00202 | aao_hnsf_ssnhl | 50-year-old patient with unilateral acute hearing loss starting 6 hours ago. Tuning fork exam suggests sensorineural loss. On exam, there is new focal neurologic deficit. Associated tinnitus is present. No significant nasal congestion. Patient is calm.
How would you manage this patient now? | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 6, "unilateral": true}, "distractor_params": {"age_years": 50, "anxiety": false, "mild_congestion": false, "tinnitus": true}} | Onset: 6 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
aao_hnsf_ssnhl-00225 | aao_hnsf_ssnhl | 35-year-old patient with bilateral acute hearing loss starting 12 hours ago. Tuning fork exam suggests sensorineural loss. On exam, there is mild facial weakness. Reports new imbalance with difficulty walking. No tinnitus. No significant nasal congestion. Patient is anxious about the symptoms.
What is the recommended ... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 12, "unilateral": false}, "distractor_params": {"age_years": 35, "anxiety": true, "mild_congestion": false, "tinnitus": false}} | Onset: 12 hours; Unilateral: no; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
aap_aom_rx-00371 | aap_aom_rx | 20-month-old child presents with ear pain in the right ear. Symptoms include fever to 39.4°C with moderate to severe otalgia. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. No significant rhinorrhea. Att... | {"decisive_params": {"age_months": 20, "bilateral": false, "otorrhea": true, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Family is open to antibiotics if needed.", "rhinorrhea": false, "viral_uri": true}} | Age: 20 months; Otorrhea: yes; Severe: yes; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea",
"severe"
] | v0.3-action-first |
idsa_abrs_rx-00593 | idsa_abrs_rx | 37-year-old patient with sinus symptoms for 14 days. No high fever or severe purulence at onset. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Denies cough. Notes some fatigue.
What is... | {"decisive_params": {"double_worsening": true, "duration_days": 14, "severe_onset": false}, "distractor_params": {"age_years": 37, "fatigue": true, "mild_cough": false, "seasonal_allergies": true}} | Duration: 14 days; Severe onset: no; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Persistent symptoms for at least 10 days meets IDSA criteria for ABRS antibiotics. | [
"duration_ge_10",
"double_worsening"
] | v0.3-action-first |
aao_hnsf_ssnhl-00392 | aao_hnsf_ssnhl | 43-year-old patient with unilateral acute hearing loss starting 36 hours ago. Tuning fork exam suggests sensorineural loss. Reports new imbalance with difficulty walking. Associated tinnitus is present. No significant nasal congestion. Patient is anxious about the symptoms.
How would you manage this patient now? | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 36, "unilateral": true}, "distractor_params": {"age_years": 43, "anxiety": true, "mild_congestion": false, "tinnitus": true}} | Onset: 36 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
aap_aom_rx-00220 | aap_aom_rx | 33-month-old child presents with ear pain in the right ear. Symptoms include mild ear discomfort without high fever. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. No significant rhinorrhea. Attends daycare. Family is ope... | {"decisive_params": {"age_months": 33, "bilateral": false, "otorrhea": false, "severe": false}, "distractor_params": {"daycare": true, "parent_preference": "Family is open to antibiotics if needed.", "rhinorrhea": false, "viral_uri": false}} | Age: 33 months; Otorrhea: no; Severe: no; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Observation/watchful waiting with analgesia and close follow-up; start antibiotics if worsening or no improvement.", "label": "watchful_waiting"}] | No otorrhea/severe symptoms and not bilateral under 24 months, so observation is appropriate. | [
"watchful_waiting"
] | v0.3-action-first |
aao_hnsf_ssnhl-00279 | aao_hnsf_ssnhl | 69-year-old patient with unilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. Denies dizziness/vertigo and any focal neurologic symptoms. Associated tinnitus is present. Mild nasal congestion is noted. Patient is calm.
How would you manage this patient now? | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 24, "unilateral": true}, "distractor_params": {"age_years": 69, "anxiety": false, "mild_congestion": true, "tinnitus": true}} | Onset: 24 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
aao_hnsf_ssnhl-00441 | aao_hnsf_ssnhl | 19-year-old patient with unilateral acute hearing loss starting 36 hours ago. Tuning fork exam suggests sensorineural loss. Reports new imbalance with difficulty walking. Associated tinnitus is present. Mild nasal congestion is noted. Patient is anxious about the symptoms.
How would you manage this patient now? | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 36, "unilateral": true}, "distractor_params": {"age_years": 19, "anxiety": true, "mild_congestion": true, "tinnitus": true}} | Onset: 36 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
aap_aom_rx-00288 | aap_aom_rx | 13-month-old child presents with ear pain in the both ears. Symptoms include fever to 39.4°C with moderate to severe otalgia. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. No significant rhinorrhea. Attends daycare. Pare... | {"decisive_params": {"age_months": 13, "bilateral": true, "otorrhea": false, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": false, "viral_uri": false}} | Age: 13 months; Otorrhea: no; Severe: yes; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Severe AOM symptoms support immediate antibiotics per AAP guidance. | [
"severe",
"bilateral_lt24"
] | v0.3-action-first |
idsa_abrs_rx-00170 | idsa_abrs_rx | 47-year-old patient with sinus symptoms for 5 days. Severe onset with high fever and purulent nasal discharge. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Denies cough. Energy level i... | {"decisive_params": {"double_worsening": true, "duration_days": 5, "severe_onset": true}, "distractor_params": {"age_years": 47, "fatigue": false, "mild_cough": false, "seasonal_allergies": true}} | Duration: 5 days; Severe onset: yes; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Severe onset with high fever/purulence meets IDSA criteria for ABRS antibiotics. | [
"severe_onset",
"double_worsening"
] | v0.3-action-first |
aap_aom_rx-00551 | aap_aom_rx | 60-month-old child presents with ear pain in the both ears. Symptoms include fever to 39.4°C with moderate to severe otalgia. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. Atten... | {"decisive_params": {"age_months": 60, "bilateral": true, "otorrhea": false, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": true, "viral_uri": true}} | Age: 60 months; Otorrhea: no; Severe: yes; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Severe AOM symptoms support immediate antibiotics per AAP guidance. | [
"severe"
] | v0.3-action-first |
aap_aom_rx-00226 | aap_aom_rx | 55-month-old child presents with ear pain in the both ears. Symptoms include mild ear discomfort without high fever. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. Mild rhinorrhea is present. Attends daycare. Parent pr... | {"decisive_params": {"age_months": 55, "bilateral": true, "otorrhea": true, "severe": false}, "distractor_params": {"daycare": true, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": true, "viral_uri": false}} | Age: 55 months; Otorrhea: yes; Severe: no; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea"
] | v0.3-action-first |
aao_hnsf_ssnhl-00385 | aao_hnsf_ssnhl | 43-year-old patient with unilateral acute hearing loss starting 48 hours ago. Tuning fork exam suggests sensorineural loss. No vertigo, imbalance, focal weakness, or severe headache is reported. No tinnitus. No significant nasal congestion. Patient is calm.
What is the best next step in management? | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 48, "unilateral": true}, "distractor_params": {"age_years": 43, "anxiety": false, "mild_congestion": false, "tinnitus": false}} | Onset: 48 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
aao_hnsf_ssnhl-00369 | aao_hnsf_ssnhl | 27-year-old patient with unilateral acute hearing loss starting 48 hours ago. Tuning fork exam suggests sensorineural loss. Denies dizziness/vertigo and any focal neurologic symptoms. Associated tinnitus is present. No significant nasal congestion. Patient is anxious about the symptoms.
What is the best next step in m... | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 48, "unilateral": true}, "distractor_params": {"age_years": 27, "anxiety": true, "mild_congestion": false, "tinnitus": true}} | Onset: 48 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
aao_hnsf_ssnhl-00214 | aao_hnsf_ssnhl | 19-year-old patient with unilateral acute hearing loss starting 48 hours ago. Tuning fork exam suggests sensorineural loss. Denies vertigo, imbalance, facial weakness, severe headache, or other neurologic symptoms. Associated tinnitus is present. No significant nasal congestion. Patient is calm.
What is the recommende... | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 48, "unilateral": true}, "distractor_params": {"age_years": 19, "anxiety": false, "mild_congestion": false, "tinnitus": true}} | Onset: 48 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
aao_hnsf_ssnhl-00578 | aao_hnsf_ssnhl | 52-year-old patient with bilateral acute hearing loss starting 6 hours ago. Tuning fork exam suggests sensorineural loss. Reports new imbalance with difficulty walking. Associated tinnitus is present. No significant nasal congestion. Patient is anxious about the symptoms.
What is the best next step in management? | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 6, "unilateral": false}, "distractor_params": {"age_years": 52, "anxiety": true, "mild_congestion": false, "tinnitus": true}} | Onset: 6 hours; Unilateral: no; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
idsa_abrs_rx-00255 | idsa_abrs_rx | 43-year-old patient with sinus symptoms for 12 days. No high fever or severe purulence at onset. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Reports a mild cough. Energy level is oth... | {"decisive_params": {"double_worsening": true, "duration_days": 12, "severe_onset": false}, "distractor_params": {"age_years": 43, "fatigue": false, "mild_cough": true, "seasonal_allergies": false}} | Duration: 12 days; Severe onset: no; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Persistent symptoms for at least 10 days meets IDSA criteria for ABRS antibiotics. | [
"duration_ge_10",
"double_worsening"
] | v0.3-action-first |
idsa_abrs_rx-00408 | idsa_abrs_rx | 65-year-old patient with sinus symptoms for 5 days. No high fever or severe purulence at onset. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Denies cough. Energy level is otherwise nor... | {"decisive_params": {"double_worsening": true, "duration_days": 5, "severe_onset": false}, "distractor_params": {"age_years": 65, "fatigue": false, "mild_cough": false, "seasonal_allergies": true}} | Duration: 5 days; Severe onset: no; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Double-worsening after initial improvement meets IDSA criteria for ABRS antibiotics. | [
"double_worsening"
] | v0.3-action-first |
idsa_abrs_rx-00048 | idsa_abrs_rx | 51-year-old patient with sinus symptoms for 8 days. Severe onset with high fever and purulent nasal discharge. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Reports a mild cough. Energy level is other... | {"decisive_params": {"double_worsening": false, "duration_days": 8, "severe_onset": true}, "distractor_params": {"age_years": 51, "fatigue": false, "mild_cough": true, "seasonal_allergies": false}} | Duration: 8 days; Severe onset: yes; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Severe onset with high fever/purulence meets IDSA criteria for ABRS antibiotics. | [
"severe_onset"
] | v0.3-action-first |
aap_aom_rx-00201 | aap_aom_rx | 21-month-old child presents with ear pain in the left ear. Symptoms include fever to 39.4°C with moderate to severe otalgia. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. Attend... | {"decisive_params": {"age_months": 21, "bilateral": false, "otorrhea": false, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Family is open to antibiotics if needed.", "rhinorrhea": true, "viral_uri": true}} | Age: 21 months; Otorrhea: no; Severe: yes; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Severe AOM symptoms support immediate antibiotics per AAP guidance. | [
"severe"
] | v0.3-action-first |
aap_aom_rx-00282 | aap_aom_rx | 35-month-old child presents with ear pain in the left ear. Symptoms include fever to 39.4°C with moderate to severe otalgia. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. Mild rhinorrhea is present. Attends daycare. Pare... | {"decisive_params": {"age_months": 35, "bilateral": false, "otorrhea": false, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": true, "viral_uri": false}} | Age: 35 months; Otorrhea: no; Severe: yes; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Severe AOM symptoms support immediate antibiotics per AAP guidance. | [
"severe"
] | v0.3-action-first |
aap_aom_rx-00098 | aap_aom_rx | 53-month-old child presents with ear pain in the both ears. Symptoms include fever to 39.4°C with moderate to severe otalgia. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. Mild rhinorrhea is present. Attends daycare. ... | {"decisive_params": {"age_months": 53, "bilateral": true, "otorrhea": true, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Family is open to antibiotics if needed.", "rhinorrhea": true, "viral_uri": false}} | Age: 53 months; Otorrhea: yes; Severe: yes; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea",
"severe"
] | v0.3-action-first |
aap_aom_rx-00014 | aap_aom_rx | 15-month-old child presents with ear pain in the both ears. Symptoms include mild ear discomfort without high fever. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. No significant rhinorrhea. Attends daycare. Parent prefer... | {"decisive_params": {"age_months": 15, "bilateral": true, "otorrhea": false, "severe": false}, "distractor_params": {"daycare": true, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": false, "viral_uri": false}} | Age: 15 months; Otorrhea: no; Severe: no; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Bilateral AOM in a child under 24 months supports immediate antibiotics per AAP guidance. | [
"bilateral_lt24"
] | v0.3-action-first |
aao_hnsf_ssnhl-00583 | aao_hnsf_ssnhl | 73-year-old patient with unilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. Denies dizziness/vertigo and any focal neurologic symptoms. No tinnitus. Mild nasal congestion is noted. Patient is anxious about the symptoms.
What is the recommended management at this point? | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 24, "unilateral": true}, "distractor_params": {"age_years": 73, "anxiety": true, "mild_congestion": true, "tinnitus": false}} | Onset: 24 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
aao_hnsf_ssnhl-00592 | aao_hnsf_ssnhl | 56-year-old patient with bilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. Reports new imbalance with difficulty walking. Associated tinnitus is present. Mild nasal congestion is noted. Patient is calm.
How would you manage this patient now? | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 24, "unilateral": false}, "distractor_params": {"age_years": 56, "anxiety": false, "mild_congestion": true, "tinnitus": true}} | Onset: 24 hours; Unilateral: no; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
aap_aom_rx-00171 | aap_aom_rx | 46-month-old child presents with ear pain in the both ears. Symptoms include fever to 39.4°C with moderate to severe otalgia. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. Does ... | {"decisive_params": {"age_months": 46, "bilateral": true, "otorrhea": false, "severe": true}, "distractor_params": {"daycare": false, "parent_preference": "Parent would like a clear plan.", "rhinorrhea": true, "viral_uri": true}} | Age: 46 months; Otorrhea: no; Severe: yes; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Severe AOM symptoms support immediate antibiotics per AAP guidance. | [
"severe"
] | v0.3-action-first |
aao_hnsf_ssnhl-00099 | aao_hnsf_ssnhl | 63-year-old patient with unilateral acute hearing loss starting 12 hours ago. Tuning fork exam suggests sensorineural loss. Reports new imbalance with difficulty walking. On exam, there is new focal neurologic deficit. No tinnitus. No significant nasal congestion. Patient is anxious about the symptoms.
What is the bes... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 12, "unilateral": true}, "distractor_params": {"age_years": 63, "anxiety": true, "mild_congestion": false, "tinnitus": false}} | Onset: 12 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
idsa_abrs_rx-00280 | idsa_abrs_rx | 30-year-old patient with sinus symptoms for 6 days. Severe onset with high fever and purulent nasal discharge. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Reports a mild cough. Energy level is otherw... | {"decisive_params": {"double_worsening": false, "duration_days": 6, "severe_onset": true}, "distractor_params": {"age_years": 30, "fatigue": false, "mild_cough": true, "seasonal_allergies": true}} | Duration: 6 days; Severe onset: yes; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Severe onset with high fever/purulence meets IDSA criteria for ABRS antibiotics. | [
"severe_onset"
] | v0.3-action-first |
aap_aom_rx-00319 | aap_aom_rx | 35-month-old child presents with ear pain in the both ears. Symptoms include mild ear discomfort without high fever. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. Does not atten... | {"decisive_params": {"age_months": 35, "bilateral": true, "otorrhea": false, "severe": false}, "distractor_params": {"daycare": false, "parent_preference": "Parent would like a clear plan.", "rhinorrhea": true, "viral_uri": true}} | Age: 35 months; Otorrhea: no; Severe: no; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Observation/watchful waiting with analgesia and close follow-up; start antibiotics if worsening or no improvement.", "label": "watchful_waiting"}] | No otorrhea/severe symptoms and not bilateral under 24 months, so observation is appropriate. | [
"watchful_waiting"
] | v0.3-action-first |
aao_hnsf_ssnhl-00413 | aao_hnsf_ssnhl | 38-year-old patient with unilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. Denies vertigo, imbalance, facial weakness, severe headache, or other neurologic symptoms. No tinnitus. Mild nasal congestion is noted. Patient is calm.
What is the recommended management at this... | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 24, "unilateral": true}, "distractor_params": {"age_years": 38, "anxiety": false, "mild_congestion": true, "tinnitus": false}} | Onset: 24 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
aap_aom_rx-00446 | aap_aom_rx | 45-month-old child presents with ear pain in the left ear. Symptoms include mild ear discomfort without high fever. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. Mild rhinorrhea is present. Attends daycare. Parent prefer... | {"decisive_params": {"age_months": 45, "bilateral": false, "otorrhea": false, "severe": false}, "distractor_params": {"daycare": true, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": true, "viral_uri": false}} | Age: 45 months; Otorrhea: no; Severe: no; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Observation/watchful waiting with analgesia and close follow-up; start antibiotics if worsening or no improvement.", "label": "watchful_waiting"}] | No otorrhea/severe symptoms and not bilateral under 24 months, so observation is appropriate. | [
"watchful_waiting"
] | v0.3-action-first |
aao_hnsf_ssnhl-00335 | aao_hnsf_ssnhl | 33-year-old patient with unilateral acute hearing loss starting 12 hours ago. Tuning fork exam suggests sensorineural loss. No vertigo, imbalance, focal weakness, or severe headache is reported. No tinnitus. No significant nasal congestion. Patient is anxious about the symptoms.
How would you manage this patient now? | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 12, "unilateral": true}, "distractor_params": {"age_years": 33, "anxiety": true, "mild_congestion": false, "tinnitus": false}} | Onset: 12 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
aap_aom_rx-00444 | aap_aom_rx | 59-month-old child presents with ear pain in the both ears. Symptoms include fever to 39.4°C with moderate to severe otalgia. No otorrhea is reported. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. No significant rhinorrhea. Does not attend dayca... | {"decisive_params": {"age_months": 59, "bilateral": true, "otorrhea": false, "severe": true}, "distractor_params": {"daycare": false, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": false, "viral_uri": false}} | Age: 59 months; Otorrhea: no; Severe: yes; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Severe AOM symptoms support immediate antibiotics per AAP guidance. | [
"severe"
] | v0.3-action-first |
aao_hnsf_ssnhl-00421 | aao_hnsf_ssnhl | 70-year-old patient with unilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. Reports new imbalance with difficulty walking. Associated tinnitus is present. No significant nasal congestion. Patient is anxious about the symptoms.
What is the recommended management at this p... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 24, "unilateral": true}, "distractor_params": {"age_years": 70, "anxiety": true, "mild_congestion": false, "tinnitus": true}} | Onset: 24 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
idsa_abrs_rx-00401 | idsa_abrs_rx | 51-year-old patient with sinus symptoms for 4 days. No high fever or severe purulence at onset. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Denies cough. Energy level is otherwise normal.
What is th... | {"decisive_params": {"double_worsening": false, "duration_days": 4, "severe_onset": false}, "distractor_params": {"age_years": 51, "fatigue": false, "mild_cough": false, "seasonal_allergies": true}} | Duration: 4 days; Severe onset: no; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Supportive care/symptomatic management; no antibiotics at this time.", "label": "supportive_care"}] | Symptoms do not meet persistent, severe-onset, or double-worsening criteria; supportive care is advised. | [
"supportive_only"
] | v0.3-action-first |
aao_hnsf_ssnhl-00617 | aao_hnsf_ssnhl | 67-year-old patient with unilateral acute hearing loss starting 12 hours ago. Tuning fork exam suggests sensorineural loss. On exam, there is mild facial weakness. Reports new imbalance with difficulty walking. Associated tinnitus is present. No significant nasal congestion. Patient is anxious about the symptoms.
How ... | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 12, "unilateral": true}, "distractor_params": {"age_years": 67, "anxiety": true, "mild_congestion": false, "tinnitus": true}} | Onset: 12 hours; Unilateral: yes; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
aap_aom_rx-00403 | aap_aom_rx | 40-month-old child presents with ear pain in the both ears. Symptoms include mild ear discomfort without high fever. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. No recent viral URI is noted. No significant rhinorrhea. Does not attend daycare. Pa... | {"decisive_params": {"age_months": 40, "bilateral": true, "otorrhea": true, "severe": false}, "distractor_params": {"daycare": false, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": false, "viral_uri": false}} | Age: 40 months; Otorrhea: yes; Severe: no; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea"
] | v0.3-action-first |
idsa_abrs_rx-00164 | idsa_abrs_rx | 53-year-old patient with sinus symptoms for 10 days. No high fever or severe purulence at onset. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. History of seasonal allergies. Denies cough. Notes some fatigue.
What is the recommended... | {"decisive_params": {"double_worsening": false, "duration_days": 10, "severe_onset": false}, "distractor_params": {"age_years": 53, "fatigue": true, "mild_cough": false, "seasonal_allergies": true}} | Duration: 10 days; Severe onset: no; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Persistent symptoms for at least 10 days meets IDSA criteria for ABRS antibiotics. | [
"duration_ge_10"
] | v0.3-action-first |
aap_aom_rx-00090 | aap_aom_rx | 32-month-old child presents with ear pain in the right ear. Symptoms include fever to 39.4°C with moderate to severe otalgia. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. At... | {"decisive_params": {"age_months": 32, "bilateral": false, "otorrhea": true, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Parent would like a clear plan.", "rhinorrhea": true, "viral_uri": true}} | Age: 32 months; Otorrhea: yes; Severe: yes; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea",
"severe"
] | v0.3-action-first |
aao_hnsf_ssnhl-00443 | aao_hnsf_ssnhl | 75-year-old patient with bilateral acute hearing loss starting 24 hours ago. Tuning fork exam suggests sensorineural loss. Reports new imbalance with difficulty walking. No tinnitus. No significant nasal congestion. Patient is anxious about the symptoms.
What is the recommended management at this point? | {"decisive_params": {"neuro_red_flags": true, "onset_hours": 24, "unilateral": false}, "distractor_params": {"age_years": 75, "anxiety": true, "mild_congestion": false, "tinnitus": false}} | Onset: 24 hours; Unilateral: no; Neurologic symptoms/signs: yes. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Urgent emergency evaluation for acute neurologic symptoms/signs (consider urgent neuroimaging/neurology pathway).", "label": "urgent_neuro_eval"}] | Acute neurologic symptoms/signs require urgent emergency/neuro evaluation. | [
"neuro_red_flags"
] | v0.3-action-first |
idsa_abrs_rx-00116 | idsa_abrs_rx | 37-year-old patient with sinus symptoms for 6 days. No high fever or severe purulence at onset. No clear double-worsening after an initial improvement. Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Reports a mild cough. Notes some fatigue.
What is the bes... | {"decisive_params": {"double_worsening": false, "duration_days": 6, "severe_onset": false}, "distractor_params": {"age_years": 37, "fatigue": true, "mild_cough": true, "seasonal_allergies": false}} | Duration: 6 days; Severe onset: no; Double-worsening: no. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Supportive care/symptomatic management; no antibiotics at this time.", "label": "supportive_care"}] | Symptoms do not meet persistent, severe-onset, or double-worsening criteria; supportive care is advised. | [
"supportive_only"
] | v0.3-action-first |
aap_aom_rx-00123 | aap_aom_rx | 39-month-old child presents with ear pain in the both ears. Symptoms include mild ear discomfort without high fever. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. Attends day... | {"decisive_params": {"age_months": 39, "bilateral": true, "otorrhea": true, "severe": false}, "distractor_params": {"daycare": true, "parent_preference": "Parent would like a clear plan.", "rhinorrhea": true, "viral_uri": true}} | Age: 39 months; Otorrhea: yes; Severe: no; Bilateral: yes. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea"
] | v0.3-action-first |
aao_hnsf_ssnhl-00087 | aao_hnsf_ssnhl | 68-year-old patient with unilateral acute hearing loss starting 48 hours ago. Tuning fork exam suggests sensorineural loss. Denies vertigo, imbalance, facial weakness, severe headache, or other neurologic symptoms. Associated tinnitus is present. Mild nasal congestion is noted. Patient is anxious about the symptoms.
W... | {"decisive_params": {"neuro_red_flags": false, "onset_hours": 48, "unilateral": true}, "distractor_params": {"age_years": 68, "anxiety": true, "mild_congestion": true, "tinnitus": true}} | Onset: 48 hours; Unilateral: yes; Neurologic symptoms/signs: no. | AAO-HNSF: Sudden Hearing Loss Update (2019) | https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ | AAOHNSF2019_SSNHL | AAOHNSF2019_SSNHL_UrgentMgmt_v1 | [{"description": "Treat as suspected sudden sensorineural hearing loss: prompt corticosteroids and urgent ENT/audiology evaluation.", "label": "urgent_steroids_ent"}] | Acute unilateral hearing loss within 72 hours warrants prompt steroids and urgent ENT/audiology. | [
"acute_unilateral"
] | v0.3-action-first |
idsa_abrs_rx-00037 | idsa_abrs_rx | 61-year-old patient with sinus symptoms for 13 days. No high fever or severe purulence at onset. Symptoms initially improved and then worsened again (double-worsening). Exam suggests acute rhinosinusitis with nasal congestion and facial pressure. No significant allergy history. Denies cough. Notes some fatigue.
What i... | {"decisive_params": {"double_worsening": true, "duration_days": 13, "severe_onset": false}, "distractor_params": {"age_years": 61, "fatigue": true, "mild_cough": false, "seasonal_allergies": false}} | Duration: 13 days; Severe onset: no; Double-worsening: yes. | IDSA: Acute Bacterial Rhinosinusitis (2012) | https://www.idsociety.org/practice-guideline/rhinosinusitis/ | IDSA2012_ABRS | IDSA2012_ABRS_RxDecision_v1 | [{"description": "Treat as acute bacterial rhinosinusitis and start antibiotics per guideline-based management.", "label": "antibiotics"}] | Persistent symptoms for at least 10 days meets IDSA criteria for ABRS antibiotics. | [
"duration_ge_10",
"double_worsening"
] | v0.3-action-first |
aap_aom_rx-00620 | aap_aom_rx | 22-month-old child presents with ear pain in the left ear. Symptoms include fever to 39.4°C with moderate to severe otalgia. There is purulent otorrhea. Otoscopy shows bulging, erythematous tympanic membrane consistent with acute otitis media. Had a recent viral URI with cough last week. Mild rhinorrhea is present. Att... | {"decisive_params": {"age_months": 22, "bilateral": false, "otorrhea": true, "severe": true}, "distractor_params": {"daycare": true, "parent_preference": "Parent prefers to avoid antibiotics if safe.", "rhinorrhea": true, "viral_uri": true}} | Age: 22 months; Otorrhea: yes; Severe: yes; Bilateral: no. | American Academy of Pediatrics: Acute Otitis Media (2013) | https://www.aepap.org/sites/default/files/oma_aap_2013.pdf | AAP2013_AOM | AAP2013_AOM_RxDecision_v1 | [{"description": "Start immediate systemic antibiotics (with appropriate analgesia and follow-up).", "label": "immediate_antibiotics"}] | Otorrhea is present, which supports immediate antibiotics per AAP AOM guidance. | [
"otorrhea",
"severe"
] | v0.3-action-first |
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