General Pediatrics: All Areas
General Pediatrics 7
Haamid S. Chamdawala, MD, MPH
Assistant Professor
Albert Einstein College of Medicine
Bronx, New York, United States
Otoscopic diagnosis in infants and young children often is difficult. A video otoscope (VO) allows trainees to record magnified images and videos of the tympanic membrane (TM) and share them with the supervising physician. Pediatric studies comparing the interrater reliability (IRR) for acute otitis media (AOM) diagnosis by trainees and supervisors are lacking.
Objective: (1) To determine the interrater reliability of the TM interpretation for the diagnosis and management of AOM among trainees and supervisors. (2) Proportion of AOM misdiagnosed by trainees and supervisors
Design/Methods:
We conducted a planned secondary analysis of a prospective, convenience sample of children aged six months to 5 years presenting with fever, upper respiratory symptoms, or otalgia who were evaluated with a VO for AOM from Nov 2021-Jul 2022 in the pediatric emergency department (PED) at an academic medical center in the Bronx, NY. Pediatric and emergency medicine (EM) residents were recruited to participate. Pediatric emergency medicine (PEM) attendings and fellows served as supervisors. Trainees used a VO to record a video clip of the ear exam, which the supervisor reviewed. The primary outcome was the interpretation of the TM findings (AOM, normal TM, middle ear effusion without infection, cerumen impaction, and ‘not sure’) and its management (oral antibiotics, watchful waiting, referral to ENT). Interrater reliability was summarized via Cohen’s κ statistics between trainees and supervisors. Categorical variables were calculated using proportions.
Results:
A total of 315 patients (630 ear exams) were evaluated by 65 trainees (pediatric=40, EM=25) and 16 supervisors (PEM attendings=10, PEM fellows=6). The IRR was determined to be moderate (κ = 0.48) for the TM interpretation and moderate (κ = 0.52) for its management between trainees and supervisors. 18 (20%) of 90 and 41 (39%) of 106 AOMs were misdiagnosed by trainees and supervisors, respectively.
Conclusion(s):
Trainees and supervisors demonstrate moderate interrater reliability in interpreting the TM and managing AOM. The rate of misdiagnosis of AOM is high among trainees and supervisors.