374 - Video Otoscopy in the Pediatric ED: Can it limit the need for repeated ear exams?
Monday, May 1, 2023
9:30 AM – 11:30 AM ET
Poster Number: 374 Publication Number: 374.405
Caitlin Keane-Bisconti, Albert Einstein College of Medicine, West Islip, NY, United States; Haamid S. Chamdawala, Albert Einstein College of Medicine, Bronx, NY, United States; Leor H. Akabas, Albert Einstein College of Medicine, New York, NY, United States
Fellow Physician Albert Einstein College of Medicine West Islip, New York, United States
Background: Acute otitis media (AOM) is one of the most prevalent childhood infections, making otoscopy a fundamental skill for clinicians. Clear visualization and interpretation of the tympanic membrane (TM) are often challenging for trainees. The video otoscope (VO) allows trainees to record magnified TM images and videos. With this capability, using a VO may avoid a supervising physician’s need to perform a repeat ear exam and makes it a valuable educational and diagnostic tool; however, data on these measures are limited. Objective: To evaluate whether trainees’ use of a VO can avoid repeat ear exams by supervising physicians and to assess its educational value compared to conventional otoscopes (CO). Design/Methods: We conducted a prospective observational study from Nov 2021-Jul 2022 in the pediatric emergency department (PED) at an academic medical center in the Bronx, NY. Pediatric and emergency medicine residents and pediatric nurse practitioners (PNP) in training were recruited to participate. Pediatric emergency medicine (PEM) attendings and fellows served as supervisors. Trainees used a VO to record the ear exam of children ages six months to 5 years presenting with fever, upper respiratory symptoms, or otalgia. The primary outcome was the supervisors’ determination if a repeat ear exam was necessary. We examined six variables (age, specialty, training level, fever, otalgia, and percent of TM visualized) using logistic regression to determine which were independently associated with first exam success. Trainees completed pre- and post-rotation questionnaires that measured their confidence in performing an otoscopic exam, diagnosing ear infections, and educational satisfaction regarding pediatric otoscopy. The trainee’s rating of the VO as a teaching and a diagnostic tool was also recorded. Results: A total of 67 trainees (pediatric=40, PNP=2, EM=25) and 368 patients were included in the analysis. 272 (75%) patients did not require a repeat exam by a supervisor. Factors independently associated with first exam success were patient age ≥2 years (aOR 2.2, 95% CI [1.3-3.9]), training level (aOR 1.8, 95% CI [1.02-3.1]), and >50% visualization of both TMs (aOR 9.6, 95% CI [5.6-16.7]). Trainee confidence in performing otoscopy, diagnosing ear infections, and educational satisfaction increased significantly post-rotation (table). Of all trainees, 65 (97%) and 57 (85%) agreed that VO was superior as both a teaching and a diagnostic tool, respectively.
Conclusion(s): Using a VO eliminated the need for a repeat exam in 75% of patients and was reported to be a superior teaching and diagnostic tool compared to CO.
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