Pichichero Michael E
Elmwood Pediatric Group, University of Rochester Medical Center, Rochester, New York 14642, USA.
Pediatrics. 2002 Dec;110(6):1064-70. doi: 10.1542/peds.110.6.1064.
To assess the accuracy of pediatric residents in recognizing the physical examination findings of acute otitis media (AOM) and otitis media with effusion (OME), technical competence to perform tympanocentesis, and knowledge of guideline-recommended antibiotic management of AOM.
A total of 383 pediatric residents from various programs in the United States viewed 9 different video-recorded pneumatic otoscopic examinations of tympanic membranes during a continuing medical education course. The ability to differentiate AOM, OME, and normal was ascertained. A mannequin of a child was used to assess technical proficiency of performing tympanocentesis on artificial tympanic membranes. A series of questions was posed regarding appropriate, pathogen-directed, second-line antibiotic selection for AOM.
The average +/- standard deviation correct diagnosis on the otoscopic video examination was 41% +/- 16% (range: 19%-70%; median: 38%) by pediatric residents, tympanocentesis was optimally performed by 89%, and appropriate antibiotic therapy for drug-resistant Streptococcus pneumoniae was selected by 78% and appropriate therapy for beta-lactamase-producing Haemophilus influenzae was selected by 74%.
According to this video-based examination, pediatric residents misdiagnose OME frequently. Pediatric residents have the skills to be trained to perform tympanocentesis. Approximately 75% of pediatric residents have knowledge of the appropriate antibiotics to select for treatment of resistant AOM pathogens. Interactive instruction with simulation technology may enhance skills and lead to improved diagnostic accuracy and treatment paradigms.
评估儿科住院医师识别急性中耳炎（AOM）和中耳积液（OME）体格检查结果的准确性、进行鼓膜穿刺术的技术能力以及对AOM指南推荐抗生素治疗的知识掌握情况。
在美国，共有383名来自不同项目的儿科住院医师在继续医学教育课程中观看了9段不同的鼓膜气耳镜检查视频录像。确定区分AOM、OME和正常情况的能力。使用儿童模型评估在人工鼓膜上进行鼓膜穿刺术的技术熟练程度。针对AOM的适当、针对病原体的二线抗生素选择提出了一系列问题。
儿科住院医师在耳镜视频检查中的平均正确诊断率为41%±16%（范围：19%-70%；中位数：38%），89%的人能最佳地进行鼓膜穿刺术，78%的人选择了针对耐药肺炎链球菌的适当抗生素治疗，74%的人选择了针对产β-内酰胺酶流感嗜血杆菌的适当治疗。
根据这项基于视频的检查，儿科住院医师经常误诊OME。儿科住院医师有接受鼓膜穿刺术培训的技能。大约75%的儿科住院医师了解治疗耐药AOM病原体时应选择的适当抗生素。采用模拟技术的交互式教学可能会提高技能并改善诊断准确性和治疗模式。
