Pichichero M E
Elmwood Pediatric Group, University of Rochester Medical Center, 601 Elmwood Avenue, Box 672, NY 14642, Rochester, USA.
Eur J Clin Microbiol Infect Dis. 2003 Sep;22(9):519-24. doi: 10.1007/s10096-003-0981-8. Epub 2003 Aug 21.
The comparative study presented here evaluated pediatricians from Italy, Greece, South Africa, and a reference group in the USA to determine (i) their ability to accurately diagnose acute otitis media (AOM) and otitis media with effusion (OME) using otoscopy, (ii) their knowledge of antibiotics, and (iii) their technical competence in performing tympanocentesis. The participants included 66 pediatricians from Italy, 115 from Greece, 36 from South Africa and 2,190 from the USA (reference group). Each pediatrician viewed nine video-recorded otoscopic examinations of tympanic membranes, after which their ability to differentiate AOM, OME and normal was ascertained. Questions were posed regarding appropriate, pathogen-directed antibiotic selection for AOM. A mannequin model was used to assess the technical proficiency of each pediatrician in performing tympanocentesis. Results were recorded for each group as the mean percentage +/- standard deviation. The correct diagnosis was made by each group of pediatricians in the following frequencies: Italy, 54+/-27% (range, 18-94%); Greece, 36+/-12% (range, 23-56%); South Africa, 53+/-21% (range, 22-88%); and the USA, 51+/-11% (range, 29-72%). The difference between results from Greece and the US reference group was statistically significant ( P=0.002). Pediatricians from each group over-diagnosed AOM with the following frequencies: Italy, 18+/-19% (range, 2-49%); Greece, 34+/-13% (8-50%); South Africa, 23+/-14% (7-44%); and the US reference group, 26+/-19% (7-51%). Pediatricians correctly selected an antibiotic recommended for treatment of AOM caused by drug-resistant Streptococcus pneumoniae as follows: Italy, 89%; Greece, 77%; South Africa, 82%; and the USA, 80%. For treatment of beta-lactamase-producing Haemophilus influenzae, the results were: Italy, 90%; Greece, 70%; South Africa, 81%; and the USA, 77%. Tympanocentesis was optimally performed by >/=86% of all pediatricians. The results indicate that pediatricians may often misdiagnose OME as AOM, but they select appropriate antibiotics about 80% of the time and can be trained to accurately perform tympanocentesis.
本文呈现的对比研究对来自意大利、希腊、南非的儿科医生以及美国的一个参照组进行了评估，以确定：（i）他们使用耳镜准确诊断急性中耳炎（AOM）和中耳积液（OME）的能力；（ii）他们对抗生素的了解；（iii）他们进行鼓膜穿刺术的技术能力。参与者包括66名来自意大利的儿科医生、115名来自希腊的儿科医生、36名来自南非的儿科医生以及2190名来自美国的儿科医生（参照组）。每位儿科医生观看了9段鼓膜的耳镜检查视频记录，之后确定他们区分AOM、OME和正常情况的能力。针对AOM提出了关于恰当的、针对病原体的抗生素选择的问题。使用人体模型评估每位儿科医生进行鼓膜穿刺术的技术熟练程度。将每组结果记录为平均百分比±标准差。每组儿科医生做出正确诊断的频率如下：意大利，54±27%（范围为18 - 94%）；希腊，36±12%（范围为23 - 56%）；南非，53±21%（范围为22 - 88%）；美国，51±11%（范围为29 - 72%）。希腊和美国参照组的结果差异具有统计学意义（P = 0.002）。每组儿科医生对AOM的过度诊断频率如下：意大利，18±19%（范围为2 - 49%）；希腊，34±13%（8 - 50%）；南非，23±14%（7 - 44%）；美国参照组，26±19%（7 - 51%）。儿科医生正确选择推荐用于治疗耐多药肺炎链球菌引起的AOM的抗生素的比例如下：意大利，89%；希腊，77%；南非，82%；美国，80%。对于治疗产β-内酰胺酶的流感嗜血杆菌，结果如下：意大利，90%；希腊，70%；南非，81%；美国，77%。所有儿科医生中≥86%能以最佳方式进行鼓膜穿刺术。结果表明，儿科医生可能经常将OME误诊为AOM，但他们大约80%的情况下能选择恰当的抗生素，并且可以通过培训准确地进行鼓膜穿刺术。
