Gibney K B, Morris P S, Carapetis J R, Skull S A, Leach A J
Department of Medicine, Royal Darwin Hospital, Darwin, Australia.
J Paediatr Child Health. 2003 Sep-Oct;39(7):540-2. doi: 10.1046/j.1440-1754.2003.00210.x.
Severe otitis media and its sequelae are common in rural and remote Aboriginal children. Identification of acute otitis media (AOM) is likely to reduce the number of children who go on to develop chronic suppurative otitis media and associated complications. The aim of this study was to compare the diagnoses made by researchers with that documented in the medical records of children admitted to the paediatric isolation ward of the Royal Darwin Hospital, Darwin, Northern Territory.
Children aged <8 years admitted to Royal Darwin Hospital were eligible for assessment by pneumatic otoscopy, video-otoscopy and tympanometry. A diagnosis was made for each child according to the state of their worst ear. Comparisons were made between the researcher diagnoses of ear disease and those documented in the hospital notes by medical staff.
Thirty-one children were enrolled during 32 admissions. Most were aged <2 years, Aboriginal, and resided in remote communities. Sixty-one video-otoscopic assessments were attempted and sufficiently good images to allow diagnosis were obtained in 105 of 122 ears. Acute otitis media was diagnosed by the research team in 20 of 32 child admissions. Of 29 children who had ear examinations documented by hospital staff, only seven had a diagnosis of AOM recorded. Overall, the research team were almost three times more likely to make this diagnosis (relative risk 2.9, 95% confidence interval 1.6, 5.2). This difference was unlikely to have occurred by chance (P = 0.0002, McNemar's Chi-squared test).
In this small study, young Aboriginal children with clear bulging of their tympanic membrane were not diagnosed with AOM by medical staff. Further training in diagnosis, including cleaning of the ear canal, may lead to more accurate assessment and appropriate recommendations for ongoing management.
严重中耳炎及其后遗症在农村和偏远地区的原住民儿童中很常见。识别急性中耳炎（AOM）可能会减少发展为慢性化脓性中耳炎及相关并发症的儿童数量。本研究的目的是比较研究人员做出的诊断与北领地达尔文市皇家达尔文医院儿科隔离病房收治儿童的病历记录中的诊断。
入住皇家达尔文医院的8岁以下儿童有资格接受鼓气耳镜检查、视频耳镜检查和鼓室图检查。根据每个孩子最差耳朵的状况做出诊断。比较研究人员对耳部疾病的诊断与医务人员在医院记录中记录的诊断。
在32次住院期间共纳入31名儿童。大多数儿童年龄小于2岁，为原住民，居住在偏远社区。共尝试了61次视频耳镜评估，122只耳朵中有105只获得了足以进行诊断的良好图像。研究团队在32例儿童住院病例中诊断出20例急性中耳炎。在医院工作人员记录了耳部检查的29名儿童中，只有7名记录有急性中耳炎的诊断。总体而言，研究团队做出该诊断的可能性几乎是医务人员的三倍（相对风险2.9，95%置信区间1.6，5.2）。这种差异不太可能是偶然发生的（P = 0.0002，McNemar卡方检验）。
在这项小型研究中，鼓膜明显膨出的年轻原住民儿童未被医务人员诊断为急性中耳炎。包括耳道清洁在内的诊断方面的进一步培训可能会带来更准确的评估以及对后续管理的适当建议。
