Rangan Shankar, Borgstein Bernie, Lowe Janet
Department of Audiovestibular Medicine, Halliwell Health and Children's Centre, Aylesford Walk, Bolton, UK.
BMJ Open. 2012 Sep 13;2(5). doi: 10.1136/bmjopen-2012-001174. Print 2012.
The aim of this study was to obtain national data regarding adherence to national guidelines for aetiological investigations for hearing loss in children and highlight any variations in practice. Information was also collected on possible factors affecting lack of adherence.
An online questionnaire based on the national guidelines for aetiological investigations for deafness was designed.
The questionnaire was distributed to the leads of all the Newborn Hearing Screening Programme (NHSP) sites across England through the Medical Research Council Hearing & Communication Group.
The questionnaire was sent to 100 recipients; from this 52 responses were obtained.
Variability in the investigations offered for hearing loss.
There was a 52% response rate. Analysis of the responses showed that audiovestibular physicians and paediatricians in audiology were more likely than other specialists to request level 1 investigations (investigations that are recommended to be offered in all cases). Respondents from London and the North West were more likely to request level 1 investigations compared with those from other regions. In all, 14 of the 19 audiovestibular physicians and paediatricians in audiology requested level 1 investigations routinely, but only 11 of 33 from other specialties did likewise. Of the 20 respondents from London and the Northwest, 15 requested level 1 investigations routinely, whereas only 10 of the 32 respondents from the other regions did the same. The difference was statistically significant in both cases. The geographical variation was specially marked for family audiograms and MRI.
There is significant variation from the national guidelines in requesting aetiological investigations for permanent hearing impairment (PHI) in children, depending on the specialty of the clinician and the geographical region, these variations appear partly to be due to the availability of local resources but also due to lack of awareness of the importance of some investigations.
本研究旨在获取关于儿童听力损失病因调查遵循国家指南情况的全国性数据,并突出实践中的任何差异。还收集了影响未遵循指南的可能因素的信息。
基于国家耳聋病因调查指南设计了一份在线问卷。
通过医学研究理事会听力与交流小组,将问卷分发给英格兰所有新生儿听力筛查项目(NHSP)站点的负责人。
问卷发送给了100名收件人;共获得52份回复。
听力损失调查的变异性。
回复率为52%。对回复的分析表明,与其他专科医生相比,听前庭科医生和听力学儿科医生更有可能要求进行一级调查(建议在所有病例中都进行的调查)。与其他地区的受访者相比,伦敦和西北部的受访者更有可能要求进行一级调查。在19名听前庭科医生和听力学儿科医生中,有14人常规要求进行一级调查,但其他专科的33人中只有11人这样做。在伦敦和西北部的20名受访者中,有15人常规要求进行一级调查,而其他地区的32名受访者中只有10人这样做。在这两种情况下,差异均具有统计学意义。家庭听力图和MRI的地域差异尤为明显。
在对儿童永久性听力障碍(PHI)进行病因调查的要求方面,与国家指南存在显著差异,这取决于临床医生的专科和地理区域,这些差异部分似乎是由于当地资源的可用性,但也由于对一些调查重要性的认识不足。