Biagio Leigh, Swanepoel De Wet, Laurent Claude, Lundberg Thorbjörn
Department of Communication Pathology, University of Pretoria, South Africa
Department of Communication Pathology, University of Pretoria, South Africa Ear Sciences Centre, School of Surgery, University of Western Australia, Nedlands, Australia Ear Science Institute Australia, Subiaco, Australia.
J Telemed Telecare. 2014 Sep;20(6):300-6. doi: 10.1177/1357633X14541038. Epub 2014 Jun 23.
We studied the diagnoses made by an otologist and general practitioner (GP) from video-otoscopy recordings on children made by a telehealth facilitator. The gold standard was otomicroscopy by an experienced otologist. A total of 140 children (mean age 6.4 years; 44% female) were recruited from a primary health care clinic. Otomicroscopic examination was performed by an otologist. Video-otoscopy recordings were assigned random numbers and stored on a server. Four and eight weeks later, an otologist and a GP independently graded and made a diagnosis from each video recording. The otologist rated the quality of the video-otoscopy recordings as acceptable or better in 87% of cases. A diagnosis could not be made from the video-otoscopy recordings in 18% of ears in which successful onsite otomicroscopy was conducted. There was substantial agreement between diagnoses made from video-otoscopy recordings and those from onsite otomicroscopy (first review: otologist κ = 0.70 and GP κ = 0.68; second review: otologist κ = 0.74 and GP κ = 0.75). There was also substantial inter-rater agreement (κ = 0.74 and 0.74 at the two reviews) and intra-rater agreement (κ = 0.77 and 0.74 for otologist and GP, respectively). A telehealth facilitator, with limited training, can acquire video-otoscopy recordings in children for asynchronous diagnosis. Remote diagnosis was similar to face-to-face diagnosis in inter- and intra-rater variability.
我们研究了耳科医生和全科医生（GP）根据远程医疗协调员为儿童拍摄的视频耳镜检查记录所做出的诊断。金标准是由经验丰富的耳科医生进行耳显微镜检查。从一家初级医疗保健诊所招募了总共140名儿童（平均年龄6.4岁；44%为女性）。由一名耳科医生进行耳显微镜检查。视频耳镜检查记录被赋予随机数字并存储在服务器上。四周和八周后，一名耳科医生和一名全科医生分别对每个视频记录进行分级并做出诊断。耳科医生将87%的视频耳镜检查记录质量评为可接受或更好。在成功进行现场耳显微镜检查的耳朵中，18%的耳朵无法根据视频耳镜检查记录做出诊断。视频耳镜检查记录做出的诊断与现场耳显微镜检查做出的诊断之间存在高度一致性（首次评估：耳科医生κ = 0.70，全科医生κ = 0.68；第二次评估：耳科医生κ = 0.74，全科医生κ = 0.75）。评分者间也存在高度一致性（两次评估时κ分别为0.74和0.74）以及评分者内一致性（耳科医生和全科医生的κ分别为0.77和0.74）。经过有限培训的远程医疗协调员可以获取儿童的视频耳镜检查记录用于异步诊断。在评分者间和评分者内变异性方面，远程诊断与面对面诊断相似。
