Richards John R, Gaylor Kelsey A, Pilgrim Ashley J
Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA.
Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA.
Am J Emerg Med. 2015 Aug;33(8):1089-92. doi: 10.1016/j.ajem.2015.04.063. Epub 2015 May 2.
Acute otitis media (AOM) is a common diagnosis under age 5 years. The primary objective was to determine if the CellScope Oto (CSO) improves tympanic membrane (TM) visualization and diagnostic precision compared to traditional otoscope. The secondary objective was to determine physician, patient, and parent device preference.
This is a prospective cross-sectional study of patients younger than 18 years presenting with ear pain, fever, or upper respiratory infection symptoms. Patients were examined by a resident then attending physician with a traditional wall-mounted otoscope followed by CSO. Each was blinded to the other's findings. Intrarater and interrater diagnostic agreement was compared. Physicians, parents, and patients were surveyed regarding their experience.
A total of 51 patients completed the study. There was substantial intrarater agreement between traditional otoscope and CSO for residents: right ear (κ = 0.74) and left ear (κ = 0.74); CSO use changed reported view for 16 of 102 TM examinations (16%), of which 7 (7%) had clinically relevant change in diagnosis to/from AOM. There was substantial to almost-perfect agreement for attending physicians: right: (κ = 0.86) and left (κ = 0.79); CSO use changed reported view for 12 (12%), with 6 (6%) clinically relevant. Resident/attending physician interrater agreement was moderate for both traditional otoscope (κ = 0.40) and CSO (κ = 0.47). Physicians agreed CSO was easy to use, enhanced TM visualization and diagnostic precision, and was a good teaching tool. Patients and parents also found the CSO images very helpful.
CellScope Oto was preferred by physicians, patients, and parents. Use of the CSO changed final diagnosis a significant number of times, including clinically relevant changes to/from AOM.
急性中耳炎（AOM）是5岁以下儿童的常见诊断疾病。主要目的是确定与传统耳镜相比，CellScope Oto（CSO）是否能改善鼓膜（TM）可视化及诊断准确性。次要目的是确定医生、患者及家长对该设备的偏好。
这是一项针对18岁以下出现耳痛、发热或上呼吸道感染症状患者的前瞻性横断面研究。患者先由住院医师检查，然后主治医生用传统壁挂式耳镜检查，最后使用CSO检查。双方对彼此的检查结果均不知情。比较了同一评估者内部及不同评估者之间的诊断一致性。对医生、家长和患者就其使用体验进行了调查。
共有51名患者完成了研究。住院医师使用传统耳镜和CSO时，同一评估者内部在右耳（κ = 0.74）和左耳（κ = 0.74）方面有高度一致性；在102次TM检查中有16次（16%）使用CSO改变了报告的观察结果，其中7次（7%）在AOM的诊断上有临床相关的改变。主治医生在右耳（κ = 0.86）和左耳（κ = 0.79）方面有高度至几乎完美的一致性；使用CSO改变报告观察结果的有12次（12%），其中6次（6%）有临床相关性。住院医师/主治医生之间，传统耳镜（κ = 0.40）和CSO（κ = 0.47）的不同评估者一致性为中等。医生们一致认为CSO易于使用，增强了TM可视化和诊断准确性，且是一个很好的教学工具。患者和家长也觉得CSO图像非常有帮助。
医生、患者和家长都更青睐CellScope Oto。CSO的使用多次改变了最终诊断，包括与AOM相关的临床相关改变。
