University of Sydney, Sydney, NSW
Sydney School of Public Health, University of Sydney, NSW.
Med J Aust. 2018 Jun 2;209(1):29-35. doi: 10.5694/mja18.00249.
To determine the degree of agreement of diagnoses by audiologists and otolaryngologists of otitis media (OM) in Aboriginal children.
Cross-sectional study of agreement between diagnoses.
Study of Environment on Aboriginal Resilience and Child Health (SEARCH), a prospective cohort study of Aboriginal children attending four Aboriginal Community Controlled Health Services in New South Wales (three metropolitan, one regional) during 2008-2012.
1310 of 1669 SEARCH participants (78.5%; mean age, 7.0 years; SD, 4.4 years) were assessed and received a diagnosis from one of five experienced audiologists. Test results (but not case histories) were forwarded to one of three otolaryngologists for blinded independent assessment.
Agreement of OM diagnoses by audiologists and otolaryngologists at ear and child levels; correctness of audiologist diagnoses (otolaryngologist diagnosis as reference).
Paired diagnoses by audiologists and otolaryngologists were available for 863 children at the child level and 1775 ears (989 children) at the ear level. Otolaryngologists diagnosed OM in 251 children (29.1%), including 11 (1.3%) with tympanic membrane perforation, and in 396 ears (22.3%), including 12 (0.7%) with perforation. Agreement between audiologists and otolaryngologists for OM at the ear level was 92.2% (κ = 0.78; 95% CI, 0.74-0.82), and at the child level 91.7% (κ = 0.81; 95% CI, 0.77-0.85). No otolaryngologist-diagnosed perforation was missed by audiologists. Among 1000 children triaged by an audiologist, there would be 45 false positives and 30 false negatives when compared with assessments by an otolaryngologist, with no missed perforations.
There was substantial agreement between audiologists' and otolaryngologists' diagnoses of OM in a high prevalence population of Aboriginal children. In settings with limited access to otolaryngologists, audiologists may appropriately triage children and select those requiring specialist review.
确定听力学家和耳鼻喉科医生对原住民儿童中耳炎（OM）诊断的一致性程度。
诊断一致性的横断面研究。
原住民适应环境与儿童健康研究（SEARCH），这是一项对新南威尔士州 2008 年至 2012 年间 4 家原住民社区控制的健康服务机构就诊的原住民儿童进行的前瞻性队列研究。
SEARCH 参与者共 1669 名，其中 1310 名（78.5%；平均年龄 7.0 岁，标准差 4.4 岁）接受了 5 位经验丰富的听力学家之一的评估和诊断。测试结果（但无病史）被转发给 3 位耳鼻喉科医生之一进行盲法独立评估。
听力学家和耳鼻喉科医生在儿童和耳部水平上 OM 诊断的一致性；听力学家诊断的正确性（以耳鼻喉科医生的诊断为参照）。
在儿童水平上，听力学家和耳鼻喉科医生的配对诊断可用于 863 名儿童，在耳部水平上可用于 1775 只耳朵（989 名儿童）。耳鼻喉科医生诊断 251 名儿童（29.1%）患有 OM，其中 11 名（1.3%）患有鼓膜穿孔，396 只耳朵（22.3%）患有穿孔，其中 12 只（0.7%）患有穿孔。耳部水平上听力学家和耳鼻喉科医生对 OM 的一致性为 92.2%（κ=0.78；95%CI，0.74-0.82），儿童水平上为 91.7%（κ=0.81；95%CI，0.77-0.85）。听力学家没有漏诊任何耳鼻喉科医生诊断的穿孔。在通过听力学家分诊的 1000 名儿童中，与耳鼻喉科医生的评估相比，有 45 例假阳性和 30 例假阴性，无漏诊穿孔。
在原住民儿童高患病率人群中，听力学家和耳鼻喉科医生对 OM 的诊断具有很大程度的一致性。在耳鼻喉科医生就诊机会有限的情况下，听力学家可以适当对儿童进行分诊，并选择需要专家审查的儿童。
