Maurrasse Sarah E, Li Carol, Modi Vikash K
Department of Otolaryngology-Head & Neck Surgery, Division of Pediatric Otolaryngology- Head & Neck Surgery, Weill Cornell Medicine, New York, NY, USA.
Department of Otolaryngology-Head & Neck Surgery, Division of Pediatric Otolaryngology- Head & Neck Surgery, Weill Cornell Medicine, New York, NY, USA.
Int J Pediatr Otorhinolaryngol. 2020 Feb;129:109740. doi: 10.1016/j.ijporl.2019.109740. Epub 2019 Oct 30.
Our objectives were to evaluate the ability of residents to diagnose pathology of the pediatric larynx on laryngoscopy, to trend this ability throughout training, to compare their skills to pediatric otolaryngologists, and to determine whether reviewing digitally captured videos in slow motion, as opposed to a live exam, enhanced diagnostic abilities. In addition, we identified pathologies and anatomical sub-sites that posed diagnostic challenges.
Qualtrics was used to design and distribute an online test, which included 15 pediatric laryngoscopy videos. Participants selected a diagnosis for each video after (1) watching it once at full speed and (2) watching the video multiple times in slow motion. Anonymous responses were exported into excel for statistical analysis, including T-test, ANOVA, and descriptive statistics.
There were 21 total participants. Median scores for full speed versus slow motion video review were 47% and 60% respectively. When analyzed by training level, there was no significant difference in scores for full speed videos, but there was a significant difference across groups for slow motion review (p = 0.04). Post Graduate Year (PGY) 4 residents and pediatric otolaryngologists performed best with an average of 69% and 77% respectively. Base of tongue, subglottic, and laryngeal cleft lesions were the most difficult to diagnose. Motor, laryngeal, and vallecular pathologies were more accurately identified.
The ability to diagnose pathology on pediatric laryngoscopy tends to improve throughout residency training. Slow motion review enhances diagnostic skills. Laryngeal and vallecular pathologies are more easily diagnosed than base of tongue and subglottic lesions.
我们的目的是评估住院医师在喉镜检查中诊断小儿喉部病变的能力，追踪其在整个培训过程中的这种能力变化，将他们的技能与小儿耳鼻喉科医生进行比较，并确定与现场检查相比，慢动作查看数字采集视频是否能提高诊断能力。此外，我们还确定了构成诊断挑战的病变和解剖亚部位。
使用Qualtrics设计并分发一项在线测试，其中包括15个小儿喉镜检查视频。参与者在（1）全速观看一次视频后和（2）多次慢动作观看视频后，为每个视频选择一个诊断。匿名回复被导出到Excel中进行统计分析，包括T检验、方差分析和描述性统计。
共有21名参与者。全速与慢动作视频查看的中位数得分分别为47%和60%。按培训水平分析时，全速视频的得分无显著差异，但慢动作查看在各组之间存在显著差异（p = 0.04）。四年级住院医师（PGY4）和小儿耳鼻喉科医生表现最佳，平均分别为69%和77%。舌根、声门下和喉裂病变最难诊断。运动、喉部和会厌谷病变的识别更准确。
小儿喉镜检查中诊断病变的能力在住院医师培训过程中往往会提高。慢动作查看可提高诊断技能。喉部与会厌谷病变比舌根和声门下病变更容易诊断。
