Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University, United States of America.
Division of General Pediatrics, Department of Pediatrics, Johns Hopkins University, United States of America.
Am J Emerg Med. 2021 Aug;46:150-155. doi: 10.1016/j.ajem.2021.04.030. Epub 2021 Apr 27.
Acute otitis media is often misdiagnosed. Pediatric trainees learn otoscopy from supervisors who cannot concurrently view the eardrum. Digital, smartphone otoscopes show promise to improve the visibility and learning due to a concurrent view by trainees and supervisors. We aimed to determine whether use of digital otoscopes improved accuracy of the ear exams between medical trainees and their supervisors, compared to using traditional otoscopes. Secondarily, we evaluated whether the use of digital otoscopes reduced the number of repeat ear examinations by supervisors, changed the trainee's confidence in their exam findings, and led to differences in the rate of antibiotics prescribed.
This study was a randomized controlled trial comparing use of a digital otoscope to a traditional otoscope, in a pediatric emergency department and primary care clinic in an academic tertiary care children's center. We used a modified validated image-based grading scale to compare accuracy of the ear exam between trainees and supervisors. Surveys documented modified OMgrade scores, frequency of supervisor exams, trainee confidence on a 5-point Likert scale, and antibiotic prescriptions. Inter-rater agreement of trainees and supervisors, the number of supervisor confirmatory examinations performed, trainee confidence, and antibiotic prescription rates were evaluated.
Amongst 188 children, 375 ears were examined by 85 trainees and 22 supervisors. The digital otoscope was utilized in 92 (48.9%) exams and 96 (51.1%) used the traditional otoscope. Accuracy of ear exam findings between trainees and supervisors improved by 11.2% (95% CI: 1.5, 21.8%, p = 0.033) using the Cellscope Oto (74.8%, 95% CI: 67.3, 82.1%) compared to the traditional otoscope (63.5%, 95% CI: 56.7, 70.4%). Fewer repeat supervisor exams were performed in the digital otoscope group (27.2%) vs. the traditional otoscope group (97.9%) (p < 0.001). There was no difference in mean trainee confidence in their examination (p = 0.955) or antibiotic prescription rates when using digital versus traditional otoscopes (p = 0.071).
Utilization of a digital otoscope resulted in increased accuracy of the ear exam between trainees and supervisors, and fewer total number of examinations performed on a given child. Compared to a traditional otoscope, a digital otoscope may be a more efficient and effective diagnostic tool.
急性中耳炎常被误诊。儿科受训者从无法同时观察鼓膜的上级主管那里学习耳镜检查。由于受训者和主管可以同时查看，数字式、智能手机耳镜有望改善可见度和学习效果。我们旨在确定与使用传统耳镜相比，使用数字耳镜是否可以提高医学受训者及其主管进行耳部检查的准确性。其次，我们评估了使用数字耳镜是否可以减少主管重复进行耳部检查的次数，是否改变了受训者对其检查结果的信心，以及是否导致开具抗生素的比率有所不同。
本研究是一项在学术性三级儿童中心的儿科急诊室和初级保健诊所中比较使用数字耳镜和传统耳镜的随机对照试验。我们使用经过改良的基于图像的分级量表来比较受训者和主管之间耳部检查的准确性。调查记录了改良的 OMgrade 评分、主管检查的频率、受训者对 5 分制 Likert 量表的信心以及抗生素的处方情况。评估了受训者和主管之间的组内一致性、进行的主管确认检查次数、受训者的信心以及抗生素的处方率。
在 188 名儿童中，85 名受训者和 22 名主管检查了 375 只耳朵。在 92 次（48.9％）检查中使用了数字耳镜，在 96 次（51.1％）检查中使用了传统耳镜。使用 Cellscope Oto（74.8％，95％CI：67.3，82.1％）进行耳部检查的受训者和主管的检查结果准确性比使用传统耳镜（63.5％，95％CI：56.7，70.4％）提高了 11.2％（95％CI：1.5，21.8％，p = 0.033）。在数字耳镜组中，进行重复主管检查的次数较少（27.2％），而在传统耳镜组中，进行重复主管检查的次数较多（97.9％）（p <0.001）。使用数字耳镜与传统耳镜相比，受训者对其检查的信心（p = 0.955）或抗生素处方率（p = 0.071）没有差异。
使用数字耳镜可提高受训者和主管之间耳部检查的准确性，并减少对每个孩子进行的检查总数。与传统耳镜相比，数字耳镜可能是一种更有效和有效的诊断工具。
