From the Division of Emergency Medicine, UnityPoint Health-Blank Children's Hospital, Des Moines, IA.
Division of Emergency Medicine, Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital.
Pediatr Emerg Care. 2024 Apr 1;40(4):274-278. doi: 10.1097/PEC.0000000000002988. Epub 2023 Jun 11.
Performing pediatric otoscopy can be difficult secondary to patient compliance, which potentiates misdiagnosis and inaccurate treatment of acute otitis media. This study used a convenience sample to assess the feasibility of using a video otoscope for the examination of tympanic membranes in children presenting to a pediatric emergency department.
We obtained otoscopic videos using the JEDMED Horus + HD Video Otoscope. Participants were randomized to video or standard otoscopy, and a physician completed their bilateral ear examinations. In the video group, physicians reviewed otoscope videos with the patient's caregiver. The caregiver and physician completed separate surveys using a 5-point Likert Scale regarding perceptions of the otoscopic examination. A second physician reviewed each otoscopic video.
We enrolled 213 participants in 2 groups (standard otoscopy, n = 94; video otoscopy, n = 119). We used Wilcoxon rank sum, Fisher exact test, and descriptive statistics to compare results across groups. For physicians, there were no statistically significant differences between groups with ease of device use, quality of otoscopic view, or diagnosis. There was moderate agreement between physician video otoscopic view satisfaction and slight agreement between physician video otologic diagnosis. Estimates of length of time to complete the ear examinations were longer more often for the video otoscope compared with standard for both caregivers (OR, 2.00; 95% confidence interval, 1.10-3.70; P = 0.02) and physicians (OR, 3.08; 95% confidence interval, 1.67-5.78; P < 0.01). There were no statistically significant differences between video and standard otoscopy with regard to caregiver perception of comfort, cooperation, satisfaction, or diagnosis understanding.
Caregivers perceive that video otoscopy and standard otoscopy are comparable in comfort, cooperation, examination satisfaction, and diagnosis understanding. Physicians made a wider range of more subtle diagnoses with the video otoscope. However, examination length of time may limit the JEDMED Horus + HD Video Otoscope's feasibility in a busy pediatric emergency department.
由于患儿配合度不佳，小儿耳镜检查可能较为困难，这增加了急性中耳炎误诊和治疗不当的风险。本研究采用便利抽样法，评估了在儿科急诊就诊的患儿中使用视频耳镜检查鼓膜的可行性。
我们使用 JEDMED Horus + HD 视频耳镜获取耳镜视频。参与者被随机分为视频耳镜组或标准耳镜组，由一名医生完成双侧耳朵检查。在视频组中，医生与患儿的照顾者一起查看耳镜视频。照顾者和医生分别使用 5 分制 Likert 量表对他们对耳镜检查的看法进行独立评估。然后，由第二位医生查看每一个视频耳镜。
我们将 213 名参与者分为 2 组（标准耳镜组，n = 94；视频耳镜组，n = 119）。我们使用 Wilcoxon 秩和检验、Fisher 确切检验和描述性统计分析比较了两组之间的结果。对于医生而言，在设备使用的便利性、耳镜检查的视野质量或诊断方面，两组之间没有统计学上的显著差异。医生对视频耳镜检查满意度的评估存在中度一致性，而对视频耳科学诊断的评估则存在轻度一致性。与标准耳镜相比，视频耳镜检查完成时间往往更长，照顾者（比值比，2.00；95%置信区间，1.10-3.70；P = 0.02）和医生（比值比，3.08；95%置信区间，1.67-5.78；P < 0.01）都如此。在照顾者对舒适度、配合度、检查满意度和诊断理解的看法方面，视频耳镜和标准耳镜之间没有统计学上的显著差异。
照顾者认为视频耳镜和标准耳镜在舒适度、配合度、检查满意度和诊断理解方面相似。与标准耳镜相比，医生使用视频耳镜能做出更多更细微的诊断。然而，检查时间可能限制了 JEDMED Horus + HD 视频耳镜在繁忙的儿科急诊中的可行性。
