Kilgore Katelyn M, Beer Emma N, Adams Jason K, Scalo Julieta F, Kilgore Aaron J, Marinelli John P, Erbele Isaac D, Dowling Glenn A, Esquivel Carlos R, Spear Samuel A
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Department of Otolaryngology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
Mil Med. 2024 May 18;189(5-6):e1036-e1044. doi: 10.1093/milmed/usad400.
The Department of Defense Medical Examination Review Board (DoDMERB) plays a pivotal role in the assessment of medical fitness for aspiring military officers. A crucial component of this process is the screening audiogram, designed to evaluate hearing capabilities. However, recent observations of high disqualification rates following screening audiograms led to concerns about their accuracy.
This quality improvement project, conducted between 2017 and 2019, aimed to assess the concordance between screening audiograms and reference-standard audiometry, as well as to investigate the relationship between disqualification status and hearing thresholds at different frequencies. A sample of 134 candidates, drawn from various locations across the United States, was analyzed.
Results revealed that the screening audiogram mean thresholds were twice that of the reference-standard audiogram, particularly in the lower frequencies. Additionally, we found that 84% of candidates were incorrectly disqualified by the screening exam when followed up by the reference-standard. Overall, Bland-Altman analysis revealed significant disagreement between these two tests. This discrepancy prompted a fundamental policy shift in 2020, where candidates who fail screening audiograms now automatically undergo reference-standard audiometry before any disqualification decision. This policy change reflects the commitment of DoDMERB to refining the medical screening process. It reduces the burden on candidates, provides a more comprehensive assessment, and ensures that qualified individuals are not erroneously disqualified.In addition to policy changes, this quality improvement project explored potential courses of action to enhance the screening audiogram process. Among these, improving contract specifications for testing facilities to minimize ambient noise emerged as the most practical and cost-effective approach.
In conclusion, the project underscores the importance of refining medical screening processes to accurately assess candidates' qualifications while retaining the utility of screening audiograms. These efforts not only benefit aspiring military officers but also contribute to maintaining the high standards required for military service.
美国国防部医学检查复审委员会（DoDMERB）在评估有抱负的军官的医学适应性方面发挥着关键作用。这一过程的一个关键组成部分是筛查听力图，旨在评估听力能力。然而，最近观察到筛查听力图后的高 disqualification 率引发了对其准确性的担忧。
这个在2017年至2019年期间进行的质量改进项目，旨在评估筛查听力图与参考标准听力测定之间的一致性，以及调查 disqualification 状态与不同频率听力阈值之间的关系。对从美国各地抽取的134名候选人的样本进行了分析。
结果显示，筛查听力图的平均阈值是参考标准听力图的两倍，特别是在低频段。此外，我们发现，在参考标准进行后续检查时，84% 的候选人被筛查考试错误地 disqualification。总体而言，Bland-Altman 分析显示这两种测试之间存在显著差异。这种差异促使在2020年进行了一项根本性的政策转变，即现在筛查听力图不合格的候选人在做出任何 disqualification 决定之前会自动接受参考标准听力测定。这一政策变化反映了 DoDMERB 对完善医学筛查过程的承诺。它减轻了候选人的负担，提供了更全面的评估，并确保合格人员不会被错误地 disqualification。除了政策变化之外，这个质量改进项目还探索了改善筛查听力图过程的潜在行动方案。其中，改善测试设施的合同规格以尽量减少环境噪音是最实际且最具成本效益的方法。
总之，该项目强调了完善医学筛查过程以准确评估候选人资格同时保留筛查听力图效用的重要性。这些努力不仅有利于有抱负的军官，也有助于维持军事服务所需的高标准。
