Folino Francesco, Caruso Marco, Bosi Pietro, Aldè Mirko, Torretta Sara, Marchisio Paola
Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Via F. Sforza 35, 20122, Milano, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Ital J Pediatr. 2024 Jan 25;50(1):19. doi: 10.1186/s13052-024-01588-y.
Diagnosis of acute otitis media (AOM) in children can be challenging, given that symptoms are often non-specific or absent, and that the direct observation of the tympanic membrane in its entirety through otoscopy can sometimes be difficult. The aim of this study is to assess the diagnostic concordance in detection of AOM episodes between primary care paediatricians and physicians especially trained in paediatric otoscopy, and to characterize the most misleading elements in diagnostic failure.
Consecutive clinical charts of children regularly followed for recurrent AOM (RAOM, i.e.: >3 episodes in 6 months or > 4 episodes in 1 year) at our Otitis Media paediatric outpatient clinic were retrospectively screened, in order to collect any diagnosis of AOM episode (and the related clinical findings/middle ear complaints) performed by primary care paediatricians/emergency room paediatricians. Diagnosis of AOM episode was validated by the same experienced physician (FF) in case of otoscopic relief of a bulging eardrum with at least one of the following: hyperaemia or yellow-like colour. The diagnostic concordance in detection of AOM episodes between primary care/emergency room paediatricians and our internal validator was expressed as the percentage of matching diagnosis.
One hundred and thirty-four single AOM episodes occurring in 87 children (mean age: 26.9 +/- 18.9 months) were included in the analysis. Diagnostic concordance in detection of AOM episodes between primary care/emergency room paediatricians and our internal validator was reported in 72.4% of cases. The most common pitfall found in our study was the misleading diagnosis of AOM in case of hyperaemic tympanic membrane without bulging (32/37 out of non-validated diagnoses).
AOM diagnosis still represents a relevant issue among paediatricians in our country, and the presence of tympanic membrane hyperaemia without concomitant bulging can be confusing.
儿童急性中耳炎（AOM）的诊断具有挑战性，因为症状往往不具特异性或不存在，而且有时通过耳镜完整观察鼓膜会有困难。本研究的目的是评估基层儿科医生与接受过儿科耳镜检查专门培训的医生在检测AOM发作方面的诊断一致性，并确定诊断失败中最具误导性的因素。
回顾性筛查了在我们的中耳炎儿科门诊定期随访复发性AOM（即：6个月内发作>3次或1年内发作>4次）的儿童的连续临床病历，以收集基层儿科医生/急诊室儿科医生对AOM发作的任何诊断（以及相关临床发现/中耳症状）。如果耳镜检查发现鼓膜膨出且伴有以下至少一项：充血或类似黄色，则由同一位经验丰富的医生（FF）对AOM发作的诊断进行验证。基层/急诊室儿科医生与我们的内部验证者在检测AOM发作方面的诊断一致性以匹配诊断的百分比表示。
分析纳入了87名儿童（平均年龄：26.9±18.9个月）中发生的134次单次AOM发作。基层/急诊室儿科医生与我们的内部验证者在检测AOM发作方面的诊断一致性在72.4%的病例中得到报告。我们研究中发现的最常见陷阱是鼓膜充血但无膨出时对AOM的误导性诊断（37例未经验证的诊断中有32例）。
在我国，AOM诊断仍是儿科医生面临的一个重要问题，鼓膜充血但无膨出可能会造成混淆。
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