González-Vallejo C, Sorum P C, Stewart T R, Chessare J B, Mumpower J L
Psychology Department, Ohio University, Athens 45701, USA.
Med Decis Making. 1998 Apr-Jun;18(2):149-62. doi: 10.1177/0272989X9801800203.
Physicians' diagnoses of acute otitis media (AOM) and their treatment choices were investigated using judgment and decision-making analyses. Thirty-two pediatricians in the Albany, New York, area provided probability judgments of the presence of AOM and made treatment decisions for 32 patient vignettes, each described in terms of historical and examination variables. Their probability judgments were well predicted by linear combinations of the patient variables (R2s ranged from 0.76 to 0.97). Information about the observed condition of the eardrum proved to be most critical to the physicians' diagnoses. They demonstrated good levels of agreement on diagnoses. They varied, however, in their tendencies to treat with amoxicillin rather than another antibiotic. Case vagueness was related to the rate of antibiotic treatment. The rate of antibiotic treatment was higher for vague than for non-vague cases when the mean judged probability of AOM was low. In combination, the findings highlight the importance of performing and interpreting ear examinations and the role that consistent training may have in improving management of AOM.
通过判断和决策分析，对医生对急性中耳炎（AOM）的诊断及其治疗选择进行了调查。纽约州奥尔巴尼地区的32名儿科医生对AOM的存在提供了概率判断，并针对32个患者病例做出了治疗决策，每个病例均根据病史和检查变量进行描述。患者变量的线性组合能够很好地预测他们的概率判断（R²范围为0.76至0.97）。事实证明，有关鼓膜观察状况的信息对医生的诊断最为关键。他们在诊断上表现出较高的一致性。然而，他们在使用阿莫西林而非其他抗生素进行治疗的倾向上存在差异。病例的模糊性与抗生素治疗率相关。当AOM的平均判断概率较低时，模糊病例的抗生素治疗率高于非模糊病例。综合来看，这些发现突出了进行耳部检查和解读的重要性，以及持续培训在改善AOM管理方面可能发挥的作用。
