Pediatric residents' clinical diagnostic accuracy of otitis media.
OBJECTIVE: Pediatric resident physicians' clinical diagnostic accuracy of otitis media is unknown. We attempted to correlate the clinical examination of pediatric house staff with pediatric otolaryngologists and tympanometry. METHODS: Pediatric residents evaluated patients who were scheduled in the pediatric acute care clinic and completed a provider examination form detailing their otoscopic findings, interpretation, and treatment plan. Patients were then immediately reevaluated by a pediatric otolaryngologist using an identical form. Tympanometry was also performed by a pediatric audiologist. We used kappa statistics to calculate correlation of clinical findings and interpretation. RESULTS: A total of 103 patients consented for the study; 70 patients were examined by 27 different pediatric residents with 43 patients (86 ears) examined by all 3 providers. Correlation of clinical findings between all pediatric residents and the pediatric otolaryngologists was a kappa statistic of 0.30 (fair agreement). The individual diagnostic finding with the greatest correlation was tympanic membrane erythema (kappa statistic: 0.40 [fair agreement]), and the worst correlate was tympanic membrane position (kappa statistic: 0.16 [slight agreement]). Resident interpretation and tympanometry yielded a kappa statistic of 0.20 (slight agreement), and the otolaryngologist interpretation and tympanometry yielded a kappa statistic of 0.32 (fair agreement). CONCLUSIONS: Otitis media is the most common disease seen by practicing general pediatricians, but there is a paucity of formalized resident education. We demonstrated only a slight to moderate correlation between the clinical diagnostic examinations of pediatric residents and pediatric otolaryngologists and tympanometry.
Steinbach, WJ; Sectish, TC; Benjamin, DK; Chang, KW; Messner, AH
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