Diagnostic Accuracy of Otitis Media and Tympanocentesis Skills Assessment Among Pediatricians

Abstract

The comparative study presented here evaluated pediatricians from Italy, Greece, South Africa, and a reference group in the USA to determine (i) their ability to accurately diagnose acute otitis media (AOM) and otitis media with effusion (OME) using otoscopy, (ii) their knowledge of antibiotics, and (iii) their technical competence in performing tympanocentesis. The participants included 66 pediatricians from Italy, 115 from Greece, 36 from South Africa and 2,190 from the USA (reference group). Each pediatrician viewed nine video-recorded otoscopic examinations of tympanic membranes, after which their ability to differentiate AOM, OME and normal was ascertained. Questions were posed regarding appropriate, pathogen-directed antibiotic selection for AOM. A mannequin model was used to assess the technical proficiency of each pediatrician in performing tympanocentesis. Results were recorded for each group as the mean percentage ± standard deviation. The correct diagnosis was made by each group of pediatricians in the following frequencies: Italy, 54±27% (range, 18–94%); Greece, 36±12% (range, 23–56%); South Africa, 53±21% (range, 22–88%); and the USA, 51±11% (range, 29–72%). The difference between results from Greece and the US reference group was statistically significant (P=0.002). Pediatricians from each group over-diagnosed AOM with the following frequencies: Italy, 18±19% (range, 2–49%); Greece, 34±13% (8–50%); South Africa, 23±14% (7–44%); and the US reference group, 26±19% (7–51%). Pediatricians correctly selected an antibiotic recommended for treatment of AOM caused by drug-resistant Streptococcus pneumoniae as follows: Italy, 89%; Greece, 77%; South Africa, 82%; and the USA, 80%. For treatment of beta-lactamase-producing Haemophilus influenzae, the results were: Italy, 90%; Greece, 70%; South Africa, 81%; and the USA, 77%. Tympanocentesis was optimally performed by ≥86% of all pediatricians. The results indicate that pediatricians may often misdiagnose OME as AOM, but they select appropriate antibiotics about 80% of the time and can be trained to accurately perform tympanocentesis.