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[Reliability of the diagnosis of acute otitis media by general practitioners]
J-M Legros1, H Hitoto, F Garnier
1Département Universitaire de Santé Publique, CHU d'Angers, 49933 Angers cedex 09, France.
Insights
General Practitioners (GPs) showed moderate reliability in diagnosing Acute Otitis Media (AOM), with a significant overdiagnosis rate. Improved training in otoscopy techniques could enhance diagnostic accuracy for AOM.
Area of Science:
- Otolaryngology
- Primary Care Medicine
- Diagnostic Accuracy
Context:
- Acute Otitis Media (AOM) is a common childhood infection.
- Accurate diagnosis by General Practitioners (GPs) is crucial for appropriate treatment.
- Variability in diagnostic skills may impact patient outcomes.
Purpose:
- To evaluate the reliability of AOM diagnoses made by GPs.
- To compare GP diagnoses against Otorhinolaryngologist (ORL) reference diagnoses.
- To identify factors influencing diagnostic accuracy in AOM.
Summary:
- GPs diagnosed AOM with certainty in 54% of cases, with ORLs confirming GP diagnoses in 83.8% of cases.
- A significant overdiagnosis rate of 21.9% was observed, particularly when otoscopy was hindered by cerumen or inflammation alone.
- Key otoscopic findings like redness and bulge were associated with higher confirmation rates.
Impact:
- Findings highlight the need for enhanced postgraduate training for GPs in AOM diagnosis.
- Recommendations include improved cerumen removal techniques and the use of pneumatic otoscopy.
- Improving diagnostic quality can lead to more appropriate AOM management and reduce unnecessary antibiotic use.
Objectives:
To assess reliability of the diagnosis of Acute Otitis Media (AOM) given by General Practitioners (GPs) compared with the diagnosis of Otorhinolaryngologists (ORLs) considered as the reference diagnosis.
Methodology:
Every GP had to include 6 children aged 1 to 4 years for whom he suspected or diagnosed AOM. Parents had to accept to consult the ORL participating in the survey within 48 h.
Results:
24 GPs took part in the survey and included at least 1 child, which amounts to a final 57% acceptability rate. Two hundred and eight eardrums were included in the survey. 21.9% of assumptions or diagnosis of AOM (30/137) were declared null by the ORL. GPs diagnose AOM with certainty only in 54% of all cases. The diagnosis and the assumption of AOM were respectively confirmed in 83.8% of all cases and 71.4% by the ORL. The combination of redness and bulge and isolated redness accounted for respectively 44.3% and 26.2% of the main otoscopical factors reminiscent of the AOM according to GPs. In the case of redness plus bulge, the diagnosis was confirmed in 83% of all cases by the ORL as opposed to 75% regarding the isolated redness. AOM was suspected in 57.1% of the eardrums little or not visible with no sign of infection and was not confirmed in 25% of all cases.
Conclusion:
The global overdiagnosis was 21.9% and 25% when the otoscopy is hindered by the presence of cerumen or when the eardrums show inflammation alone. Even though the overdiagnosis was lower than the reported one in literature, post-graduate teaching on the various cerumen removal techniques and the use of pneumatic otoscopy should contribute to improve the quality of diagnosing AOM.
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