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Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
reducing false positives in newborn hearing screening program: how and why
Hung-Ching Lin1, Min-Tsan Shu, Kuo-Sheng Lee
1Department of Otolaryngology, Hearing & Speech Center, Mackay Memorial Hospital, Taipei, Taiwan. hclin59@ms29.hinet.net
Insights
The one-step automated auditory brainstem response (AABR) protocol significantly reduced referral rates in newborn hearing screening compared to transient evoked otoacoustic emissions (TEOAE) or combined TEOAE/AABR. This AABR approach also proved most cost-effective, minimizing parental anxiety.
Area of Science:
- Audiology
- Neonatal Care
- Public Health
Background:
- Newborn hearing screening is crucial for early detection of congenital hearing loss.
- Transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) are common screening tools.
- Optimizing screening protocols balances efficacy, cost, and parental experience.
Purpose of the Study:
- To compare the effectiveness and cost-efficiency of three newborn hearing screening protocols.
- Protocols evaluated: one-step TEOAE, two-step TEOAE + AABR, and one-step AABR.
- To determine the most cost-effective protocol with minimal false positives.
Main Methods:
- A retrospective study of 25,588 healthy newborns screened between 1998 and 2006.
- Screening groups: TEOAE alone (n=18,260), TEOAE + AABR (n=3,540), and AABR alone (n=3,788).
- Data collected on referral rates, accurate identification of hearing loss, and direct/intangible costs.
Main Results:
- The one-step AABR protocol achieved a significantly lower referral rate (0.8%) compared to TEOAE + AABR (1.6%) and TEOAE alone (5.8%).
- Accurate identification rates for congenital hearing loss were not significantly different across protocols (0.42% AABR, 0.25% TEOAE+AABR, 0.45% TEOAE).
- Total costs per screening were lowest for AABR ($7.33), followed by TEOAE + AABR ($8.60), and TEOAE alone ($10.04), with reduced parental anxiety in the AABR group.
Conclusions:
- One-step AABR is a highly effective protocol for newborn hearing screening, significantly reducing referral rates.
- No significant difference in the accurate detection of congenital hearing loss was observed between the protocols.
- The AABR protocol offers the lowest overall cost, including reduced expenditures and intangible costs associated with fewer false positives.
Objective:
To compare the initial referral rate, the accurate identification rate of congenital hearing loss, and the cost between one step with transient evoked otoacoustic emissions (TEOAEs), two steps with TEOAE and automated auditory brainstem response (AABR), and one step with AABR in newborn hearing screening program. The aim of this study is to compare their efficacy between our three different protocols and to see which one is most cost-effective.
Study Design:
From November 1998 to April 2006, 25,588 healthy newborns were screened for hearing loss in Mackay Memorial Hospital, Taipei. In the periods from November 1998 to January 2004, from February 2004 to February 2005, and from March 2005 to April 2006, the screening tools used were TEOAE alone (n = 18,260), TEOAE plus AABR (n = 3,540), and AABR (n = 3,788), respectively.
Results:
A statistically significant decrease in referral rate was achieved in the group using AABR as screening tools when compared with TEOAE plus AABR and TEOAE alone (0.8 versus 1.6 versus 5.8%). The accurate identification rate of congenital hearing loss was 0.42% in AABR protocol, 0.25% in TEOAE and AABR protocol, and 0.45% in TEOAE protocol, which was not statistically significant. The total direct costs (including predischarge screening and postdischarge follow-up costs) per screening were US $10.04 for the program using TEOAE alone, US $8.60 for TEOAE plus AABR, and US $7.33 for AABR. The intangible cost (parental anxiety) was much higher in the earlier program due to higher referral rate.
Conclusion:
In the efficacy of the hearing screening program using the one-step TEOAE, two-step TEOAE and AABR, and one-step AABR programs, the latter significantly decreased the referral rate from 5.8, to 1.6, and to 0.8%. No significant difference was noted between their accurate identification rates of congenital hearing loss. The total costs, including expenditures and intangible cost, were much lower in the protocol with AABR due to reduction in false positives.
