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Diagnostic and management plan concordance across advanced audiologists, paediatric audiologists and non-specialist
Michelle A Pokorny1, Peter R Thorne2,3, Bernard C S Whitfield4,5
1Discipline of Audiology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Insights
Advanced audiologists (AA), junior doctors (JD), and pediatric audiologists (PA) showed similar diagnostic agreement with Ear, Nose, and Throat (ENT) specialists for pediatric hearing concerns. However, AAs demonstrated superior agreement on management plans.
Area of Science:
- Audiology and Otolaryngology
- Pediatric Healthcare
- Clinical Diagnostics
Background:
- Accurate diagnosis and management of pediatric middle ear and hearing concerns are crucial for child development.
- Evaluating the concordance among different healthcare professionals in pediatric audiology is essential for optimizing patient care pathways.
Purpose of the Study:
- To compare the diagnostic and management agreement between advanced audiologists (AA), junior doctors (JD), and pediatric audiologists (PA) and an Ear, Nose, and Throat (ENT) specialist for pediatric hearing issues.
Main Methods:
- A clinical equivalence study design was employed.
- Ten online pediatric cases with video-otoscopic images and clinical findings were asynchronously reviewed by three AAs, five JDs, three PAs, and one ENT specialist.
- Kappa statistics were used to quantify agreement levels for diagnosis and management.
Main Results:
- Significant agreement with the ENT specialist was observed for diagnosis across all groups, with moderate to near-perfect levels for AAs and PAs, and moderate levels for JDs.
- For management decisions, two AAs showed substantial to near-perfect agreement, while one PA showed moderate agreement.
- Inter-rater agreement for management plans was substantial for AAs and JDs, and moderate for PAs.
Conclusions:
- Advanced audiologists, junior doctors, and pediatric audiologists exhibit comparable agreement with ENT specialists in diagnosing pediatric middle ear and hearing concerns.
- Advanced audiologists demonstrated a higher likelihood of agreeing with ENT specialists on management plans compared to junior doctors and pediatric audiologists.
Objective:
To compare the concordance of advanced audiologists (AA), junior doctors (JD) and paediatric audiologists (PA) with an Ear, Nose and Throat (ENT) specialist on the diagnosis and management of children with middle ear or hearing concerns.
Design:
A clinical equivalence (concordance) study.
Study Sample:
Three AAs, five JDs, three PAs and one ENT specialist asynchronously reported diagnoses and management plans for ten, online paediatric cases consisting of video-otoscopic images and clinical findings.
Results:
For medical diagnosis, significant agreement with the ENT specialist was observed at moderate and near-perfect levels for two AAs (k = 0.561 and 0.815), moderate levels for four JDs (k = 0.5 to 0.603) and near-perfect level for one PA (k = 0.815). For management decisions, significant agreement with the ENT specialist was observed at substantial (k = 0.636) and near-perfect (k = 0.818) levels for two AAs, and at a moderate level (k = 0.538) for one PA. Within group inter-rater agreement for management plans was substantial for AAs and JDs, and moderate for PAs.
Conclusions:
For children with middle ear disease or hearing concerns, AAs, JDs and PAs showed similar levels of agreement with an ENT specialist on diagnosis, but AAs were more likely than JDs or PAs to agree with an ENT specialist on management.
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