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PEDIATRICS Vol. 109 No. 6 June 2002, pp. 993-998

Pediatric Residents’ Clinical Diagnostic Accuracy of Otitis Media

William J. Steinbach, MD*,§, Theodore C. Sectish, MD*, Daniel K. Benjamin, Jr, MD, MPH§, Kay W. Chang, MD{ddagger} and Anna H. Messner, MD{ddagger}

* Division of General Pediatrics
{ddagger} Pediatric Otolaryngology, Stanford University School of Medicine, Stanford, California
§ Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham, North Carolina

--> 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.

Key Words: otitis media • pediatric resident • education

Abbreviations: AOM, acute otitis media • OME, otitis media with effusion • MEE, middle ear effusion • ACC, acute care clinic • PGY, postgraduate year • TM, tympanic membrane

Received for publication Oct 15, 2001; Accepted Jan 30, 2002.


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