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Haemophilus influenzae Infections

PEDIATRICS Vol. 110 No. 6 December 2002, pp. 1064-1070

Diagnostic Accuracy, Tympanocentesis Training Performance, and Antibiotic Selection by Pediatric Residents in Management of Otitis Media

Michael E. Pichichero, MD

From the Elmwood Pediatric Group, University of Rochester Medical Center, Rochester, New York

--> Objective. To assess the accuracy of pediatric residents in recognizing the physical examination findings of acute otitis media (AOM) and otitis media with effusion (OME), technical competence to perform tympanocentesis, and knowledge of guideline-recommended antibiotic management of AOM.

Methods. A total of 383 pediatric residents from various programs in the United States viewed 9 different video-recorded pneumatic otoscopic examinations of tympanic membranes during a continuing medical education course. The ability to differentiate AOM, OME, and normal was ascertained. A mannequin of a child was used to assess technical proficiency of performing tympanocentesis on artificial tympanic membranes. A series of questions was posed regarding appropriate, pathogen-directed, second-line antibiotic selection for AOM.

Results. The average ± standard deviation correct diagnosis on the otoscopic video examination was 41% ± 16% (range: 19%–70%; median: 38%) by pediatric residents, tympanocentesis was optimally performed by 89%, and appropriate antibiotic therapy for drug-resistant Streptococcus pneumoniae was selected by 78% and appropriate therapy for ß-lactamase-producing Haemophilus influenzae was selected by 74%.

Conclusions. According to this video-based examination, pediatric residents misdiagnose OME frequently. Pediatric residents have the skills to be trained to perform tympanocentesis. Approximately 75% of pediatric residents have knowledge of the appropriate antibiotics to select for treatment of resistant AOM pathogens. Interactive instruction with simulation technology may enhance skills and lead to improved diagnostic accuracy and treatment paradigms.

Key Words: otitis media • antibiotics • medical education • tympanocentesis

Abbreviations: OM, otitis media • AOM, acute otitis media • OME, otitis media with effusion • CME, continuing medical education • CDC, Centers for Disease Control and Prevention • TM, tympanic membrane • SD, standard deviation • CI, confidence interval

Received for publication Apr 22, 2002; Accepted Jul 2, 2002.




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