Diagnostic and management plan concordance across advanced audiologists, paediatric audiologists and non-specialist ENT doctors

Abstract

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.

Keywords:

• Video-otoscopy
• diagnosis
• management
• concordance
• ENT
• Audiology

Ethical approval

Ethical clearance was provided by the Metro-South Human Research Ethics Committee within Queensland Health (HREC/13/QPAH/688) and the University of Queensland Human Research Ethics Committee.

Disclosure statement

No potential conflict of interest was reported by the author(s).