Assessing Diagnostic Accuracy and Tympanocentesis Skills by Nurse Practitioners in Management of Otitis Media

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PurposeTo assess healthcare provider accuracy in rec-ognizing the physical examination findings of acute otitis media (AOM) and otitis media with effusion (OME) and technical compe-tence in performing tympanocentesis using a simulation model.Data SourcesA descriptive study of 1,271 pediatricians and 206 nurse practitioners (NPs) who viewed 9 dif-ferent video-recorded pneumatic otoscopic examinations of tympanic membranes (TMs) during a continuing medical education (CME) course. Diagnostic differentiation of AOM, OME and normal was ascertained. A mannequin model of a one-two year old child was used to assess technical proficiency of performing tympa-nocentesis on artificial tympanic membranes.ConclusionsOverall, the average correct diagnosis by all healthcare providers was 46% (range=25% to 71%); by pediatricians it was 50% (25% to 71%) and by NPs 42% (25% to 68%). Pediatricians and NPs correctly recognized the absence of normality 86% to 99% and 68% to 99% of the time; they over-diagnosed AOM in 7% to 58% (average 27%) and 10% to 65% of examinations (average 31%), respectively. Performance of tympanocentesis was optimal-ly performed by 73% of NPs.Implications for PracticeThe distinction between AOM and OME is important for antibiotic management deci-sions; tympanocentesis may be useful in diag-nosis of AOM in selected patients. Healthcare providers may misdiagnose AOM and OME with some frequency. Nurse pactitioners and pediatricians have the skills to be trained in the tympanocentesis procedure. Interactive CME courses with simulation technology may enhance skills and lead to a willingness to change and improve diagnostic accuracy and treatment paradigms.

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