Article record

疑似急性中耳炎的诊断准确性与管理：一项使用鼓膜图像进行临床病例分析的多大陆初级保健医生调查

Diagnostic accuracy and management of suspected acute otitis media: A multi-continental survey of primary care physicians using tympanic membrane images in clinical cases.

临床研究耳科IF 2.8Q2

文献信息

PMID	42726662
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Ida Lindman 查看其他 22 位作者 Lisa Ahlstrand；Thorbjörn Lundberg；Anna Moberg；Karin Mossberg；Lidia Caballero；Clare Heal；Samuel Coenen；Ingrid Picard；Hanna Kaduszkiewicz；Catharina Escales；Julia Hansmann-Wiest；Noirin Fitzgerald；Tomoko Ito；Guro Haugen Fossum；Anja Maria Braend；Owen Eales；Sanele Ngcobo；Carl Llor；Oliver Van Hecke；Mark Ebell；Ronny Gunnarsson；Pär-Daniel Sundvall
作者单位	Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden. 查看其他 18 条单位信息 General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.；Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.；Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.；San Miguel Primary Health Care Center, Posadas, Public Health Ministry of Misiones, Misiones, Argentina.；College of Medicine and Dentistry, James Cook University, Queensland, Australia.；Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium.；Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.；Institute of General Practice, Kiel University, Kiel, Germany.；Department of General Practice, School of Medicine, University of Galway, Galway, Ireland.；Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.；General Practice Research Unit, Department of General Practice, University of Oslo, Oslo, Norway.；Department of Family Medicine, School of Medicine, University of Pretoria, Pretoria, South Africa.；Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.；CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.；Centre for General Practice, Department of Public Health and Primary care, Ghent University, Ghent, Belgium.；Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA.；Centre for Antibiotic Resistance Research (CARe) at University of Gothenburg, Gothenburg, Sweden.；College of Medicine and Dentistry, James Cook University, Cairns, Australia.
期刊	The European journal of general practice
SCI 分区	Q2
IF	2.8
研究类型	临床研究 · 临床
所属专科	耳科

中文摘要

背景： 急性中耳炎（AOM）是儿童初级保健就诊和抗生素处方的主要原因。诊断不确定性和管理上的差异导致误诊和不恰当的抗生素使用。
目的： 本研究通过临床病例探讨不同国家的初级保健医生如何诊断和管理疑似AOM。
方法： 采用结构化临床病例和经过验证的鼓膜图像进行国际横断面调查。该调查在12个国家（阿根廷、澳大利亚、比利时、德国、爱尔兰、日本、挪威、南非、西班牙、瑞典、英国和美国）的初级保健医生专业会议期间进行。
结果： 共有1，365名初级保健医生参与。在所有对AOM病例的回答中，60%被正确诊断为AOM，而在涉及正常鼓膜的回答中，仅31%被正确识别。抗生素处方在不同国家之间以及不同病例之间存在显著差异。多变量回归分析显示，诊断准确性是抗生素处方的显著预测因素。正确识别正常鼓膜的医生开具抗生素的可能性显著更低（p < 0.001）。各国之间的处方模式存在明显差异。
结论： 初级保健医生对疑似AOM的诊断准确性普遍较低，且各国之间差异很大。即使不存在AOM，也经常开具抗生素。这凸显了改进诊断教育以减少全球不必要抗生素使用的必要性。

英文摘要

BACKGROUND: Acute otitis media (AOM) is a leading cause of primary care visits and antibiotic prescriptions in children. Diagnostic uncertainty and variability in management contribute to misdiagnosis and inappropriate antibiotic use.
OBJECTIVE: This study examines how primary care physicians across countries diagnose and manage suspected AOM through clinical cases.
METHODS: International cross-sectional survey using structured clinical cases with validated tympanic membrane images. The survey was administered during professional meetings for primary care physicians in 12 countries (Argentina, Australia, Belgium, Germany, Ireland, Japan, Norway, South Africa, Spain, Sweden, United Kingdom, and the United States).
RESULTS: A total of 1,365 primary care physicians participated. Across all responses to AOM cases, 60% were correctly diagnosed as AOM, while only 31% of responses involving a normal tympanic membrane were correctly identified. Antibiotic prescribing varied substantially across countries and between cases. Multivariable regression analyses showed that diagnostic accuracy was a significant predictor of antibiotic prescribing. Physicians who correctly identified a normal tympanic membrane were significantly less likely to prescribe antibiotics (p < 0.001). Notable differences in prescribing patterns were evident between countries.
CONCLUSION: Diagnostic accuracy for suspected AOM was generally low among primary care physicians, with wide variation across countries. Antibiotics were frequently prescribed even in the absence of AOM. This underscores the need for improved diagnostic education to reduce unnecessary antibiotic use globally.