Ear, Nose and Throat (ENT) disease diagnostic error in low-resource health care: Observations from a hospital-based cross-sectional study

Abstract

Although the global burden of ear, nose and throat (ENT) diseases is high, data relating to ENT disease epidemiology and diagnostic error in resource-limited settings remain scarce. We conducted a retrospective cross-sectional review of ENT patients’ clinical records at a resource-limited tertiary hospital. We determined the diagnostic accuracy and appropriateness of patient referrals for ENT specialist care using descriptive statistics. Cohens kappa coefficient (κ) was calculated to determine the diagnostic agreement between non-ENT clinicians and the ENT specialist, and logistic regression applied to establish the likelihood of patient misdiagnosis by non-ENT clinicians. Of the 1543 patients studied [age 0–87 years, mean age 25(21) years (mean(SD)], non-ENT clinicians misdiagnosed 67.4% and inappropriately referred 50.4%. Compared to those aged 0–5 years, patients aged 51–87 years were 1.77 (95%CI: 1.03–3.04) fold more likely to have a referral misdiagnosis for specialist care. Patients with ear (aOR: 1.63; 95% CI: 1.14–2.33) and those with sinonasal diseases (aOR: 1.80; 95% CI: 1.14–2.45) had greater likelihood of referral misdiagnosis than those with head and neck diseases. Agreement in diagnosis between the ENT specialist and non-ENT clinicians was poor (κ = 0.0001). More effective, accelerated training of clinicians may improve diagnostic accuracy in low-resource settings.

Antibiotics Prescriptions in the Otolaryngology Department of the Departmental and Teaching Hospital of Borgou-Alibori in 2020

“…Acute otitis media accounted for 45.6% of otological cases, while sinusitis accounted for 56% of rhino-sinus infections. This observation has been made in other studies, making AOM the most frequent otological infection, leading to over 20 million antibiotic prescriptions annually [5,[8][9][10]. Delays in patient consultation and inadequate management in peripheral centers are among the causes of the high proportion of suppurative otitis observed.…”

Analysis of Ear, Nose, Throat and Head & Neck Surgery Consultations and Diagnostic Accuracy in a Tertiary Care Hospital of Western Nepal

“…diagnoses). Similarly, Lukama L et al11 in their study concluded 67.4% (n = 916) of all referral diagnoses did not match the ENT specialists with most (36.5%, n = 333) of the misdiagnosed patients had sinonasal diseases and the least (26.2%, n = 239) had ear diseases. Whereas in our study we found 44 different consultation reasons and 39 different diagnoses with Throat pain 45(11.25%).…”

Applications and challenges of neural networks in otolaryngology (Review)

“…In addition, the most common disability internationally was disabling hearing impairment (8). ENT diseases treated at health facilities constitute 20-50% of the cases, with an incidence of diagnostic error varying 0.7-15% in developed countries (9) ENT surgical sub-specialties are also evolving, where risk awareness is increasing for specialists becoming deskilled in the case of certain emergencies (10). Apart from surgical interventions, other diagnostic aspects are also of importance, such as rhinology, phoniatrics, laryngology and audiology (7).…”