American Journal of Otolaryngology最新文献

Objective: There is currently a paucity of literature detailing the socioeconomic implications on management and outcomes of pediatric subglottic stenosis. Through this study, we sought to ascertain whether disparities of social determinants of health did have a discernible impact on management of subglottic stenosis through endoscopic versus open procedures and whether there would be a difference in outcomes.

Study design: The study is a multi- institutional, academic center, retrospective case series.

Methods: The study examines pediatric patients under the age of 18 evaluated by Ochsner-affiliated hospitals through May 2012 to May 2022 with the diagnosis of subglottic stenosis, acquired or congenital, through Epic SlicerDicer search engine. Patients were stratified into low and high socioeconomic status (SES), which served as independent variables, using principal component analysis of several social determinants. We recorded sex, age, ethnicity, and completion of college education. Interventions reviewed included endoscopic treatment, open airway surgery, and presence of tracheostomy. Outcome measurements included decannulation, time to decannulation, and death. Chi squared analysis was performed on dichotomous variables and student t-test was performed for continuous variables.

Results: The groups were similar in demographics: sex, age, ethnicity, and proportion with college degree. Cotton Meyer grade was significantly higher in low SES compared to high SES (p = 0.04). Patients of low SES were significantly more likely to die (p < 0.001). Low SES patients were more likely to have an acquired rather than a congenital subglottic stenosis as compared to their high SES counterparts (p = 0.02). Low SES patients were also more likely to undergo endoscopic intervention (p = 0.03). There was no statistically significant difference in tracheostomy status or decannulation success between the two groups.

Conclusion: There were statistically significant findings between low and high SES groups. Overall, patients of low SES appeared to have greater severity of subglottic stenosis, with greater number of endoscopic interventions, and greater mortality. This study which collected data from an area with marginalized patients with poor health literacy, demonstrates that sociodemographic factors contribute to disparate intervention and outcomes in pediatric patients with subglottic stenosis.

Background: Low health literacy among patients hinders comprehension of care instructions and worsens outcomes, yet most otolaryngology patient materials and chatbot responses to medical inquiries exceed the recommended reading level of sixth- to eighth-grade. Whether chatbots can be pre-programmed to provide accurate, plain-language responses has yet to be studied. This study aims to compare response readability of a GPT model customized for plain language with GPT-4 when answering common otolaryngology patient questions.

Methods: A custom GPT was created and provided thirty-three questions from Polat et al. (Int J Pediatr Otorhinolaryngol., 2024), and their GPT-4 answers were reused with permission. Questions were grouped by theme. Readability was calculated with Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) via online calculator. A board-certified, practicing otolaryngologist assessed content similarity and accuracy. The primary outcome was readability, measured by FKGL (0-18; equivalent to United States grade level) and FRE (0-100; higher scores indicate greater readability).

Results: The custom GPT reduced FKGL by an average of 4.2 grade levels (95 % confidence interval [CI]: 3.2, 5.1; p < 0.001) and increased FRE by an average of 17.3 points (95 % CI: 12.5, 21.7; p < 0.001). Improvements remained significant in three of four theme subgroups (p < 0.05). Readability was consistent across question types, and variances were equal between models. Expert review confirmed overall accuracy and content similarity.

Conclusion: Preprogramming a custom GPT to generate plain-language instructions yields outputs that meet Centers for Medicare & Medicaid Services readability targets without significantly compromising content quality. Tailored chatbots could enhance patient communication in otolaryngology clinics and other medical settings.