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Donna R. Halloran, MD, MSPH; Terry C. Wall, MD, MPH; H. Hughes Evans, MD, PhD; J. Michael Hardin, PhD; Audie L. Woolley, MD

Arch Pediatr Adolesc Med. 2005;159:949-955.

Objectives  To determine hearing screening failure rates in primary care settings and to examine the referral practices in response to an abnormal screening test.

Methods  We enrolled a convenience sample of children between 3 and 19 years of age who were undergoing hearing screening during a well-child visit. A failure was defined as missing any frequency (1000, 2000, or 4000 Hz) in either ear at 20-dB hearing level. The pediatrician made the decision of whether to refer the patient for further evaluation.

Results  Three academic and 5 private practices enrolled 1061 children. Sixty-seven children (7%) were unable to complete the screening. Of the 948 children who completed the screen, a total of 852 children (90%) passed the screening and 96 children (10%) failed. After multivariable logistic regression analysis, the only statistically significant factor predictive of a failed screen was developmental delay (P = .02). Of the 96 children who failed the hearing screening, 57 (59%) had no further evaluation, 12 (13%) were rechecked, and 27 (28%) were referred. Similar percentages were seen with children who could not be screened.

Conclusions  Although 10% of the children failed hearing screening, pediatricians neither rechecked nor referred more than half of these children. Screening that does not result in action for those failing the screening wastes resources and fails to properly identify hearing impairment in children.

Author Affiliations: Division of General Pediatrics and Adolescent Medicine, Departments of Pediatrics (Drs Halloran, Wall, and Evans) and Surgery (Dr Woolley), University of Alabama at Birmingham; and Department of Information Systems, Statistics, and Management Science, University of Alabama at Tuscaloosa (Dr Hardin). Dr Halloran is now with the Division of General Academic Pediatrics, Department of Pediatrics, Saint Louis University, St Louis, Mo.

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