Accuracy and variability in clinical predictions of speech recognition outcomes for cochlear implant users.
Valeriy Shafiro, Michael S Harris, Berenice Ramirez and 2 others
PMID 39869056WHAT IT FOUND
Clinicians were poor at predicting cochlear implant speech outcomes, with most estimates off by more than 10 percentage points.
Predictions varied widely between clinicians, and confidence did not correlate with accuracy. This suggests individualized prognostication is unreliable.
Key findings
01Most clinical predictions differed from actual six-month speech scores by more than 10 percentage points, with clinicians tending to underestimate high performers and overestimate low performers.
02There was no significant correlation between a clinician's confidence in their prediction and its accuracy.
03Individual agreement between predictions and true scores was low, with median Intraclass Correlation Coefficients between 0.110 and 0.132 across three speech tests.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study used a hypothetical online survey rather than real-time clinical interactions, so face-to-face cues and patient questions were absent. Most participants were audiologists, so findings may not fully represent speech-language pathologists or other clinicians. The 10 percentage point error margin used to define 'acceptable' prediction was arbitrary, as no clinically meaningful threshold is established. The sample size of clinicians who completed all 15 cases was small (43).
Declared interests
The authors declared no conflicts of interest. The study was approved by the Institutional Review Board at Rush University.
The easy way to misread this
Do not interpret the low accuracy of these predictions as evidence that cochlear implants are ineffective. The implants worked well for the patients; the clinicians were simply poor at guessing exactly how well they would perform on specific tests.