Visual reinforcement audiometry and its association with neonatal hearing screening and the offer of speech therapists, services and equipment.

The study used state-level data, so it cannot explain individual patient reasons for missing appointments or specific local barriers. The health information systems used may have underreported or missed data, and the records did not specify the age at which VRA was performed, making it hard to confirm if the test was used for the correct age group (5-24 months). The analysis did not account for children who might have accessed private healthcare, potentially skewing the public system rates.

The authors declared no financial support and no conflicts of interest.

Do not assume that hiring more speech therapists or buying more VRA equipment will automatically increase the number of children diagnosed. The study found no correlation between these resources and VRA rates, suggesting that other factors, such as referral pathways or clinical protocols, are the primary bottlenecks.