Darlow Brian A, Elder Mark J, Horwood L John, Donoghue Deborah A, Henderson-Smart David J
Department of Paediatrics, University of Otago, Christchurch, New Zealand.
Clin Exp Ophthalmol. 2008 Jan-Feb;36(1):43-6. doi: 10.1111/j.1442-9071.2007.01652.x.
We aimed to indirectly assess the contribution from observer bias to between centre variability in the incidence of acute retinopathy of prematurity (ROP).
The Australian and New Zealand Neonatal Network (ANZNN) collected data on the highest stage of acute ROP in either eye in 2286 infants born at less than 29 weeks in 1998-1999 and cared for in one of 25 neonatal intensive care units (NICUs). Chi-squared analysis was used to detect differences in the proportion of stages of ROP for each neonatal intensive care unit. These proportions were compared with those reported in two large studies of treatment for ROP.
The incidence of acute ROP in the ANZNN cohort was 42% and the ratio of stage 1:2:3 ROP was 1.5:1.9:1. There was considerable variation in both the incidence of acute ROP and the proportions with stage 1:2:3 ROP between centres. A chi-squared test determined that the assignment of stages 1, 2 and 3/4 ROP was not independent of centre (chi(2)(48) = 165.2; P < 0.0001). Treatment of stage 3 ROP varied between 15% and 120%, indicating some eyes were treated at less than stage 3.
The data are highly suggestive of observer bias contributing to the observed between centre variation in the incidence of acute ROP. In neonatal intervention studies where acute ROP is an outcome it would seem important to have an accreditation process for examining ophthalmologists, and there are similar arguments for neonatal networks which collect these data.
我们旨在间接评估观察者偏倚对早产儿急性视网膜病变（ROP）发病率中心间变异性的影响。
澳大利亚和新西兰新生儿网络（ANZNN）收集了1998 - 1999年出生时孕周小于29周、在25个新生儿重症监护病房（NICU）之一接受护理的2286名婴儿单眼急性ROP最高分期的数据。采用卡方分析检测每个新生儿重症监护病房ROP分期比例的差异。将这些比例与两项关于ROP治疗的大型研究报告的比例进行比较。
ANZNN队列中急性ROP的发病率为42%，1:2:3期ROP的比例为1.5:1.9:1。中心间急性ROP的发病率以及1:2:3期ROP的比例均存在相当大的差异。卡方检验确定1、2和3/4期ROP的分配并非与中心无关（χ(2)(48) = 165.2；P < 0.0001）。3期ROP的治疗比例在15%至120%之间变化，表明有些眼睛在不到3期时就接受了治疗。
数据强烈提示观察者偏倚导致了所观察到的急性ROP发病率的中心间差异。在以急性ROP作为结局的新生儿干预研究中，对眼科检查医生进行认证过程似乎很重要，对于收集这些数据的新生儿网络也有类似的观点。
