Scott Karen E, Kim David Y, Wang Lu, Kane Steven A, Coki Osode, Starren Justin, Flynn John T, Chiang Michael F
Department of Ophthalmology, Division of Neonatology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Ophthalmology. 2008 Jul;115(7):1222-1228.e3. doi: 10.1016/j.ophtha.2007.09.006. Epub 2008 May 23.
To evaluate the intraphysician agreement between ophthalmoscopic examination and image-based telemedical interpretation for retinopathy of prematurity (ROP) diagnosis, when performed by the same expert physician grader.
Prospective, nonrandomized, comparative study.
Sixty-seven consecutive premature infants who underwent ROP examination at a major university medical center whose parents consented for participation.
Infants underwent standard dilated ophthalmoscopy by one of two pediatric ophthalmologists, followed by retinal imaging with a commercially available wide-angle fundus camera by a trained neonatal nurse. Study examinations were performed at 31 to 33 weeks postmenstrual age (PMA) and/or 35 to 37 weeks PMA. Images were uploaded to a Web-based telemedicine system developed by the authors. After a 4- to 12-month period, telemedical interpretations were performed in which each physician graded images from infants upon whom he had initially performed ophthalmoscopic examinations. Diagnoses were classified using an ordinal scale: no ROP, mild ROP, type 2 prethreshold ROP, and treatment-requiring ROP.
Absolute intraphysician agreement and kappa statistic between ophthalmoscopic examination and telemedical interpretation were calculated by eye. All intraphysician discrepancies were reviewed, and underlying causes were classified by eye as no ROP identified by ophthalmoscopic examination, no ROP identified by telemedical interpretation, discrepancy about presence of zone 1 ROP, discrepancy about presence of plus disease, or other discrepancy in classification of ROP stage.
Absolute intraphysician agreement between ophthalmoscopic examination and telemedical interpretation was 86.3%. The kappa statistic for intraphysician agreement between examinations ranged from 0.657 (substantial agreement) for diagnosis of treatment-requiring ROP to 0.854 (near-perfect agreement) for diagnosis of mild or worse ROP. Among 206 eye examinations (103 infant examinations), there were 28 (13.6%) intraphysician discrepancies in diagnosis, 8 of which resulted from uncertainty about presence of zone 1 disease and 4 from uncertainty about presence of plus disease.
Intraphysician agreement between ophthalmoscopic examination and telemedical interpretation for ROP was very high. Neither examination modality appeared to have a systematic tendency to overdiagnose or underdiagnose ROP. Diagnosis of zone 1 disease and plus disease were major sources of clinically significant discrepancies.
评估由同一位专家医生分级者进行眼底镜检查与基于图像的远程医疗解读对早产儿视网膜病变（ROP）诊断的医生内部一致性。
前瞻性、非随机、对照研究。
在一所主要大学医学中心连续67例接受ROP检查的早产儿，其父母同意参与研究。
婴儿由两名小儿眼科医生之一进行标准散瞳眼底镜检查，随后由一名经过培训的新生儿护士使用市售广角眼底相机进行视网膜成像。研究检查在孕龄（PMA）31至33周和/或PMA 35至37周时进行。图像上传至作者开发的基于网络的远程医疗系统。在4至12个月后进行远程医疗解读，每位医生对其最初进行过眼底镜检查的婴儿的图像进行分级。诊断采用有序量表分类：无ROP、轻度ROP、2型阈值前ROP和需要治疗的ROP。
计算眼底镜检查与远程医疗解读之间的医生内部绝对一致性和kappa统计量。对所有医生内部的差异进行审查，并按眼睛将潜在原因分类为眼底镜检查未发现ROP、远程医疗解读未发现ROP、关于1区ROP存在的差异、关于附加病变存在的差异或ROP分期分类中的其他差异。
眼底镜检查与远程医疗解读之间的医生内部绝对一致性为86.3%。检查之间医生内部一致性的kappa统计量范围从诊断需要治疗的ROP时的0.657（高度一致）到诊断轻度或更严重ROP时的0.854（几乎完全一致）。在206次眼科检查（103例婴儿检查）中，有28例（13.6%）医生内部诊断差异，其中8例是由于对1区疾病存在的不确定性，4例是由于对附加病变存在的不确定性。
眼底镜检查与远程医疗解读对ROP的医生内部一致性非常高。两种检查方式均未表现出对ROP过度诊断或诊断不足的系统倾向。1区疾病和附加病变的诊断是具有临床意义差异的主要来源。
