Department of Ophthalmology and Visual Sciences, Toronto, Canada.
Br J Ophthalmol. 2011 Dec;95(12):1719-22. doi: 10.1136/bjophthalmol-2011-300248. Epub 2011 Oct 8.
Retinal haemorrhages are an important finding in children with abusive and accidental head trauma. There are no standardised and validated protocols to describe them in a consistent manner. The aim of this web-based study was to establish the reliability and validity of a new retinal haemorrhage description tool.
Our tool is a comprehensive questionnaire, which is applied using a retinal schematic that divides the retina into four independent zones. Four independent observers scored retinal haemorrhages from 80 retinal photographs. Inter- and intra-rater agreement (by repeat assessment of 10 photographs for each examiner) were calculated using Fleiss κ statistics.
A high inter-rater agreement was noted for haemorrhages in the peripapillary zones, whereas agreement was only fair for all other zones. Intra-rater agreement was high only for the posterior pole. Photographs may be an unreliable way of documenting retinal haemorrhages particularly from the peripheral retina, thus underscoring the importance of a thorough clinical examination.
This study shows that the tool achieves some validity for describing haemorrhages in the posterior retina. It performs less well in the peripheral zones.
视网膜出血是儿童虐待和意外头部外伤的重要发现。目前尚无标准化和经过验证的方案来一致地描述这些出血。本网络研究的目的是建立一种新的视网膜出血描述工具的可靠性和有效性。
我们的工具是一个综合问卷，使用视网膜示意图进行应用，该示意图将视网膜分为四个独立区域。四名独立观察者对 80 张视网膜照片中的视网膜出血进行评分。使用 Fleiss κ 统计计算观察者间和观察者内的一致性（每位观察者重复评估 10 张照片）。
在视盘周围区域，观察者间的出血一致性很高，而对于所有其他区域，一致性仅为中等。只有后极的观察者内一致性较高。照片可能是一种不可靠的记录视网膜出血的方法，特别是来自周边视网膜的出血，因此强调了彻底的临床检查的重要性。
本研究表明，该工具在描述后极视网膜出血方面具有一定的有效性。它在周边区域的表现较差。
