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远程医疗评估早产儿急性期视网膜病变研究中诊断性临床检查结果与数字图像相应评估之间的差异分析。

Analysis of Discrepancy Between Diagnostic Clinical Examination Findings and Corresponding Evaluation of Digital Images in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study.

作者信息

Quinn Graham E, Ells Anna, Capone Antonio, Hubbard G Baker, Daniel Ebenezer, Hildebrand P Lloyd, Ying Gui-Shuang

机构信息

Department of Ophthalmology, University of Pennsylvania, Philadelphia2Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Department of Ophthalmology, University of Calgary, Calgary, Alberta, Canada.

出版信息

JAMA Ophthalmol. 2016 Nov 1;134(11):1263-1270. doi: 10.1001/jamaophthalmol.2016.3502.

Abstract

IMPORTANCE

As effective treatments for potentially blinding retinopathy of prematurity (ROP) have been introduced, the importance of consistency in findings has increased, especially with the shift toward retinal imaging in infants at risk of ROP.

OBJECTIVE

To characterize discrepancies in findings of ROP between digital retinal image grading and examination results from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity study, conducted from May 2011 to October 2013.

DESIGN, SETTING, AND PARTICIPANTS: A poststudy consensus review of images was conducted by 4 experts, who examined discrepancies in findings between image grades by trained nonphysician readers and physician examination results in infants with referral-warranted ROP (RW-ROP). Images were obtained from 13 North American neonatal intensive care units from eyes of infants with birth weights less than 1251 g. For discrepancy categories with more than 100 cases, 40 were randomly selected; in total, 188 image sets were reviewed.

MAIN OUTCOMES AND MEASURES

Consensus evaluation of discrepant image and examination findings for RW-ROP components.

RESULTS

Among 5350 image set pairs, there were 161 instances in which image grading did not detect RW-ROP noted on clinical examination (G-/E+) and 854 instances in which grading noted RW-ROP when the examination did not (G+/E-). Among the sample of G-/E+ cases, 18 of 32 reviews (56.3%) agreed with clinical examination findings that ROP was present in zone I and 18 of 40 (45.0%) agreed stage 3 ROP was present, but only 1 of 20 (5.0%) agreed plus disease was present. Among the sample of G+/E- cases, 36 of 40 reviews (90.0%) agreed with readers that zone I ROP was present, 23 of 40 (57.5%) agreed with readers that stage 3 ROP was present, and 4 of 16 (25.0%) agreed that plus disease was present. Based on the consensus review results of the sampled cases, we estimated that review would agree with clinical examination findings in 46.5% of the 161 G-/E+ cases (95% CI, 41.6-51.6) and agree with trained reader grading in 70.0% of the 854 G+/E- cases (95% CI, 67.3-72.8) for the presence of RW-ROP.

CONCLUSIONS AND RELEVANCE

This report highlights limitations and strengths of both the remote evaluation of fundus images and bedside clinical examination of infants at risk for ROP. These findings highlight the need for standardized approaches as ROP telemedicine becomes more widespread.

摘要

重要性

随着针对可能导致失明的早产儿视网膜病变(ROP)的有效治疗方法的引入,研究结果一致性的重要性日益增加,尤其是在向有ROP风险的婴儿进行视网膜成像转变的情况下。

目的

描述2011年5月至2013年10月进行的“评估早产儿急性期视网膜病变的远程医疗方法”研究中,数字视网膜图像分级与检查结果之间ROP研究结果的差异。

设计、设置和参与者:4位专家对图像进行了研究后共识审查,他们检查了经过培训的非医生读者对图像的分级与有转诊指征的ROP(RW-ROP)婴儿的医生检查结果之间的差异。图像取自北美13个新生儿重症监护病房中出生体重小于1251g的婴儿的眼睛。对于病例数超过100的差异类别,随机选择40例;总共审查了188套图像。

主要结局和指标

对RW-ROP各组成部分的差异图像和检查结果进行共识评估。

结果

在5350对图像集中,有161例图像分级未检测到临床检查中发现的RW-ROP(G-/E+),854例分级发现了RW-ROP而检查未发现(G+/E-)。在G-/E+病例样本中,32份审查中有18份(56.3%)同意临床检查结果,即I区存在ROP,40份中有18份(45.0%)同意存在3期ROP,但20份中只有1份(5.0%)同意存在附加病变。在G+/E-病例样本中,40份审查中有36份(90.0%)同意读者的意见,即I区存在ROP,40份中有23份(57.5%)同意读者的意见,即存在3期ROP,16份中有4份(25.0%)同意存在附加病变。根据抽样病例的共识审查结果,我们估计在161例G-/E+病例中,46.5%(95%CI,41.6 - 51.6)的审查结果将与临床检查结果一致,在854例G+/E-病例中,70.0%(95%CI,67.3 - 72.8)的审查结果将与经过培训的读者分级一致,即存在RW-ROP。

结论和意义

本报告强调了对ROP风险婴儿进行眼底图像远程评估和床边临床检查的局限性和优势。这些发现凸显了随着ROP远程医疗的更广泛应用,需要标准化方法。

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