Daniel Ebenezer, Pan Wei, Quinn Graham E, Smith Eli, Baumritter Agnieshka, Ying Gui-Shuang
Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
J AAPOS. 2018 Feb;22(1):32-37. doi: 10.1016/j.jaapos.2017.09.005. Epub 2017 Dec 20.
To evaluate the sensitivity and specificity of single, independent, nonphysician trained reader (TR) gradings in the Telemedicine Approaches to Evaluating Acute-phase Retinopathy of Prematurity (e-ROP) study.
Secondary analyses of image grading results from 1,235 infants of birth weights <1251 g. Two of three TRs independently graded image sets; discrepancies were adjudicated by the reading center director (an ophthalmologist) to reach final grading. Sensitivity and specificity of each TR grading and final grading was calculated by comparing gradings to clinical examination results.
Of 7,808 double graded image sets, TR1 graded 5,165; TR2, 3,787; and TR3, 6,664. Compared to final grading for referral warranted retinopathy of prematurity (RW-ROP), two TRs had relatively lower sensitivity (TR1, 75% vs 79% [P = 0.03]; TR2, 73% vs 77% [P = 0.02]) and specificity (TR1, 80% vs 83% [P < 0.001]; TR2, 82% vs 83% [P = 0.09]). TR3 had similar sensitivity (83% vs 83% [P = 0.78]) and specificity (83% vs 84% [P = 0.02]). Compared to final grading, TR1 had lower sensitivity for zone I ROP (47% vs 56% [P = 0.04]) and stage ≥3 ROP (71% vs 77% [P = 0.002]); TR2 had lower sensitivity for stage ≥3 ROP (69% vs 77% [P < 0.001]) and lower specificity for all three components (P < 0.001); TR3 had lower sensitivity for detecting plus disease (23% vs 35% [P < 0.001]) and similar sensitivity for zone I ROP and stage ≥3 ROP.
There is a small but significant decrease in the sensitivity and specificity for RW-ROP when single-reader grading is compared to double adjudicated grading.
在远程医疗评估早产儿急性期视网膜病变（e-ROP）研究中，评估未经医师培训的单一独立阅片者（TR）分级的敏感性和特异性。
对1235例出生体重<1251g婴儿的图像分级结果进行二次分析。三名TR阅片者中的两名独立对图像集进行分级；分歧由阅片中心主任（一名眼科医生）裁决以得出最终分级。通过将分级结果与临床检查结果进行比较，计算每个TR分级和最终分级的敏感性和特异性。
在7808组双份分级图像集中，TR1分级5165组；TR2分级3787组；TR3分级6664组。与最终分级相比，对于需要转诊的早产儿视网膜病变（RW-ROP），两名TR阅片者的敏感性相对较低（TR1，75%对79%[P = 0.03]；TR2，73%对77%[P = 0.02]），特异性也较低（TR1，80%对83%[P < 0.001]；TR2，82%对83%[P = 0.09]）。TR3的敏感性（83%对83%[P = 0.78]）和特异性（83%对84%[P = 0.02]）相似。与最终分级相比，TR1对I区ROP的敏感性较低（47%对56%[P = 0.04]），对≥3期ROP的敏感性也较低（71%对77%[P = 0.002]）；TR2对≥3期ROP的敏感性较低（69%对77%[P < 0.001]），对所有三个组成部分的特异性均较低（P < 0.001）；TR3对plus病的检测敏感性较低（23%对35%[P < 0.001]），对I区ROP和≥3期ROP的敏感性相似。
与双份裁决分级相比，单阅片者分级对RW-ROP的敏感性和特异性有小幅但显著的降低。
