Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
Centre of Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK.
BMJ Open. 2022 Sep 9;12(9):e059205. doi: 10.1136/bmjopen-2021-059205.
To compare the accuracy of trained level 1 diabetic retinopathy (DR) graders (nurses, endocrinologists and one general practitioner), level 2 graders (midlevel ophthalmologists) and level 3 graders (senior ophthalmologists) in Vietnam against a reference standard from the UK and assess the impact of supplementary targeted grader training.
Diagnostic test accuracy study.
Secondary care hospitals in Southern Vietnam.
DR training was delivered to Vietnamese graders in February 2018 by National Health Service (NHS) UK graders. Two-field retinal images (412 patient images) were graded by 14 trained graders in Vietnam between August and October 2018 and then regraded retrospectively by an NHS-certified reference standard UK optometrist (phase I). Further DR training based on phase I results was delivered to graders in November 2019. After training, a randomised subset of images from January to October 2020 (115 patient images) was graded by six of the original cohort (phase II). The reference grader regraded all images from phase I and II retrospectively in masked fashion.
Sensitivity was calculated at the two different time points, and χ was used to test significance.
In phase I, the sensitivity for detecting any DR for all grader groups in Vietnam was low (41.8-42.2%) and improved in phase II after additional training was delivered (51.3-87.2%). The greatest improvement was seen among level 1 graders (p<0.001), and the lowest improvement was observed among level 3 graders (p=0.326). There was a statistically significant improvement in sensitivity for detecting referable DR and referable diabetic macular oedema between all grader levels. The post-training values ranged from 40.0 to 61.5% (including ungradable images) and 55.6%-90.0% (excluding ungradable images).
This study demonstrates that targeted training interventions can improve accuracy of DR grading. These findings have important implications for improving service delivery in DR screening programmes in low-resource settings.
比较经过培训的一级糖尿病视网膜病变（DR）分级员（护士、内分泌专家和一名全科医生）、二级分级员（中级眼科医生）和三级分级员（高级眼科医生）在越南的准确性，以英国的参考标准为对照，并评估补充有针对性的分级员培训的影响。
诊断测试准确性研究。
越南的二级保健医院。
2018 年 2 月，英国国民保健署（NHS）的分级员向越南的 DR 分级员提供培训。2018 年 8 月至 10 月间，14 名经过培训的越南分级员对 412 名患者的双视野视网膜图像进行分级，然后由 NHS 认证的参考标准英国验光师进行回顾性重新分级（第一阶段）。2019 年 11 月，根据第一阶段的结果，对分级员进行了进一步的 DR 培训。培训后，从 2020 年 1 月至 10 月随机抽取的一组图像（115 名患者的图像）由最初的 6 名队列成员（第二阶段）进行分级。参考分级员以盲法对第一阶段和第二阶段的所有图像进行了回顾性重新分级。
在两个不同的时间点计算了敏感性，χ 用于检验显著性。
在第一阶段，越南所有分级员组检测任何 DR 的敏感性均较低（41.8%-42.2%），在提供额外培训后，第二阶段的敏感性提高（51.3%-87.2%）。一级分级员的改善最大（p<0.001），而三级分级员的改善最小（p=0.326）。所有分级员的参考 DR 和参考糖尿病性黄斑水肿的检测敏感性均有统计学显著提高。培训后的数值范围为 40.0%至 61.5%（包括不可分级图像）和 55.6%-90.0%（不包括不可分级图像）。
本研究表明，有针对性的培训干预可以提高 DR 分级的准确性。这些发现对改善资源匮乏环境中的 DR 筛查计划中的服务提供具有重要意义。
