Inter-expert and Intra-expert Agreement on the Diagnosis and Treatment of Retinopathy of Prematurity
Inter-expert and Intra-expert Agreement on the Diagnosis and Treatment of Retinopathy of Prematurity
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DOI：
10.1016/j.ajo.2015.05.016
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发表时间：
2015-09-01
影响因子：
4.2
通讯作者：
Schmidt-Erfurth, Ursula
中科院分区：
文献类型：
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作者：
Gschliesser, Andreas;Stifter, Eva;Schmidt-Erfurth, Ursula
目的：评价专家间和专家内对早产儿视网膜病变（ROP）诊断和治疗的共识。设计：前瞻性量表内和量表间信度分析。方法：在这项多中心研究中，将52例患者的260张宽视场数码照片连续2天，间隔8周提交给7位公认的ROP专家。专家被要求评估患者的ROP分期、是否存在附加疾病、是否存在侵袭性后路ROP、治疗的必要性和建议的治疗方法。用Fleiss的kappa和Cohen的kappa来测量一致性水平。结果：专家间对ROP分期（kappa = 0.24）、合并疾病（kappa = 0.32）和侵袭性后路ROP （kappa = 0.35）的共识是公平的；治疗必要性为中度（kappa = 0.41）；对于这种治疗来说是公平的（kappa = 0.38）。在所有患者中，9.6%为0-5期ROP， 45.1%为>= 2期ROP， 17.3%为加重性疾病，57.7%为侵袭性后路ROP， 25%为需要治疗。专家间的一致性高于专家间的一致性，对于ROP分期（kappa = 0.56）和合并疾病（kappa = 0.51）的一致性为中度，对于侵袭性后路ROP的一致性为中度至重度（kappa = 0.60），对于治疗必要性的一致性为中度（kappa = 0.47），对于治疗类型的一致性为重度（kappa = 0.63）。结论：不同专家和1位专家在不同时间做出的ROP诊断和治疗决策存在差异，说明评分过程是主观的，在诊断ROP时存在观察者偏倚。这些结果可能影响ROP评估和培训的现行做法，并促使进一步完善国际ROP准则。(C) 2015年Elsevier Inc.版权所有。
PURPOSE: To evaluate inter-expert and intra-expert agreement on the diagnosis and treatment of retinopathy of prematurity (ROP).DESIGN: Prospective intra-and inter-rater reliability analysis.METHODS: In this multicenter study, 260 wide-field digital photographs of 52 patients were presented to 7 recognized ROP experts on 2 consecutive assessment days 8 weeks apart. Experts were asked to assess the patients for ROP stage, presence of plus disease, presence of aggressive posterior ROP, necessity for treatment, and suggested treatment. Agreement levels were measured with Fleiss' kappa and Cohen's kappa.RESULTS: Inter-expert agreement was fair for the ROP stage (kappa = 0.24), plus disease (kappa = 0.32), and aggressive posterior ROP (kappa = 0.35); moderate for the necessity for treatment (kappa = 0.41); and fair for the kind of treatment (kappa = 0.38). Perfect inter-expert agreement was found in 9.6% of all patients for ROP stage 0-5, 45.1% for >= stage 2 ROP, 17.3% for plus disease, 57.7% for aggressive posterior ROP, and 25% for the necessity for treatment. Intra-expert agreement was higher than inter-expert agreement and was moderate for the ROP stage (kappa = 0.56) and plus disease (kappa = 0.51), moderate to substantial for aggressive posterior ROP (kappa = 0.60), moderate for the necessity for treatment (kappa = 0.47), and substantial for the kind of treatment (kappa = 0.63).CONCLUSIONS: ROP diagnosis and treatment decisions differ between experts and by 1 expert made on different days, indicating that the grading process is subjective and there is an observer bias when diagnosing ROP. These results could influence current practice in ROP assessment and training, and prompt further refinement of international ROP guidelines. (C) 2015 by Elsevier Inc. All rights reserved.