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.
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.
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DOI：
10.1001/jamaophthalmol.2016.3502
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发表时间：
2016-11-01
影响因子：
8.1
通讯作者：
e-ROP (Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity) Cooperative Group
中科院分区：
文献类型：
--
作者：
Quinn GE;Ells A;Capone A Jr;Hubbard GB;Daniel E;Hildebrand PL;Ying GS;e-ROP (Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity) Cooperative Group
随着潜在致盲性早产儿视网膜病变（ROP）的有效治疗方法的引入，结果一致性的重要性日益增加，特别是在有ROP风险的婴儿转向视网膜成像的情况下。表征2011年5月至2013年10月进行的“早产儿急性期视网膜病变远程医疗评估方法”研究中数字视网膜图像分级与检查结果之间的ROP差异。4位专家进行了一项研究后对图像的共识审查，他们检查了经培训的非医生读者和医生检查结果在转诊保证ROP （RW-ROP）婴儿的图像分级之间的差异。图像来自13个北美新生儿重症监护病房，来自出生体重小于1251 g的婴儿的眼睛。差异类别超过100例，随机抽取40例；总共审查了188个图像集。RW-ROP组件的差异图像和检查结果的一致评价。在5350对图像集中，有161例图像分级未检测到临床检查中注意到的RW-ROP (G−/E+)， 854例图像分级在检查中没有注意到RW-ROP （G+/E−）。在G−/E+病例样本中，32篇综述中有18篇（56.3%）同意临床检查结果，即I区存在ROP， 40篇综述中有18篇（45.0%）同意存在3期ROP，但20篇综述中只有1篇（5.0%）同意存在正性疾病。在G+/E−病例样本中，40篇综述中有36篇（90.0%）同意读者认为存在I区ROP， 40篇综述中有23篇（57.5%）同意读者认为存在3期ROP， 16篇综述中有4篇（25.0%）同意存在加重疾病。基于对样本病例的一致评价结果，我们估计在161例G+/E +病例中，有46.5% （95% CI, 41.6-51.6）的评价与临床检查结果一致，在854例G+/E +病例中，有70.0% （95% CI, 67.3-72.8）的评价与训练过的读者对RW-ROP存在的评分一致。本报告强调了眼底图像远程评估和有ROP风险的婴儿床边临床检查的局限性和优势。这些发现强调了标准化方法的必要性，因为ROP远程医疗变得更加广泛。
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. 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. 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. Consensus evaluation of discrepant image and examination findings for RW-ROP components. 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. 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.
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影响因子：
1.8
作者：
Graham E Quinn;e-ROP Cooperative Group
通讯作者：
e-ROP Cooperative Group
影响因子：
1.6
作者：
Wallace, David K.;Quinn, Graham E.;Chiang, Michael F.
通讯作者：
Chiang, Michael F.
影响因子：
13.7
作者：
Ells, AL;Holmes, JM;Hebert, M
通讯作者：
Hebert, M
影响因子：
8.1
作者：
Daniel, Ebenezer;Quinn, Graham E.;Ying, Gui-Shuang
通讯作者：
Ying, Gui-Shuang
影响因子：
4.2
作者：
Gschliesser, Andreas;Stifter, Eva;Schmidt-Erfurth, Ursula
通讯作者：
Schmidt-Erfurth, Ursula