Accuracy of retinopathy of prematurity image-based diagnosis by pediatric ophthalmology fellows: Implications for training
Accuracy of retinopathy of prematurity image-based diagnosis by pediatric ophthalmology fellows: Implications for training
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DOI：
10.1016/j.jaapos.2011.06.011
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发表时间：
2011-12-01
期刊：
影响因子：
1.6
通讯作者：
Chiang, Michael F.
中科院分区：
文献类型：
--
作者：
Myung, Jane S.;Chan, Robison Vernon Paul;Chiang, Michael F.
目的：测量基于图像的早产儿视网膜病变（ROP）诊断的准确性由pediatric ophthalmology fellows.METHODS这是一个比较的病例系列的专家与非专家临床医生在基于图像的ROP诊断。用广角照相机（RetCam-II，Clarity Medical Systems，普莱森顿，CA）从67名早产儿的248只眼睛捕获804个视网膜图像的图谱。将图像上传到研究网站，由一名儿科视网膜专家和五名儿科眼科研究员独立提供每只眼睛的诊断（无ROP、轻度ROP、2型ROP或需要治疗的ROP）。两名不同的视网膜专家在ROP检查经验作为额外的控制。主要结果指标是研究员基于图像的ROP诊断的敏感性和特异性，与儿科视网膜专家基于图像的解释的参考标准进行比较。结果5名受试者检测轻度或重度ROP的平均敏感度（范围）为0.850（0.670-0.962），特异度为0.919（0.832-0.964）。对2型或更严重的ROP的诊断，平均（范围）敏感性为0.527（0.356-0.709），特异性为0.938（0.777-1.000）。对于需要治疗的ROP的检测，平均（范围）的敏感性为0.515（0.267-0.765）和特异性为0.949（0.805-1.00）。结论儿童眼科研究员在这项研究中表现出较高的诊断特异性，在基于图像的ROP诊断，但是，敏感性较低，特别是对临床意义的疾病。（J AAPOS 2011;15：573-578）
PURPOSE To measure the accuracy of image-based retinopathy of prematurity (ROP) diagnosis by pediatric ophthalmology fellows.METHODS This was a comparative case series of expert versus nonexpert clinicians in image-based ROP diagnosis. An atlas of 804 retinal images was captured from 248 eyes of 67 premature infants with a wide-angle camera (RetCam-II, Clarity Medical Systems, Pleasanton, CA). Images were uploaded to a study website from which an expert pediatric retinal specialist and five pediatric ophthalmology fellows independently provided a diagnosis (no ROP, mild ROP, type 2 ROP, or treatment-requiring ROP) for each eye. Two different retinal specialists experienced in ROP examination served as additional controls. Primary outcome measures were sensitivity and specificity of image-based ROP diagnosis by fellows compared to a reference standard of image-based interpretation by the expert pediatric retinal specialist. Secondary outcome measure was intraphysician reliability.RESULTS For detection of mild or worse ROP, the mean (range) sensitivity among the five fellows was 0.850 (0.670-0.962) and specificity was 0.919 (0.832-0.964). For detection of type 2 or worse ROP by fellows, mean (range) sensitivity was 0.527 (0.356-0.709) and specificity was 0.938 (0.777-1.000). For detection of treatment-requiring ROP, mean (range) sensitivity was 0.515 (0.267-0.765) and specificity was 0.949 (0.805-1.00).CONCLUSIONS Pediatric ophthalmology fellows in this study demonstrated high diagnostic specificity in image-based ROP diagnosis; however, sensitivity was lower, particularly for clinically significant disease. (J AAPOS 2011;15:573-578)