Does observer bias contribute to variations in the rate of retinopathy of prematurity between centres?
Does observer bias contribute to variations in the rate of retinopathy of prematurity between centres?
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DOI：
10.1111/j.1442-9071.2007.01652.x
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发表时间：
2008-01-01
影响因子：
4
通讯作者：
Henderson-Smart, David J.
中科院分区：
文献类型：
--
作者：
Darlow, Brian A.;Elder, Mark J.;Henderson-Smart, David J.
目的：我们旨在间接评估观察者偏差对早产儿急性视网膜病变 (ROP) 发病率中心变异性的影响。方法：澳大利亚和新西兰新生儿网络 (ANZNN) 收集了 1998 年至 1999 年出生的 29 周以下的 2286 名婴儿中任一眼急性 ROP 最高阶段的数据，这些婴儿在 25 个新生儿重症监护病房 (NICU) 之一接受护理。卡方分析用于检测每个新生儿重症监护病房 ROP 阶段比例的差异。将这些比例与两项大型 ROP 治疗研究报告的比例进行比较。结果：ANZNN 队列中急性 ROP 的发生率为 42%，1:2:3 期 ROP 的比例为 1.5:1.9:1。各中心之间急性 ROP 的发生率和 1:2:3 期 ROP 的比例存在相当大的差异。卡方检验确定阶段 1、2 和 3/4 ROP 的分配并不独立于中心 (chi(2)(48) = 165.2；P < 0.0001）。 3 期 ROP 的治疗范围在 15% 到 120% 之间，表明一些眼睛的治疗时间低于 3 期。结论：数据高度表明观察者偏差导致观察到的急性 ROP 发生率中心之间的差异。在以急性 ROP 为结果的新生儿干预研究中，对眼科医生进行检查的认证流程似乎很重要，并且收集这些数据的新生儿网络也存在类似的争论。
Purpose: We aimed to indirectly assess the contribution from observer bias to between centre variability in the incidence of acute retinopathy of prematurity (ROP).Methods: The Australian and New Zealand Neonatal Network (ANZNN) collected data on the highest stage of acute ROP in either eye in 2286 infants born at less than 29 weeks in 1998-1999 and cared for in one of 25 neonatal intensive care units (NICUs). Chi-squared analysis was used to detect differences in the proportion of stages of ROP for each neonatal intensive care unit. These proportions were compared with those reported in two large studies of treatment for ROP.Results: The incidence of acute ROP in the ANZNN cohort was 42% and the ratio of stage 1:2:3 ROP was 1.5:1.9:1. There was considerable variation in both the incidence of acute ROP and the proportions with stage 1:2:3 ROP between centres. A chi-squared test determined that the assignment of stages 1, 2 and 3/4 ROP was not independent of centre (chi(2)(48) = 165.2; P < 0.0001). Treatment of stage 3 ROP varied between 15% and 120%, indicating some eyes were treated at less than stage 3.Conclusion: The data are highly suggestive of observer bias contributing to the observed between centre variation in the incidence of acute ROP. In neonatal intervention studies where acute ROP is an outcome it would seem important to have an accreditation process for examining ophthalmologists, and there are similar arguments for neonatal networks which collect these data.