Retinopathy of prematurity management using single-image vs multiple-image telemedicine examinations.
Retinopathy of prematurity management using single-image vs multiple-image telemedicine examinations.
复制标题
使用单图像与多图像远程医疗检查进行早产儿视网膜病变管理。
DOI：
10.1016/j.ajo.2008.04.012
复制
发表时间：
2008
影响因子：
4.2
通讯作者：
Chiang,MichaelF
中科院分区：
文献类型：
--
作者：
Lajoie,Alexandra;Koreen,Susan;Wang,Lu;Kane,StevenA;Lee,ThomasC;Weissgold,DavidJ;Berrocal,AudinaM;Du,YunlingE;Coki,Osode;Flynn,JohnT;Starren,Justin;Chiang,MichaelF
方法：在一个学术机构，由一名受过训练的新生儿护士在31 - 33周和/或35 - 37周的经后年龄（PMA）对67名连续婴儿的248只眼睛进行广角视网膜成像。数据被上传到一个基于网络的远程医疗系统，并由三名戴面具的视网膜专家解释。根据每个婴儿双眼的单个图像以及随后的多个图像提供诊断。结果进行了比较，由儿科眼科医生间接检眼镜的参考标准。主要结果测量推荐的随访间隔，存在的加号疾病，存在的2型或更差的ROP，和存在的可见的周边ROP. PTSAmong的三个分级，平均灵敏度/特异性检测的婴儿需要在不到一个星期的后续行动是0.85/0.93单图像检查和0.91/0.88多图像检查在35至37周PMA。在35至37周PMA时，单图像检查检测2型或更严重ROP婴儿的平均灵敏度/特异性为0.82/0.95，多图像检查为1.00/0.91。在35至37周PMA时，单图像检查检测阳性疾病的平均灵敏度/特异性为1.00/0.86，多图像检查为1.00/0.87。单图像和多图像远程医疗检查的准确性之间没有显著的等级内差异，以检测加diseases. CONCLUSIONSSsingle-image和多图像远程医疗检查执行推荐的后续间隔和检测加疾病的确定。这可能对筛查方案的制定产生影响，特别是在眼科护理有限的地区。
PURPOSETo compare performance of single-image vs multiple-image telemedicine examinations for retinopathy of prematurity (ROP) diagnosis.DESIGNProspective comparative study.METHODSA total of 248 eyes from 67 consecutive infants underwent wide-angle retinal imaging by a trained neonatal nurse at 31 to 33 weeks and/or 35 to 37 weeks postmenstrual age (PMA) at a single academic institution. Data were uploaded to a web-based telemedicine system and interpreted by three masked retinal specialists. Diagnoses were provided based on single images, and subsequently on multiple images, from both eyes of each infant. Findings were compared to a reference standard of indirect ophthalmoscopy by a pediatric ophthalmologist. Primary outcome measures were recommended follow-up interval, presence of plus disease, presence of type-2 or worse ROP, and presence of visible peripheral ROP.RESULTSAmong the three graders, mean sensitivity/specificity for detection of infants requiring follow-up in less than one week were 0.85/0.93 by single-image examination and 0.91/0.88 by multiple-image examination at 35 to 37 weeks PMA. Mean sensitivity/specificity for detection of infants with type-2 or worse ROP were 0.82/0.95 by single-image examination and 1.00/0.91 by multiple-image examination at 35 to 37 weeks PMA. Mean sensitivity/specificity for detection of plus disease were 1.00/0.86 by single-image examination and 1.00/0.87 by multiple-image examination at 35 to 37 weeks PMA. There were no statistically-significant intragrader differences between accuracy of single-image and multiple-image telemedicine examinations for detection of plus disease.CONCLUSIONSSingle-image and multiple-image telemedicine examinations perform comparably for determination of recommended follow-up interval and detection of plus disease. This may have implications for development of screening protocols, particularly in areas with limited access to ophthalmic care.