Sources of error in the use of a system for classifying mechanical injuries of the eye

ocular trauma produces psychological, social and occupational effects that can cause significant impairment. Evaluation of ocular trauma has been standardized by a system for classifying mechanical injuries of the eye (SCMIE). Parameters that are most commonly a source of error for the evaluator and that may lead to classification errors have not been identified.

an observational, retrospective, descriptive, cross-sectional and open study was conducted. Files of patients of either gender, aged 6 years or older, with ocular trauma graded with the SCMIE between 1997 and 2009 were re-evaluated by an independent investigator. The rate and 95% confidence intervals (95% CI) of evaluations that resulted in errors during the re-evaluation of ocular trauma were identified in the sample and in general for each parameter. The disparity between the initial evaluation and the re-evaluation (MacNemar) and the concordance between the evaluations (kappa) were analyzed.

of 817 evaluations, 294 had at least one grading error (36%, 95% CI 32.7-39.3). The most frequent error source was the parameter type. The disparity was significant in parameters type A, D, grade 2 and zone II. Overall concordance was good.

it is necessary to reinforce the learning curve for some parameters of the SCMIE, especially type, in order to improve its evaluation, so that it can become a valid communication tool that favors early referral to the specialist.