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Retinal haemorrhage description tool
Anamika Tandon1, Susan McIntyre, Anna Yu
1Department of Ophthalmology and Visual Sciences, Toronto, Canada.
Insights
A new tool for describing retinal hemorrhages in children with head trauma shows good reliability in the posterior retina but less consistency in peripheral zones. This highlights the importance of clinical examination for accurate diagnosis.
Area of Science:
- Ophthalmology
- Pediatric Traumatology
- Medical Imaging
Background:
- Retinal hemorrhages are critical indicators in pediatric head trauma cases.
- Current methods lack standardized, validated protocols for consistent description.
- Accurate documentation is crucial for differentiating abusive from accidental injuries.
Purpose of the Study:
- To establish the reliability and validity of a novel web-based tool for describing retinal hemorrhages.
- To assess the consistency of a new descriptive protocol in pediatric head trauma evaluations.
- To improve the standardization of retinal hemorrhage documentation.
Main Methods:
- A comprehensive questionnaire utilizing a four-zone retinal schematic was developed.
- Four independent observers assessed 80 retinal photographs using the tool.
- Inter-rater and intra-rater reliability were calculated using Fleiss kappa statistics.
Main Results:
- High inter-rater agreement was observed for hemorrhages in peripapillary zones.
- Fair agreement was noted for hemorrhages in all other retinal zones.
- High intra-rater agreement was specific to the posterior pole; peripheral zones showed lower agreement.
Conclusions:
- The developed tool demonstrates validity for describing posterior retinal hemorrhages.
- The tool's performance is less reliable for peripheral retinal hemorrhages.
- Photographic documentation of peripheral retinal hemorrhages may be unreliable, emphasizing clinical examination.
Background:
Retinal haemorrhages are an important finding in children with abusive and accidental head trauma. There are no standardised and validated protocols to describe them in a consistent manner. The aim of this web-based study was to establish the reliability and validity of a new retinal haemorrhage description tool.
Materials And Method:
Our tool is a comprehensive questionnaire, which is applied using a retinal schematic that divides the retina into four independent zones. Four independent observers scored retinal haemorrhages from 80 retinal photographs. Inter- and intra-rater agreement (by repeat assessment of 10 photographs for each examiner) were calculated using Fleiss κ statistics.
Results:
A high inter-rater agreement was noted for haemorrhages in the peripapillary zones, whereas agreement was only fair for all other zones. Intra-rater agreement was high only for the posterior pole. Photographs may be an unreliable way of documenting retinal haemorrhages particularly from the peripheral retina, thus underscoring the importance of a thorough clinical examination.
Conclusion:
This study shows that the tool achieves some validity for describing haemorrhages in the posterior retina. It performs less well in the peripheral zones.
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