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Development and validation of a standardized tool for reporting retinal findings in abusive head trauma
Wai Siene Ng1, Patrick Watts, Zoe Lawson
1Department of Ophthalmology, University Hospital Wales, Cardiff, United Kingdom.
Insights
A new tool for reporting retinal findings in abusive head trauma cases shows excellent agreement among specialists. This standardized approach improves the accuracy of documenting eye injuries in children.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Forensic Medicine
Background:
- Abusive head trauma (AHT) is a serious concern in child abuse investigations.
- Retinal hemorrhages are a key indicator of AHT, but their reporting can be inconsistent.
- Standardized tools are needed to improve the accuracy and reliability of describing ophthalmic findings.
Purpose of the Study:
- To develop and validate a standardized reporting tool for describing retinal findings in children with suspected abusive head trauma.
- To assess the interobserver and intraobserver agreement of this tool among pediatric ophthalmologists and residents.
Main Methods:
- Developed an evidence-based assessment pro forma for recording retinal hemorrhages and associated features.
- Eight consultant pediatric ophthalmologists and seven ophthalmology residents evaluated 105 RetCam images from 21 eyes.
- Assessed interobserver and intraobserver agreement using kappa, intraclass correlation coefficients, and concordance coefficients.
Main Results:
- Almost-perfect interobserver agreement was found for the presence and number of hemorrhages (ICC 0.91 and 0.87) and their location (Concordance 0.86 and 0.85).
- Substantial agreement was noted for hemorrhage size, with moderate agreement for morphology and other findings.
- Intraobserver agreement among pediatric ophthalmologists was substantial to perfect across various hemorrhage characteristics.
Conclusions:
- A validated, standardized clinical reporting tool for ophthalmic findings in suspected abusive head trauma has been developed.
- The tool demonstrates excellent interobserver and intraobserver agreement among specialists and residents.
- Implementation of this tool is expected to enhance standardized clinical reporting in AHT cases.
Purpose:
To develop and validate a robust standardized reporting tool for describing retinal findings in children examined for suspected abusive head trauma.
Design:
A prospective interobserver and intraobserver agreement study.
Method:
An evidence-based assessment pro forma was developed, recording hemorrhages (location, layer, severity) and additional features. Eight consultant pediatric ophthalmologists and 7 ophthalmology residents assessed a series of 105 high-quality RetCam images of 21 eyes from abusive head trauma cases with varying degrees of retinal hemorrhage and associated findings. The pediatric ophthalmologists performed a repeat assessment of the randomized images. The images were observed simultaneously with standardized display settings. Interobserver and intraobserver agreement was assessed using free-marginal multirater kappa, intraclass correlation coefficients, and concordance coefficients.
Results:
Almost-perfect interobserver agreement was observed for residents and pediatric ophthalmologists recording the presence and number of fundus hemorrhages (intraclass correlation coefficients 0.91 and 0.87, respectively) and the location of hemorrhages (concordance coefficients 0.86 and 0.85, respectively). Substantial agreement was observed by both groups regarding size of hemorrhage (concordance coefficients 0.73 and 0.76), moderate agreement for hemorrhage morphology (concordance coefficients 0.53 and 0.52), and other findings (concordance coefficients 0.48 and 0.59). Intraobserver agreement for pediatric ophthalmologists varied by question, ranging from substantial to perfect for the presence, number, location, size, and morphology of fundus hemorrhage.
Conclusion:
We have developed and validated a standardized clinical reporting tool for ophthalmic findings in suspected abusive head trauma, which has excellent interobserver and intraobserver agreement among consultant specialists and residents. We suggest that its use will improve standardized clinical reporting of such cases.
