Related Experiment Videos
Retinal hemorrhage in abusive head trauma: finding a common language
Alex V Levin1, Jose A Cordovez1, Benjamin E Leiby1
1Pediatric Ophthalmology and Ocular Genetics Service, Wills Eye Institute (Dr Levin and Dr Cordovez), the Department of Ophthalmology, Thomas Jefferson University (Dr Levin), and the Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University (Dr Leiby and Mr Pequignot), Philadelphia, Pennsylvania; and Pediatric Ophthalmology, Leicester Royal Infirmary NHS Trust, Leicester, United Kingdom (Dr Tandon).
A refined web tool effectively documents retinal hemorrhages in abusive head trauma cases, showing good to very good agreement among observers. Performance varied by retinal zone, with the macula zone needing further improvement.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Medical Imaging
Background:
- Abusive head trauma (AHT) often involves retinal hemorrhages.
- Accurate documentation of these hemorrhages is critical for diagnosis.
- Existing documentation methods may lack standardization and precision.
Purpose of the Study:
- To evaluate a refined web-based tool for documenting retinal hemorrhage characteristics in suspected AHT.
- To assess the interobserver and intraobserver agreement of the tool across different retinal zones.
Main Methods:
- Pilot testing of a secure web platform with digital image analysis (color, B&W, 4-zone overlay).
- Four pediatric ophthalmologists documented hemorrhage number, zone, and type on 80 images.
- Interobserver agreement (Fleiss kappa) and intraobserver agreement (Cohen's kappa) were calculated.
Main Results:
- Good to very good interobserver agreement was achieved for most questions, particularly in the peripapillary zone (Zone A).
- Agreement was generally good to very good in mid-peripheral (Zone C) and peripheral (Zone D) zones, except for hemorrhage number.
- The macula zone (Zone B) showed fair to good agreement, with poor agreement for superficial hemorrhages.
Conclusions:
- The refined web-based tool demonstrates good to very good performance in documenting retinal hemorrhages in AHT.
- Zone B (macula) underperformance is attributed to larger hemorrhage areas and poor contrast.
- Further refinement may be needed for optimal documentation in all retinal regions.