An interrater reliability study of a new 'zonal' classification for reporting the location of retinal haemorrhages in childhood for clinical, legal and research purposes. Issue 7 (21st October 2009)

• Record Type: Journal Article
• Authors: Fleck, Brian W; Tandon, Anamika; Jones, Patricia A; Mulvihill, Alan O; Minns, Robert A
• Is Part Of: British journal of ophthalmology. Volume 94:Issue 7(2010)
• Page Start: 886
• Page End: 890
• Publication Date: 2009-10-21
• Subjects: accidental traumatic brain injury -- child health (paediatrics) -- imaging -- medico-legal reports -- non-accidental (inflicted) traumatic brain injury -- retinal haemorrhages -- retinal zones -- trauma; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjo.2009.162271
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Background/Aims: To develop and assess a zonal classification of the retina to facilitate description of the location of retinal haemorrhages in children. Methods: A novel zonal classification of the retina was devised based on the anatomical landmarks of the optic disc and vascular arcades, by reviewing a large number of wide field digital retinal images drawn from our database of children with accidental and non-accidental head injury and other encepthalopathies. Four expert examiners then independently 'located' 142 retinal haemorrhages by zone, from 31 high quality photographs. Results: Cohen's unweighted κ scores for all possible pairs of the four raters (ie, six pairs) ranged from 0.86 to 0.92, that is 'almost perfect' agreement. Fleiss' κ for agreement between multiple raters (four) and for multiple categories (three) was 0.8841, that is 'almost perfect' agreement. Cohen's unweighted κ statistic for intrarater reliability gave an overall concordance that ranged from 'substantial' to 'perfect' agreement. Conclusion: This new retinal zone classification and the use of photographs and templates is a very reliable tool for reporting the location of retinal haemorrhages from multiple aetiologies in children, and may be useful for research and medico-legal reports.