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An interrater reliability study of a new ‘zonal’ classification for reporting the location of retinal haemorrhages in childhood for clinical, legal and research purposes
  1. Brian W Fleck1,2,3,
  2. Anamika Tandon1,
  3. Patricia A Jones3,
  4. Alan O Mulvihill1,2,
  5. Robert A Minns2,3
  1. 1Princess Alexandra Eye Pavilion, Edinburgh, UK
  2. 2Royal Hospital for Sick Children, Edinburgh, UK
  3. 3Child Life and Health, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Brian W Fleck, Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh EH3 9HA, UK; brian.fleck{at}luht.scot.nhs.uk

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.

  • accidental traumatic brain injury
  • child health (paediatrics)
  • imaging
  • medico-legal reports
  • non-accidental (inflicted) traumatic brain injury
  • retinal haemorrhages
  • retinal zones
  • trauma

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Footnotes

  • Funding This study was supported by the RS MacDonald Charitable Trust and the Royal College of Surgeons Edinburgh (Ophthalmology Grant-Royal Blind).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Lothian Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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