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)
- medico-legal reports
- non-accidental (inflicted) traumatic brain injury
- retinal haemorrhages
- retinal zones
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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.