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Retinal haemorrhage description tool
  1. Anamika Tandon1,
  2. Susan McIntyre2,
  3. Anna Yu3,
  4. Derek Stephens4,
  5. Benjamin Leiby4,
  6. Sean Croker5,
  7. Alex V Levin6,7
  1. 1Department of Ophthalmology and Visual Sciences
  2. 2Institute of Medical Science, Toronto, Canada
  3. 3Child Health Evaluative Sciences, Research Institute, University of Toronto, Toronto, Canada
  4. 4Clinical Research Support Unit, Research Institute, Toronto, Canada
  5. 5Department of Pharmacology and, Experimental Therapeutics, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  6. 6Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  7. 7Wills Eye Institute, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Alex V Levin, Chief, Department of Pediatric Ophthalmology and Ocular Genetics, Wills Eye Institute, 840 Walnut Street, Philadelphia, PA 19107, USA; alevin{at}


Background Retinal haemorrhages are an important finding in children with abusive and accidental head trauma. There are no standardised and validated protocols to describe them in a consistent manner. The aim of this web-based study was to establish the reliability and validity of a new retinal haemorrhage description tool.

Materials and method Our tool is a comprehensive questionnaire, which is applied using a retinal schematic that divides the retina into four independent zones. Four independent observers scored retinal haemorrhages from 80 retinal photographs. Inter- and intra-rater agreement (by repeat assessment of 10 photographs for each examiner) were calculated using Fleiss κ statistics.

Results A high inter-rater agreement was noted for haemorrhages in the peripapillary zones, whereas agreement was only fair for all other zones. Intra-rater agreement was high only for the posterior pole. Photographs may be an unreliable way of documenting retinal haemorrhages particularly from the peripheral retina, thus underscoring the importance of a thorough clinical examination.

Conclusion This study shows that the tool achieves some validity for describing haemorrhages in the posterior retina. It performs less well in the peripheral zones.

  • retinal haemorrhages
  • RetCam
  • non-accidental injury
  • child health (paediatrics)
  • imaging
  • retina
  • public health
  • treatment surgery
  • genetics
  • embryology and development
  • intraocular pressure

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  • Presented in part at the Annual Meeting of the American Association of Pediatric Ophthalmology and Strabismus, Orlando, Florida, April 2010.

  • Funding The study was funded in part by the Brandan's Eye Research Fund and The Foerderer Fund. Both these funding sources had no role to play in the study design, collection, analysis or interpretation of the data or in the writing of this article.

  • Competing interests None.

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

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