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M. F. Chiang, L. Jiang, R. Gelman, Y. E. Du, J. T. Flynn; Inter-Expert Agreement of Plus Disease Diagnosis in Retinopathy of Prematurity. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3096.
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© ARVO (1962-2015); The Authors (2016-present)
To measure agreement of plus disease diagnosis among retinopathy of prematurity (ROP) experts.
A set of 34 wide-angle retinal photographs from infants with ROP was compiled on a secure website, and interpreted independently by 22 recognized ROP experts. Diagnostic agreement was analyzed using 3-level ("plus," "pre-plus," "neither") and 2-level ("plus," "not plus") categorizations.
In the 3-level categorization, all experts agreed on the same diagnosis in 4 (11.8%) of the 34 images, and the mean weighted kappa for each expert compared to all others was between 0.21-0.40 (fair agreement) in 7 (31.8%) experts, and 0.41-0.60 (moderate agreement) in 15 (68.2%) experts. In the 2-level categorization, all experts who provided a diagnosis agreed in 7 (20.6%) of the 34 images, and the mean kappa for each expert compared to all others was between 0-0.20 (slight agreement) in 1 (4.5%) expert, 0.21-0.40 (fair agreement) in 3 (13.6%) experts, 0.41-0.60 (moderate agreement) in 12 (54.5%) experts, and 0.61-0.80 (substantial agreement) in 6 (27.3%) experts.
Inter-expert agreement of plus disease diagnosis is imperfect. This may have important implications for clinical ROP management, continued refinement of the international ROP classification system, development of computer-based diagnostic algorithms, and implementation of ROP telemedicine systems.
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