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P.B. Dray, A.M. Lora, P. Neerukonda, R.M. Ahuja; Comparison of the Accuracy of Diagnosis of Retinopathy of Prematurity between Residents and Attendings . Invest. Ophthalmol. Vis. Sci. 2003;44(13):601.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To compare the diagnostic accuracy of the staging and zoning of retinopathy of prematurity (ROP) between a single senior attending and experienced ROP service residents at a teaching institution. Methods: Retrospective chart review of infants seen in the Cook County Hospital Neonatal Intensive Care Unit (NICU) and Mount Sinai Hospital NICU between 1997 and 2002. Patients were separated into an attending group consisting of patients examined by the attending alone or an attending and a junior resident, and a resident group consisting of patients examined by the ROP trained senior resident alone. Each group of patients was subdivided into very low birth weight (VLBW) 501-899 grams and low birth weight (LBW) 900-1249 grams groups. The highest stage and lowest zone of ROP were recorded. Results: A total of 473 patients were included in the study. For both VLBW and LBW infants, the rate of Stage 1 ROP in the resident group was 22.9 % and 23.1%, respectively, compared to the attending group rates of 16.0% and 18.0%. The rate of Stage 2 was similar between the two groups for VLBW infants. For LBW infants Stage 2, the resident's group rate was 20.5% compared to the attending group rate of 28.0%. The rate of Stage 3 was 10.4% and 0.0% for VLBW and LBW infants in the residents group compared to15.0% and 4.0% in the attending group. The rate of diagnosis for Zone II disease was 43.8% vs. 54.5% for VLBW infants and 8.0% vs. 25.0% for LBW infants. The rate of diagnosis for residents versus the attending for Zone III disease was 31.3% vs. 22.5% for VLBW infants and 33.0% vs. 25.0% for LBW infants. The overall diagnosis rate of any ROP between the two groups was similar for both VLBW and LBW infants. Statistical analysis for all rate comparisons showed significance only in the rate of diagnosis of Zone II disease in LBW infants. Conclusions: There was no statistically significant difference between experienced residents and the attending in the staging of ROP for all stages. There was a significant difference between residents and the attending in assigning the correct zone in LBW infants with Zone II ROP. Experienced senior residents can be reliable ROP examiners; however, they may have difficulty with placement of the disease in the proper zone. Zone II disease, the most common overall, is established by the exclusion of Zone I and III disease. A key tool in zoning ROP is the visualization of the nasal periphery. Since there are no clear landmarks by which to judge the Zone II anatomic location, a poor view of the nasal periphery may cause the examiner to conclude the zone to be more peripheral.
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