Quinn GE, Ells A, Capone A, et al.
远程医疗 早产儿 视网膜
重要性：由于引入了早产儿潜在致盲性视网膜病变（ROP）的有效治疗，发现的一致性更加重要，特别是具有ROP风险的婴儿视网膜成像的移动。目的：描述来自2011年5月至2013年10月间早产儿急性期视网膜病变的远程医疗评估研究的数字视网膜成像分级和检查结果之间ROP发现的差异。设计、设置和参与者：图像的研究后共识审查由4位专家进行，专家负责检查受过训练的非医学阅片者的图像分级和RW-ROP婴儿的医师考试结果之间的差异。图像采自13个北美新生儿童重症监护病房体重不足1251克的新生儿眼睛。超过100例的差异分类中，40例被随机选择，综述了188个图像集。主要结果和措施：RW-ROP组分的差异图像和检查结果的一致性评价。结果：在5350个图像集中，有161例有临床检查注释但图像分级没有检测出RW-ROP（G-/E+），有854例分级注释RW-ROP而临床检查没有发现（G+/E-）。在G-/E+病例中，32例中有18例（56.3%）与ROP存在的临床检查发现一致，40例中有18例（45.0%）同意3级ROP存在，但是20例中只有1例（5.0%）同意外加疾病存在。在G+/E-病例样本中，40例中有36例（90.0%）与1区ROP存在的阅片者一致，40例中有23例（57.5%）与认为3级ROP存在的阅片者一致，16例汇总有4例（25.0%）同意外加疾病存在。在样本数量一致性综述结果的基础上，我们评估了RW-ROP存在的综述与161 G-/E+病例中46.5%临床检查发现一致（95%可信区间41.6-51.6），与854 G+/E-病例中70.0%受训阅片者分级一致（95%可信区间67.3-72.8）。结论和相关性：这份报告强调了ROP风险婴儿的眼底成像远程评估和床旁临床检查局限性和优势。这些发现强调了对ROP远程医疗标准化方法的需求越来越普遍。
Importance:As effective treatments for potentially blinding retinopathy of prematurity (ROP) have been introduced, the importance of consistency in findings has increased, especially with the shift toward retinal imaging in infants at risk of ROP.Objective:To characterize discrepancies in findings of ROP between digital retinal image grading and examination results from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity study, conducted from May 2011 to October 2013.Design, Setting, and Participants:A poststudy consensus review of images was conducted by 4 experts, who examined discrepancies in findings between image grades by trained nonphysician readers and physician examination results in infants with referral-warranted ROP (RW-ROP). Images were obtained from 13 North American neonatal intensive care units from eyes of infants with birth weights less than 1251 g. For discrepancy categories with more than 100 cases, 40 were randomly selected; in total, 188 image sets were reviewed.Main Outcomes and Measures:Consensus evaluation of discrepant image and examination findings for RW-ROP components.Results:Among 5350 image set pairs, there were 161 instances in which image grading did not detect RW-ROP noted on clinical examination (G-/E+) and 854 instances in which grading noted RW-ROP when the examination did not (G+/E-). Among the sample of G-/E+ cases, 18 of 32 reviews (56.3%) agreed with clinical examination findings that ROP was present in zone I and 18 of 40 (45.0%) agreed stage 3 ROP was present, but only 1 of 20 (5.0%) agreed plus disease was present. Among the sample of G+/E- cases, 36 of 40 reviews (90.0%) agreed with readers that zone I ROP was present, 23 of 40 (57.5%) agreed with readers that stage 3 ROP was present, and 4 of 16 (25.0%) agreed that plus disease was present. Based on the consensus review results of the sampled cases, we estimated that review would agree with clinical examination findings in 46.5% of the 161 G-/E+ cases (95% CI, 41.6-51.6) and agree with trained reader grading in 70.0% of the 854 G+/E- cases (95% CI, 67.3-72.8) for the presence of RW-ROP.Conclusions and Relevance:This report highlights limitations and strengths of both the remote evaluation of fundus images and bedside clinical examination of infants at risk for ROP. These findings highlight the need for standardized approaches as ROP telemedicine becomes more widespread.