Inter-grader reliability in the Danish screening programme for diabetic retinopathy.
diabetic retinopathy
interrater agreement
reliability
screening
Journal
Acta ophthalmologica
ISSN: 1755-3768
Titre abrégé: Acta Ophthalmol
Pays: England
ID NLM: 101468102
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
revised:
18
11
2022
received:
20
09
2022
accepted:
27
03
2023
medline:
10
10
2023
pubmed:
18
4
2023
entrez:
17
4
2023
Statut:
ppublish
Résumé
The Danish Registry of Diabetic Retinopathy includes information from >200 000 patients who attends diabetic retinopathy (DR) screening in Denmark. Screening of patients with uncomplicated type 2 diabetes is often performed by practicing ophthalmologists, while patients with type 1 and complicated type 2 diabetes attends screening at hospitals. We performed a clinical reliability study of retinal images from Danish screening facilities to explore the inter-grader agreement between the primary screening ophthalmologist and a blinded, certified grader. Invitations to participate were sent to screening facilities across Denmark. The primary grader uploaded fundus photographs with information on estimated level of DR (International Clinical Diabetic Retinopathy scale as 0 [no DR], 1-3 [mild, moderate or severe nonproliferative DR {NPDR}], or 4 [proliferative DR {PDR}]), region of screening, image style, and screening facility. Images were then regraded by a blinded, certified, secondary grader. Weighted kappa analysis was performed to evaluate agreement. Fundus photographs from 230 patients (458 eyes) were received from practicing ophthalmologists (52.6%) and hospital-based grading centres (47.4%) from all Danish regions. Reported levels of DR by the primary graders were 66.8%, 12.2%, 13.1%, 1.3% and 5.5% for DR levels 0-4. The overall agreement between primary and secondary graders was 93% (κ = 0.83). Based on screening facility agreement was 96% (κ = 0.89) and 90% (κ = 0.76) for practicing ophthalmologists and hospital-based graders. In this nationwide study, we observed a high overall inter-grader agreement and based on this, it is reasonable to assume that reported DR gradings in the screening programme in Denmark, accurately reflect the truth.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
783-788Subventions
Organisme : M.L. Jørgensen og Gunnar Hansen Foundation
Organisme : Steno Diabetes Center Odense (SDCO)
Organisme : Velux Fonden
ID : 00028744
Informations de copyright
© 2023 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.
Références
Andersen, J.K.H., Hubel, M.S., Savarimuthu, T.R., Rasmussen, M.L., Sørensen, S.L.B. & Grauslund, J. (2022) A digital online platform for education and certification of diabetic retinopathy health care professionals in the region of southern Denmark. Acta Ophthalmologica, 100, 589-595.
Andersen, N., Hjortdal, J.O., Schielke, K.C., Bek, T., Grauslund, J., Laugesen, C.S. et al. (2016) The Danish registry of diabetic retinopathy. Clinical Epidemiology, 8, 613-619.
Cunha, L.P., Figueiredo, E.A., Araújo, H.P., Costa-Cunha, L.V.F., Costa, C.F., Neto, J.M.C. et al. (2018) Non-mydriatic fundus retinography in screening for diabetic retinopathy: agreement between family physicians, general ophthalmologists, and a retinal specialist. Frontiers in Endocrinology, 9, 251.
Dansk Diabetes Database: National årsrapport (2020/2021): [Danish Diabetes Database: National Annual Report 2020/2021]. Newest report available from: https://www.sundhed.dk/sundhedsfaglig/kvalitet/kliniske-kvalitetsdatabaser/kroniske-sygdomme/diabetes/.Danish
Grauslund, J., Andersen, N., Andresen, J., Flesner, P., Haamann, P., Heegaard, S. et al. (2018) Evidence-based Danish guidelines for screening of diabetic retinopathy. Acta Ophthalmologica, 96, 763-769.
Grauslund, J., Stokholm, L., Ohm Kyvik, K., Dornonville de la Cour, M., Kessel, L. & Hass Rubin, K. (2020) Interactions between ocular and systemic disease using national register-based data in the Danish excellence Centre in Ophthalmic Epidemiology (DECODE-EYE): study perspective. Acta Ophthalmologica, 98, 573-578.
Gwet, K.L. (2021) Handbook of inter-rater reliability, 5th edition, Analysis of Categorical Ratings. USA: Publisher Services. pp. 28-69.
Larsen, M., Godt, J., Larsen, N., Lund-Andersen, H., Sjølie, A.K., Agardh, E. et al. (2003) Automated detection of fundus photographic red lesions in diabetic retinopathy. Investigative Ophthalmology & Visual Science, 44, 761-766.
Potapenko, I., Kristensen, M., Thiesson, B., Ilginis, T., Lykke Sørensen, T., Nouri Hajari, J. et al. (2022) Detection of oedema on optical coherence tomography images using deep learning model trained on noisy clinical data. Acta Ophthalmologica, 100, 103-110.
Potapenko, I., Thiesson, B., Kristensen, M., Hajari, J.N., Ilginis, T., Fuchs, J. et al. (2022) Automated artificial intelligence-based system for clinical follow-up of patients with age-related macular degeneration. Acta Ophthalmologica, 100, 927-936.
Rêgo, S., Dutra-Medeiros, M., Bacelar-Silva, G.M., Borges, T., Soares, F. & Monteiro-Soares, M. (2021) Reliability of classification by ophthalmologists with telescreening fundus images for diabetic retinopathy and image quality. Journal of Diabetes Science and Technology, 15, 710-712.
Scott, I.U., Bressler, N.M., Bressler, S.B., Browning, D.J., Chan, C.K., Danis, R.P. et al. (2008) Agreement between clinician and reading center gradings of diabetic retinopathy severity level at baseline in a phase 2 study of intravitreal bevacizumab for diabetic macular edema. Retina, 28, 36-40.
StataCorp. 2021. Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC.
Thapa, R., Bajimaya, S., Pradhan, E., Sharma, S., Kshetri, B. & Paudyal, G. (2020) Agreement on grading retinal findings of patients with diabetes using fundus photographs by allied medical personnel when compared to an ophthalmologist at a diabetic retinopathy screening program in Nepal. Clinical Ophthalmology, 14, 2731-2737.
Xie, Q. (2013) Agree or disagree? A demonstration of an alternative statistic to Cohen's kappa for measuring the extent and reliability of agreement between observers. MacroSys, LLC: The Federal Committee on Statistical Methodology (FCSM), pp. 1-12.