title: Retinal haemorrhage description tool.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  This study shows that the tool achieves some validity for describing haemorrhages in the posterior retina. It performs less well in the peripheral zones.
authors: Department of Ophthalmology and Visual Sciences, Toronto, Canada.
authors: Anamika
authors: A
authors: Tandon
authors: Susan
authors: S
authors: McIntyre
authors: Anna
authors: A
authors: Yu
authors: Derek
authors: D
authors: Stephens
authors: Benjamin
authors: B
authors: Leiby
authors: Sean
authors: S
authors: Croker
authors: Alex V
authors: AV
authors: Levin
mesh_terms: D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications / Q000473:pathology*; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D012160:Retina / Q000473:pathology*; D012166:Retinal Hemorrhage / Q000145:classification / Q000209:etiology / Q000473:pathology*; D011795:Surveys and Questionnaires; D017216:Telemedicine