title: Development and validation of a standardized tool for reporting retinal findings in abusive head trauma.
abstract: OBJECTIVE
  To develop and validate a robust standardized reporting tool for describing retinal findings in children examined for suspected abusive head trauma.
  
  
  METHODS
  A prospective interobserver and intraobserver agreement study.
  
  
  METHODS
  An evidence-based assessment pro forma was developed, recording hemorrhages (location, layer, severity) and additional features. Eight consultant pediatric ophthalmologists and 7 ophthalmology residents assessed a series of 105 high-quality RetCam images of 21 eyes from abusive head trauma cases with varying degrees of retinal hemorrhage and associated findings. The pediatric ophthalmologists performed a repeat assessment of the randomized images. The images were observed simultaneously with standardized display settings. Interobserver and intraobserver agreement was assessed using free-marginal multirater kappa, intraclass correlation coefficients, and concordance coefficients.
  
  
  RESULTS
  Almost-perfect interobserver agreement was observed for residents and pediatric ophthalmologists recording the presence and number of fundus hemorrhages (intraclass correlation coefficients 0.91 and 0.87, respectively) and the location of hemorrhages (concordance coefficients 0.86 and 0.85, respectively). Substantial agreement was observed by both groups regarding size of hemorrhage (concordance coefficients 0.73 and 0.76), moderate agreement for hemorrhage morphology (concordance coefficients 0.53 and 0.52), and other findings (concordance coefficients 0.48 and 0.59). Intraobserver agreement for pediatric ophthalmologists varied by question, ranging from substantial to perfect for the presence, number, location, size, and morphology of fundus hemorrhage.
  
  
  CONCLUSIONS
  We have developed and validated a standardized clinical reporting tool for ophthalmic findings in suspected abusive head trauma, which has excellent interobserver and intraobserver agreement among consultant specialists and residents. We suggest that its use will improve standardized clinical reporting of such cases.
authors.affiliation: Department of Ophthalmology, University Hospital Wales, Cardiff, United Kingdom.
authors.forename: Wai Siene
authors.initials: WS
authors.lastname: Ng
authors.forename: Patrick
authors.initials: P
authors.lastname: Watts
authors.forename: Zoe
authors.initials: Z
authors.lastname: Lawson
authors.forename: Alison
authors.initials: A
authors.lastname: Kemp
authors.forename: Sabine
authors.initials: S
authors.lastname: Maguire
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015588:Observer Variation; D009885:Ophthalmology / Q000592:standards; D010781:Photography / Q000295:instrumentation* / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012166:Retinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology