Inter-observer concordance in grading retinopathy in cerebral malaria
Beare, N.A.; Southern, C.; Lochhead, J.; Molyneux, M.E.; Lewallen, S.; Harding, S.P.
Annals of Tropical Medicine and Parasitology 96(1): 105-108
2002
ISSN/ISBN: 0003-4983 PMID: 11989526 DOI: 10.1179/000349802125000565Document Number: 236157
The level of agreement between 2 independent observers (junior ophthalmologists in the UK) who used a grading system to grade retinopathy in cerebral malaria (CM) was investigated. Consecutive patients with CM who were admitted to the Malaria Project's research ward at the Queen Elizabeth Central Hospital in Blantyre, Malawi were examined by these observers . The results from left eyes and weighted kappa statistics were used for data analysis. Of 56 patients examined, 25 were each considered to have normal fundi by both observers. The other 31 patients had retinal changes. Three patients were classified as having papilloedema (2 by both observers and one by one observer only). The weighted kappa values (and their 95% confidence intervals) for the other retinal signs, such as haemorrhages (0.85; 0.71-0.98), macular whitening (0.68; 0.51-0.85), foveal whitening (0.71; 0.52-0.91), peripheral whitening (0.38; 0.18-0.57), vessel changes (0.63; 0.37-0.88) and capillary whitening (0.58; 0.27-0.90) indicate a high degree of inter-observer agreement in grading most of the retinal changes in CM.