Subject(s)
Adrenal Insufficiency , Perioperative Care , Humans , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/drug therapy , Child , Perioperative Care/standards , Perioperative Care/methods , Adolescent , Practice Guidelines as Topic , Child, Preschool , Consensus , Infant , Female , MaleSubject(s)
Abdominal Pain , Neonatology , Infant , Humans , Abdominal Pain/diagnosis , Abdominal Pain/etiologySubject(s)
Hypoxia , Neonatology , Humans , Hypoxia/diagnosis , Hypoxia/etiology , Infant, Newborn , Respiratory System , ResuscitationABSTRACT
BACKGROUND/AIMS: To determine the diagnostic accuracy of trained rural ophthalmologists and non-medical image graders in the assessment of diabetic retinopathy (DR) in rural China. METHODS: Consecutive patients with diabetes mellitus were examined from January 2014 to December 2015 at 10 county-level facilities in rural Southern China. Trained rural ophthalmologists performed a complete eye examination, recording diagnoses using the UK National Diabetic Eye Screening Programme (NDESP) classification system. Two field, mydriatic, 45° digital photographs were made by nurses using NDESP protocols and graded by trained graders with no medical background using the NDESP system. A fellowship-trained retina specialist graded all images in masked fashion and served as reference standard. RESULTS: Altogether, 375 participants (mean age 60±10 years, 48% men) were examined and 1277 images were graded. Grader sensitivity (0.82-0.94 (median 0.88)) and specificity (0.91-0.99 (median 0.98)), reached or exceeded NDESP standards (sensitivity 80%, specificity 95%) in all domains except specificity detecting any DR. Rural ophthalmologists' sensitivity was 0.65-0.95 (median 0.66) and specificity 0.59-0.95 (median 0.91). There was strong agreement between graders and the reference standard (kappa=0.84-0.87, p<0.001) and weak to moderate agreement between rural doctors and the reference (kappa=0.48-0.64, p<0.001). CONCLUSION: This is the first study of diagnostic accuracy in DR grading among non-medical graders or ophthalmologists in low-income and middle-income countries. Non-medical graders can achieve high levels of accuracy, whereas accuracy of trained rural ophthalmologists is not optimal.