TY - JOUR
T1 - Characterization of Errors in Retinopathy of Prematurity Diagnosis by Ophthalmologists-in-Training in the United States and Canada
AU - GEN-ROP Research Consortium, i-ROP Research Consortium
AU - Al-Khaled, Tala
AU - Patel, Samir N.
AU - Valikodath, Nita G.
AU - Jonas, Karyn E.
AU - Ostmo, Susan
AU - Allozi, Rawan
AU - Hallak, Joelle
AU - Campbell, J. Peter
AU - Chiang, Michael F.
AU - Chan, R. V.Paul
AU - Sonmez, Kemal
AU - Jonas, Karyn
AU - Horowitz, Jason
AU - Coki, Osode
AU - Eccles, Cheryl Ann
AU - Sarna, Leora
AU - Berrocal, Audina
AU - Negron, Catherin
AU - Denser, Kimberly
AU - Cumming, Kristi
AU - Osentoski, Tammy
AU - Check, Tammy
AU - Zajechowski, Mary
AU - Lee, Thomas
AU - Kruger, Evan
AU - McGovern, Kathryn
AU - Simmons, Charles
AU - Murthy, Raghu
AU - Galvis, Sharon
AU - Rotter, Jerome
AU - Chen, Ida
AU - Li, Xiaohui
AU - Taylor, Kent
AU - Roll, Kaye
AU - Kalpathy-Cramer, Jayashree
AU - Erdogmus, Deniz
AU - Martinez-Castellanos, Maria Ana
AU - Salinas-Longoria, Samantha
AU - Romero, Rafael
AU - Arriola, Andrea
AU - Olguin-Manriquez, Francisco
AU - Meraz-Gutierrez, Miroslava
AU - Dulanto-Reinoso, Carlos M.
AU - Montero-Mendoza, Cristina
AU - Mackeen, Leslie D.
AU - Wu, Wei Chi
AU - Anzures, Rachelle Go Ang Sam
AU - Ventura, Camila V.
N1 - Publisher Copyright:
© 2022 Al-Khaled, Patel, Valikodath, et al; licensee SLACK Incorporated.
PY - 2023
Y1 - 2023
N2 - Purpose: To identify the prominent factors that lead to misdiagnosis of retinopathy of prematurity (ROP) by ophthalmologists- in-training in the United States and Canada. Methods: This prospective cohort study included 32 ophthalmologists-in-training at six ophthalmology training programs in the United States and Canada. Twenty web-based cases of ROP using wide-field retinal images were presented, and ophthalmologists-in-training were asked to diagnose plus disease, zone, stage, and category for each eye. Responses were compared to a consensus reference standard diagnosis for accuracy, which was established by combining the clinical diagnosis and the image-based diagnosis by multiple experts. The types of diagnostic errors that occurred were analyzed with descriptive and chi-squared analysis. Main outcome measures were frequency of types (category, zone, stage, plus disease) of diagnostic errors; association of errors in zone, stage, and plus disease diagnosis with incorrectly identified category; and performance of ophthalmologists-in-training across postgraduate years. Results: Category of ROP was misdiagnosed at a rate of 48%. Errors in classification of plus disease were most commonly associated with misdiagnosis of treatment-requiring (plus error rate = 16% when treatment-requiring was correctly diagnosed vs 81% when underdiagnosed as type 2 or pre-plus; mean difference: 64.3; 95% CI: 51.9 to 76.7; P < .001) and type 2 or pre-plus (plus error rate = 35% when type 2 or pre-plus was correctly diagnosed vs 76% when overdiagnosed as treatment-requiring; mean difference: 41.0; 95% CI: 28.4 to 53.5; P < .001) disease. The diagnostic error rate of postgraduate year (PGY)-2 trainees was significantly higher than PGY-3 trainees (PGY-2 category error rate = 61% vs PGY-3 = 35%; mean difference, 25.4; 95% CI: 17.7 to 33.0; P < .001). Conclusions: Ophthalmologists-in-training in the United States and Canada misdiagnosed ROP nearly half of the time, with incorrect identification of plus disease as a leading cause. Integration of structured learning for ROP in residency education may improve diagnostic competency. [J Pediatr Ophthalmol Strabismus. 2023;60(5):337-343.].
AB - Purpose: To identify the prominent factors that lead to misdiagnosis of retinopathy of prematurity (ROP) by ophthalmologists- in-training in the United States and Canada. Methods: This prospective cohort study included 32 ophthalmologists-in-training at six ophthalmology training programs in the United States and Canada. Twenty web-based cases of ROP using wide-field retinal images were presented, and ophthalmologists-in-training were asked to diagnose plus disease, zone, stage, and category for each eye. Responses were compared to a consensus reference standard diagnosis for accuracy, which was established by combining the clinical diagnosis and the image-based diagnosis by multiple experts. The types of diagnostic errors that occurred were analyzed with descriptive and chi-squared analysis. Main outcome measures were frequency of types (category, zone, stage, plus disease) of diagnostic errors; association of errors in zone, stage, and plus disease diagnosis with incorrectly identified category; and performance of ophthalmologists-in-training across postgraduate years. Results: Category of ROP was misdiagnosed at a rate of 48%. Errors in classification of plus disease were most commonly associated with misdiagnosis of treatment-requiring (plus error rate = 16% when treatment-requiring was correctly diagnosed vs 81% when underdiagnosed as type 2 or pre-plus; mean difference: 64.3; 95% CI: 51.9 to 76.7; P < .001) and type 2 or pre-plus (plus error rate = 35% when type 2 or pre-plus was correctly diagnosed vs 76% when overdiagnosed as treatment-requiring; mean difference: 41.0; 95% CI: 28.4 to 53.5; P < .001) disease. The diagnostic error rate of postgraduate year (PGY)-2 trainees was significantly higher than PGY-3 trainees (PGY-2 category error rate = 61% vs PGY-3 = 35%; mean difference, 25.4; 95% CI: 17.7 to 33.0; P < .001). Conclusions: Ophthalmologists-in-training in the United States and Canada misdiagnosed ROP nearly half of the time, with incorrect identification of plus disease as a leading cause. Integration of structured learning for ROP in residency education may improve diagnostic competency. [J Pediatr Ophthalmol Strabismus. 2023;60(5):337-343.].
UR - http://www.scopus.com/inward/record.url?scp=85174535220&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85174535220&partnerID=8YFLogxK
U2 - 10.3928/01913913-20220609-01
DO - 10.3928/01913913-20220609-01
M3 - Article
C2 - 36263935
AN - SCOPUS:85174535220
SN - 0191-3913
VL - 60
SP - 337
EP - 343
JO - Journal of pediatric ophthalmology and strabismus
JF - Journal of pediatric ophthalmology and strabismus
IS - 5
ER -