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Background There is currently no universally accepted classification of childhood retinal haemorrhages. Aim To measure the inter- and intra-observer agreement of clinical classifications of retinal haemorrhages in children. Methods Four examiners (two consultant ophthalmologists and two other clinicians) were shown 142 retinal haemorrhages on 31 RetCam photographs. The retinal haemorrhages were from children with accidental or abusive head injury, or other encephalopathies, and included retinal haemorrhages of different ages. Specified haemorrhages were initially classified by each examiner according to their clinical understanding. Altogether, 26 haemorrhages were represented to test intra-observer consistency. Examiners then agreed a common description for each haemorrhage type and five categories were described (vitreous, pre-retinal, nerve fibre layer, intra-retinal/subretinal or indeterminate) and the study repeated. Results There was 'fair agreement' initially (Fleiss' unweighted κ=0.219) and, with the agreed classification, slight improvement (0.356). Intra-observer agreement marginally improved on re-test. The two consultant ophthalmologists showed 'fair' agreement on both occasions (paired κ statistic). The other rater pair improved from 'fair' to 'substantial' agreement with the new classification. Conclusions The classification of retinal haemorrhage in children by appearance alone shows only fair agreement between examiners. Clinicians who are not consultant ophthalmologists appear to benefit from the new succinct classification. [ABSTRACT FROM AUTHOR]

BACKGROUND/AIMS: To develop and assess a zonal classification of the retina to facilitate description of the location of retinal haemorrhages in children. METHODS: A novel zonal classification of the retina was devised based on the anatomical landmarks of the optic disc and vascular arcades, by reviewing a large number of wide field digital retinal images drawn from our database of children with accidental and non-accidental head injury and other encepthalopathies. Four expert examiners then independently ‘located’ 142 retinal haemorrhages by zone, from 31 high quality photographs. RESULTS: Cohen's unweighted κ scores for all possible pairs of the four raters (ie, six pairs) ranged from 0.86 to 0.92, that is ‘almost perfect’ agreement. Fleiss' κ for agreement between multiple raters (four) and for multiple categories (three) was 0.8841, that is ‘almost perfect’ agreement. Cohen's unweighted κ statistic for intrarater reliability gave an overall concordance that ranged from ‘substantial’ to ‘perfect’ agreement. CONCLUSION: This new retinal zone classification and the use of photographs and templates is a very reliable tool for reporting the location of retinal haemorrhages from multiple aetiologies in children, and may be useful for research and medico-legal reports. [ABSTRACT FROM AUTHOR]