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Importance of Including Borderline Cases in Trachoma Grader Certification

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  • F. I. Proctor Foundation, Department of Ophthalmology, Department of Epidemiology and Biostatistics, Institute for Global Health, University of California, San Francisco, California; Programme National de Lutte Contre la Cecité Niamey, Niger; The Carter Center, Addis Ababa, Ethiopia

We assessed trachoma grading agreement among field graders using photographs that included the complete spectrum of disease and compared it with cases where there was consensus among experienced graders. Trained photographers took photographs of children's conjunctiva during a clinical trial in Ethiopia. We calculated κ-agreement statistics using a complete set of 60 cases and then recalculated the κ using a consensus set where cases were limited to those cases with agreement among experienced graders. When the complete set of 60 cases was used, agreement was moderate (κ = 0.61, 95% confidence interval [95% CI] = 0.56–0.67). When the consensus set was used, agreement improved significantly (κ = 0.75, 95% CI = 0.68–0.80). The κ of the consensus set was higher than the complete set by 0.14 (95% CI = 0.12–0.16) (P < 0.001). If testing sets remove difficult-to-grade cases, agreement in trachoma grading may be higher than actually seen in population-based trachoma surveys.

Author Notes

* Address correspondence to Bruce D. Gaynor, F. I. Proctor Foundation, Department of Ophthalmology, University of California at San Francisco, 513 Parnassus, Med Sci 334C, San Francisco, CA 94143. E-mail: bruce.gaynor@ucsf.edu

Financial support: This work was supported by National Institutes of Health Grants NIH/NEI U10 EY016214 and K23 EYO19881-01 and National Institutes of Health/University of California San Francisco-Clinical & Translational Science Institute (CTSI) Grant Number KL2 TR000143.

Authors' addresses: Bruce D. Gaynor, Nicole E. Stoller, Sun N. Yu, Puja A. Cuddapah, Jeremy D. Keenan, and Thomas M. Lietman, F. I. Proctor Foundation, University of California, San Francisco, CA, E-mails: Bruce.Gaynor@ucsf.edu, Nicole.Stoller@ucsf.edu, Sun.Yu@ucsf.edu, Puja.Cuddapah@ucsf.edu, Jeremy.Keenan@ucsf.edu, and Tom.Lietman@ucsf.edu. Abdou Amza, Boubacar Kadri, and Baido Nassirou, Programme Faculté des Sciences de la Santé/Université Abdou Moumouni de Niamey, Programme Nationale des Soins Oculaire, Niger, E-mails: dr.amzaabdou@gmail.com, boubacarkadri@gmail.com, and nasbeido@yahoo.fr. Sintayehu Gebresailassie, The Carter Center, Addis Ababa, Ethiopia, E-mail: sint_selam@yahoo.com.

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