Aims: This audit aims to assess the quality and accuracy of primary graders in the diabetic retinopathy screening program in the occupied Palestinian territories. Subjects and Methods: A retrospective audit of 198 image sets from eight fully trained primary graders in the diabetic retinopathy screening program in the occupied Palestinian territories was performed. An expert grader regraded all images and audited their quality. The interobserver agreement between primary graders and the expert grader and the corresponding Kappa coefficient were determined for overall grading, referable, nonreferable disease, and ungradable disease. The audit standard was set at 80% for interobserver agreement with a Kappa coefficient of 0.7. Results: The interobserver agreement was 80% or better for overall outcome, referable, and nonreferable disease. The Kappa coefficient was 0.70 (substantial) for the overall grading results, 0.72 (substantial) for referable disease, 0.86 (almost perfect) for nonreferable disease, and was 0.21 (fair) for ungradable disease. About 82% of pictures showed two positions, and 75% of pictures showed good and adequate quality. Conclusions: The audit demonstrates an adequate level of quality and accuracy for primary grading in the diabetic retinopathy screening program in the occupied Palestinian territories.
Key-words:
Diabetic screening - grader - interobserver agreement - kappa - Palestine
