Inter-observer concordance in grading retinopathy in cerebral malaria

In children severe Plasmodium falciparum malaria causes a unique set of retinal signs (Lewallen et al. 1993; Hero et al. 1997). Some of these changes are entirely specific to severe malaria and have been associated with fatal outcome in cerebral malaria (Lewallen et al. 1996; unpubl. obs.). Observations of these retinopathies therefore have a contribution to continuing studies on the patho-physiological processes in cerebral malaria (CM). Lewallen et al. (1999) described these opthalmic changes in detail and proposed a system for grading them. In an attempt to validate and standardize this grading system the level of agreement between two independent observers who used the system to grade retinopathy in CM and then recorded their findings on standardized charts was investigated in a prospective study. The patients investigated were the consecutive children with CM who were admitted to the Malaria Projects research ward at the Queen Elizabeth Central Hospital in Blantyre Malawi during one malaria season. For the purposes of this study CM was defined as a Blantyre coma score of 2 or less in the presence of P. falciparum parasitaemia with no other explanation of coma (Molyneux et al. 1989). The Malawi College of Medicines Research Committee gave ethical approval for the study and patients were included only after permission from their parents or guardians was obtained. The tenets of the Declaration of Helsinki were also followed. (excerpt)