ArticlePLoS neglected tropical diseases2014
Reliability of trachoma clinical grading--assessing grading of marginal cases.
Article in PLoS neglected tropical diseases, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Cost-effectiveness of adding measurement of Chlamydia trachomatis infection and serology to trachoma prevalence surveys in Tanzania and Mozambique.PLoS neglected tropical diseases · 2025Article
- Accuracy, acceptability and feasibility of photography for use in trachoma surveys: a mixed methods study in Tanzania.International health · 2024Article
- High prevalence of trachomatous inflammation-follicular with no trachomatous trichiasis: can alternative indicators explain the epidemiology of trachoma in Côte d'Ivoire?International health · 2023Article
- Explaining the continuing high prevalence of trachomatous trichiasis unknown to the health system in evaluation units: a mixed methods explanatory study in four trachoma-endemic countries.International health · 2023Article
- Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys.Ophthalmic epidemiology · 2023Article
- Photographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2023Article
- Evaluation of photography using head-mounted display technology (ICAPS) for district Trachoma surveys.PLoS neglected tropical diseases · 2021Observational
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Authors and funding
12 authors.
Funding
Abstract
backgroundClinical examination of trachoma is used to justify intervention in trachoma-endemic regions. Currently, field graders are certified by determining their concordance with experienced graders using the kappa statistic. Unfortunately, trachoma grading can be highly variable and there are cases where even expert graders disagree (borderline/marginal cases). Prior work has shown that inclusion of borderline cases tends to reduce apparent agreement, as measured by kappa. Here, we confirm those results and assess performance of trainees on these borderline cases by calculating their reliability error, a measure derived from the decomposition of the Brier score. METHODS AND
findingsWe trained 18 field graders using 200 conjunctival photographs from a community-randomized trial in Niger and assessed inter-grader agreement using kappa as well as reliability error. Three experienced graders scored each case for the presence or absence of trachomatous inflammation-follicular (TF) and trachomatous inflammation-intense (TI). A consensus grade for each case was defined as the one given by a majority of experienced graders. We classified cases into a unanimous subset if all 3 experienced graders gave the same grade. For both TF and TI grades, the mean kappa for trainees was higher on the unanimous subset; inclusion of borderline cases reduced apparent agreement by 15.7% for TF and 12.4% for TI. When we assessed the breakdown of the reliability error, we found that our trainees tended to over-call TF grades and under-call TI grades, especially in borderline cases.
conclusionsThe kappa statistic is widely used for certifying trachoma field graders. Exclusion of borderline cases, which even experienced graders disagree on, increases apparent agreement with the kappa statistic. Graders may agree less when exposed to the full spectrum of disease. Reliability error allows for the assessment of these borderline cases and can be used to refine an individual trainee's grading.
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