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PubMed2003

The nosology of psychotic disorders: a comparison among competing classification systems.

This study examined the concordance and predictive validity of two empirical and two operational classification systems of psychotic disorders. Latent class analysis (LCA) was applied to 16 index episode and to their corresponding 16 lifetime symptom ratings of 660 psychotic inpatients, who were also diagnosed according to DSM-IV and ICD-10 criteria. The resulting classes or diagnoses were validated against clinical (premorbid adjustment, treatment response, and course) and etiologic (morbidity risk of schizophrenia and major mood disorders) variables. LCA of index episode and lifetime ratings showed that five classes of psychotic disorders provided the best fit to the data: schizophrenia, psychosis, schizomania/schizobipolar, schizodepression, and mixed psychosis (cycloid psychosis for index episode ratings and atypical schizophrenia for lifetime ratings). The concordance between the empirical and operational classification systems was poor. Irrespective of the classification method used, the most powerful validators were the clinical ones, whereas the etiologic validators played a negligible role in validating the classes or diagnoses. Overall, DSM-IV and ICD-10 classifications had more clinical validity than empirical classifications, mainly because of circularity in operational definitions regarding treatment response and course of the disorders. With the exception of the category of schizophrenia, which showed some nosological stability across the four classification systems, the number and type of categories of psychosis were highly dependent upon the set of classification procedures. These results make clear the problems inherent in drawing well-defined boundaries between psychotic disorders.

Adult↗
PubMed1994

Impairments and disabilities--the difference: proposal for adjustment of the International Classification of Impairments, Disabilities, and Handicaps.

In this article, a proposal for adjustment of the Classification of Impairments and the Classification of Disabilities of the International Classification of Impairments, Disabilities, and Handicaps is presented. This proposal is a result of a project conducted by the Dutch National Institute for Research and Postgraduate Education in Physical Therapy. The project was executed in collaboration with the professional national organizations of five health professions: occupational therapy, chiropody, Cesar therapy (exercise therapy), Mensendieck therapy (exercise therapy), and physical therapy. The proposal includes reformulated definitions of impairment and disability, an inventory of the impairments and disabilities that are relevant for the health professions that participated in the project, a description of the domain of the Classification of Impairments and the Classification of Disabilities, a new subdivision for both classifications in chapters, and a set of "types of characteristics" and "characteristics" that subdivide the different chapters of the two classifications.

Disability Evaluation↗
PubMed2003

A classification study of clinical subsets in an inception cohort of early psoriatic peripheral arthritis--'DIP or not DIP revisited'.

INTRODUCTION: Multiple psoriatic arthritis (PsA) classification criteria exist, but these are based on established PsA when pre-existing joint damage and the effect of medication may confound their validity. This study examined the application of the Veale classification criteria in early PsA to determine the effect of disease progression and treatment on classification and to determine the effect of the number of involved joints and the presence of distal interphalangeal (DIP) joint involvement at initial presentation on clinical and radiological outcome. METHODS: A total of 129 patients presenting with PsA to an Irish early synovitis clinic were assessed at presentation and at 1- and 2-yr follow-up. The Veale criteria were used for PsA classification and the Sharp score of hands and feet was used to quantify radiological outcome. RESULTS: At presentation, 52 (40%) had oligoarticular PsA and 77 (60%) had polyarticular PsA. Patients with polyarticular PsA were administered disease-modifying anti-rheumatic drugs (DMARDs) more frequently than patients with oligoarticular PsA and this resulted in a significant number of polyarticular PsA patients being reclassified as oligoarticular PsA at 1- [27/70 (39%)] and 2-yr [26/53 (49%)] follow-up. Fewer patients initially classified with oligoarticular PsA were reclassified as polyarticular PsA. More patients with oligoarticular PsA at baseline were in DMARD-free remission and there was less radiological damage at 2-yr follow-up. DIP disease was associated with other classic seronegative disease features-enthesopathy and nail dystrophy-but did not influence clinical or radiological outcome and the separation of DIP disease as a distinct subgroup in classification criteria was not supported. Synovitis-acne-pustulosis-hyperostosis (SAPHO) syndrome was not observed as a separate subgroup. CONCLUSION: This study confirms that the application of classification criteria of PsA based on the pattern and number of involved joints may be confounded in established PsA by the effects of DMARDs. The application of classification criteria based on disease pattern prior to treatment may be more useful in studies of pathogenesis and long-term outcome in PsA.

Adolescent↗
PubMed1997

A critical assessment of factors influencing reliability in the classification of fractures, using fractures of the tibial plafond as a model.

OBJECTIVE: To investigate three factors that may influence the reliability of a fracture classification system: (a) the quality of the radiographs; (b) the ability of observers to identify the fracture fragments; and (c) the use of binary decision making. DESIGN: Assessment of interobserver reliability of blinded observers. SETTING: Medical school department of orthopaedics. PARTICIPANTS: Two attending orthopaedists, two PGY-5 orthopaedic residents, and two PGY-3 orthopaedic residents served as observers. INTERVENTION: Observers classified radiographs of twenty-five tibial plafond fractures according to the Rüedi-Allgöwer and binary classification systems, and also rated the quality of each radiograph as adequate or inadequate for accurately classifying the fracture. At a second session, observers classified the same radiographs after marking the fragments of the tibial articular surface, as well as radiographs that had the articular fragments premarked by the senior author. MAIN OUTCOME MEASURES: Pairwise interobserver reliability was analyzed by kappa statistics, and mean kappa values were compared for each method of fracture classification. RESULTS: No difference in interobserver reliability was detected between the Rüedi-Allgöwer and binary classification systems. Interobserver agreement on the adequacy of the radiographs was poorer than agreement on the classification of the fractures themselves. Having observers mark the fragments of the tibial articular surface had no effect on interobserver reliability; having the articular fragments premarked, however, significantly improved interobserver reliability in classifying the fractures. CONCLUSIONS: The results of this study underscore the complexity of tibial plafond fractures and the difficulty observers have in reliably interpreting fracture radiographs. Fracture classification systems, such as the Rüedi-Allgöwer, predicated on identification of the number and displacement of articular fragments, may inherently perform poorly on reliability analyses because of observer difficulty in reliably identifying the fragments. Because binary decision making did not improve the reliability of fracture classification in this study, further investigation of the effectiveness of binary decision making may be advisable before such strategies are put into widespread use.

Adult↗
PubMed1997

Avoidable morbidity in infants. A classification based on diagnoses in administrative databases.

OBJECTIVES: A hierarchical classification for avoidable morbidity in infants was developed based on a conceptual model for causes of morbidity. Experts rated the impact of risk factors and health services on diseases coded according to the International Classification of Diseases, 9th Revision, Classification Modification (ICD-9-CM). An etiologic framework was chosen for the classification because knowledge of etiology often suggests strategies for prevention. Causes of morbidity that cluster on the basis of similar risk factors might be avoided using similar strategies. METHODS: Diseases (346 different diagnoses) were rated by 16 general pediatricians; 12 attributes were considered, including the impact on disease occurrence and on severity of five risk factors, preventive health services, and medical treatment. Raters evaluated the impact of health services, constitutional risk factors, and environmental risk factors without regard for service site (eg, inpatient, emergency department, primary care office). Environmental risk factors categories, including family, social, and physical environments, were rated separately. The impact of health services was rated on prevention, treatment, and complications of care. RESULTS: Only ratings indicating that the impact of a risk factor category was substantial were used for the final classification of 275 diagnoses. Consistent with the multifactorial etiology of many diseases, many diagnoses had ratings indicating substantial impact of multiple risk factors. Five mutually exclusive clusters were derived from the 12 ratings based on factor analysis and recognized strategies for prevention. Ordered by level of avoidability, these clusters were termed vaccine-preventable, health-care quality indicators, environmental, environmental/constitutional, and constitutional. CONCLUSIONS: The usefulness of this classification for policy-oriented epidemiologic and health services research is grounded in the premise that prevention is the cardinal objective of child health policy. Cluster-specific hospitalization rates, ie, rates aggregated for all diagnoses falling in a cluster, might be used for allocating resources to interventions directed at environmental or health service determinants of morbidity. Widespread use of ICD-9-CM codes in hospital discharge and ambulatory databases suggests many potential applications for this classification of morbidity burden in population groups.

Databases, Factual↗
PubMed2005

Interobserver reliability of a CT-based fracture classification system.

OBJECTIVES: This study was designed to determine whether the interobserver reliability of a fracture classification scheme applied based on a single, carefully defined, computed tomography (CT) cut is greater than those previously reported for systems designed for use with plain radiographs. DESIGN: Observer review of selected cases. SETTING: Four, level one, trauma centers. PATIENTS: Pretreatment CT scans of patients with calcaneus fractures were screened by the authors. Thirty cases were selected that had an appropriate semicoronal CT image. Ten orthopaedic traumatologists who were members of the Orthopaedic Trauma Association and had a minimum of 5 years postresidency experience were selected as reviewers. INTERVENTION: The reviewers were provided with a digital CT image for each case as well as written and diagrammatic representations of the Sanders classification system. The observers then classified each fracture according to the Sanders classification. RESULTS: : The mean kappa value for interobserver reliability for fracture types I-IV was 0.41 +/- 0.02 (mean +/- standard error of the mean; range, 0.07-0.64). Observers disagreed by more than 1 fracture type (ie, I vs. III or II vs. IV) in 10% of the cases. Observers agreed on the location of the fracture lines (A, B, C) in 90% of type II fractures and 52% of type III fractures. CONCLUSIONS: The results indicate that in a carefully controlled paradigm, the interobserver reliability with a classification system based on interpretation of a single, carefully defined CT image was no better than the results reported for the same classification system used with full CT data or for other classification systems used for various fractures in the skeleton. Agreement in identifying the location of the fracture lines was very good for simple fractures but much worse for complex injuries. Additional study may determine whether the use of a full complement of CT images can improve reliability in classification of complex injuries.

Ankle Injuries↗
PubMed2003

Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial.

STUDY DESIGN: A randomized clinical trial was conducted. OBJECTIVE: To compare the effectiveness of classification-based physical therapy with that of therapy based on clinical practice guidelines for patients with acute, work-related low back pain. SUMMARY OF BACKGROUND DATA: Clinical practice guidelines recommend minimal intervention during the first few weeks after acute low back injury. However, studies supporting this recommendation have not attempted to identify which patients are likely to respond to particular interventions. METHODS: For this study, 78 subjects with work-related low back pain of less than 3 weeks duration were randomized to receive therapy based on a classification system that attempts to match patients to specific interventions or therapy based on the Agency for Health Care Policy and Research guidelines. The subjects were followed for 1 year. Outcomes included the impairment index, Oswestry scale, SF-36 component scores, satisfaction, medical costs, and return to work status. RESULTS: After adjustment for baseline factors, subjects receiving classification-based therapy showed greater change on the Oswestry (P = 0.023) and the SF-36 physical component (P = 0.029) after 4 weeks. Patient satisfaction was greater (P = 0.006) and return to full-duty work status more likely (P = 0.017) after 4 weeks in the classification-based group. After 1 year, there was a trend toward reduced Oswestry scores in the classification-based group (P = 0.063). Median total medical costs for 1 year after injury were 1003.68 dollars for the guideline-based group and 774.00 dollars for the classification-based group (P = 0.13). CONCLUSIONS: For patients with acute, work-related low back pain, the use of a classification-based approach resulted in improved disability and return to work status after 4 weeks, as compared with therapy based on clinical practice guidelines. Further research is needed on the optimal timing and methods of intervention for patients with acute low back pain.

Acute Disease↗
PubMed2006

An examination of the reliability of a classification algorithm for subgrouping patients with low back pain.

STUDY DESIGN: Test-retest design to examine interrater reliability. OBJECTIVE: Examine the interrater reliability of individual examination items and a classification decision-making algorithm using physical therapists with varying levels of experience. SUMMARY OF BACKGROUND DATA: Classifying patients based on clusters of examination findings has shown promise for improving outcomes. Examining the reliability of examination items and the classification decision-making algorithm may improve the reproducibility of classification methods. METHODS: Patients with low back pain less than 90 days in duration participating in a randomized trial were examined on separate days by different examiners. Interrater reliability of individual examination items important for classification was examined in clinically stable patients using kappa coefficients and intraclass correlation coefficients. The findings from the first examination were used to classify each patient using the decision-making algorithm by clinicians with varying amounts of experience. The reliability of the classification algorithm was examined with kappa coefficients. RESULTS: A total of 123 patients participated (mean age 37.7 [+/-10.7] years, 44% female), 60 (49%) remained stable between examinations. Reliability of range of motion, centralization/peripheralization judgments with flexion and extension, and the instability test were moderate to excellent. Reliability of centralization/peripheralization judgments with repeated or sustained extension or aberrant movement judgments were fair to poor. Overall agreement on classification decisions was 76% (kappa = 0.60, 95% confidence interval 0.56, 0.64), with no significant differences based on level of experience. CONCLUSION: Reliability of the classification algorithm was good. Further research is needed to identify sources of disagreements and improve reproducibility.

Adolescent↗
PubMed2006

Risk-informed radioactive waste classification and reclassification.

Radioactive waste classification systems have been developed to allow wastes having similar hazards to be grouped for purposes of storage, treatment, packaging, transportation, and/or disposal. As recommended in the National Council on Radiation Protection and Measurements' Report No. 139, Risk-Based Classification of Radioactive and Hazardous Chemical Wastes, a preferred classification system would be based primarily on the health risks to the public that arise from waste disposal and secondarily on other attributes such as the near-term practicalities of managing a waste, i.e., the waste classification system would be risk informed. The current U.S. radioactive waste classification system is not risk informed because key definitions--especially that of high-level waste--are based on the source of the waste instead of its inherent characteristics related to risk. A second important reason for concluding the existing U.S. radioactive waste classification system is not risk informed is there are no general principles or provisions for exempting materials from being classified as radioactive waste which would then allow management without regard to its radioactivity. This paper elaborates the current system for classifying and reclassifying radioactive wastes in the United States, analyzes the extent to which the system is risk informed and the ramifications of its not being so, and provides observations on potential future direction of efforts to address shortcomings in the U.S. radioactive waste classification system as of 2004.

Decision Making↗
PubMed2005

Supervised nonlinear dimensionality reduction for visualization and classification.

When performing visualization and classification, people often confront the problem of dimensionality reduction. Isomap is one of the most promising nonlinear dimensionality reduction techniques. However, when Isomap is applied to real-world data, it shows some limitations, such as being sensitive to noise. In this paper, an improved version of Isomap, namely S-Isomap, is proposed. S-Isomap utilizes class information to guide the procedure of nonlinear dimensionality reduction. Such a kind of procedure is called supervised nonlinear dimensionality reduction. In S-Isomap, the neighborhood graph of the input data is constructed according to a certain kind of dissimilarity between data points, which is specially designed to integrate the class information. The dissimilarity has several good properties which help to discover the true neighborhood of the data and, thus, makes S-Isomap a robust technique for both visualization and classification, especially for real-world problems. In the visualization experiments, S-Isomap is compared with Isomap, LLE, and WeightedIso. The results show that S-Isomap performs the best. In the classification experiments, S-Isomap is used as a preprocess of classification and compared with Isomap, WeightedIso, as well as some other well-established classification methods, including the K-nearest neighbor classifier, BP neural network, J4.8 decision tree, and SVM. The results reveal that S-Isomap excels compared to Isomap and WeightedIso in classification, and it is highly competitive with those well-known classification methods.

Algorithms↗
PubMed2004

A classification of disulfide patterns and its relationship to protein structure and function.

We report a detailed classification of disulfide patterns to further understand the role of disulfides in protein structure and function. The classification is applied to a unique searchable database of disulfide patterns derived from the SwissProt and Pfam databases. The disulfide database contains seven times the number of publicly available disulfide annotations. Each disulfide pattern in the database captures the topology and cysteine spacing of a protein domain. We have clustered the domains by their disulfide patterns and visualized the results using a novel representation termed the "classification wheel." The classification is applied to 40,620 protein domains with 2-10 disulfides. The effectiveness of the classification is evaluated by determining the extent to which proteins of similar structure and function are grouped together through comparison with the SCOP and Pfam databases, respectively. In general, proteins with similar disulfide patterns have similar structure and function, even in cases of low sequence similarity, and we illustrate this with specific examples. Using a measure of disulfide topology complexity, we find that there is a predominance of less complex topologies. We also explored the importance of loss or addition of disulfides to protein structure and function by linking classification wheels through disulfide subpattern comparisons. This classification, when coupled with our disulfide database, will serve as a useful resource for searching and comparing disulfide patterns, and understanding their role in protein structure, folding, and stability. Proteins in the disulfide clusters that do not contain structural information are prime candidates for structural genomics initiatives, because they may correspond to novel structures.

Animals↗
PubMed1983

Concordance of the Kiel and Lukes-Collins classifications of non-Hodgkin's lymphomas.

The Kiel and Lukes-Collins classifications of non-Hodgkin's lymphomas are the only classifications based on immunological concepts. Their cytological types have been confirmed by numerous immunological studies as B- and T-cell types and have been related to clinico-pathological entities. In this presentation, the cytological types of the two classifications are compared. Eleven of the 13 major types of the Lukes-Collins classification are essentially identical with the Kiel counterparts, though the terminology differs in four of the 11 types. In the two types in which discordance occurs, the relationship between the types of the two classifications are clarified. As a result, the two classifications are placed into effective alignment for understanding and translating terminological differences. Both classifications represent sound bases for morphological diagnoses and also for relating the results of the broad range of current and future immunological studies to morphology.

B-Lymphocytes↗
PubMed2006

Reliability of the European Pressure Ulcer Advisory Panel classification system.

AIM: This paper reports a study examining the interrater and intrarater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using photographs of pressure ulcers and incontinence lesions. BACKGROUND: Pressure ulcer classification is an essential tool for assessing ulcers and their severity and determining which preventive or therapeutic action is needed. Many classification systems are described in the literature. There are only a limited number of studies that evaluate the interrater reliability of pressure ulcer grading scales. The intrarater reliability is seldom studied. METHODS: The study consisted of two phases. In the first phase 56 photographs, together with a random selection of nine photographs from the same set, were presented to 473 nurses. In the second phase, the 56 photographs were presented twice to 86 other nurses with an interval of one month and in a different order. All the nurses were familiar with the European Pressure Ulcer Advisory Panel classification. They did not receive any additional training on classification, and were asked to classify the lesions as normal skin, blanchable erythema, pressure ulcers (four grades, European Pressure Ulcer Advisory Panel classification) or incontinence lesions. RESULTS: In the first phase, the multirater-Kappa for the 473 participating nurses was 0.37 (P < 0.001). Non-blanchable erythema was often confused with blanchable erythema and incontinence lesions. Also incontinence lesions were frequently not correctly classified. The intrarater agreement was low (kappa = 0.38). In the second phase, the interrater agreement was not significantly different in both sessions. The intrarater agreement was 0.52. CONCLUSION: Both the interrater and intrarater reliability of the European Pressure Ulcer Advisory Panel classification of lesion photographs by nurses was very low. Differentiation between pressure ulcers and incontinence lesions seems to be difficult.

Adult↗
PubMed1992

MATIC--an intracardiac tachycardia classification system.

The use of an additional atrial sensing electrode together with a morphology recognition algorithm provides a significant improvement in classification performance over the current rate based algorithms used in implantable cardioverter defibrillator (ICD) devices. The classification system, called morphology and timing intracardiac classifier (MATIC), follows a classification process similar to that used by cardiologists. Timing between the atrial and ventricular channels is examined using a decision tree and forms the primary criterion for arrhythmia classification. A neural network based morphology classifier is used for cases such as ventricular tachycardia with 1:1 retrograde conduction where timing alone cannot make a reliable decision. MATIC achieves 99.6% correct classification on a database of intracardiac electrogram (ICEG) signals containing 12,483 QRS complexes recorded from 67 patients during electrophysiological studies. Arrhythmias in this database include sinus tachycardia, normal sinus rhythm, normal sinus rhythm with bundle branch block, sinus tachycardia with bundle branch block, atrial fibrillation (AF), various supraventricular tachycardias, ventricular tachycardia, ventricular tachycardia with 1:1 retrograde conduction, and ventricular fibrillation. Within these arrhythmias, there were numerous ventricular ectopic beats, fusion beats, noise, and other artifacts. MATIC addresses the classification problem from start to finish, inputs being raw intracardiac electrogram signals and the outputs being the recommended ICD therapy. Results achieved with MATIC were compared with a classifier used in the Telectronics Guardian ATP 4210, which achieved 75.9% correct classification on the same database. MATIC is simple and efficient, making it suitable for use in a low power implantable device.

Defibrillators, Implantable↗
PubMedDate not supplied

Classification of thymic epithelial neoplasms: a controversial issue coming to an end?

The classification of thymic epithelial neoplasms has been one of the most controversial issues in tumor pathology. There are two opposing schools of pathologists holding different views regarding the classification of thymic epithelial neoplasms. One school of pathologists believe that histological classification of thymomas is not possible or useful. Another school of pathologists believe that thymomas can be histologically subclassified despite their complex histomorphology and that these histological subtypes correlate with their aggressiveness and clinical behavior. A compromised histological classification has been established by World Health Organization (WHO) to designate thymic epithelial neoplasms with letters and numbers. This classification should be adopted internationally to facilitate the communication among concerned pathologists and oncologists. A simple histological classification of thymomas based on cytomorphology and supported by cytokeratin expressions is proposed and compared to the WHO and Müller-Hermelink's histogenetic classifications.

Humans↗
PubMed1983

Classification and diagnosis of depression.

There is no general consensus how to classify and diagnose depressive disorders. The main reason is disagreement regarding etiology. This is reflected in the several theoretical models of depression which has been proposed. On the other hand, a reliable way of characterizing groups of patients that can be used by both clinicians and researchers, is necessary both for communication and progress of research. Facing this situation, the inclusion of etiological theories in classification of depression obviously would be an obstacle to the use of such a classification system by clinicians of various theoretical orientation at current. Thus, a classification system which describes the clinical features of the mental disorders comprehensively and at the lowest order of inference necessary to identify the disorder in a reliable way is needed. The third edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-III) represents such a classification system. By providing operational diagnostic criteria for each diagnosis, DSM-III represents a major achievement of classification in clinical psychiatry and research. This paper will present the classification of depression and the problem of differential diagnosis as outlined in DSM-III. Further, the validity of the DSM-III classification of depression will be discussed with reference to some recent research findings on biopsychosocial and treatment aspects of depressive disorders.

Adjustment Disorders↗
PubMed2001

Classification of endocardial electrograms using adapted wavelet packets and neural networks.

The discrimination of ventricular tachycardias with 1:1 retrograde conduction from sinus tachycardia still remains a challenge for rate based algorithms commonly used in dual-chamber implantable cardioverter defibrillators. Morphology based analysis techniques for a classification of antegrade and retrograde atrial activation patterns can be used to cope with this problem. Here time-domain template matching techniques are known approaches. However, a time-domain representation of endocardial electrograms is not optimal for classification tasks as the dimensionality of the underlying signal space is high and features being irrelevant for a signal characterization are involved in the analysis. Therefore, the aim of this study is to develop an enhanced morphological analysis tool for a classification of antegrade and retrograde atrial activation by using a transform domain representation of endocardial electrograms. For this, we applied an adapted wavelet-packet decomposition to extract discriminating features in endocardial electrograms representing antegrade and retrograde activation patterns. Further, a feed-forward neural network was utilized to produce a classification based on the extracted information. In using our hybrid method, no false classification of the physiological and pathological cardiac state was made. It is concluded that the proposed classification scheme represents a highly efficient approach for a classification of antegrade and retrograde atrial activation.

Algorithms↗
PubMed2004

An ultrasound based classification of periocular haemangiomas.

AIMS: To propose a classification system for periocular haemangiomas based on ultrasound evaluation. METHODS: Retrospective review of ultrasound images from children seen in the authors' unit with periocular haemangiomas. Static ultrasound images from 50 patients with periocular haemangiomas were reviewed as identified from a computerised database. Each haemangioma ultrasound image was classified into three categories: (1) preseptal only; (2) preseptal + extraconal; (3) preseptal + extraconal + intraconal. These were compared with the categories given to each patient at first presentation after dynamic scanning. RESULTS: Classification was possible from the static images in 44 (88%) cases. Of those classified 20 (45%) were preseptal only; 17 (39%) were preseptal + extraconal, and seven (16%) had an additional intraconal component. The classification in all 44 cases was the same as that given at the time of presentation. In the small number of cases which went to surgery or had neuroimaging, the ultrasound classification was confirmed. CONCLUSIONS: Ultrasound classification was not difficult to perform and no child needed sedation or general anaesthesia for this exam. Ultrasound anatomical classification is an important first step in determining appropriate treatment of periocular haemangiomas. The authors present what they believe to be the first such classification.

Child↗