Reliability of the Neuro-ophthalmic Aspects of a Telemedicine Exam in Concussion (Tele-BCPE)
Scott Grossman1, Alani Jack2, Helena Digney3, Carter Bell4, Jacob McPherson5, Ghazala Saleem6, Mohammad Haider7, John Leddy8, Barry Willer6, Steven Galetta9, Neil Busis10, Daniel Torres11, Laura Balcer12
1New York University, Langone Health, 2NYU Langone Department of Neurology, 3NYU Langone, 4NYU Neurology, 5University at Buffalo, 6State University of New York at Buffalo, 7University At Buffalo, SUNY, 8UBMD Orthopaedics & Sports Medicine, 9NYU Langone Medical Center, 10NYU Langone Health, 11Northwell Health, 12NYU School of Medicine
Objective:
To determine intermodality (in-person vs. telemedicine examination) and inter-examiner (two tele-examiners) agreement for capturing neuro-ophthalmic manifestations of concussion using the Telemedicine Buffalo Concussion Physical Examination (Tele-BCPE), a 29 item validated instrument for remote evaluation of the neurological manifestations of concussion.
Background:
It is unknown whether concussion can be examined reliably using telemedicine; such assessments are especially important for neuro-ophthalmic findings. The Tele-BCPE is a standardized telemedicine concussion exam that includes 7 neuro-ophthalmic elements (optic nerve, ocular motility, smooth pursuits, repetitive saccades, vestibulo-ocular reflex, and two tests of near point of convergence).
Design/Methods:
Twenty-one patients evaluated within two weeks of suspected concussion participated. Their treating neurologist examined them in-person and via telemedicine. Another neurologist performed a second telemedicine examination. Cohen’s kappa measured agreement between elements, scored as present vs. absent, of the two tele-examinations and between the in-person and tele-examinations (inter-modality agreement). Intraclass correlation coefficients were used to determine agreement between total scores of the Tele-BCPE for in-person vs. tele- exam and between the two tele-exams.
Results:
There was at least moderate agreement (kappa > 0.41) for 3 of 7 neuro-ophthalmic elements between in person and tele-examination by a single examiner and at least moderate agreement for 4 of 7 examination subcategories between two different tele-examiners. For total scores incorporating only neuro-ophthalmic examination elements, inter-modality agreement (in-person vs. telemedicine, intraclass correlation coefficient [ICC] = 0.78) was in the “excellent” range. Inter-rater agreement (for two telemedicine raters, ICC = 0.49) was in the low-moderate reliability range (ICC >0.75).
Conclusions:
Standardized neuro-ophthalmic assessments performed by the same examiner are highly reliable, even when performed across modalities of in-person vs. telemedicine settings. Agreement is at least moderate when two different telemedicine examiners assess the same patients when using standardized examinations such as the Tele-BCPE.