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Abstract Details

Reliability of the Neuro-ophthalmic Aspects of a Telemedicine Exam in Concussion (Tele-BCPE)
Neuro-ophthalmology/Neuro-otology
P11 - Poster Session 11 (5:30 PM-6:30 PM)
10-004
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).  
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.
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.
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).  
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.
Authors/Disclosures
Scott Grossman, MD (New York University, Langone Health)
PRESENTER
Dr. Grossman has nothing to disclose.
Alani Jack (NYU Langone Department of Neurology) Ms. Jack has nothing to disclose.
Helena Digney, Other (NYU Langone) Miss Digney has nothing to disclose.
Carter A. Bell (NYU Neurology) Mr. Bell has nothing to disclose.
Jacob I. McPherson, PT (University at Buffalo) Mr. McPherson has nothing to disclose.
Ghazala Saleem (State University of New York at Buffalo) No disclosure on file
Mohammad N. Haider (University At Buffalo, SUNY) Mr. Haider has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for BlinkCNS. The institution of Mr. Haider has received research support from NIH.
John J. Leddy, MD, FACSM, FACP (UBMD Orthopaedics & Sports Medicine) Dr. Leddy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurolign. Dr. Leddy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stage 2 Contract Engineering. Dr. Leddy has received stock or an ownership interest from Highmark Innovations. The institution of Dr. Leddy has received research support from NIH. The institution of Dr. Leddy has received research support from DoD. The institution of Dr. Leddy has received research support from AMSSM.
Barry Willer (State University of New York at Buffalo) No disclosure on file
Steven Galetta, MD, FAAN (NYU Langone Medical Center) Dr. Galetta has nothing to disclose.
Neil A. Busis, MD, FAAN (NYU Langone Health) Dr. Busis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for American Academy of Neurology. Dr. Busis has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology Today.
Daniel Torres, MD Dr. Torres has received publishing royalties from a publication relating to health care.
Laura J. Balcer, MD, MSCE, FAAN (NYU Grossman School of Medicine) An immediate family member of Dr. Balcer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Children's Hospital of Philadelphia. Dr. Balcer has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for North American Neuro-Ophthalmology Society.