Jack Alani I, Digney Helena T, Bell Carter A, Grossman Scott N, McPherson Jacob I, Saleem Ghazala T, Haider Mohammad N, Leddy John J, Willer Barry S, Balcer Laura J, Galetta Steven L, Busis Neil A, Torres Daniel M
Department of Neurology (AIJ, HTD, CAB, SNG, LJB, SLG, NAB), New York University Grossman School of Medicine, NY; Department of Rehabilitation Sciences (JIM, GTS), School of Public Health and Health Professions, State University of New York at Buffalo; UBMD Department of Orthopaedics and Sports Medicine (MNH, JJL) and Department of Psychiatry (BSW), Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo; Departments of Population Health (LJB) and Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, NY; and Department of Neurology (DMT), Lenox Hill Hospital at Northwell Health, New York, NY.
Neurol Clin Pract. 2024 Oct;14(5):e200328. doi: 10.1212/CPJ.0000000000200328. Epub 2024 Jun 14.
We determined inter-modality (in-person vs telemedicine examination) and inter-rater agreement for telemedicine assessments (2 different examiners) using the Telemedicine Buffalo Concussion Physical Examination (Tele-BCPE), a standardized concussion examination designed for remote use.
Patients referred for an initial evaluation for concussion were invited to participate. Participants had a brief initial assessment by the treating neurologist. After a patient granted informed consent to participate in the study, the treating neurologist obtained a concussion-related history before leaving the examination room. Using the Tele-BCPE, 2 virtual examinations in no specific sequence were then performed from nearby rooms by the treating neurologist and another neurologist. After the 2 telemedicine examinations, the treating physician returned to the examination room to perform the in-person examination. Intraclass correlation coefficients (ICC) determined inter-modality validity (in-person vs remote examination by the same examiner) and inter-rater reliability (between remote examinations done by 2 examiners) of overall scores of the Tele-BCPE within the comparison datasets. Cohen's kappa, κ, measured levels of agreement of dichotomous ratings (abnormality present vs absent) on individual components of the Tele-BCPE to determine inter-modality and inter-rater agreement.
For total scores of the Tele-BCPE, both inter-modality agreement (ICC = 0.95 [95% CI 0.86-0.98, < 0.001]) and inter-rater agreement (ICC = 0.88 [95% CI 0.71-0.95, < 0.001]) were reliable (ICC >0.70). There was at least substantial inter-modality agreement (κ ≥ 0.61) for 25 of 29 examination elements. For inter-rater agreement (2 telemedicine examinations), there was at least substantial agreement for 8 of 29 examination elements.
Our study demonstrates that the Tele-BCPE yielded consistent clinical results, whether conducted in-person or virtually by the same examiner, or when performed virtually by 2 different examiners. The Tele-BCPE is a valid indicator of neurologic examination findings as determined by an in-person concussion assessment. The Tele-BCPE may also be performed with excellent levels of reliability by neurologists with different training and backgrounds in the virtual setting. These findings suggest that a combination of in-person and telemedicine modalities, or involvement of 2 telemedicine examiners for the same patient, can provide consistent concussion assessments across the continuum of care.
我们使用布法罗脑震荡远程体格检查（Tele-BCPE）（一种专为远程使用设计的标准化脑震荡检查），确定了远程医疗评估（2名不同检查者）的不同检查方式（面对面检查与远程医疗检查）之间以及检查者之间的一致性。
邀请因脑震荡接受初次评估的患者参与。参与者由主治神经科医生进行简短的初步评估。在患者签署知情同意书参与研究后，主治神经科医生在离开检查室前获取与脑震荡相关的病史。然后，主治神经科医生和另一位神经科医生从附近房间按照无特定顺序进行2次虚拟检查，使用Tele-BCPE。2次远程医疗检查后，主治医生返回检查室进行面对面检查。组内相关系数（ICC）确定了比较数据集中Tele-BCPE总分的不同检查方式有效性（同一检查者的面对面检查与远程检查）和检查者间可靠性（2名检查者进行的远程检查之间）。Cohen's kappa（κ）测量了Tele-BCPE各个组成部分二分法评分（存在异常与不存在异常）的一致性水平，以确定不同检查方式和检查者间的一致性。
对于Tele-BCPE的总分，不同检查方式的一致性（ICC = 0.95 [95% CI 0.86 - 0.98，< 0.001]）和检查者间的一致性（ICC = 0.88 [95% CI 0.71 - 0.95，< 0.001]）均可靠（ICC > 0.70）。29项检查要素中的25项存在至少高度的不同检查方式一致性（κ ≥ 0.61）。对于检查者间的一致性（2次远程医疗检查），29项检查要素中的8项存在至少高度一致性。
我们的研究表明，无论由同一检查者进行面对面检查还是虚拟检查，或者由2名不同检查者进行虚拟检查，Tele-BCPE都能产生一致的临床结果。Tele-BCPE是面对面脑震荡评估所确定的神经学检查结果的有效指标。在虚拟环境中，不同培训背景的神经科医生也能以极高的可靠性进行Tele-BCPE检查。这些发现表明，面对面检查和远程医疗检查方式相结合，或者由2名远程医疗检查者对同一患者进行检查，能够在整个连续护理过程中提供一致的脑震荡评估。
