THU203 Self-puberty Staging In Endocrine Encounters During The COVID Pandemic
Authors: Ebo Chineze , McCray Jordyn , Bowers Katherine , Rose Susan R , Jones Nana-Hawa Yayah 
Published: October 2023

Abstract
Disclosure: C. Ebo: None. J. McCray: None. K. Bowers: None. S.R. Rose: None. N. Yayah Jones: None.
Background and Objective: Telemedicine became increasingly necessary during the COVID 19 pandemic. It presents challenges for evaluating pubertal staging, essential for endocrine care. Studies testing validity of pubertal self-staging compared with clinical examination have had conflicting results and have not focused on telemedicine encounters. The aim of this study was to determine validity and reliability of patients’ self-staging pubertal assessments for potential use at home during telemedicine visits. Methods: Study included patients [referred to Cincinnati Children Hospital Medical Center pediatric endocrinology center for specialty care], age 7-22y, who required pubertal staging as part of their comprehensive evaluation. Upon clinic check-in, patients received a packet with description of study procedure and rationale; an option to “opt in” or “opt out” of the study; written sex-specific instructions on how to do self-pubertal staging; and gender-appropriate illustration sheet(s) depicting Tanner (T) stages. Boys’ packets included drawings and descriptions for pubic hair (PH) stages T1-T5; girls’ packets included drawings and descriptions for PH and also for breast development (BR) stages T1-T5. Patients who “opted in” were given &lt;10 minutes alone in their clinic room to choose the image(s) that most resembled their bodies. Their selection went in a sealed envelope. Patients then underwent their clinic visit with physical examination by a board-certified pediatric endocrinologist including BR staging for girls, assessment of testicular size in boys, and PH staging in both sexes. Results: We received 243 self-assessments (51.4% girls), of which 80% were complete with self- and endocrinologist staging (48.0% girls). Mean age of participants was 12.8y. Mean BMI was 22.2 kg/m2 (boys), 23.7 (girls). Hypothyroidism was the most common endocrine diagnosis among participants. We calculated a Tanner stage kappa statistic for agreement with the endocrinologist with 95%CI for BR/PH by sex. Kappa &gt;0.60 was considered strong agreement; 0.40-0.60 moderate agreement; 0.20-0.40 fair agreement. Agreement for girls was highest in T1 (BR 0.65, 95%CI 0.44-0.86; PH 0.57, 95%CI 0.35-0.79) and T5 (BR 0.57, 95%CI 0.37-0.77; PH 0.65, 95%CI 0.47-0.83). Agreement for boys PH was highest in T1 (0.73, 95%CI 0.59-0.87) and T2 (0.58, 95%CI 0.59-0.87). A greater level of agreement was found when female (F) and male (M) T stages were grouped by pre-puberty (T1; BR 0.65, FPH 0.57, MPH 0.73), early-mid puberty (T2-3; BR 0.60, FPH 0.52, MPH 0.59), and late puberty (T4-5; BR 0.76, FPH 0.74, MPH 0.79). Conclusion: Using self-staging of puberty, children and adolescents can distinguish between "puberty" and "no puberty", although differentiating between later pubertal stages is less reliable. These results contribute to defining utility and limitations of self-staging during telemedicine visits.
Presentation: Thursday, June 15, 2023