The Vestibular/Ocular Motor Screening–Child (VOMS-C) tool for concussion evaluation in 5- to 9-year-old pediatric patients: preliminary evidence

Alicia M. TrbovichUniversity of Pittsburgh Medical Center, Pittsburgh;

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Anne MuchaCenter for Rehab Services, Pittsburgh; and

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Shawn EagleUniversity of Pittsburgh Medical Center, Pittsburgh;
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

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Bindal Makwana MehmelUniversity of Pittsburgh Medical Center, Pittsburgh;

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Nathan KegelUniversity of Pittsburgh Medical Center, Pittsburgh;

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Vanessa Fazio SumrokUniversity of Pittsburgh Medical Center, Pittsburgh;

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Michael W. CollinsUniversity of Pittsburgh Medical Center, Pittsburgh;

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Anthony P. KontosUniversity of Pittsburgh Medical Center, Pittsburgh;

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OBJECTIVE

Vestibular and ocular motor dysfunction occurs in an estimated 60%–90% of concussion patients. The Vestibular/Ocular Motor Screening (VOMS) tool is validated for use in concussion patients older than 9 years. The goal of the current study was to adapt the current VOMS tool for a pediatric sample of children aged 5–9 years and establish its clinical utility in this patient population.

METHODS

In this case-control study, 80 symptomatic concussion patients (n = 33 [41%] female) aged 5–9 years (mean age 7.40 ± 1.09 years) and 40 (n = 18 [45%] female) age- and sex-matched uninjured controls (mean age 7.10 ± 1.26 years) completed the VOMS–Child (VOMS-C), a version of the VOMS adapted for younger patients. Differences in binary "yes" or "no" symptom provocation for headache, dizziness, and nausea/"tummy ache" across the 7 items of the VOMS-C, and near point of convergence (NPC) distance, were examined. Logistic regression (LR) models were built to classify concussion and controls. Predicted probabilities were generated from the LR model and entered into receiver operating characteristic (ROC) curve models to generate area under the curve (AUC) values.

RESULTS

VOMS-C item provocation ranged from 13% to 30% for concussed patients and 3% to 20% for controls. The LR model distinguished concussed participants from controls (R2 = 0.39; p < 0.001), with significant predictors being smooth pursuits, family depression history, and NPC distance. The ROC analysis had an AUC of 0.81 (95% CI 0.73–0.89; p < 0.001) in the good range.

CONCLUSIONS

Accurate diagnosis of concussion in the clinic setting requires comprehensive evaluation in multiple domains, including detailed clinical interview, neurocognitive testing, and vestibular/ocular motor assessment, regardless of patient age. Our results provide preliminary support for the VOMS-C as a developmentally appropriate tool for concussion management.

ABBREVIATIONS

ADHD = attention-deficit/hyperactivity disorder; AUC = area under the curve; Child SCAT-5 = Sport Concussion Assessment Tool–5 child version; ImPACT Pediatric = Immediate Postconcussion Assessment and Cognitive Testing pediatric version; LD = learning disability; LR = logistic regression; NPC = near point of convergence; ROC = receiver operating characteristic; VMS = visual motion sensitivity; VOMS = Vestibular/Ocular Motor Screening; VOMS-C = VOMS–Child; VOR = vestibular/ocular reflex.

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Images from Chiang et al. (pp 595–601).

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