Research Reports - Vestibulo-ocular dysfunction in pediatric sports-related concussion

J Neurosurg Pediatr. 2015 Jun 2:1-8

Ellis MJ(1,)(2,)(3,)(4,)(5), Cordingley D(4), Vis S(4), Reimer K(4), Leiter
J(1,)(4), Russell K(2,)(5)

OBJECT The objective of this study was 2-fold: 1) to examine the prevalence of
vestibulo-ocular dysfunction (VOD) among children and adolescents with acute
sports-related concussion (SRC) and postconcussion syndrome (PCS) who were
referred to a multidisciplinary pediatric concussion program; and 2) to determine
if VOD is associated with the development of PCS in this cohort. METHODS The
authors conducted a retrospective review of all patients with acute SRC
(presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least
1 month) referred to a multidisciplinary pediatric concussion program between
September 2013 and July 2014. Initial assessment included clinical history,
physical examination, and Post-Concussion Symptom Scale assessment. Patients were
also assessed for VOD, which was defined as more than one subjective vestibular
and oculomotor complaint (dizziness, blurred vision, and so on) and more than one
objective physical examination finding (abnormal smooth pursuits, saccades,
vestibulo-ocular reflex, and so on). This study was approved by the local
institutional ethics review board. RESULTS A total of 101 patients (mean age 14.2
years, SD 2.3 years; 63 male and 38 female patients) participated, including 77
(76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients
(28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical
criteria for VOD. The median duration of symptoms was 40 days (interquartile
range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with
21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a
statistically significant increase in the adjusted odds of developing PCS among
patients with acute SRC who had VOD compared with those without VOD (adjusted OR
4.10; 95% CI 1.04-16.16). CONCLUSIONS Evidence of VOD was detected in a
significant proportion of children and adolescents with acute SRC and PCS who
were referred to a multidisciplinary pediatric concussion program. This clinical
feature was a significant risk factor for the subsequent development of PCS in
this pediatric acute SRC cohort.

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