Purpose Balance and vestibulo-ocular deficits, secondary to abnormalities of the vestibular system, have been recognized as objective measures of dysfunction and markers of morbidity and recovery from concussions. In order to understand how to interpret these deficits in concussed youth, it is important to quantify the performance of normal controls on vestibulo-ocular testing. Limited data exist describing the distribution of findings in a control population, or at what age the examination can be reliably completed. The objective of this study was to determine the proportion of non-concussed, neurologically normal children who exhibit vestibulo-ocular deficits on examination in a population of those seeking care in the emergency department (ED); secondary objectives included determining at what age the vestibulo-ocular examination can be reliably completed, and the vestibulo-ocular deficit distribution across age groups. Methods This was a cross-sectional study of patients age 6-18 years old presenting to a pediatric ED in a tertiary care children’s hospital with non-neurologic chief complaints (including, but not limited to, abdominal pain, chest pain, rash, mild respiratory distress, and upper extremity trauma). Patients with underlying neurologic conditions, recent head injury, or use of psychoactive medications were excluded. The vestibulo-ocular examination for concussion includes assessments of (1) dysmetria, (2) nystagmus, (3) smooth pursuits, (4) fast saccades, (5) gaze stability (both the horizontal and vertical vestibulo-ocular reflex), (6) near-point convergence, and (7) gait/balance (tandem gait forwards and backwards eyes open and closed). This previously standardized examination was performed by one physician. Baseline and demographic characteristics were summarized using standard descriptive statistics. Results A total of 170 patients were enrolled in the study. 44 patients (26%) had at least one abnormality on the vestibulo-ocular examination. Of those, 16 (36%) reported feeling mild dizziness after completing at least 20 horizontal or vertical saccades, but had an otherwise normal examination. 23 patients (14%) had >1 abnormality on the exam. 32% of females and 21% of males had abnormal examinations. By age, 16% of patients age 6-8 years old, 30% age 9-11, 32% age 12-14, and 22% age 15-18 had abnormal examinations. Overall, 16 (9%) were unable to complete the exam due to developmental age; all were age 6-9 (27% of those ages 6-9 years). Conclusion 26% of neurologically-normal pediatric patients had a deficit on the vestibulo-ocular examination for concussion, though a significant proportion of those patients had either one isolated abnormality, or only reported mild symptoms when completing fast saccades. The exam can be reliably completed in all patients age 10 and older, and can be attempted on patients as young as 6 years old. These data should allow clinicians to effectively implement the use of the vestibulo-ocular examination as a diagnostic and prognosticative measure for those presenting to the ED with concussion.
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Council on Sports Medicine & Fitness Program| January 01 2018
Vestibular and Oculomotor Findings Neurologically-normal, Non-concussed Children
Daniel J. Corwin, MD;
Mark R. Zonfrillo, MD, MSCE;
Pediatrics (2018) 141 (1_MeetingAbstract): 208.
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Daniel J. Corwin, Mark R. Zonfrillo, Kristy B. Arbogast; Vestibular and Oculomotor Findings Neurologically-normal, Non-concussed Children. Pediatrics January 2018; 141 (1_MeetingAbstract): 208. 10.1542/peds.141.1MA3.208
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