A-15 Predictive Utility of Risk Factors Associated with Vestibular and Oculomotor Outcomes Following Sport-Related Concussion

Abstract

Abstract Purpose The purpose of the present study was to determine the ability of these risk factors to predict vestibular/oculomotor symptom provocation on the Vestibular/Oculomotor Screening (VOMS). It was hypothesized that both pre- and post-injury risk factors would predict symptom provocation on the VOMS. Methods This was a retrospective chart review of patients (n=78; 41 male) aged 15.2±1.7 years (range 12-18 years) seeking care at a concussion specialty clinic. Participants were seen 5.1±3.2 days (range 1-14 days) post-injury and completed a clinical interview, history questionnaire, symptom inventory, and VOMS as part of routine clinical care. Data analysis included chi-square tests with odds ratios to examine the association between identified risk factors and VOMS outcomes. An alpha value of .05 was used for all analyses. Results Personal history of motion sickness (χ2=7.6, p=.006, OR=11.4), personal history of oculomotor dysfunction (Fisher’s exact test, p=.01, OR=1.2), post-traumatic migraine (PTM) symptoms (χ2=11.7, p<.001, OR=5.4), and post-injury fogginess (χ2=10.1, p=.001, OR=4.8), were associated with presence of one or more post-injury VOMS individual item scores above clinical cutoff (i.e., symptom elevation >2). History of oculomotor dysfunction (Fisher’s exact test p=.013, OR=6.6) and PTM symptoms (χ2=5.0, p=.025, OR=3.3) were associated with obtaining a post-injury near-point convergence (NPC) distance >5 cm. Gender, loss of consciousness status, concussion history, history of migraine, and psychiatric history were not associated with VOMS symptom provocation or abnormal NPC. Conclusions Findings indicate that both pre-injury risk factors (i.e., personal history of motion sickness and history of oculomotor dysfunction) and post-injury risk factors (i.e., fogginess, PTM symptoms) were associated with clinically meaningful symptom provocation on the VOMS. In addition, history of oculomotor dysfunction and PTM symptoms were both associated with abnormal NPC distance. These results reinforce the importance of a comprehensive evaluation including a clinical history and vestibular and oculomotor screening following SRC. Consistent with prior research, loss of consciousness status and concussion history were not associated with increased risk for vestibular/oculomotor outcomes.