Utility of the Vestibular/Ocular Motor Screening (VOMS) Tool During High School Sport Participation

Abstract

The Vestibular/Ocular Motor Screening (VOMS) Tool has previously demonstrated the ability to identify differences between healthy and concussed participants in clinical populations, with an 89% positive prediction value. However, there is little information on incidence of clinically significant change in healthy athletes. PURPOSE: To identify rates of change scores on the VOMS in a sideline testing environment with healthy adolescent athletes, within an 89% PPV, allowing for an 11% false positive rate. METHODS: Seventy-eight healthy athletes (15.77 ± 1.39 years) were administered the VOMS three times during their sport season; prior to their sport season (T1) and at a later date, before practice (T2) and within 5 minutes of removal from sport practice (T3). Descriptive statistics and multivariate base rate analyses were performed using Microsoft Excel. RESULTS: Multivariate base rate analyses reveals that a change of 2+ symptom provocation on any 1, 2, or 3 VOMS items achieved a false positive rate of 21%, 14%, and 10% respectively. Using a change of 3+ symptom provocation on any 1, 2, or 3 VOMS items achieved a false positive rate of 13%, 9%, and 6% respectively. Using a change of 4+ symptom provocation on any 1, 2, or 3 VOMS items achieved a false positive rate of 9%, 6%, and 3% respectively. The false positive rate using NPC distance ≥5 cm ranged from 21% to 32% across the three times. In the context of sport participation (T3), a more valid clinical metric during sport participation would be using a change of 2+ symptom provocation on 3 VOMS items, 3+ on 2 VOMS items, or 4+ on 1 VOMS item. CONCLUSIONS: To our knowledge, this is the first study to examine the utility of multivariate base rates in interpreting VOMS change scores in the context of a structured high school sport practice. Our findings suggest interpretation of clinical change on the VOMS using a change of 2+ on 3 VOMS items, 3+ on 2 VOMS items, or 4+ symptom on 1 VOMS item would obtain a false positive rate of ≤11%, whereas a NPC distance of ≥5 centimeters greatly increases the rate of false positive.