Vestibular and vision deficits following concussion in children under 12

Abstract

ObjectiveVestibular and oculomotor visual (VOM) deficits are emerging as key characteristics of youth concussion. However, since most studies of paediatric concussion focus on adolescents, little is known about the extent to which younger children experience this deficit. To address this gap, we used an electronic health record (EHR) system across a large paediatric healthcare network to quantify the presence of VOM deficits following concussion in patients under age 12.DesignDescriptive epidemiology.SettingData were collected from all primary (n=31) and relevant specialty care (n=4) network settings.ParticipantsWe identified all patients aged 5–11 years who had ≥1 clinical visit for concussion at a network primary or specialty care site from 7/1/2014 through 6/30/2015. We included the 82% of these patients for whom a concussion electronic clinical decision support tool within the EHR was used during their initial visit.Outcome measuresThe proportion who demonstrated each VOM deficit – balance, saccades, gaze stability, and convergence – was calculated among all who were assessed for that deficit.Main results871 patients were included (median [IQR]: 10 [8, 11] years). On physical examination, 58% had at least one VOM deficit. 44% had balance abnormalities, 39% had saccadic dysfunction, 28% had deficits in gaze stability, and 10% convergence insufficiency.ConclusionsIn this sample, vestibular oculomotor visual deficits following concussion in young children were common. Improved recognition of the deficits will lead to timely diagnosis and appropriate management, including school accommodations for oculomotor visual challenges and vestibular therapy for motion sensitivity issues.Competing interestsNone.KB, Arbogast serves as a consultant to the National Football League Players Association on head injury topics.