Discriminative Validity of Vestibular Ocular Motor Screening in Identifying Concussion Among Collegiate Athletes: A National Collegiate Athletic Association–Department of Defense Concussion Assessment, Research, and Education Consortium Study

Abstract

Background: Vestibular and ocular motor screening tools, such as the Vestibular/Ocular Motor Screening (VOMS), are recognized as important components of a multifaceted evaluation of sport-related concussion. Previous research has supported the predictive utility of the VOMS in identifying concussion, but researchers have yet to examine the predictive utility of the VOMS among collegiate athletes in the first few days after injury. Purpose: To determine the discriminative validity of individual VOMS item scores and an overall VOMS score for identifying collegiate athletes with an acute sport-related concussion (≤72 hours) from healthy controls matched by age, sex, and concussion history. Study Design: Case-control study; Level of evidence, 3. Methods: Participants (N = 570) aged 17 to 25 years were included from 8 institutions of the National Collegiate Athletic Association–Department of Defense CARE Consortium (Concussion Assessment, Research, and Education): 285 athletes who were concussed (per current consensus guidelines) and 285 healthy controls matched by age, sex, and concussion history. Participants completed the VOMS within 3 days of injury (concussion) or during preseason (ie, baseline; control). Symptoms are totaled for each VOMS item for an item score (maximum, 40) and totaled across items for an overall score (maximum, 280), and distance (centimeters) for near point of convergence (NPC) is averaged across 3 trials. Receiver operating characteristic analysis of the area under the curve (AUC) was performed on cutoff scores using Youden index ( J) for each VOMS item, overall VOMS score, and NPC distance average. A logistic regression was conducted to identify which VOMS scores identified concussed status. Results: A symptom score ≥1 on each VOMS item and horizontal vestibular/ocular reflex ≥2 significantly discriminated concussion from control (AUC, 0.89-0.90). NPC distance did not significantly identify concussion from control (AUC, 0.51). The VOMS overall score had the highest accuracy (AUC, 0.91) for identifying sport-related concussion from control. Among the individual items, vertical saccades ≥1 and horizontal vestibular/ocular reflex ≥2 best discriminated concussion from control. Conclusion: The findings indicate that individual VOMS items and overall VOMS scores are useful in identifying concussion in collegiate athletes within 3 days of injury. Clinicians can use the cutoffs from this study to help identify concussion in collegiate athletes.

Determining Sport Concussion Assessment Tool fifth Edition (SCAT5) reliable change in male professional hockey players

“…Similarly, the data presented in this study may contribute to further development of the SCAT tools. Specifically, several modifications may lead to improved reliability and utility of the instrument, including (1) Expanding the length of the number strings on the Concentration Index to reduce ceiling effects; (2) Creating validated cognitive index scores that aggregate performance and produce a more stable estimate of ability; (3) Including strict administration instructions that reduce individual (eg, ensuring adequate sleep at each time point) and environmental (eg, single administrator) variation; (4) Developing performance validity criteria that indicate a need for retesting when players do not provide best effort24; (5) Using two baselines to obtain a more stable estimate of a player’s true abilities25 26 and (6) In light of recent research,18 27 future iterations of the SCAT should also consider inclusion of tools to more fully assess oculomotor functioning 2…”

Vestibular/ocular motor screening (VOMS) score for identification of concussion in cases of non-severe head injury: A systematic review

“…Table 1 provides an overview of studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] included in this review. The table lists study design (categorized as per Mathes and Pieper's suggested approach for systematic reviews 19 ) as well as brief highlights of methods and/or findings.…”

“…Complete removal of such bias could be difficult (e.g., concussion status may be suggested by pre-provocation symptom score), but it remains the case that suspected awareness of concussion status can bias results of diagnostic Consortium. 8,11,13,17 One study, Ferris2022 17 , pointed out that some of its subjects had been previously analyzed in other work from the same group. There may have been other subjects in the CARE registry that were subject to inclusion in more than one investigation.…”

“…1,2 Whether utilized on the athletic field sidelines, the sports medicine clinic, or the Emergency Department (ED), VOMS has been the subject of multiple investigations assessing its ability to correctly classify the head-injured into concussed vs. non-concussed status. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Despite the growing VOMS evidence base, and despite the existence of systematic reviews of other sideline SRC evaluation tools (e.g., King-Devick), 18 a 2022 literature search identified no systematic review with or without meta-analysis (MA) addressing VOMS diagnostic performance.…”

Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review

“…The VOMS was evaluated in 22 studies, including four high quality studies. The VOMS was usually administered as per Mucha et al ,140 and was found to (1) discriminate concussion from no concussion with high levels of sensitivity, particularly in the acute phase of injury (ie, <24 hours), and (2) identified increased total VOMS symptom scores and/or greater proportion of the sample with scores above the cut-point post concussion52 141–143 even in the absence of baseline testing 52. Seven studies evaluated the function of the VOR with variable results and used several different outcomes.…”