Using change scores on the vestibular ocular motor screening (VOMS) tool to identify concussion in adolescents

Elbin, R.J.; Eagle, Shawn R.; Marchetti, Gregory F.; Anderson, Morgan; Schatz, Philip; Womble, Melissa N.; Covassin, Tracey; Collins, Michael W.; Mucha, Anne; Kontos, Anthony P.

doi:10.1080/21622965.2021.1911806

Cited by 18 publications

(27 citation statements)

References 31 publications

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“…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.…”

Section: Overview Of Studies Included In This Reviewmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Thomas¹,

Thomas

Bloom

2023

Journal of Concussion

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Background and importance Each year, 1.4 million patients attend a UK ED with a head injury. Mild traumatic brain injury affects up to 300/100 000 admitted patients/year and a greater number of non-admitted patients. Identifying those patients with a head injury that have concussion, and of those, which will have a prolonged recovery, is critical for discharge planning. The Vestibular/Ocular Motor Screening test (VOMS) has been reported as a useful “sideline tool” to evaluate for sports-related concussion (SRC). VOMS has been assessed for utility primarily for predicting in head-injured, which cases will have concussion, and secondarily in predicting in concussed patients, which will have prolonged recovery. Originally described in 2014, VOMS has not been subject to systematic review or meta-analysis, with regard to its predictive performance for concussion. Objective To assess the state of VOMS evidence for dichotomously classifying concussion status in patients with non-severe head injury Design Systematic review. Setting and participants Studies comprising the review enrolled ambulatory head-injured adults and children, usually from sports-related settings, in Europe or the USA. Exposure VOMS. Outcome measures Presence of concussion, presence of prolonged recovery in concussed patients Main results The review identified 17 studies, characterized by a wide variety of specific approaches to administering and scoring VOMS. While VOMS showed promise as a screening tool for concussion, marked study heterogeneity precluded generation of a pooled effect estimate for VOMS performance. Conclusion VOMS is potentially useful as a concussion screening tool. Available evidence from the SRC arena suggests sensitivity ranging from 58–96%, with specificity 46−92%. Directions for future VOMS research should include evaluation of standardized administration and scoring, potentially of a simpler VOMS (with fewer components), in a general head-injured population. Further analysis of precisely defined VOMS application may be useful to determine the proper place of VOMS screening for the head-injured.

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Section: Overview Of Studies Included In This Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Thomas¹,

Thomas

Bloom

2023

Journal of Concussion

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Section: Methodsmentioning

confidence: 99%

“…As previous literature has demonstrated cutoff scores of ≥ 2 total symptoms after any VOMS item to have a high rates (96%) of identifying concussion (30), and the presence of symptom provocation on at least 1 VOMS task to have negative effects on recovery (22), a variable of overall symptom provocation was used in this study. This variable was defined as an increase of 2 or more points on any task in the VOMS according to optimal change score cut-off scores recently published in Elbin et al (37). Clinical performance: In addition to noting the symptom provocation induced by each task, assessors also noted performance-based observations (normal-abnormal, qualitative descriptors) for each task included in the VOMS: smooth pursuit (vertical and horizontal), voluntary saccades (vertical and horizontal), convergence, VOR (vertical and horizontal) and VOR suppression (VMS task), as well as measured near point of convergence (NPC, cm).…”

Section: Clinical Outcome Measures Vestibular/ocular-motor Screeningmentioning

confidence: 99%

Characterizing the evolution of oculomotor and vestibulo-ocular function over time in children and adolescents after a mild traumatic brain injury

et al. 2022

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BackgroundImpairments to oculomotor (OM) and vestibulo-ocular reflex (VOR) function following pediatric mTBI have been demonstrated but are poorly understood. Such impairments can be associated with more negative prognosis, affecting physical and mental wellbeing, emphasizing the need to more fully understand how these evolve.Objectivesto determine i) the extent to which performance on clinical and computerized tests of OM and VOR function varies over time in children and adolescents at 21 days, 3-, and 6-months post-mTBI; ii) the proportion of children and adolescents with mTBI presenting with abnormal scores on these tests at each timepoint.DesignProspective longitudinal design.SettingTertiary care pediatric hospital.Participants36 participants with mTBI aged 6 to18.ProceduresParticipants were assessed on a battery of OM and VOR tests within 21 days, at 3- and 6-months post injury.Outcome measuresClinical measures: Vestibular/ocular motor screening tool (VOMS) (symptom provocation and performance); Computerized measures: reflexive saccade test (response latency), video head impulse test (VOR gain), and dynamic visual acuity test (LogMAR change).AnalysisGeneralized estimating equations (parameter estimates and odd ratios) estimated the effect of time. Proportions above and below normal cut-off values were determined.ResultsOur sample consisted of 52.8% females [mean age 13.98 (2.4) years, assessed on average 19.07 (8–33) days post-injury]. Older children performed better on visual motion sensitivity (OR 1.43, p = 0.03) and female participants worse on near point of convergence (OR 0.19, p = 0.03). Change over time (toward recovery) was demonstrated by VOMS overall symptom provocation (OR 9.90, p = 0.012), vertical smooth pursuit (OR 4.04, p = 0.03), voluntary saccade performance (OR 6.06, p = 0.005) and right VOR gain (0.068, p = 0.013). Version performance and VOR symptom provocation showed high abnormal proportions at initial assessment.DiscussionResults indicate impairments to the VOR pathway may be present and driving symptom provocation. Vertical smooth pursuit and saccade findings underline the need to include these tasks in test batteries to comprehensively assess the integrity of OM and vestibular systems post-mTBI.ImplicationsFindings demonstrate 1) added value in including symptom and performance-based measures in when OM and VOR assessments; 2) the relative stability of constructs measured beyond 3 months post mTBI.

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“…Since its 2014 description by a sports concussion group, the vestibular ocular/motor screening (VOMS) for post-concussive syndrome (PCS) has been reported as useful [1][2][3][4][5][6][7][8][9][10][11]. As used for screening head injury (HI) patients -usually athletes -VOMS entails the performance of seven provocative maneuvers, with scoring based on post-maneuver symptom assessments.…”

mentioning

confidence: 99%

Standard vs. modified vestibular/ocular motor screening for emergency department prediction of symptom persistence 1 week after minor head injury

Thomas,

Pathan,

Bhutta

et al. 2023

European Journal of Emergency Medicine

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Using change scores on the vestibular ocular motor screening (VOMS) tool to identify concussion in adolescents

Cited by 18 publications

References 31 publications

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

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

Characterizing the evolution of oculomotor and vestibulo-ocular function over time in children and adolescents after a mild traumatic brain injury

Standard vs. modified vestibular/ocular motor screening for emergency department prediction of symptom persistence 1 week after minor head injury

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