Risk Factors for Vestibular and Oculomotor Outcomes After Sport-Related Concussion

Melissa N. Womble, Inova Sports Medicine Concussion Program, Fairfax, Virginia.
Jamie McAllister-Deitrick, Department of Kinesiology, Coastal Carolina University, Conway, South Carolina.
Gregory F. Marchetti, Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania.
Erin Reynolds, Baylor Scott & White Sports Therapy & Research, Sports Concussion Center, Frisco, Texas.
Michael W. Collins, Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania; and.
R J. Elbin, Department of Health, Human Performance and Recreation, Office for Sport Concussion Research, University of Arkansas, Fayetteville, Arkansas.
Anthony P. Kontos, Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania; and.

Abstract

OBJECTIVE: To investigate the association between risk factors and vestibular-oculomotor outcomes after sport-related concussion (SRC). STUDY DESIGN: Cross-sectional study of patients seen 5.7 ± 5.4 days (range 0-30 days) after injury. SETTING: Specialty clinic. PARTICIPANTS: Eighty-five athletes (50 male athletes and 35 female athletes) aged 14.1 ± 2.8 years (range 9-24 years) seeking clinical care for SRC. INTERVENTIONS: Participants completed a clinical interview, history questionnaire, symptom inventory, and vestibular/ocularmotor screening (VOMS). Chi-square tests with odds ratios and diagnostic accuracy were used to examine the association between risk factors and VOMS outcomes. MAIN OUTCOME MEASURES: The VOMS. RESULTS: Female sex (χ2 = 4.9, P = 0.03), on-field dizziness (χ2 = 7.1, P = 0.008), fogginess (χ2 = 10.3, P = 0.001), and post-traumatic migraine (PTM) symptoms including headache (χ2 = 16.7, P = 0.001), nausea (χ2 = 10.9, P = 0.001), light sensitivity (χ2 = 14.9, P = 0.001), and noise sensitivity (χ2 = 8.7, P = 0.003) were associated with presence of one or more postconcussion VOMS score above clinical cutoff. On-field dizziness (χ2 = 3.8, P = 0.05), fogginess (χ2 = 7.9, P = 0.005), and PTM-like symptoms including nausea (χ2 = 9.0, P = 0.003) and noise sensitivity (χ2 = 7.2, P = 0.007) were associated with obtaining a postconcussion near-point convergence (NPC) distance cutoff >5 cm. The likelihood ratios were 5.93 and 5.14 for VOMS symptoms and NPC distance, respectively. CONCLUSIONS: Female sex, on-field dizziness, fogginess, and PTM symptoms were predictive of experiencing vestibular-oculomotor symptoms/impairment after SRC.