Reliability of the visio-vestibular examination for concussion among providers in a pediatric emergency department

Corwin, Daniel J.; Arbogast, Kristy B.; Swann, Casey; Haber, Rebecca A.; Grady, Matthew F.; Master, Christina L.

doi:10.1016/j.ajem.2020.06.020

Cited by 24 publications

(26 citation statements)

References 32 publications

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“…Predictor variables from the BCPE included (1) orthostatic intolerance23 (OI, defined as reporting symptoms of lightheadedness or dizziness24 using the 1 min standing25 after 2 min supine26 orthostatic manoeuvre); (2) ocular smooth pursuits (SP); (3) horizontal repetitive saccades; (4) vertical repetitive saccades; (5) vestibulo-ocular reflex (VOR); (6) near point convergence; (7) tandem gait;27 (8) neck tenderness; (9) neck muscle spasm and (10) neck range of motion. Directions for each component of the BCPE have been published previously17 and directions for the specific physical examination components that made it to the final scoring tool are provided in online supplemental file 2.…”

Section: Methodsmentioning

confidence: 99%

Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms

et al. 2021

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ObjectiveThe Buffalo Concussion Physical Examination (BCPE) is a brief, but pertinent physical examination designed for the subacute, outpatient assessment of concussion. The purpose of this study was to perform the BCPE on a larger sample and derive a scoring system to identify children at risk for Persistent Post-Concussive Symptoms (PPCS, recovery ≥30 days).MethodsThis prospective, observational cohort study from September 2016 to March 2019 was performed at three university-affiliated concussion clinics. Male and female children (n=270, 14.92±1.86 years, range 8–18, 38% female) were diagnosed with a concussion within 14 days of injury and followed-up until recovery. Logistic regression was used with history and physical examination variables to predict PPCS and a weighted scoring metric was derived.ResultsOut of 15 predictor variables, the main effects of 1 preinjury variable (≥3 previous concussions), 2 injury characteristic variables (days-since-injury and type-of-injury), 3 physical examination variables (orthostatic intolerance (OI), vestibulo-ocular reflex (VOR) and tandem gait) and 2 interaction terms (OI/VOR and tandem gait/type-of-injury) produced a score that was 85% accurate for identifying children with low-risk, medium-risk and high-risk for PPCS on cross-validation.ConclusionThe Risk for Delayed Recovery (RDR)-Score allows physicians in an outpatient setting to more accurately predict which children are at greater risk for PPCS early after their injury, and who would benefit most from targeted therapies. The RDR-Score is intended to be used as part of a comprehensive assessment that should include validated symptom checklists, mental health history and adjunct testing (eg, cognitive or physical exertion) where clinically indicated.

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Section: Methodsmentioning

confidence: 99%

Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms

et al. 2021

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“…18 One version of vestibular testing, the VisioVestibular Examination for Concussion (VVE), is described in Table 2 and Figure 2, and includes 9 test elements: (1) smooth pursuit, (2) horizontal and (3) vertical saccades; (4) horizontal and (5) vertical gaze stability (the angular vestibuloocular reflex), ( 6) near-point of convergence, (7) right and (8) left monocular accommodation; and (9) complex tandem gait. [37][38][39] The VVE has been standardized across providers in primary care, emergency medicine, and sports medicine at a large, tertiary-care pediatric institution, and has been shown to be reliable in multiple practice settings. 2,38,40 It takes approximately 3 to 5 minutes to complete, and can be performed in children as young as 6 years.…”

Section: Physical Examinationmentioning

confidence: 99%

“…[37][38][39] The VVE has been standardized across providers in primary care, emergency medicine, and sports medicine at a large, tertiary-care pediatric institution, and has been shown to be reliable in multiple practice settings. 2,38,40 It takes approximately 3 to 5 minutes to complete, and can be performed in children as young as 6 years. 38 There are multiple benefits to performing visiovestibular testing in the acute setting.…”

Section: Physical Examinationmentioning

confidence: 99%

“…2,38,40 It takes approximately 3 to 5 minutes to complete, and can be performed in children as young as 6 years. 38 There are multiple benefits to performing visiovestibular testing in the acute setting. The testing is highly diagnostic, as previous work has found that each abnormal element of the 9 subtests of the VVE increases likelihood of a concussion diagnosis by 2.1 times, 38e and that 10% of youth concussions will report minimal symptoms, but exhibit VVE abnormalities on physical examination.…”

Section: Physical Examinationmentioning

confidence: 99%

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Evaluation and Management of Pediatric Concussion in the Acute Setting

et al. 2021

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Concussion, a type of mild traumatic brain injury, is a common injury encountered by providers caring for pediatric patients in the emergency department (ED) setting. Our understanding of the pathophysiologic basis for symptom and recovery trajectories for pediatric concussion continues to rapidly evolve. As this understanding changes, so do recommendations for optimal management of concussed youth. As more and more children present to EDs across the country for concussion, it is imperative that providers caring for children in these settings remain up-to-date with diagnostic recommendations and management techniques. This article will review the definition, epidemiology, pathophysiology, diagnosis, and management of pediatric concussion in the ED setting.

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“…Abnormality for smooth pursuits, saccades, VOR, and VMS was defined as provocation of symptoms within the number of repetitions that required the participant to stop testing. For more detailed information on testing refer to our prior work, which has shown the testing to be reliable and specific for concussion across multiple clinical settings 7,[20][21][22][23] . Participants with symptom exacerbation by definition cannot complete the target number of repetitions.…”

Section: Data Collection Sessionsmentioning

confidence: 99%

The relationship between visually evoked effects and concussion in youth

Gentile

Aguirre

Arbogast

et al. 2021

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Increased sensitivity to light is common following concussion. Viewing a flickering light can also produce uncomfortable somatic sensations like nausea or headache. Here we examined effects evoked by viewing a patterned, flickering screen in a cohort of 81 uninjured youth athletes and 84 youth with concussion. We used exploratory factor analysis and identified two primary dimensions of variation: the presence or absence of visually evoked effects, and variation in the tendency to manifest effects that localized to the eyes (e.g., eye watering), versus more generalized neurologic symptoms (e.g., headache). Based on these two primary dimensions, we grouped participants into three categories of evoked symptomatology: no effects, eye-predominant effects, and brain-predominant effects. A similar proportion of participants reported eye-predominant effects in the uninjured (33.3%) and concussion (32.1%) groups. By contrast, participants who experienced brain-predominant effects were almost entirely from the concussion group (1.2% of uninjured, 35.7% of concussed). The presence of brain-predominant effects was associated with a higher concussion symptom burden and reduced performance on visio-vestibular tasks. Our findings indicate that the experience of negative constitutional, somatic sensations in response to a dynamic visual stimulus is a salient marker of concussion and is indicative of more severe concussion symptomatology. We speculate that differences in visually evoked effects reflect varying levels of activation of the trigeminal nociceptive system.

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Reliability of the visio-vestibular examination for concussion among providers in a pediatric emergency department

Cited by 24 publications

References 32 publications

Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms

Derivation of the Buffalo Concussion Physical Examination risk of delayed recovery (RDR) score to identify children at risk for persistent postconcussive symptoms

Evaluation and Management of Pediatric Concussion in the Acute Setting

The relationship between visually evoked effects and concussion in youth

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