Vestibular and ocular motor screening tools like Vestibular/Ocular Motor Screening are effective at identifying concussions among collegiate athletes within the first three days post injury, a new study finds.
Vestibular, Ocular Motor Scores Detect Concussion Within 72 Hours
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These screening tools “are recognized as important components of a multifaceted evaluation of sport-related concussion,” wrote the researchers of “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.”
“Previous research has supported the predictive utility of the Vestibular/Ocular Motor Screening (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.”
The study, which was published online on May 12, 2021 in The American Journal of Sports Medicine, sought to determine the discriminative validity of individual VOMS item scores and an overall VOMS score.
Participants aged 17 to 25 years were recruited from 8 institutions of the National Collegiate Athletic Association-Department of Defense CARE Consortium (Concussion Assessment, Research, and Education). Analysis was based on data from 285 concussed athletes and 285 healthy controls who were matched by age, sex, and concussion history.
All the participants completed the VOMS either within 3 days of injury or during the preseason. The symptoms were totaled for each VOMS item and for an overall score. Distance for near point of convergence (NPC) was averaged across 3 trials and a receiver operating characteristic analysis of the area under the curve (AUC) was also performed on cutoff scores using Youden Index (J) for each VOMS item, overall VOMS score and NPC distance average.
A symptom score of greater than or equal to 1 on each VOMS item and horizontal vestibular/ocular reflex greater than or equal to 2 were effective at discriminating between concussion and control (AUC, 0.89-0.90). The NPC distance however was not able to tell the difference in any significant way (AUC, 0.51).
The VOMS overall score had the highest accuracy (AUC, 0.91) for identifying sport-related concussion.
When it came to individual VOMS items, vertical saccades greater than or equal to 1 and horizontal vestibular/ocular reflex greater than or equal to 2 was the most effective at discriminating between concussion from control.
“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,” the researchers wrote.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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