title: Vestibulo-ocular dysfunction in pediatric sports-related concussion.
abstract: OBJECTIVE
  The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort.
  
  
  METHODS
  The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board.
  
  
  RESULTS
  A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16).
  
  
  CONCLUSIONS
  Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort.
authors.affiliation: Departments of 1 Surgery and.|Pediatrics and Child Health and.|Section of Neurosurgery, University of Manitoba.|Pan Am Clinic, and.|Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ellis
authors.affiliation: Pan Am Clinic, and.
authors.forename: Dean
authors.initials: D
authors.lastname: Cordingley
authors.affiliation: Pan Am Clinic, and.
authors.forename: Sara
authors.initials: S
authors.lastname: Vis
authors.affiliation: Pan Am Clinic, and.
authors.forename: Karen
authors.initials: K
authors.lastname: Reimer
authors.affiliation: Departments of 1 Surgery and.|Pan Am Clinic, and.
authors.forename: Jeff
authors.initials: J
authors.lastname: Leiter
authors.affiliation: Pediatrics and Child Health and.|Children's Hospital Research Institute of Manitoba, Canada North Concussion Network, Winnipeg, Manitoba, Canada.
authors.forename: Kelly
authors.initials: K
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000150:complications*; D001924:Brain Concussion / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D009483:Neuropsychological Tests; D016017:Odds Ratio; D038223:Post-Concussion Syndrome / Q000453:epidemiology* / Q000503:physiopathology*; D015995:Prevalence; D012027:Reflex, Vestibulo-Ocular; D012189:Retrospective Studies; D055815:Young Adult
keywords: ICD-10 = International Classification of Diseases, 10th Revision; IQR = interquartile range; LOC = loss of consciousness; NPC = near-point convergence; PCS = postconcussion syndrome; PCSS = Post-Concussion Symptom Scale; SRC = sports-related concussion; VOD = vestibulo-ocular dysfunction; VOR = vestibulo-ocular reflex; mTBI = mild traumatic brain injury; pediatric; postconcussion syndrome; sports-related concussion; trauma; vestibular therapy; vestibulo-ocular dysfunction