Vestibular and oculomotor findings in neurologically-normal, non-concussed children

ABSTRACT

Objective: To determine the proportion of non-concussed, neurologically normal children with failures on a vestibular and oculomotor examination for concussion performed in an acute setting.

Design: This was a cross-sectional study of subjects 6–18 years old presenting to a paediatric emergency department with non-neurologic chief complaints. The examination was administered by a paediatric emergency medicine physician, and includes assessments of dysmetria, nystagmus, smooth pursuits, saccades, gaze stability, near-point of convergence, and gait/balance testing.

Results: Of the 295 subjects enrolled, 24% failed at least one element of testing. About 13% had >1 failed element and 5% had >2 failed elements. About 29% of females and 19% of males had failed examinations. By age, 15% of subjects 6–8 years old, 32% 9–11 years, 32% 12–14 years, and 26% 15–18 years had failed examinations. Overall, 10% were unable to complete the exam due to developmental age.

Conclusions: The provider should be aware that a proportion of non-concussed children may demonstrate failure on a single element of the vestibular and oculomotor exam. While this testing is of benefit to the acute care provider in diagnosing paediatric concussion, its utility is greatest in the context of an injury history with acute onset of concussion symptoms.

Keywords:

• Concussion
• Pediatric
• Vestibular and oculomotor examination

Financial disclosure

The authors have no relevant financial relationships to disclose. No an honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

Conflicts of interest

The authors have no conflicts of interest relevant to this article to disclose.

Additional information

Funding

This study was supported by a pilot grant from the Penn Injury Science Center and the Centers for Disease Control #R49CE002474 and a training grant from the National Institutes of Health, Neurologic Clinical Epidemiology Training Grant [Grant # T32-NS-061779], both awarded to Dr. Corwin.