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Contributions of PCSS, CISS, and VOMS for Identifying Vestibular/Ocular Motor Deficits in Pediatric Concussions
Rishi D Patel1, Cynthia R LaBella1,2
1Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Insights
Pediatric concussion patients often have vestibular/ocular motor dysfunction. Combining the Post-Concussion Symptom Scale (PCSS), Convergence Insufficiency Symptom Survey (CISS), and Vestibular/Ocular Motor Screening (VOMS) effectively identifies these issues.
Area of Science:
- Pediatric Sports Medicine
- Neurology
- Ophthalmology
Background:
- Vestibular/ocular motor dysfunction is common in pediatric concussions, impacting learning and athletics.
- Three clinical tools were assessed: Post-Concussion Symptom Scale (PCSS), Convergence Insufficiency Symptom Survey (CISS), and Vestibular/Ocular Motor Screening (VOMS).
Purpose of the Study:
- To evaluate the effectiveness of PCSS, CISS, and VOMS in identifying vestibular/ocular motor dysfunction in pediatric concussion patients.
- To determine if combining these tools captures more symptomatic patients than any single tool.
Main Methods:
- Cross-sectional data from a prospective cohort study of 156 patients (ages 8-17).
- Data collected included VOMS, PCSS, and CISS scores from initial clinic visits.
- Descriptive statistics, correlations, and logistic regressions analyzed tool relationships.
Main Results:
- 82.7% of patients had vestibular/ocular motor dysfunction.
- VOMS and CISS together identified 49.6% of patients who did not report visual problems on PCSS.
- Higher PCSS scores predicted abnormal CISS and VOMS results.
Conclusions:
- Combining PCSS, CISS, and VOMS identified vestibular/ocular motor dysfunction in nearly 83% of pediatric concussion patients.
- Integrating CISS and VOMS into concussion evaluations aids clinicians in identifying post-concussion vestibular/ocular motor dysfunction.
Background:
Vestibular/ocular motor dysfunction can occur in pediatric concussions, which can impair reading, learning, and participation in athletics. This study evaluated 3 clinical tools for identifying postconcussion vestibular/ocular motor dysfunction: (1) Post-Concussion Symptom Scale (PCSS), (2) Convergence Insufficiency Symptom Survey (CISS), and (3) Vestibular/Ocular Motor Screening (VOMS).
Hypothesis:
Evaluating vestibular/ocular motor dysfunction with multiple clinical tools will capture more symptomatic patients than any 1 tool alone.
Study Design:
Cross-sectional data from a prospective cohort study.
Level Of Evidence:
Level 4.
Methods:
Patients were between 8 and 17 years old and seen in a tertiary care pediatric sports medicine clinic between August 2014 and February 2018. Data were collected from initial visit and included VOMS, PCSS, and CISS. Descriptive statistics, Pearson's correlations, and logistic regressions were used to describe relationships between clinical tools.
Results:
Of the 156 patients (55.1% female; 14.35 ± 2.26 years old) included, this study identified 129 (82.7%) with vestibular/ocular motor dysfunction. Of these 129, 65 (50.4%) reported "visual problems" on PCSS, 93 (72.1%) had abnormal CISS, and 99 (76.7%) had abnormal VOMS. Together, VOMS and CISS identified 64 (49.6%) patients without reported "visual problems" on PCSS. Higher total PCSS scores predicted abnormal CISS (odds ratio [OR], = 1.11; 95% CI, 1.07-1.17) and abnormal VOMS (OR, 1.03; 95% CI, 1.01-1.06). "Visual problems" on PCSS did not predict abnormal CISS or VOMS.
Conclusion:
Vestibular/ocular motor dysfunction were identified in nearly 83% of study subjects when PCSS, CISS, and VOMS are used together.
Clinical Relevance:
These results suggest adding CISS and VOMS to the clinical evaluation of concussions can help clinicians identify post-concussion vestibular/ocular motor dysfunction.
