Sex and age-related differences in vestibular/ocular motor screening (VOMS) symptom provocation following concussion

Objective: To examine the effects and interaction of sex and age in Vestibular/Ocular Motor Screen (VOMS) symptom provocation (i.e. change scores) at patients' initial clinic visit following concussion. Method: A secondary analysis of patients (10-21 years) presenting to a specialty concussion clinic from 2015-2019 with complete VOMS data at their initial clinic visit <21 days post-injury. Independent samples t-tests, Mann-Whitney U, and chi-square (χ²) tests compared descriptive characteristics and VOMS symptom provocation (Ocular Motor domain items: Smooth Pursuits [SP], Horizontal/Vertical Saccades [HSAC/VSAC], Near Point Convergence [NPC]; Vestibular domain items: Horizontal/Vertical Vestibular-Ocular Reflex [HVOR/VVOR], Visual Motion Sensitivity [VMS]) between sex (male/female) and age (younger adolescent [YA, 10-14 years]/older adolescent [OA, 15-21 years]) groups. Two-way analyses of variance and covariance examined the interaction between sex and age on VOMS overall symptom provocation (i.e. all VOMS items/domains). Results: 235 participants were enrolled in the study (121 [51.5%] male, 114 [48.5%] female; 75 [31.9%] YA, 160 [68.1%] OA). Females had greater odds of dizziness provocation on ocular motor (_adjOR = 3.05, p < 0.001) and vestibular (_adjOR =2.15, p = 0.01) items; headache provocation across all items (_adjOR =2.51, p = 0.01); and provocation on the ocular motor (_adjOR = 1.84, p = 0.03) domain and overall VOMS (_adjOR = 2.44, p = 0.025) compared to males. YAs had greater odds of dizziness provocation following SP (_adjOR =2.63, p = 0.04) and HSAC (_adjOR = 2.24, p = 0.03) and greater total provocation following HSAC (_adjOR = 2.28, p = 0.01) compared to OAs. The sex-by-age interaction on VOMS overall change score was not significant (F(1, 231)=0.09, p = 0.76). Conclusions: Females reported more dizziness and overall provocation on the VOMS than males. There were no differences in overall VOMS provocation between younger and older adolescents and no interaction between sex and age on VOMS outcomes.