Risk Factors for Benign Paroxysmal Positional Vertigo in an Acutely Concussed Adolescent Population

The purpose of this study was to describe the prevalence of benign paroxysmal positional vertigo (BPPV) in an acutely concussed, adolescent sport population and to identify factors for at-risk individuals.

Specialty concussion clinic.

Adolescents aged 12-19 years who were acutely diagnosed with a concussion and referred to vestibular physical therapy by the participating concussion provider (n = 334).

Retrospective cohort.

Symptom severity was measured using the Post-Concussion Symptom Scale, while vestibular and ocular motor functioning was assessed using the Vestibular Ocular Motor Screening (VOMS) at the initial evaluation with the participating concussion provider. Benign paroxysmal positional vertigo-related symptoms were measured using the 5-item BPPV subscale of the Dizziness Handicap Inventory (DHI) and BPPV diagnosis and involved canal was based on standardized testing using infrared video Frenzel goggles at the initial vestibular physical therapy evaluation.

Thirty (9%) acutely concussed adolescents were diagnosed with BPPV. Patients with BPPV had a significantly higher 5-item DHI score (median 12 vs. 6, P < .01) and were less likely to complete the Vestibular Ocular-Motor Screening (VOMS; 50% vs. 88% completion rate). In the final multivariate analysis, both incomplete VOMS (odds ratio = 4.80, 95% confidence interval: 2.05-11.24, P < .01) and a higher 5-item DHI score (odds ratio = 1.17, 95% confidence interval: 1.06-1.29, P < .01) increased BPPV risk. The prediction model demonstrated good discrimination (area under the curve = 0.75).

Risk factors for BPPV in acutely concussed adolescents include a higher score on the 5-item DHI and an inability to complete the VOMS.