Knell Gregory, Caze Todd, Burkhart Scott O
Center for Pedatric Population Health, Children's Health System of Texas and University of Texas Health Science Center at Houston, Dallas, TX, USA.
Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, Dallas, TX, USA.
BMJ Open Sport Exerc Med. 2021 Mar 25;7(1):e000970. doi: 10.1136/bmjsem-2020-000970. eCollection 2021.
To understand the relationship between initial vestibular and ocular motor screening (VOMS) and recovery time, and the utility of VOMS to screen for protracted recovery in youth/adolescent patients with sport-related concussion (SRC).
Participants (8-18 years) who were diagnosed with an SRC within 7 days of the injury were administered the VOMS test by certified medical personnel. Recovery time (days) and protracted recovery (>30 days) were the primary outcomes. Multivariable regression models were used to evaluate the association between VOMS symptom provocation and (1) recovery time (days) and (2) protracted recovery. Measures of VOMS validity, predictive ability and receiver operator curves were used to assess VOMS as a prognostic tool to accurately classify a normal/protracted recovery.
After adjustment, any symptom provocation across all VOMS domains was associated (p<0.05) with greater recovery time, except the convergence test (p=0.08) in females. All VOMS test thresholds (≥1 to ≥10) in males and (≥1 to ≥5) in females were associated (p<0.05) with recovery time. However, the VOMS test performed poorly among males (receiver operating characteristic (ROC) area=0.66) and failed among females (ROC area=0.56) as a prognostic tool to identify those that will have a normal/protracted recovery.
In this sample, overall, the VOMS test was associated with recovery time (days); however, the VOMS was not a valid stand-alone prognostic tool to identify a delayed recovery, but may be useful in combination with other concussion symptomology assessments. Future studies should confirm these findings in larger samples while taking into consideration other comorbid factors that may influence recovery time.
了解初始前庭与眼动筛查（VOMS）与恢复时间之间的关系，以及VOMS在筛查青少年运动相关脑震荡（SRC）患者长期恢复情况方面的效用。
在受伤7天内被诊断为SRC的参与者（8 - 18岁）由认证医务人员进行VOMS测试。恢复时间（天）和长期恢复（>30天）是主要结果。使用多变量回归模型评估VOMS症状激发与（1）恢复时间（天）和（2）长期恢复之间的关联。采用VOMS有效性、预测能力和受试者操作曲线等指标来评估VOMS作为一种预后工具对正常/长期恢复进行准确分类的能力。
调整后，除女性的集合试验（p = 0.08）外，所有VOMS领域的任何症状激发均与更长的恢复时间相关（p<0.05）。男性所有VOMS测试阈值（≥1至≥10）和女性（≥1至≥5）均与恢复时间相关（p<0.05）。然而，作为识别将有正常/长期恢复者的预后工具，VOMS测试在男性中表现不佳（受试者操作特征曲线（ROC）面积 = 0.66），在女性中则无效（ROC面积 = 0.56）。
在本样本中，总体而言，VOMS测试与恢复时间（天）相关；然而，VOMS并非识别延迟恢复的有效独立预后工具，但可能与其他脑震荡症状评估相结合时有用。未来研究应在更大样本中证实这些发现，同时考虑可能影响恢复时间的其他合并因素。
