Indiana University School of Optometry, United States.
University of Pittsburgh, United States.
Vision Res. 2022 Nov;200:108081. doi: 10.1016/j.visres.2022.108081. Epub 2022 Aug 1.
The Vestibular/Ocular-Motor Screening (VOMS), an important component in acute (<72 h) sport-related concussion (SRC) assessment, is increasingly used alongside the Sport Concussion Assessment Tool (SCAT) and as part of the Military Acute Concussion Evaluation 2 (MACE2). VOMS demonstrates clinically useful diagnostic accuracy for acute SRC and improves the overall utility when added to the SCAT3. However, potential overlap among VOMS's vestibular and oculomotor items suggests the possibility of a more efficient version. VOMS and SCAT3 scores were analyzed for 3,958 preseason (47.8% female) and 496 acute-SRC (37.5% female) NCAA-DoD Concussion Assessment, Research, and Education (CARE) consortium collegiate athlete evaluations. Analyses revealed very large effect sizes (d = 2.39-2.45) and high correlations (rho = 0.95-0.99) among all VOMS items except near point of convergence distance (d = 0.79, rho ≤ 0.341). Receiver operating characteristic (ROC) curve analyses showed clinically useful discriminative utility for VOMS Total (AUC = 0.85) and the VOMS Total change score, where pretest symptoms were incorporated (AUC = 0.81). A modified VOMS (mVOMS) consisting of four items (smooth pursuits, horizontal saccades, horizontal vestibulo-ocular reflex, visual motion sensitivity) yielded identical AUCs to VOMS Total. Integer cutoff analyses suggest a score of ≥4 for VOMS Total and ≥4 for mVOMS Total optimizes concussion identification. Incorporating VOMS or mVOMS into SCAT3 (AUC = 0.79) significantly improved the combined tool's acute utility for acute concussion identification by a maximum of 4% (SCAT3+VOMS AUC = 0.84, SCAT3+mVOMS AUC = 0.83). Future versions of SCAT or MACE may want to consider incorporating a more parsimonious VOMS for the purpose of identifying acute concussion.
前庭/眼动筛查（VOMS）是急性（<72 小时）运动相关脑震荡（SRC）评估中的重要组成部分，越来越多地与运动脑震荡评估工具（SCAT）一起使用，并作为军事急性脑震荡评估 2 版（MACE2）的一部分。VOMS 对急性 SRC 具有临床有用的诊断准确性，并在添加到 SCAT3 后提高了整体效用。然而，VOMS 的前庭和眼动项目之间存在潜在的重叠，这表明可能存在更有效的版本。对 3958 名（47.8%为女性） preseason和 496 名急性-SRC（37.5%为女性）NCAA-DoD 脑震荡评估、研究和教育（CARE）联合会大学生运动员评估的 VOMS 和 SCAT3 评分进行了分析。分析显示，除近点会聚距离外，所有 VOMS 项目之间的效应量都非常大（d=2.39-2.45），相关性很高（rho=0.95-0.99）（d=0.79，rho≤0.341）。受试者工作特征（ROC）曲线分析显示，VOMS 总分（AUC=0.85）和包含术前症状的 VOMS 总分变化得分具有临床有用的区分能力（AUC=0.81）。由四个项目（平滑追踪、水平扫视、水平前庭眼反射、视觉运动敏感性）组成的改良 VOMS（mVOMS）与 VOMS 总分的 AUC 相同。整数截断分析表明，VOMS 总分≥4 和 mVOMS 总分≥4 可优化脑震荡识别。将 VOMS 或 mVOMS 纳入 SCAT3（AUC=0.79）可将急性脑震荡识别的联合工具的急性效用提高最大 4%（SCAT3+VOMS AUC=0.84，SCAT3+mVOMS AUC=0.83）。SCAT 或 MACE 的未来版本可能希望考虑纳入更简约的 VOMS，以识别急性脑震荡。
