Hoppes Carrie W, Garcia de la Huerta Tomas, Faull Stefanie, Weightman Margaret, Stojak Margaret, Dibble Leland, Pelo Ryan M, Fino Peter C, Richard Holly, Lester Mark, King Laurie A
Advanced Exposures, Diagnostics, Interventions, and Biosecurity (AEGIS) Program, Joint Base San Antonio-Lackland Air Force Base, TX 78236, USA.
Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA.
Mil Med. 2025 Apr 23;190(5-6):e969-e977. doi: 10.1093/milmed/usae494.
The Vestibular/Ocular Motor Screening (VOMS) was created as a brief clinical screening tool for identifying vestibular and ocular motor symptoms and impairments post-concussion. It was found to have predictive validity in correctly identifying concussed athletes from healthy controls. In 2018, the Military Acute Concussion Evaluation 2 (MACE2) replaced the original Military Acute Concussion Evaluation (MACE); the most prominent change between the MACE and MACE2 was the addition of the VOMS. Despite its adoption into military medicine, it is not known if the addition of the VOMS to the MACE2 is acutely helpful, and if it provides additional information for diagnosis, prognosis, and/or management. The purposes of this systematic review were: (1) to determine the utility of the VOMS in correctly identifying concussed individuals, particularly as it pertains to military medicine; (2) to explore the extent to which the VOMS can inform concussion prognosis; and (3) to establish the value of the VOMS as a measure for monitoring the evolution of symptoms throughout a service member's course of care.
A comprehensive search of PubMed was performed from January 1, 2014 through August 16, 2023. Articles were included if they researched concussion or a related health condition or healthy controls and administered the VOMS. Articles were excluded if they discussed health conditions other than concussion; did not administer the VOMS; or were written in languages other than English. The tools used to assess methodological quality and risk of bias varied according to study design. Articles were classified into three primary domains: diagnosis, prognosis, and/or rehabilitation/recovery over time.
A total of 231 articles were retrieved and 3 were duplicates, leaving 228 articles for review. Of the 228 articles screened, 100 relevant full-text articles were assessed for eligibility. Fifty-nine articles met our inclusion and exclusion criteria while the other 41 articles were rejected. Thirty-two articles helped to inform diagnosis, 15 prognosis, and 16 rehabilitation/recovery over time.
The VOMS had excellent internal consistency and moderate to good test-retest reliability; however, a false-positive rate of 21.9% was found. Most studies indicated that a positive VOMS was associated with a delayed recovery. Several studies indicated that VOMS scores improved with targeted, active interventions and/or a symptom-guided progressive return to activity. The greatest limitation was the paucity of published evidence in the military population. More research is needed on the use of the VOMS in service members.
前庭/眼动筛查（VOMS）是作为一种简短的临床筛查工具而创建的，用于识别脑震荡后的前庭和眼动症状及损伤。研究发现，它在从健康对照中正确识别脑震荡运动员方面具有预测效度。2018年，军事急性脑震荡评估2（MACE2）取代了原来的军事急性脑震荡评估（MACE）；MACE和MACE2之间最显著的变化是增加了VOMS。尽管它已被应用于军事医学，但尚不清楚在MACE2中增加VOMS是否具有急性帮助，以及它是否能为诊断、预后和/或管理提供额外信息。本系统评价的目的是：（1）确定VOMS在正确识别脑震荡个体方面的效用，特别是在军事医学领域；（2）探讨VOMS能在多大程度上为脑震荡预后提供信息；（3）确定VOMS作为一种监测军人整个治疗过程中症状演变的指标的价值。
对2014年1月1日至2023年8月16日期间的PubMed进行了全面检索。如果文章研究脑震荡或相关健康状况或健康对照，并实施了VOMS，则纳入研究。如果文章讨论的是脑震荡以外的健康状况；未实施VOMS；或用英语以外的语言撰写，则排除这些文章。根据研究设计，用于评估方法学质量和偏倚风险的工具各不相同。文章被分为三个主要领域：诊断、预后和/或随时间的康复/恢复。
共检索到231篇文章，其中3篇为重复文章，剩余228篇文章进行评审。在筛选的228篇文章中，对100篇相关全文文章进行了资格评估。59篇文章符合我们的纳入和排除标准，其他41篇文章被拒绝。32篇文章有助于提供诊断信息，15篇有助于提供预后信息，16篇有助于提供随时间的康复/恢复信息。
VOMS具有出色的内部一致性和中度至良好的重测信度；然而，发现假阳性率为21.9%。大多数研究表明，VOMS阳性与恢复延迟有关。几项研究表明，通过有针对性的积极干预和/或症状引导的逐步恢复活动，VOMS评分有所改善。最大的局限性是军事人群中发表的证据匮乏。需要对军人使用VOMS进行更多研究。
