A - 20 Identifying Concussion in College-Aged Individuals Using a Multimodal Assessment of Vestibular and Oculomotor Function

Abstract

Vestibular and oculomotor assessments are fundamental tools to identify concussions. However, research is unclear on which vestibular and oculomotor assessment or combination of assessments best detect concussions. The purpose of this study was to assess the discriminant ability of the Vestibular/Ocular Motor Screening (VOMS), Balance Error Scoring System (BESS), modified BESS (mBESS), and High-Level Mobility Assessment Tool (HiMAT) to identify college-aged individuals with concussion from controls. A prospective study of college-aged individuals (18–30 years) diagnosed with concussion within 5 days of enrollment was conducted. Demographics, injury information, VOMS, BESS/mBESS, and HiMAT were completed at the initial visit. Logistic regressions (LR) and receiver operating characteristic (ROC) analyses of the area-under-the-curve (AUC) determined the ability of the VOMS, BESS/mBESS, and HiMAT to identify concussion from control. A total of 214 participants (mean age = 20.4¬ ± 2.5 years, 52.8% female) were enrolled, with 137 (64.0%) concussions and 77 (36.0%) controls. The VOMS total (AUC = 0.93, 95%CI = 0.90–0.97, p < 0.001) and HiMAT total (AUC = 0.79, 95%CI = 0.65–0.93, p < 0.001) significantly identified concussion from control, while the BESS (AUC = 0.58, 95%CI = 0.50–0.67, p = 0.05) and mBESS (AUC = 0.55, 95%CI = 0.47–0.64, p = 0.23) did not. A 2-factor model with combined VOMS and HiMAT totals did not improve identification (AUC = 0.92, 95%CI = 0.85–1.00, p < 0.001). The VOMS total score demonstrated outstanding discriminant ability, HiMAT total score demonstrated adequate discriminant ability, and BESS/mBESS total errors demonstrated unacceptable discriminant ability in identifying concussions from controls. Our findings suggest that the VOMS remains a preferred vestibular and oculomotor functioning assessment for identifying concussion. Furthermore, incorporating objective assessments with the VOMS, such as HiMAT, does not improve diagnostic yield.