Statement of purpose The purpose of this study was to investigate visio-vestibular examination (VVE) outcomes in high school-aged patients presenting with their first concussion vs. recurrent concussion.
Methods/Approach This study was performed by querying data collected prospectively in the electronic health record for patients aged 14–18 years old presenting for their initial injury visit to specialty concussion care centers within 28 days of injury between January 2018 and August 2020. Demographic information including lifetime concussions were self-reported prior to the start of the exam. The VVE consisted of 9 maneuvers: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Primary outcomes included self-reported lifetime concussions (1 vs. 2+), VVE subtests (normal/abnormal for each), and total VVE score (abnormal= 2+ abnormal subtests). A multivariable logistic regression was employed to determine if recurrent concussion was associated with abnormal VVE outcomes while controlling for age.
Results One thousand fifty-two patients were included in analysis (age=15.6±1.2 years). Five hundred and nineteen (49.3%) presented with a recurrent concussion (median lifetime concussions=3, IQR=2,3). When controlling for age, there were no significant associations between first vs. recurrent concussion and VVE outcome on any of the 9 subtests or total VVE score (P>0.05).
Conclusion First vs. recurrent concussion is not associated with abnormal VVE outcomes in high school-aged patients. Our findings suggest that patients with a concussion history present with similar visio-vestibular function to those with no concussion history at initial visit following injury.
Significance Recurrent concussions have been associated with cumulative clinical deficits and longer recovery in collegiate athletes. This study provides novel insight into the initial presentation of pediatric concussion patients with and without a previous concussion history. Additionally, our study adds formative data regarding cumulative clinical effects of concussion in younger athletes.