Visio-vestibular Examination is a Critical Component of Diagnosing Concussion in Young Athletes, Feasible Across Multiple Care Settings
Published on in CHOP News
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Published on in CHOP News
Early and accurate diagnosis leads to optimal recovery from concussion. Over the past year across a series of studies, the Minds Matter Concussion Program research team at Children’s Hospital of Philadelphia (CHOP) has systematically evaluated the use of the visio-vestibular examination (VVE) and its ability to enhance concussion diagnosis and management. The latest of these studies published online today in the Clinical Journal of Sports Medicine.
The VVE involves a series of brief eye movement and balance tests intended to identify deficits in brain function involving the visual and vestibular systems. Researchers found that the VVE presents several advantages over current clinical measures, moving beyond subjective symptoms with a rapid, repeatable and quantifiable clinical exam. The team also found that the VVE is easy to administer across various clinical settings where children are initially seen following head injury when a concussion is suspected. In doing so, researchers believe there is the opportunity to ensure the diagnosis is made accurately and soon after injury to improve outcomes for all youth who suffer a concussion.
“There is growing evidence that visual, vestibular, and balance impairments are common after concussion, and these impairments have been linked to worse outcomes, including a delayed return to school and sports,” says lead investigator Christina L. Master, MD, a sports medicine pediatrician and co-director of the Minds Matter Concussion Program at CHOP. “Recently, we have focused our efforts on developing objective measures of impaired eye movement and pupil response as physiological biomarkers of concussion. In this line of research, we also wanted to see if this simple and rapid clinical exam could provide diagnostic utility for a variety of providers outside the specialist setting.”
Across four different studies published over the past year, the CHOP research team make a strong case for the implementation of the VVE across a variety of practice settings:
“With its ease-of-administration, the visio-vestibular examination can be conducted in multiple care settings where children are initially seen with head injury to effectively diagnose concussion,” says co-author Daniel J. Corwin, MD, MSCE, an emergency medicine physician, associate director of research in the Division of Emergency Medicine at CHOP, and Minds Matter Concussion Program researcher. “This is particularly important since many concussed youth are diagnosed outside of the specialty setting where these tests were initially developed. Our previous research also underscores how early and accurate diagnosis can improve outcomes in children.”
With training and clinical support tools, pediatricians, emergency medicine clinicians, and advanced practice practitioners are able to conduct the VVE assessments for saccades, gaze stability, and tandem gait in a repeatable manner in the workflow of a high-volume acute care setting.
“Health care professionals have new important considerations for evaluating and managing sports-related concussion,” Master said. “The visio-vestibular examination is an inexpensive, feasible, and readily available means by which concussions can be more accurately diagnosed, thereby improving outcomes for these vulnerable patients. In doing so, we have the opportunity to shorten the time to diagnosis and treatment to improve outcomes for all youth who suffer a concussion.”
This work was supported by the Pennsylvania Department of Health and the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number R01NS097549.
Storey et al, “Assessment of saccades and gaze stability in the diagnosis of pediatric concussion.” Clin J Sport Med, online April 13, 2021. DOI: 10.1097/JSM.0000000000000897.
Corwin et al. “Clinical and Device-based Metrics of Gait and Balance in Diagnosing Youth Concussion.” Med Sci Sports Exerc. March 2020. DOI: 10.1249/MSS.0000000000002163.
Corwin et al. “Reliability of the visio-vestibular examination for concussion among providers in a pediatric emergency department.” Am J Emer Med. September 2020. DOI: 10.1016/j.ajem.2020.06.020.
Corwin et al. “Characteristics and Outcomes for Delayed Diagnosis of Concussion in Pediatric Patients Presenting to the Emergency Department.” J Emerg Med. December 2020. DOI: 10.1016/j.jemermed.2020.09.017.
Contact: Ben Leach, The Children’s Hospital of Philadelphia, 267-426-2857 or firstname.lastname@example.org