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Vestibular and vision deficits following concussion in children under 12
  1. Christina L Master,
  2. Allison E Curry,
  3. Ronni Kessler,
  4. Melissa R Pfeiffer,
  5. Matthew F Grady,
  6. Roni Robinson,
  7. Kristy B Arbogast
  1. Children’s Hospital of Philadelphia, 34th and Civic Centre Blvd, Philadelphia, PA, USA

Abstract

Objective Vestibular and oculomotor visual (VOM) deficits are emerging as key characteristics of youth concussion. However, since most studies of paediatric concussion focus on adolescents, little is known about the extent to which younger children experience this deficit. To address this gap, we used an electronic health record (EHR) system across a large paediatric healthcare network to quantify the presence of VOM deficits following concussion in patients under age 12.

Design Descriptive epidemiology.

Setting Data were collected from all primary (n=31) and relevant specialty care (n=4) network settings.

Participants We identified all patients aged 5–11 years who had ≥1 clinical visit for concussion at a network primary or specialty care site from 7/1/2014 through 6/30/2015. We included the 82% of these patients for whom a concussion electronic clinical decision support tool within the EHR was used during their initial visit.

Outcome measures The proportion who demonstrated each VOM deficit – balance, saccades, gaze stability, and convergence – was calculated among all who were assessed for that deficit.

Main results 871 patients were included (median [IQR]: 10 [8, 11] years). On physical examination, 58% had at least one VOM deficit. 44% had balance abnormalities, 39% had saccadic dysfunction, 28% had deficits in gaze stability, and 10% convergence insufficiency.

Conclusions In this sample, vestibular oculomotor visual deficits following concussion in young children were common. Improved recognition of the deficits will lead to timely diagnosis and appropriate management, including school accommodations for oculomotor visual challenges and vestibular therapy for motion sensitivity issues.

Competing interests None.

KB, Arbogast serves as a consultant to the National Football League Players Association on head injury topics.

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