Objective To assess the diagnostic and prognostic utility of pupillary light reflex (PLR) and visio-vestibular examination (VVE) deficits among acutely concussed pediatric patients.

Design Prospective observational.

Setting Emergency department of a tertiary care children’s hospital.

Participants Concussed youth age 8–18 years.

Assessments (1) PLR (response to a brief white light stimulus) measures: maximum/minimum pupil size, percent constriction, maximum/minimum constriction and dilation velocities, latency, and T75 (time to reach 75% of maximum size); (2) VVE (smooth pursuits, horizontal/vertical saccades and gaze stability, near point of convergence, monocular accommodation, and complex tandem gait); (3) Symptom burden (Postconcussion Symptom Inventory; PCSI) at presentation and 28 days post-injury.

Outcome Measures (1) Comparison of PLR and VVE measures to established measures in healthy controls; (2) Clinical recovery (symptoms returning to pre-injury baseline).

Main Results Among 33 subjects (mean age 13 years, 52% female), 7 PLR metrics were significantly different between concussed participants and normative data, as was the composite VVE (Table 1). There was a trend toward control-level values for many PLR metrics and the composite VVE deficits for those evaluated less acutely (>12–72 hours). VVE deficits (AUC = 0.750) outperformed initial symptom score (AUC = 0.504) and nearly all PLR measures in predicting recovery (Table 2).

Conclusions Both PLR and VVE have diagnostic utility in acutely concussed patients. The time trajectory of both PLR and VVE measures suggest these begin to normalize even within 72 hours post-injury. VVE deficits show significant promise in identification of those at risk for prolonged recovery.