Abstract
Background
Visio-vestibular examination (VVE) deficits are common following pediatric concussion.
Guidelines recommend assessing these deficits on all potentially concussed youth given
their diagnostic and prognostic value, however test psychometrics of the VVE in the
emergency department (ED) setting are unknown. Our objective was to determine the
inter-rater (IRR) and test-retest reliability (TRR) of the VVE in a pediatric ED.
Methods
We enrolled 155 patients (112 IRR; 43 TRR) age 6–18 years with head injury presenting
to the ED of a tertiary care children's hospital. Exams were performed by a group
of 65 attending/fellow physicians, pediatricians, and advanced practice providers.
The VVE consisted of 9 maneuvers (smooth pursuits, horizontal/vertical saccades and
gaze stability, binocular convergence, left/right monocular accommodation, complex
tandem gait). Cohen's kappa was calculated for IRR and TRR for each element.
Results
For IRR, 5/9 kappas (saccades, gaze stability, monocular accommodation) were in the
moderate agreement range (0.40 to 0.60); remaining kappas showed fair agreement. For
TRR, 6/9 maneuvers (saccades, horizontal gaze stability, monocular accommodation,
tandem gait) showed substantial agreement (0.60 to 0.80). Kappas of 7/9 elements for
subjects age 15–18 showed improved IRR and TRR.
Conclusions
The individual elements of the VVE show fair to moderate agreement between providers
and moderate to substantial agreement among the same provider in the ED setting. These
findings suggest a role in the VVE in evaluating concussion acutely, particularly
given its previously demonstrated ability to assist in risk stratification of concussed
youth and the importance of early diagnosis for improved outcomes.
Abbreviations:
ED (emergency department), IR (inter-rater), TR (test-retest), VOMS (vestibular/oculomotor screening), VVE (visio-vestibular examination)Keywords
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Article Info
Publication History
Published online: June 10, 2020
Accepted:
June 4,
2020
Received in revised form:
May 28,
2020
Received:
January 29,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
