False-Positive Rates, Risk Factors, and Interpretations of the Vestibular Ocular Motor Screen in Collegiate Athletes

Abstract

Context: Biological sex and history of motion sickness are known modifiers associated with a false-positive baseline Vestibular Ocular Motor Screen (VOMS). However, other factors may associate with a false-positive VOMS in collegiate athletes. Objective: Identify contributing factors to false-positive VOMS assessments using population specific criteria. We also critically appraised previously reported interpretation criterion. Design: Descriptive Laboratory. Setting: Single site collegiate athletic training clinic. Patients or other Participants: NCAA Division 1 athletes (n=462[41% female]) who were 18.8±1.4 years old. Main Outcome Measures: Participants completed the Athlete Sleep Behavior Questionnaire (ASBQ), Generalized Anxiety Index (GAD-7), the ImPACT battery, Patient Health Questionnaire (PHQ-9), Revised Head Injury Scale (HIS-r), the Sensory Organization Test (SOT), and the VOMS as part of a multidimensional baseline concussion assessment. Participants were classified into two groups based on whether they had a total symptom score of ≥8 following VOMS administration, excluding the baseline checklist. Chi-squared (χ2) and independent t-tests compared group demographics. A binary logistic regression with adjusted odds ratios (OR) evaluated the influence of sex, corrected vision, ADHD, ImPACT composite scores, concussion history, a history of treatment for headache and/or migraine, GAD-7, PHQ-9, ASBQ, and SOT Equilibrium Score, and Somatosensory, Visual, and Vestibular sensory ratios on false-positive rates. Results: Approximately 9.1% (42/462 [30 females]) met criteria for a false-positive VOMS. A significantly greater proportion of females had false-positives (χ2(1) = 18.37, p < 0.001). Female sex (OR=2.79, 95% CI [1.17-6.65], p =.02) and history of treatment for headache (OR=4.99, 95% CI [1.21-20.59], p=0.026) were the only significant predictors of false-positive VOMS. Depending on cutoff interpretation, false-positive rates using our data ranged from 9.1%-22.5%. Conclusions: Our results support the most recent interpretation guidelines for the VOMS in collegiate athletes due to a low false-positive rate and ease of interpretation. Biological sex and history of headaches should be considered when administering the VOMS in the absence of a baseline.