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Author Notes:

Christina L. Master, MD, FAAP, CAQSM, FACSM, Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104, Phone number: 215-590-1527, Fax number: 215-590-1501. Email: masterc@email.chop.edu

We would like to acknowledge Ronni Kessler, Fairuz Mohammed, Olivia Podolak, Ari Fish, Julia Vanni, Shelly Sharma, Alexis Brzuchalski, Taylor Valerio, and Kate Rownd for their contributions to data collection. We are grateful to the students and parents from the Shipley School and families at Children’s Hospital of Philadelphia for their participation in this research study. We would also like to thank the Shipley School administration and athletic training staff, in particular Mark Duncan, Director of Athletics, and Drs. Steve Piltch and Michael G. Turner, former and current Head of School, for their support.

The authors have no conflicts of interest relevant to this article to disclose.


Research Funding:

Funding for this research has been provided by the Pennsylvania Department of Health. Research reported in this publication was also supported by National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number R01NS097549. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Orthopedics
  • Physiology
  • Sport Sciences
  • visio-vestibular examination
  • saccades
  • gaze stability
  • vestibulo-ocular reflex
  • pediatric concussion

Assessment of Saccades and Gaze Stability in the Diagnosis of Pediatric Concussion


Journal Title:



Volume 32, Number 2


, Pages 108-113

Type of Work:

Article | Post-print: After Peer Review


Objective:To evaluate the discriminatory ability of different repetition increments of saccades and gaze stability testing for diagnosing concussion in adolescents.Design:Cross-sectional.Setting:Suburban high school and academic pediatric tertiary care center.Participants:Sixty-nine adolescent athletes within 28 days of a sports- or recreation-related concussion and 69 adolescent athletes without recent concussion.Assessment of Independent Variables:Symptom provocation with horizontal and vertical saccades and gaze stability testing performed up to 30 repetitions.Main Outcome Measures:Sensitivity and specificity at 10-repetition increments (≤10, ≤20, ≤30) and area under the receiver operating characteristic curves (AUC) of a visio-vestibular examination (VVE) subscore, scored 0 to 4 based on the number of assessments with symptom provocation, at each repetition increment.Results:Sensitivity improved when increasing from ≤10 to ≤20 to ≤30 repetitions for horizontal (25% to 50% to 69%) and vertical (32% to 52% to 74%) saccades and horizontal (19% to 45% to 71%) and vertical (23% to 45% to 72%) gaze stability. Specificity was comparable at ≤10 and ≤20 repetitions, but decreased at ≤30 repetitions across assessments. For a VVE subscore (0-4) based on the number of symptomatic assessments, the discriminatory ability of the test was highest at ≤20 repetitions (AUC of 0.79) with an optimal subscore of one (sensitivity 59%, specificity 96%).Conclusions:A VVE including a higher threshold level of repetitions for saccades and gaze stability has improved discriminatory ability for concussion, with an optimized AUC of 0.79 at ≤20 repetitions.Clinical Relevance:The findings in this study suggest that a higher threshold level of repetitions of 2 commonly used visio-vestibular assessments enables clinicians to more accurately diagnose youth concussion.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/rdf).
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