Body Mass Index As A Modifier Of Visio-vestibular Deficits In Children And Adolescents With Concussion

PURPOSE: To characterize the relationship between body mass index (BMI) and visio-vestibular examination (VVE) outcomes in patients with concussion aged 5-18 years. METHODS: This observational study included patients presenting to a specialty care concussion setting within 28 days post-injury and non-concussed participants from a local high school. BMI was classified into four categories (i.e., underweight, healthy weight, overweight, and obese) based on CDC growth charts. The VVE consists of assessments of smooth pursuit, saccades, vestibular-ocular reflex (VOR), binocular convergence, monocular accommodation, and complex tandem gait. Kruskal-Wallis and chi-square tests were performed to analyze group differences. Post hoc tests with Bonferroni-adjusted p-values were conducted for pairwise comparisons. RESULTS: A total of 5,534 participants were included: 5,439 pediatric patients with concussion (1.4% underweight, 65.6% healthy weight, 17.9% overweight, and 15.1% obese) and 95 non-concussed participants (83.6% healthy weight and 16.4% overweight/obese). More obese patients demonstrated abnormality in horizontal saccades than underweight patients (54.1% vs 36.5%, p = 0.032). For VOR, fewer underweight patients demonstrated abnormality than patients with healthy weight (H) or obesity (OB) (horizontal: 33.3% vs H: 49.6%, OB: 52.4%, p ≤ 0.045; vertical: 31.1% vs H: 48.0%, OB: 49.1%, p ≤ 0.035). More obese patients showed abnormal tandem gait compared with patients with healthy weight or overweight (OV) (32.2% vs H: 26.1%, OV: 24.1%, p ≤ 0.006). There were no significant differences in pursuit, binocular convergence, or monocular accommodation across BMI categories in pediatric patients. Additionally, there were no significant differences in all VVE metrics by BMI in non-concussed participants. CONCLUSION: Among concussed pediatric patients at initial visit, obese children showed more abnormality in saccades, VOR, and tandem gait compared with others. Although a greater proportion of abnormality in pursuit, binocular convergence, and accommodation were observed in obese children, differences did not reach statistical significance. This study may identify the potential role of BMI as a modifier for visio-vestibular deficits and functional impairment in pediatric concussion.