Pediatric Concussion Epidemiology
Concussion is the most common traumatic brain injury in the pediatric population. Understanding the age-stratified incidence, mechanism distribution, and sex-specific outcomes is essential for appropriate screening, diagnosis, and management across clinical settings.
| Age Group | Annual Incidence | Primary Mechanism | Clinical Notes |
|---|---|---|---|
| 0–4 years | Elevated vs. older children | Falls (dominant) | Non-accidental trauma peaks under 12 months; limited verbal reporting |
| 5–12 years | 1.85 per 100/year | Falls, organized sports | No validated baseline tool; children minimize symptoms to preserve play time |
| 13–17 years | 18.3% annually | Sports collision, MVA | Peak incidence at 14–15; girls show worse outcomes despite lower incidence |
| Female vs. Male | Males: higher incidence | Contact sports | Females: worse symptom burden, longer recovery, higher PCS rates |
| PCS Risk | ~30% of all pediatric | — | Symptoms >4 weeks; requires specialist management |
CDC National Concussion Surveillance System (NCSS)
The CDC is actively developing the NCSS — the first national system to produce standardized incidence estimates across all age groups and settings, including unorganized sport. It cannot function without a standardized, objective assessment instrument. ClearGazeTest is designed to serve as that infrastructure layer.
Why Current Tools Are Insufficient
SCAT5, ImPACT, and King-Devick are the current clinical standards. All rely substantially on patient self-report. None are validated for children under 5. None produce an objective neurological performance metric independent of examiner variability. None have demonstrated sensitivity for subclinical injury — the majority of pediatric concussions.
The Reporting Gap
Published estimates suggest 50% or more of pediatric concussions go unreported. Contributing factors include: children concealing symptoms to preserve play eligibility; parental minimization; absence of loss of consciousness (present in <10% of cases); and symptom onset delayed by hours to days post-injury.
Post-Concussion Syndrome: Underdiagnosed in Children
PCS affects approximately 30% of concussed children. Risk factors include: female sex, prior concussion, migrainous phenotype, psychiatric comorbidity, and delayed diagnosis. PCS requires active management — vestibular rehabilitation, neuropsychological support, academic accommodation, and structured exertion protocols. Symptom questionnaires alone are insufficient to guide management.
Second Impact Syndrome
A rare but potentially catastrophic complication of repeat concussion before full neurological recovery. Diffuse cerebral edema from loss of cerebrovascular autoregulation can result in rapid herniation. Documented predominantly in pediatric and adolescent athletes. Objective clearance — not symptom resolution — is the appropriate standard for return-to-play authorization.
Pathophysiology & Neuroanatomy
Concussion produces a cascade of ionic, metabolic, and vascular disturbances that disrupt normal neural function without causing structural injury detectable on conventional imaging. The oculomotor system integrates the widest array of neural structures of any functional output — making it uniquely sensitive to diffuse and focal concussive injury.
Clinical Presentation — Four Domains
Pediatric concussion presents across four symptom domains. Clinicians should systematically assess each domain — the absence of symptoms in one does not rule out significant injury in others. Cognitive and sleep symptoms may be the most actionable for school accommodation and management planning.
Body Symptoms
- Headache / head pressure
- Nausea, vomiting
- Dizziness, imbalance
- Visual disturbance
- Photophobia
- Phonophobia
- Fatigue
- Sleep disturbance
Thinking Symptoms
- Feeling slowed / "foggy"
- Attention difficulty
- Memory impairment
- Confusion
- Word-finding difficulty
- Slowed processing
- Academic regression
Mood Symptoms
- Irritability
- Emotional lability
- Anxiety
- Depressive symptoms
- Social withdrawal
- Personality change
- Loss of motivation
Sleep Symptoms
- Hypersomnia
- Insomnia
- Fragmented sleep
- Difficulty waking
- Excessive daytime somnolence
- Unrefreshing sleep
Emergency Referral Indications — Immediate ER / Neurosurgery
Oculomotor Biomarkers of TBI
The 12 biomarkers below represent the full oculomotor assessment profile captured by the ClearGazeTest platform. Each metric corresponds to a distinct neural pathway — enabling localization of dysfunction and differentiation between concussive and non-concussive causes of symptom presentation.
Assessment is conducted in a fully controlled VR environment at ≥120 Hz eye-tracking sampling rate. Results are compared against the patient's individual baseline and against an age-stratified normative database.
ClearGazeTest Assessment Protocol
The ClearGazeTest assessment is a structured, five-minute VR-based protocol delivering standardized stimuli across 10 sequential modules. Total assessment time: 4–5 minutes. No specialized technician required. Applicable from age 5. Results exportable to EMR.
Current Standard (SCAT5 / King-Devick / ImPACT)
- Symptom checklist — fully patient-reported
- Results vary by examiner and setting
- Not validated below age 10
- Cannot detect subclinical neurological dysfunction
- No objective metric for legal or return-to-play clearance
- King-Devick: single metric (rapid number naming)
- No normative database for comparison
ClearGazeTest Objective Assessment
- 12 quantitative oculomotor biomarkers — no self-report required
- Identical stimulus delivered every administration
- Designed for children from age 5 upward
- Detects subclinical dysfunction before symptom onset
- Quantitative, documentable, legally defensible output
- Full oculomotor profile + reaction time + VOR + pupillometry
- Individual baseline + age-stratified normative database comparison
CPT Reimbursement Guide
ClearGazeTest assessments are billable under existing CPT codes — no new codes required. The following codes are applicable depending on clinical context and the scope of assessment delivered. Verify coverage with individual payers; codes and rates are as of 2026.
| CPT Code | Description | Applicable Setting | Est. Reimbursement |
|---|---|---|---|
| 96132 | Neuropsychological testing evaluation, first hour, physician | Pediatrics, neurology, sports medicine | $175–$350 |
| 96133 | Neuropsychological testing, each additional 30 minutes | Add-on to 96132 | $80–$150 |
| 92083 | Visual field examination, unilateral or bilateral | Ophthalmology, optometry | $60–$120 |
| 92060 | Sensorimotor examination — strabismus, vergence testing | Ophthalmology | $85–$160 |
| 95930 | Visual evoked potential testing, bilateral | Neurology, neuro-ophthalmology | $120–$200 |
| 97750 | Physical performance test or measurement — reaction time component | Sports medicine, PM&R | $50–$100 |
| 99173 | Visual acuity screening — high volume, primary care | Pediatrics, primary care | $15–$30 |
| DoD / VA | TBI evaluation episode — DRG-based inpatient + outpatient codes | Military, veteran health | $400–$1,200 |
Regulatory Pathway
ClearGazeTest is pursuing a phased FDA regulatory strategy designed to enable immediate clinical deployment under Class I, with progressive clearance that elevates clinical credibility and unlocks additional reimbursement categories.
Device Pricing & Commercial Model
ClearGazeTest is sold — not leased. Practices purchase the system outright and pay a monthly service contract that covers software updates, normative database access, cloud storage, and technical support. The purchase price is recovered rapidly through standard CPT billing.
Return on Investment
A single ClearGazeTest unit billing 6–8 assessments per day at $100 average net reimbursement recovers the full purchase price within 9–12 billing days. The service contract represents less than a single afternoon of billing volume annually. It keeps the practice's system current, the clinician supported, and the normative database building — compounding in value with every patient assessed.
full purchase recovery
Supporting Evidence
The ClearGazeTest platform is grounded in peer-reviewed oculomotor neuroscience. The following domains represent the strongest recurring signals in the concussion and mTBI literature supporting the biomarker strategy.
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Clinical Data, or Pilot Enrollment
ClearGazeTest was developed by Dr. Michael Duplessie (M.B., B.Ch., B.A.O., L.R.C.P.&S.I.) — a physician-surgeon who organized the first US LASIK course, pioneered modern lamellar corneal transplantation, and most recently founded Medical Card Exam™ (30,000+ patients) and the ANCHOR™ national outcomes initiative. We are actively seeking clinical pilot partners, IRB co-investigators, and early-adopter practices. Device demonstrations available by request.