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King-Devick test shows reliability in assessing sports-related concussion
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The King-Devick test of oculomotor performance is a simple and reliable tool for diagnosing sports-related concussion, according to a study.
The authors recommend that it should be more widely adopted for rapid identification of sports-related concussion (SRC) by sport teams.
The study was conducted on a sub-elite West Australian Football League reserves team. Seven players suspected of having SRC secondary to head impact, as reported by a qualified head physiotherapist, and selected players without SRC were tested and re-tested with the King-Devick (K-D) test.
The test required the players to read series of numerals, left to right and top to bottom that were progressively more difficult to read in a flowing manner. Reading speed and reading accuracy were measured.
Subjects with suspected SRC reported significantly lower scores, and the test showed high sensitivity and specificity over the duration of the study.
Visual function uses a number of circuits throughout the brain and is, therefore, recognized as a significant indicator of brain trauma. Among other vision-based tests, the K-D has the advantage of being easy to administer by a nonmedically trained person. It can, therefore, be used as a rapid assessment tool in the case of head trauma.
Australian football has lower rates of SRC and impact exposures than rugby and American football, but is still “a high-intensity sport involving body contact, collision and tackling,” the authors noted.
“Therefore, the need for an accurate screening test is required, as players may not exhibit gross outwardly signs and symptoms of SRC,” they wrote. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Perspective
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Suzanne Wickum, OD, FAAO
SRC is a serious neurological event with potential for devastating long-term sequelae. It is important for concussion to be identified quickly and to remove affected athletes from play.
Hecimovich and colleagues found strong test-retest reliability and high sensitivity and specificity for concussion detection in Australian football players; however, they found less increase in reading time post-concussion than other studies.
The K-D test is a simple, efficient, fatigue-tolerant sideline test for SRC screening and, when combined with additional sideline tests, shows upwards of 100% detection of concussions.
When utilizing this test we should consider questions such as: How often might athletes deliberately underperform on baseline testing to mask future concussion? When should baseline testing be performed, at the start of a season, monthly, weekly or before each event? Does the increase in reading time relate to severity of concussion?
As more study results are published we will hopefully find answers to these questions. In the meantime, the K-D test is an effective screening tool for the detection of SRC.
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