The
King-Devick test for sideline concussion screening in collegiate football
King-Devick test for sideline concussion screening in collegiate football
Leong DF, Balcer LJ, Galetta SL, Evans G, Gimre M, Watt D. Journal of Optometry. 2015. doi:
10.1016/j.optom.2014.12.005. [Epub]
10.1016/j.optom.2014.12.005. [Epub]
Take Home Message: The King-Devick test is a
quick and reliable method to assess vision, eye movements, language function,
and attention. An athlete with a concussion tends to complete the test slower
than his/her preseason assessment while other athletes improve over time.
quick and reliable method to assess vision, eye movements, language function,
and attention. An athlete with a concussion tends to complete the test slower
than his/her preseason assessment while other athletes improve over time.
With recent attention on the potential consequences
associated with concussions there has been an emphasis on rapid and accurate
diagnosis of concussions. This will aid in removal from activity to
assist recovery and hopefully prevent athletes from sustaining further head
trauma. The purpose of this article was
to assess the validity of the King-Devick test as a sideline concussion
assessment among collegiate athletes. 127 student-athletes (football, men’s and
women’s basketball) with a mean age of ~20 years participated in this study. Participants completed a baseline King-Devick
test during preseason physicals. The
test takes two minutes and requires an athlete to quickly read a series of
numbers on three test cards. If an athlete sustained a concussion then he/she completed
the King-Devick test and Sport Concussion Assessment Tool 2 (SCAT-2)
immediately on the sideline. Non-concussed participants completed post-season
testing to compare to the baseline results in order to assess performance
changes and reliability over the season.
Basketball players also completed the test immediately after an intense
sprint workout to see how the test was affected by exercise. During the course
of the season 11 athletes sustained a concussion and 9 failed their sideline
SCAT-2 test. The authors found that individuals who suffered a concussion took longer
to complete the King-Devick test compared with their baseline measurements. On average concussed participants took 4.4 seconds
longer compared with their baseline times.
In contrast, participants without a concussion were slightly faster
during post-season testing, which may indicate a learning effect. The test had excellent
retest reliability from baseline to post-season in non-concussed participants. The post-workout results were similar to the
post-season results, which indicated that fatigue did not influence the test
times.
associated with concussions there has been an emphasis on rapid and accurate
diagnosis of concussions. This will aid in removal from activity to
assist recovery and hopefully prevent athletes from sustaining further head
trauma. The purpose of this article was
to assess the validity of the King-Devick test as a sideline concussion
assessment among collegiate athletes. 127 student-athletes (football, men’s and
women’s basketball) with a mean age of ~20 years participated in this study. Participants completed a baseline King-Devick
test during preseason physicals. The
test takes two minutes and requires an athlete to quickly read a series of
numbers on three test cards. If an athlete sustained a concussion then he/she completed
the King-Devick test and Sport Concussion Assessment Tool 2 (SCAT-2)
immediately on the sideline. Non-concussed participants completed post-season
testing to compare to the baseline results in order to assess performance
changes and reliability over the season.
Basketball players also completed the test immediately after an intense
sprint workout to see how the test was affected by exercise. During the course
of the season 11 athletes sustained a concussion and 9 failed their sideline
SCAT-2 test. The authors found that individuals who suffered a concussion took longer
to complete the King-Devick test compared with their baseline measurements. On average concussed participants took 4.4 seconds
longer compared with their baseline times.
In contrast, participants without a concussion were slightly faster
during post-season testing, which may indicate a learning effect. The test had excellent
retest reliability from baseline to post-season in non-concussed participants. The post-workout results were similar to the
post-season results, which indicated that fatigue did not influence the test
times.
The King-Devick test appears to be a valid and reliable assessment
for concussions among college athletes. The
King-Devick tests’ portability and simplistic approach makes it an ideal
sideline assessment for detecting changes in quick eye movements and saccades
observed in individuals suffering from head trauma. Although the King-Devick
test seems to be an effective method to assess concussions, it is not clear yet
if it can serve as a standalone evaluation.
Multiple measures may be ideal to gain a complete picture of an
individual athlete’s symptoms and deficits.
Considering there are limited studies on the King-Devick test, more
research needs to be completed to assess its’ effectiveness to assist
clinicians for rehabilitation purposes and return-to-play decisions. It is
important to note that this study had a small number of athletes with
concussions, which limits our ability to apply these results to other
collegiate athletes and limited the authors’ ability to suggest clinically
relevant cut-points that may differentiate athletes with or without a
concussion. Despite these limitations, this
is another tool sports medicine professionals may use on the sidelines to
assist in the rapid detection of concussions.
for concussions among college athletes. The
King-Devick tests’ portability and simplistic approach makes it an ideal
sideline assessment for detecting changes in quick eye movements and saccades
observed in individuals suffering from head trauma. Although the King-Devick
test seems to be an effective method to assess concussions, it is not clear yet
if it can serve as a standalone evaluation.
Multiple measures may be ideal to gain a complete picture of an
individual athlete’s symptoms and deficits.
Considering there are limited studies on the King-Devick test, more
research needs to be completed to assess its’ effectiveness to assist
clinicians for rehabilitation purposes and return-to-play decisions. It is
important to note that this study had a small number of athletes with
concussions, which limits our ability to apply these results to other
collegiate athletes and limited the authors’ ability to suggest clinically
relevant cut-points that may differentiate athletes with or without a
concussion. Despite these limitations, this
is another tool sports medicine professionals may use on the sidelines to
assist in the rapid detection of concussions.
Questions for Discussion: What sideline
assessments do you use for concussions? Which do you think are the most
effective? Have you tried using the King-Devick test?
assessments do you use for concussions? Which do you think are the most
effective? Have you tried using the King-Devick test?
Written
by: Adam Rosen and Andrew Sheridan
by: Adam Rosen and Andrew Sheridan
Reviewed
by: Jeffrey Driban
by: Jeffrey Driban
Related
Post:
Post:
Leong, D., Balcer, L., Galetta, S., Evans, G., Gimre, M., & Watt, D. (2015). The King–Devick test for sideline concussion screening in collegiate football Journal of Optometry DOI: 10.1016/j.optom.2014.12.005
Really interesting article!
I am excited to hear that the King-Devick test is a reliable measure for evaluating concussion. As in this article, I also use the SCAT 2 in concussion assessment. While the SCAT 2 assess lower extremity coordination, I think it also important to look at eye coordination. The eyes will often overshoot if you look at them closely in concussed athletes. It is something the athlete can absolutely not lie about, as my team physician taught me, "the eyes can't lie".
I think the best concussion evaluation is a comprehensive one, assessing all impairments concussion can cause. I think the King-Devick showed that it can be another tool in the tool box. It is definitely administered faster than the SCAT 2, but is not as comprehensive.
I have tried the King-Devick test myself. It is quite difficult to do. I once tried it against someone who was concussed and she got a better score then me. Just as a SCAT 2, I think baseline scores are important if an ATC decides to implement the use of the King-Devick.
Kaitlyn Grossman ATC
Kaitlyn, thanks for the comment. Baseline scores are absolutely necessary for the King-Devick test to be reliable. It’s quick and easy and may only add 2 minutes or so to your preseason screening, which is obviously beneficial when performing on a large number of athletes at once. As you point out is another tool in the toolbox and should just be one of many items to take into consideration after an athlete suffers a concussion. Do you use any other tests besides the SCAT2 during your concussion evaluations?
With recently popularity in concussion research and prevention, I have read several articles focusing on baseline concussion testing, preventative measures, sideline assessment, diagnosis, and return to play protocol. More specifically related to sideline concussion assessment, there has been many tools to examine an athlete when you may think they have a concussion. Unfortunately, a majority of these tools tend to be costly and therefore almost useless in a financially restricted setting. The King-Devick test is a very interesting article and I think that it could be very useful as an effective sideless concussion assessment, beside SCAT.
We use the SCAT3 and BESS testing in sideline concussion assessment, followed by an ImPACT test for return to play. I think the King-Devick test could be found a quick and effective tool for eye coordination and full assessment.
I have looked up the King-Devick test and look forward to trying it out experimentally in the athletic training room. Additionally, I’m excited to read more about the King-Devick test in upcoming research and potentially utilizing it as a sideline tool myself in the future.