Evaluation of the King–Devick test as a concussion screening tool in high school football players

Seidman, Daniel H.; Burlingame, Jennifer; Yousif, Lina R.; Donahue, Xinh P.; Krier, Joshua; Rayes, Lydia J.; Young, Rachel; Lilla, Muareen; Mazurek, Rochelle; Hittle, Kristie; McCloskey, Charles; Misra, Saroj; Shaw, Michael K.

doi:10.1016/j.jns.2015.06.021

Cited by 35 publications

(27 citation statements)

References 23 publications

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“…A number of studies have reported ICC from KD testing among college and high school athletes to be good to excellent. 21–23 We found similarly high ICC for a much younger cohort with a majority being 6 th to 9 th grade athletes. Intraclass correlation coefficients are widely used as a marker of repeatability in continuous measures.…”

Section: Discussionsupporting

confidence: 53%

“…Consistent with other studies, prior history of concussion was not associated with KD time beyond the immediate concussion and post-concussion period. 23 Among this group, those with a history of concussion had faster median times.…”

Section: Discussionmentioning

confidence: 94%

“…In looking at Seidman, et. al.’s 23 report of nine concussed high school athletes, the smallest reported change in KD time associated with a medically diagnosed concussion was 6.5 seconds. In a study of junior rugby players (mean aged 10 years), greater than 3 seconds was associated with concussion with the average slowing over 7 seconds.…”

Section: Discussionmentioning

confidence: 96%

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King-Devick and Pre-season Visual Function in Adolescent Athletes

et al. 2017

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Purpose The King-Devick Test (KD) has been studied as a remove-from-play sideline test in college-age athletes and older; however, studies in younger athletes are limited. A cross-sectional study of the KD and other vision correlates was completed on school-aged athletes during pre-season physicals for a variety of sports to determine the repeatability of the KD. The study also evaluated how convergence, alignment, or pupil function contributed to a slower King-Devick baseline reading. Methods 785 athletes underwent vision screenings in a hospital or school setting by trained/certified staff as part of pre-season physicals. 619 had KD testing completed per the manufacturer’s suggested protocol and repeated. Other baseline vision testing included visual acuity, Modified Thorington testing for alignment, convergence testing, and pupil function using the NeurOptics (NPI-200) NPi. Results The mean fastest, error-minimized KD time for all participants was 43.9 seconds(s) (sd±11.6, range 24–120). Median KD time got faster (+) with age (p <.0001). The inter-class correlation coefficient for all scores was 0.92. The absolute mean time difference for any two tests was 3.5s (sd±2.5, range 0–23). There was no association between the best KD time and reduced NPC (p=0.63), Modified Thorington measure of alignment (p = 0.55), or NPi pupil function (p=0.79). The Bland Altman repeated measure limits of agreement was ±6.5s for those in the 10th–12th grades, and ±10.2s for those in 6th–9th grades. Conclusions King-Devick score in junior high and high-school athletes is variable but gets faster and more repeatable with increasing age. The KD does not correlate significantly with reduced convergence, alignment, or pupil function. Based on grouped data, a slowing of 10 seconds for younger athletes and 6 seconds for older athletes on a second administration represents a true difference in testing speed. Within-player variability should be considered when removal-from-play decisions are influenced by KD results.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 94%

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King-Devick and Pre-season Visual Function in Adolescent Athletes

et al. 2017

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“…Significant postinjury differences (each p<0.01) for the modified BESS (SCAT) were identified in one study 48. BESS balance deficits in concussed college football players were described immediately after the injury with a gradual improvement within several days 16. Houston et al 41 identified an association between BESS score and health-related quality-of-life measures 72 hours post injury.…”

Section: Resultsmentioning

confidence: 99%

“…An (indirect) ocular motor test (King Devick) was included in one study (NOS rating: fair)16 that evaluated nine concussed high school football players. This test demonstrated a significant increase in reading time (p=0.001) when comparing immediate (<30 min) postinjury results to individual preseason baseline tests and to non-concussed controls.…”

Section: Resultsmentioning

confidence: 99%

What domains of clinical function should be assessed after sport-related concussion? A systematic review

Feddermann-Demont¹,

Echemendía²,

Schneider³

et al. 2017

Br J Sports Med

101

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The overall quality of the studies was considered low. The absence of an objective, gold standard criterion makes the accurate diagnosis of SRC challenging. Current approaches tend to emphasise cognition, symptom assessment and postural stability with less of a focus on other domains of functioning. We propose that the clinical assessment of SRC should be symptom based and interdisciplinary. Whenever possible, the SRC assessment should incorporate neurological, vestibular, ocular motor, visual, neurocognitive, psychological and cervical aspects.

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