Utility of the King–Devick Test for Assessment of Sports-Related Concussion
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In a prospective cohort of 22 male Australian football players, the investigators evaluated the diagnostic accuracy and test–retest repeatability of the King–Devick (K–D) test for identifying sports-related concussion. With a positive likelihood ratio of 11.6 and a positive predictive value of 89%, the K–D test was shown to be an effective screening tool for identifying impaired oculomotor function, a marker for sports-related concussion.
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The K–D test may help sports medicine professionals make faster decisions regarding management of sports-related concussion and player fitness on the field.
abstract
This article is open access.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVES
Sport-related concussion (SRC) research has focused on impaired oculomotor function. The King-Devick (K-D) test measures oculomotor performance and is reported to identify suboptimal brain function. The use of the K-D test in Australian football (AF), a sport involving body contact and tackling, has not been documented. Therefore, the objective of this study was to determine the test-retest reliability and diagnostic accuracy of the K-D test on a sub-elite AF team.
DESIGN
Prospective cohort study METHODS: In total, 22 male players (19.6+2.3 years) were tested and re-tested on the K-D test. Those suspected of having a SRC secondary to a significant head impact were tested. Randomly selected additional players without SRC were assessed for comparison.
RESULTS
There were observable learning effects between the first and second baseline testing (48 vs. 46s). The ICC for the first and second baseline tests was 0.91. Post-match test times were longer than the baseline times for players with SRC (n=7) (-1.9s; z=-5.08; p<0.0001). Players tested with no signs of SRC (n=13) had an improvement in time when compared with their baseline score (3.0s; z=-4.38; p<0.0001). The overall sensitivity was 0.98, specificity 0.96, and a kappa of κ=0.94. The positive likelihood ratio was 11.6 and the positive predictive value was 89.0%.
CONCLUSIONS
This study supports the use of the K-D test due to its test-retest reliability, high sensitivity and specificity, and fast and simple use that is ideal for sports medicine professionals to make quick judgement on management and playability.
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Additional Info
Disclosure statements are available on the authors' profiles:
The King–Devick Test Is a Valid and Reliable Tool for Assessing Sport-Related Concussion in Australian Football: A Prospective Cohort Study
J Sci Med Sport 2018 Oct 01;21(10)1004-1007, M Hecimovich, D King, AR Dempsey, M MurphyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This article adds to a growing body of literature that the K–D is a valuable screening tool for assessing sport-related concussion (SRC). This prospective cohort study showed that athletes who were concussed exhibited slower saccadic tracking time on retest from baseline, whereas those who were not concussed showed the expected increase from baseline. The strength of the study is that it used a lengthier test (the SCAT) to confirm the diagnosis, whereas a potential limitation was that the examiner wasn't masked. But, in the real world of SRC test protocols, there is no masking, and real-time decisions have to be made based on data that are sometimes conflicting.
The authors do not suggest that the K–D can be used as a stand-alone screening test, and they recommend that further studies be done to see if there is a link between the degree of saccade tracking time reduction and the extent of SRC. They conclude that, given the economic value, rapidity of the test, and its test–retest reliability, it is a valuable adjunct in assessing SRC.