The study provides more evidence that the King-Devick test, a one-minute test where athletes read single-digit numbers on index cards, can be used in addition to other tests to increase the accuracy in diagnosing concussion.
The King-Devick test capitalizes on a subtle but important symptom of brain injury: a disruption in the eyes' ability to travel smoothly across a page, and to shift direction upon the brain's command.
New research presented at the American Academy of Neurology's 66th Annual Meeting in Philadelphia indicates that a quick vision test, known as the King-Devick test, combined with a series of other simple tests, could yield near-perfect concussion detection rates on the sidelines of a game.
Many sports medicine professionals suggest that those coaches who do not have immediate access to an athletic trainer use easy and reliable screening tools. One of the most effective screening tools is the King-Devick test. Personally, I recommend every high school and youth coach to use this screening tool. It is very easy to learn and does not require a medical professional to administer. The King-Devick test can be easily implemented into an existing concussion management protocol.
Concussion is hard to recognize and diagnose. Initial sideline assessment via the Sports Concussion Assessment Tool 3 (SCAT3), Child-SCAT3 or King-Devick test should be undertaken to identify athletes with concussion as part of a continuum of assessment modalities and athlete management.
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Dr. Press: The merging of technology available to administer tests such as the King-Devick saccade test, and how to dovetail this information with batteries such as the ImPACT Test, represent a significant advancement in clinical concepts as well as tools.
One of the main benefits of this concussion program is the donation of an effective and reliable concussion screening device known as the King-Devick Test, an objective, rapid sideline screening test for concussions that can be administered by coaches, athletic trainers, and athletic support personnel.
The NYU Cover Story, notes: “Drs. Galetta and Balcer believe the King-Devick test works because at least 50 percent of the brain’s circuits are involved in vision. Thus the test can pick up deficiencies occurring across a wide range of neurological geography.
“Right now, these tests — King-Devick, SCAT2, balance, computerized assessment — are considered the standard of care, or the best procedure, for diagnosing concussions,” head Notre Dame University Physician Dr. Jim Moriarty said. “The key for us is if you’re a physician on the sidelines, you’d like to know the tests you’re running are reliable. There are symptoms that confirm concussions, but most people don’t have that. Most people have the lesser symptoms which cause you to have doubts whether you’re making the right choice or not.”
The Mayo Clinic study team used the King-Devick neurocognitive performance test, which is commonly used to identify cognitive changes related to sports-related concussions, and to assess cognitive function under conditions of low oxygen-simulating altitude. The King-Devick test assesses the time in viewing, identifying and reading aloud a series of numbers on three consecutive test cards. Based on test times of 25 participants, the study concluded that the King-Devick test is an effective tool to detect "impairment of cognitive performance at a presymptomatic stage of hypoxia."
Press Release: ImPACT® Partners with King-Devick Test in Support of Multifaceted Approach to Concussion Management
The need for sideline rapid assessment of mild head injury is fundamental to limiting the deleterious effects of repeated impacts to the head. The great majority of athletes are at the youth sports level and not in collegiate or professional sports, which leaves many important decisions to be made by parents and coaches on the sideline. This structural element of sport is unlikely to change since allocating medically trained people to youth sports will require unavailable financial resources. Accordingly, empowering adults to administer a simple, rapid, yet effective test is paramount to preventing repeated head injury. As increasing evidence suggests that even mild impact to the head can lead to accruing neuropathology, it may be prudent to routinely perform sideline testing for players involved in even modest collisions. This could help avoid return to play of athletes with sub-concussive impacts as knowledge about head injury continues to evolve.
Steve Devick and Chris Nowinski discuss concussions and football with the University of Miami.
With help from an Association of Applied Sport Psychology (AASP) grant and King-Devick, the Academy has made presentations to more than 50 coaches about concussions and given training on how to use the King-Devick test to quickly and accurately determine on the sideline if any player has suffered head trauma. In addition, each coach and team received a comprehensive manuals about concussion safety, fact sheets, and King-Devick Playbooks that included the tests to administer on players.
The latest episode of Raising Canes continues the showcase of Miami's industry-leading concussion testing procedures utilized by the sports medicine staff.
Dr. Rahul Jandial demonstrates King-Devick Test on the Today Show!
The King-Devick Test (KD) is one solution that is relatively low-tech but has high-tech abilities and research supporting its use for TBI/concussion and sports. This test has been available for more than 25 years to assess oculomotor dysfunction.
The K-D measures the time it takes for an athlete to read a series of single digit numbers displayed on index-sized cards. Previous studies of boxers and mixed martial arts (MMA) fighters (2), collegiate athletes in contact sports (3), and in a New Zealand rugby league (4,5) found that an increase (worsening) in the time needed to complete the one-minute K-D was predictive of concussion. While K-D detects fast eye (i.e. saccadic) movements, it also captures language and concentration, all of which have been shown to be impaired as a result of concussion.
The King-Devick Test has the benefit of providing objective baseline and post-injury data for rapid comparison. This may help athletic trainers and coaches determine whether players should be removed from games.
Last year he introduced to the club the King-Devick test, a screening that can help determine whether a player has suffered a concussive incident during the game.
A player does an initial test in the preseason to record a baseline score. The players are then tested after every game, and if anyone is three-seconds slower than his baseline score, he is deemed to have suffered a concussion. Because the test is calculated on an iPad, it can even be used during a game if a concussion is suspected.
Last year there were five concussions witnessed on the field, but another 17 were diagnosed through the King-Devick test (which is named after another King, not Doug).
Major League Lacrosse will become the first professional sports organization to mandate the King-Devick test -- an objective rapid sideline screening test of concussions that a growing body of studies show is an effective test for concussion -- as an additional sideline assessment tool.
The K-D Test serves as a “remove from play” test and is actually more suited to a sports role than one might think. Since players can only be on the sidelines for a few minutes between plays or drives, time is of the essence. The player has to be assessed immediately; continued play with head trauma can be increasingly dangerous. “We do know that if you put a kid back in with concussive symptoms, he’s at really high risk to get hit again,” says Dr. Gillian Hotz of the University of Miami’s Miller School of Medicine.
Unlike SCAT, the King-Devick test is also more straightforward for a physician to score. It is not only less subjective than SCAT, but also more informative. In fact, in trials for the test, many concussed athletes have passed SCAT but failed the King-Devick test.
“As a direct result of the findings using the King-Devick Test, the club has implemented a wider concussion awareness program to assist in identification and management of concussion for the upcoming season,” Dr. Doug King, the senior author of the study, said in a news release.
The advantage of the King-Devick is that it’s much more straightforward for an inexperienced physician or coach to grade than the SCAT-2, which relies on subjective analysis of symptoms and test results. Many concussed athletes in the team’s trials have passed the SCAT-2 exam but failed the King-Devick Test.