Concussions are a type of Traumatic Brain Injury (TBI) that can vary in clinical presentation, including cognitive, physical, and behavioral changes. Current recommendations for adolescent concussion diagnosis includes standardized screening tools such as PCSS, ImPACT, SAC, and SCAT3. This paper poses the following question: In adolescents (age 9-19) with concussions, does the King-Devick Test provide a more efficient screening tool when compared to traditional concussion screening tools such as ImPACT, SAC, and SCAT3?
A literature search was conducted through EBSCO and PubMed in November 2018. A total of five articles were selected based on keywords and excluded based on inappropriate age range, potential research bias, study of long term effects, study of non-concussed participants, and comorbid conditions. The results of these articles were analyzed and compared.
Based on the literature review, many different screening tools are used to diagnose and manage concussions. Three articles found that the KD test gave similar results to visual motor speed and reaction time of the ImPACT test, and visual symptoms on the PCSS. Two articles looked at the VOMS test and noted that vertical and horizontal vestibular ocular reflex are most useful to diagnose and manage adolescent concussions.
All of the studies were cross-sectional cohort studies with one having a retrospective design. Reporting bias was unlikely throughout. The studies focused on the adolescent population ages 9-19 and two of the studies had all male participants. Four of the studies had a sample size of less than 100 concussed participants. They all analyzed the efficiency of screening tools such as VOMS, PCSS, KD, SCAT3, ImPACT, and NPC. All five of the studies provided similar results that oculomotor function is vital to concussion diagnosis in adolescents.
Early recognition of a concussion is vital to recovery and risk of long term complications. The King-Devick test is an efficient screening tool that provides an objective measure of oculomotor deficits often seen in adolescent concussions. Results of the KD test are similar to that of traditional screening tools but may be more favorable due to cost, time, and practicality. The KD test is an effective screening tool but is not a complete neurologic assessment and must be used concurrently with a clinical evaluation for appropriate diagnosis.