The purpose of this study is to investigate the efficiency of the King-Devick Test (KDT) as a screening tool for concussion in a pediatric collision-sport population prone to concussion. Further, the accuracy of the KDT when administered by trained laypersons is examined.
The KDT is an efficient sideline assessment tool for sport-related concussion (Howitt et al., 2016). KDT has been shown to be sensitive to the effects of concussion, reliable, and easy to use and interpret (Echemendia et al., 2017). The KDT has effectively been administered by non-medically trained laypersons in a cohort of amateur boxers (Leong et al., 2013). Given that there are rarely medical professionals on the sideline of youth events, parent-administered tools to aid in the detection of concussion are needed.
Prior to the season, lay Safety Officers received concussion education and training in a sideline protocol that included administration of the KDT. During the season, 32 sideline KDTS evaluations (21 possible concussions; 11 controls; 3 excluded due to inability to confirm concussion diagnosis) of 28 collision sport athletes (1 female) aged 7 to 15 were conducted. Sideline KDT time was compared to baseline KDT time to determine pass or fail (>1 second longer = fail). Sensitivity and specificity for KDT were calculated to determine KDT ability to identify concussion. Medical professional identification of concussion was used to determine diagnosis of concussion. 10 concussions were identified. Further analysis evaluated sensitivity and specificity of KDT based on who conducted the sideline evaluation (medical professional n=19; layperson n=10).
The overall sensitivity was 80% and specificity was 89.5%. When administered by a layperson, sensitivity was 100% and specificity was 80%. When a medical professional administered KDT, sensitivity was 60% and specificity was 92.9%.
KDT is an adequate screening tool for detecting the presence of concussion and correctly identifying individuals without concussion. KDT should be considered an efficient sideline assessment tool in a pediatric population prone to concussion and therefore should be added to sideline concussion screening in this population. Ideally, medical professionals should be present, however, when administered by laypersons, the KDT yielded excellent sensitivity and adequately identified those without concussion, supporting its effective administration of the KDT by trained laypersons as a practical screening tool. This study was a small study and thus should be replicated on a larger sample of pediatric athletes.
- Sensitivity and specificity of the KDT were both high (80% and 89.5% respectively).
- When administered by laypersons, the KDT yielded excellent sensitivity and adequately identified those without concussion.
- Trained laypersons can effectively administer the KDT as a practical screening tool.