Background: Sports-related concussion has received increasing awareness due to short- and long-term neurologic sequelae seen among athletes. The King-Devick (K-D) test captures impairment of eye movements and other correlates of suboptimal brain function. We investigated the K-D test as a screening for concussion when administered by layperson sports parents in a cohort of amateur boxers.
Methods: The K-D test was administered pre-fight and post-fight by laypersons masked to the head trauma status of each athlete. Matches were watched over by a ringside physician and boxing trainer. Athletes with suspected head trauma received testing with the Military Acute Concussion Evaluation (MACE) by the ringside physician to determine concussion status. Athletes sustaining concussion were compared to the athletes screened using the K-D test.
Results: Post-fight K-D scores were lower (better) than the best baseline score (41.0 vs. 39.3 seconds, p = 0.34, Wilcoxon signed-rank test), in the absence of concussion. One boxer sustained a concussion as determined by the ringside physician. This boxer was accurately identified by the layperson K-D testers due to a worsening in K-D test compared to baseline (3.2 seconds) and an increased number of errors. High levels of test-retest reliability were observed (intraclass correlation coefficient 0.90 [95% CI 0.84 – 0.97]). Additionally, 6 boxers who participated in multiple bouts showed no worsening of their K-D times further supporting that scores are not affected by the fatigue associated with sparring.
Conclusion: The K-D test is a rapid sideline screening tool for concussion that can be effectively administered by non-medically trained laypersons.
Summary Points:
- K-D Test was administered by masked layperson sports parents in a cohort of 33 amateur boxers, pre- and post-fight.
- Post-fight K-D scores were lower (better) than the best baseline (39.3s vs 41s) in non-concussed boxers.
- One boxer was diagnosed with a concussion and had a worse K-D score compared to baseline (3.2 s slower, increased errors).
- Six boxers were tested after multiple bouts showed no worsening of their scores, supporting that scores are not affected by fatigue.