Objective: We examined the King-Devick (K-D) test, a vision-based measure of rapid number naming, as a complement to the Sport Concussion Assessment Tool, 3rd edition (SCAT3/Child-SCAT3) for sideline diagnosis in youth athletes.
Background: Particularly in youth sports, identification of rapid yet simple diagnostic tests for concussion is critical. These rapid tests must be interpreted in the context of developmental status and age.
Methods: Members of a suburban youth ice hockey league participated in a prospective study to examine three brief rink-side tests: K-D test, Standardized Assessment of Concussion (SAC, cognition) and timed tandem gait (balance). To perform the K-D test, athletes read numbers from three laminated test cards from left to right as quickly as possible. The cards become progressively more difficult due to changes in vertical spacing between lines; this is particularly notable for card 3.
Results: Ninety-nine athletes (mean age 10.8±3.0 years, range 6-17 years) underwent pre-season baseline testing for this study. Athletes completed the K-D test in an average of 56.5 seconds (best of two baseline trials, range 27.5-159.8 seconds). Average total SAC scores were 26/ maximum 30 points (range 17-30); average best of four trials for timed tandem gait was 15.9±6.0 seconds. All three tests showed better scores among older athletes (p<0.001 for all, linear regression). Time scores for K-D were significantly slower (worse) for younger athletes (p<0.001). This association of worse K-D scores with younger age was most evident for K-D card 3, the card with the greatest degree of vertical visual crowding (average of 3.9 seconds slower vs. card 1, p<0.001, linear regression).
Conclusions: Scores for rapid sideline concussion tests may vary with age and developmental status of youth athletes; better scores in this cohort were noted among older players. Visual crowding, an age-dependent inability to perceive objects due to clutter, may in part explain the more dramatic association of slower time scores on test card 3 with younger age for the K-D test.
Summary Points:
- 121 hockey players (ages 5-17) performed the K-D test, timed tandem gait (balance), and SAC.
- Older ages, teens, scored faster (better) on K-D test than younger athletes.
- Visual crowding may explain the difference in K-D Test performance in younger athletes.
- Up-to-date pre-season baseline test scores are important due to score differences among age groups.