The King–Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand

  • D. King
    Correspondence
    Corresponding author at: Emergency Department, Hutt Valley District Health Board, Private Bag 31-907, Lower Hutt, New Zealand. Tel.: +64 22 477 7285 (mobile).
    Affiliations
    Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium Campus, Faculty of Health and Environmental Science, Auckland University of Technology, New Zealand

    Emergency Department, Hutt Valley District Health Board, Lower Hutt, New Zealand
    Search for articles by this author
  • C. Gissane
    Affiliations
    School of Sport, Health and Applied Science, St Mary's University, Twickenham, Middlesex, United Kingdom
    Search for articles by this author
  • P.A. Hume
    Affiliations
    Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium Campus, Faculty of Health and Environmental Science, Auckland University of Technology, New Zealand
    Search for articles by this author
  • M. Flaws
    Affiliations
    Emergency Department, Hutt Valley District Health Board, Lower Hutt, New Zealand
    Search for articles by this author
Published:February 26, 2015DOI:https://doi.org/10.1016/j.jns.2015.02.035

      Highlights

      • The King–Devick (K–D) test was used for routine sideline concussion assessment.
      • The K–D had an overall ICC of 0.92 (0.88 to 0.94) over three years.
      • The K–D had an overall sensitivity of 1.00, specificity or 0.94 and kappa of 0.98.
      • The K–D and SCAT3 helped identify cognitive impairment in players without symptoms.
      • There was a significant correlation between the K–D and the SAC total scores.

      Abstract

      Aim

      To use the King–Devick (K–D) test in senior amateur rugby union and rugby league players over a domestic competition season to see if it could identify witnessed and unwitnessed episodes of concussion that occurred from participation in competition matches over three years.

      Methods

      A prospective observational cohort study was conducted on a club level senior amateur rugby union team (n = 36 players in 2012 and 35 players in 2013) and a rugby league team (n = 33 players in 2014) during competition seasons in New Zealand. All 104 players completed two trials 10 min apart of the K–D at the beginning of their competition season. Concussions (witnessed or unwitnessed) were only recorded if they were formally diagnosed by a health practitioner.

      Results

      A total of 52 (8 witnessed; 44 unwitnessed) concussive events were identified over the duration of the study resulting in a concussion injury incidence of 44 (95% CI: 32 to 56) per 1000 match participation hours. There was a six-fold difference between witnessed and unwitnessed concussions recorded. There were observable learning effects observed between the first and the second K–D test baseline testing (50 vs. 45 s; z = −8.81; p < 0.001). For every 1 point reduction in each of the post-injury SAC components there was a corresponding increase (worsening) of K–D test times post-match for changes in orientation (2.9 s), immediate memory (1.8 s) concentration (2.8 s), delayed recall (2.0 s) and SAC total score (1.7 s).

      Discussion

      The rate of undetected concussion was higher than detected concussions by using the K–D test routinely following matches. Worsening of the K–D test post-match was associated with reduction in components of the SAC. The appeal of the K–D test is in the rapid, easy manner of its administration and the reliable, objective results it provides to the administrator. The K–D test helped identify cognitive impairment in players without clinically observable symptoms.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Tjarks B.
        • Dorman J.
        • Valentine V.
        • Munce T.
        • Thompson P.
        • Kindt S.
        • et al.
        Comparison and utility of King–Devick and ImPACT composite scores in adolescent concussion patients.
        J Neurol Sci. 2013; 334: 148-153
        • Harmon K.
        • Drezner J.
        • Gammons M.
        • Guskiewicz K.
        • Halstead M.
        • Herring S.
        • et al.
        American Medical Society for sports medicine position statement: concussion in sport.
        Br J Sports Med. 2013; 47: 15-26
        • Koh J.
        • Cassidy J.
        • Watkinson E.
        Incidence of concussion in contact sports: a systematic review of the evidence.
        Brain Inj. 2003; 17: 901-917
        • McCrea M.
        • Hammeke T.
        • Olsen G.
        • Leo P.
        • Guskiewicz K.
        Unreported concussion in high school football players: implications for prevention.
        Clin J Sport Med. 2004; 14: 13-17
        • McCrory P.
        • Meeuwisse W.
        • Aubry M.
        • Cantu R.
        • Dvořák J.
        • Echemendia R.
        • et al.
        Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.
        Br J Sports Med. 2013; 47: 250-258
        • Talavage T.
        • Nauman E.
        • Breedlove E.
        • Yoruk U.
        • Dye A.
        • Morigaki K.
        • et al.
        Functionally-detected cognitive impairment in high school football players without clinically-diagnosed concussion.
        J Neurotrauma. 2014; 31: 327-338
        • Martini D.
        • Eckner J.
        • Kutcher J.
        • Broglio S.
        Sub-concussive head impact biomechanics: comparing differing offensive schemes.
        Med Sci Sports Exerc. 2013; 45: 755-761
        • Bailes J.
        • Petraglia A.
        • Omalu B.
        • Nauman E.
        • Talavage T.
        Role of subconcussion in repetitive mild traumatic brain injury.
        J Neurosurg. 2013; 119: 1235-1245
        • Ciuffreda K.
        • Kapoor N.
        • Rutner D.
        • Suchoff I.
        • Han M.
        • Craig S.
        Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis.
        Optometry. 2007; 78: 155-161
        • Goodrich G.
        • Flyg H.
        • Kirby J.
        • Chang C.
        • Martinsen G.
        Mechanisms of TBI and visual consequences in military and veteran populations.
        Optom Vis Sci. 2013; 90: 105-112
        • Heitger M.
        • Anderson T.
        • Jones R.
        Saccade sequences as markers for cerebral dysfunction following mild closed head injury.
        in: Hyona DPMWH J. Radach R. Progress in brain research. Elsevier, 2002: 433-448
      1. A new approach to predicting postconcussion syndrome after mild traumatic brain injury based upon eye movement function.
        in: Heitger M. Jones R. Anderson T. Conference Proceedings of the IEEE Engineering in Medicine and Biology Society. Institute of Electrical and Electronic Engineers, New Jersey2008
        • Krumholtz I.
        Results from a pediatric vision screening and it ability to predict academic performance.
        Optometry. 2000; 71: 426-430
        • Stepanek J.
        • Pradhan G.
        • Cocco D.
        • Smith B.
        • Bartlett J.
        • Studer M.
        • et al.
        Acute hypoxic hypoxia and isocapnic hypoxia effects on oculometric features.
        Aviat Space Environ Med. 2014; 85: 700-707
        • Davies E.
        • Henderson S.
        • Balcer L.
        • Galetta S.
        Residency training: the King–Devick test and sleep deprivation: study in pre- and post-call neurology residents.
        Neurology. 2012; 78: e103-e106
        • Lin T.
        • Adler C.
        • Hentz J.
        • Balcer L.
        • Galetta S.
        • Devick S.
        Slowing of number naming speed by King–Devick test in Parkinson's disease.
        Parkinsonism Relat Disord. 2014; 20: 226-229
        • Dhawan P.
        • Starling A.
        • Tapsell L.
        • Adler J.
        • Galetta S.
        • Balcer L.
        • et al.
        King–Devick test identifies symptomatic concussion in real-time and asymptomatic concussion over time. (S11.003).
        Neurology. 2014; 82: S11.003
        • Galetta K.
        • Barrett J.
        • Allen M.
        • Madda F.
        • Delicata D.
        • Tennant A.
        • et al.
        The King–Devick test as a determinant of head trauma and concussion in boxers and MMA fighters.
        Neurology. 2011; 76: 1456-1462
        • Galetta K.
        • Brandes L.
        • Maki K.
        • Dziemianowicz M.
        • Laudano E.
        • Allen M.
        • et al.
        The King–Devick test and sports-related concussion: study of a rapid visual screening tool in a collegiate cohort.
        J Neurol Sci. 2011; 309: 34-39
        • Galetta M.
        • Galetta K.
        • McCrossin J.
        • Wilson J.
        • Moster S.
        • Galetta S.
        • et al.
        Saccades and memory: baseline associations of the King–Devick and SCAT2 SAC tests in professional ice hockey players.
        J Neurol Sci. 2013; 328: 28-31
        • King D.
        • Brughelli M.
        • Hume P.
        • Gissane C.
        Concussions in amateur rugby union identified with the use of a rapid visual screening tool.
        J Neurol Sci. 2013; 326: 59-63
        • King D.
        • Clark T.
        • Gissane C.
        Use of a rapid visual screening tool for the assessment of concussion in amateur rugby league: a pilot study.
        J Neurol Sci. 2012; 320: 16-21
        • Leong D.
        • Balcer L.
        • Galetta S.
        • Liu Z.
        • Master C.
        The King–Devick test as a concussion screening tool administered by sports parents.
        J Sports Med Phys Fitness. 2014; 54: 70-77
        • Marinides Z.
        • Galetta K.
        • Andrews C.
        • Wilson J.
        • Herman D.
        • Robinson C.
        • et al.
        Vision testing is additive to the sideline assessment of sports-related concussion.
        Neurol Clin Pract. 2014; https://doi.org/10.1212.CPJ/0000000000000060
        • Dziemianowicz M.
        • Kirschen M.
        • Pukenas B.
        • Laudano E.
        • Balcer L.
        • Galetta S.
        Sports-related concussion testing.
        Curr Neurol Neurosci Rep. 2012; 12: 547-559
        • Vartiainen M.
        • Holm A.
        • Peltonen K.
        • Luoto T.
        • Iverson G.
        • Hokkanen L.
        King–Devick test normative reference values for professional male ice hockey players.
        Scand J Med Sci Sports. 2014; https://doi.org/10.1111/sms.12307
        • Spradley B.
        • Wiriyanpinit S.
        • Magner A.
        Baseline concussion testing in different environments: a pilot study.
        The Sport J [Internet]. 2014 ([14 Mar 2014; March Available from: thesportjournal.org/article/baseline-concussion-testing-in-different-environments-a-pilot-study])
        • Guskiewicz K.
        • Register-Mihalik J.
        • McCrory P.
        • McCrea M.
        • Johnston K.
        • Makdissi M.
        • et al.
        Evidence-based approach to revising the SCAT2: introducing the SCAT3.
        Br J Sports Med. 2013; 47: 289-293
        • Maddocks D.
        • Dicker G.
        • Saling M.
        The assessment of orientation following concussion in athletes.
        Clin J Sport Med. 1995; 5: 32-35
        • McCrea M.
        Standardized mental status assessment of sports concussion.
        Clin J Sport Med. 2001; 11: 176-181
        • Hunt T.
        • Ferrara M.
        • Bornstein R.
        • Baumgartner T.
        The reliability of the modified balance error scoring system.
        Clin J Sport Med. 2009; 19: 471-475
        • Altman D.
        • Bland J.
        Statistics notes: diagnostic tests 1: sensitivity and specificity.
        BMJ. 1994; 308: 1552
        • Landis J.
        • Koch G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Brooks J.
        • Kemp S.
        Recent trends in rugby union injuries.
        Clin J Sport Med. 2008; 27: 51-73
        • Austin D.
        • Gabbett T.
        • Jenkins D.
        The physical demands of Super 14 rugby union.
        J Sci Med Sport. 2011; 14: 259-263
        • DeSouza J.
        • Menon R.
        • Everling S.
        Preparatory set associated with pro-saccades and anti-saccades in humans investigated with event-related fMRI.
        J Neurophysiol. 2003; 89: 1016-1023
        • Eckner J.
        • Kutcher J.
        Concussion symptoms scales and sideline assessment tools: a critical literature update.
        Curr Sports Med Rep. 2010; 9: 8-15
        • Valovich McLeod T.
        • Perrin D.
        • Guskiewicz K.
        • Shultz S.
        • Diamond R.
        • Gansneder B.
        Serial administration of clinical concussion assessments and learning effects in healthy young athletes.
        Clin J Sport Med. 2004; 14: 287-295
        • Giza C.
        • Hovda D.
        The new neurometabolic cascade of concussion.
        Neurosurgery. 2014; 75: S24-S33