Abstract
Although the King-Devick (K-D) test has been used frequently in assessing sports related concussion early after injury, its characteristics over time after injury and in patients with prolonged persistent symptoms are unknown. The purpose of this paper was to: evaluate the ability of the K-D Test to distinguish patients seen early after concussion from those with symptoms persisting more than 3 months compared to controls, assess changes in the K-D test times over time after concussion, and determine the relationship of K-D times to the Stroop Color and Word Test scores. We performed cross-sectional comparisons of patients with recent concussive brain injury (acute group) and those with symptoms persisting more than 3 months to healthy controls on the K-D test, the Sports Concussion Assessment Tool 3 (SCAT3), and the Stroop Color and Word Test. Longitudinal comparisons of the acute group over time within the first month after injury were also made. Post-concussive syndrome (PCS) patients had significantly higher K-D times compared to controls (p = 0.01), while the acute group did not differ from controls(p = 0.33). K-D times at the second visit for the acute group were similar to those of controls (54.7 vs. 49.6, p = 0.31). While SCAT3 scores improved over time in the acute group, the K-D scores did not change between the first and second visit (55.2 vs. 54.7, p = 0.94). K-D scores correlated significantly with the Stroop scores for all three participant groups. The K-D test is likely useful very early after concussion in conjunction with baseline scores, and while scores in PCS patients remain elevated, they can be confounded by factors such as pre-morbid depression and medication use. High correlations with Stroop scores also suggest that performance on the K-D test can by proxy provide additional insight about cognitive function and predict performance on more cognitively demanding tasks.
Highlights
Rising public concern regarding the occurrence of mild traumatic brain injuries including concussion in sports has led to the development of tools that can help assist in the screening, diagnosis and follow-up of these injuries
The single visit for the Post-concussive syndrome (PCS) patients occurred at a median of 366 days (IQR = 164–659) after injury
We were not able to show any differences in K-D times between acutely injured patients at a median of 5 days post injury and neither did we find times to improve over the subsequent two weeks
Summary
Rising public concern regarding the occurrence of mild traumatic brain injuries (mTBIs) including concussion in sports has led to the development of tools that can help assist in the screening, diagnosis and follow-up of these injuries. Characterizing the King-Devick test in the assessment of concussions design, data collection and analysis, decision to publish, or preparation of the manuscript
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