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Relationship Between the King-Devick Test and Commonly Used Concussion Tests at Baseline

J Athl Train. 2019 Oct;

Clugston, J. R., Houck, Z. M., Asken, B. M., Boone, J. K., Kontos, A. P., Buckley, T. A., . . . Ortega, J. D..

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Abstract:

CONTEXT:

Comprehensive assessments are recommended to evaluate sport-related concussion (SRC). The degree to which the King-Devick (KD) test adds novel information to an SRC evaluation is unknown.

OBJECTIVE:

To describe relationships at baseline among the KD and other SRC assessments and explore whether the KD provides unique information to a multimodal baseline concussion assessment.

DESIGN:

Cross-sectional study.

SETTING:

Five National Collegiate Athletic Association institutions participating in the Concussion Assessment, Research, and Education (CARE) Consortium.

PATIENTS OR OTHER PARTICIPANTS:

National Collegiate Athletic Association student-athletes (N = 2258, age = 20 ± 1.5 years, 53.0% male, 68.9% white) in 11 men’s and 13 women’s sports.

MAIN OUTCOME MEASURE(S):

Participants completed baseline assessments on the KD and (1) the Symptom Inventory of the Sports Concussion Assessment Tool-3rd edition, (2) the Brief Symptom Inventory-18, (3) the Balance Error Scoring System, (4) the Standardized Assessment of Concussion (SAC), (5) the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test battery, and (6) the Vestibular/Ocular Motor Screening tool during their first year in CARE. Correlation coefficients between the KD and the 6 other concussion assessments in isolation were determined. Assessments with ρ magnitude >0.1 were included in a multivariate linear regression analysis to evaluate their relative association with the KD.

RESULTS:

Scores for SAC concentration, ImPACT visual motor speed, and ImPACT reaction time were correlated with the KD (ρ = -0.216, -0.276, and 0.164, respectively) and were thus included in the regression model, which explained 16.8% of the variance in baseline KD time (P < .001, Cohen f2 = 0.20). Better SAC concentration score (β = -.174, P < .001), ImPACT visual motor speed (β = -.205, P < .001) and ImPACT reaction time (β = .056, P = .020) were associated with faster baseline KD performance, but the effect sizes were small.

CONCLUSIONS:

Better performance on cognitive measures involving concentration, visual motor speed, and reaction time was weakly associated with better baseline KD performance. Symptoms, psychological distress, balance, and vestibular-oculomotor provocation were unrelated to KD performance at baseline. The findings indicate limited overlap at baseline among the CARE SRC assessments and the KD.

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