King-Devick testing and concussion recovery time in collegiate athletes

Bridget M Whelan; Emma L Gause; Justus D Ortega; Brianna M Mills; Julianne D Schmidt; Thomas W Kaminski; Thomas A Buckley; Katherine M Breedlove; Anthony P Kontos; James R Clugston; Joshua T Goldman; Kimberly G Harmon; Michael A McCrea; Thomas W McAllister; Steven P Broglio; Sara P D Chrisman

doi:10.1016/j.jsams.2022.08.012

King-Devick testing and concussion recovery time in collegiate athletes

J Sci Med Sport. 2022 Nov;25(11):930-934. doi: 10.1016/j.jsams.2022.08.012. Epub 2022 Aug 27.

Authors

Bridget M Whelan¹, Emma L Gause², Justus D Ortega³, Brianna M Mills², Julianne D Schmidt⁴, Thomas W Kaminski⁵, Thomas A Buckley⁵, Katherine M Breedlove⁶, Anthony P Kontos⁷, James R Clugston⁸, Joshua T Goldman⁹, Kimberly G Harmon¹⁰, Michael A McCrea¹¹, Thomas W McAllister¹², Steven P Broglio¹³, Sara P D Chrisman¹⁴

Affiliations

¹ Department of Family Medicine, University of Washington, USA. Electronic address: bwhelan@uw.edu.
² Harborview Injury Prevention and Research Center, USA.
³ Department of Kinesiology and Recreation Administration, Humboldt State University, USA.
⁴ Department of Kinesiology, University of Georgia, USA.
⁵ Department of Kinesiology and Applied Physiology, 349 STAR Tower, University of Delaware, USA.
⁶ Brigham and Women's Hospital and Department of Radiology, Harvard Medical School, USA.
⁷ Department of Orthopaedic Surgery, University of Pittsburgh, USA.
⁸ Department of Community Health and Family Medicine, University of Florida, USA.
⁹ Department of Family Medicine, University of California Los Angeles, USA.
¹⁰ Department of Family Medicine, University of Washington, USA.
¹¹ Department of Neurosurgery, Medical College of Wisconsin, USA.
¹² Department of Psychiatry, Indiana University School of Medicine, USA.
¹³ School of Kinesiology, University of Michigan, USA.
¹⁴ Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, USA.

PMID: 36130846
DOI: 10.1016/j.jsams.2022.08.012

Abstract

Objectives: To assess whether the King-Devick (KD) test is useful as a prognostic test for prolonged concussion symptoms by examining the relationship between a) change in performance on KD test from baseline to within two days post-injury and b) the absolute KD time at post-concussion testing, with an outcome of time to return to play (RTP).

Design: Prospective Cohort Study.

Methods: Collegiate varsity athletes in the Concussion Assessment, Research, and Education (CARE) Consortium completed baseline and post-injury King-Devick tests from 2014 to 2018. Two exposures were evaluated: 1) change in KD score from baseline to within two days post-injury and 2) absolute KD score within two days post-injury, adjusted for baseline KD. We used Cox proportional hazards models to analyze the relationships between these exposures and time to RTP post-concussion.

Results: A total of 309 concussion injuries were included. Median baseline KD score was 40.0 s (IQR: 35.8, 45.2). Median post-injury KD score was 45.8 s (IQR: 39.8, 57.1). Median number of days until RTP in this cohort was 11 (IQR: 8, 17). Post-injury KD score adjusted for baseline KD had a stronger association with time to RTP duration (HR: 0.99 (0.98, 1.00), p = 0.03) than the difference in KD score from baseline to post-injury (HR: 0.99 (0.99, 1.00), p = 0.07).

Conclusions: Higher post-injury KD scores are associated with longer RTP. The association between KD post-concussion test and longer RTP warrants further investigation to assess the utility of the KD for prognostication in a clinical setting.

Keywords: Athletics; Concussion; Prognosis; Symptoms.

MeSH terms

Athletes
Athletic Injuries* / diagnosis
Brain Concussion* / diagnosis
Cohort Studies
Humans
Neuropsychological Tests
Prospective Studies