By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
I really like the King Devick rapid number naming testas part of a comprehensive concussion assessment program. We find it to be easy, fast, reliable, and with a large amount of independent scientific studies vouching for its validity. At the high schools I work with we use the King Devick in our preseason concussion baseline assessment and then use it as a part of our comprehensive evaluation for in-game concussions. I’d recommend you consider using it too. (Neither I, nor Sideline Sports Doc have any financial relationship with the company).
The test is performed on an iPad (there is a paper version available but you may need to contact the company directly for details on this), and involves the individual reading out loud a series of numbers that are shown at irregular intervals on the screen. The test is timed. The method tests the athlete’s ability to concentrate as well as the eye movements. We obtain a pre-season healthy baseline and then perform the test immediately after a suspected concussion on-field. Any increases in time post-injury compared to the baseline are suggestive of a concussion.
Concussion assessment involves evaluation of several areas and at least so far, there is no single perfect tool to definitively provide a sideline concussion diagnosis. A skilled athletic trainer or physician will assess how the injury occurred, check the athlete for concussion symptoms, and then perform a number of tests to assess cognitive function, memory, and balance. We use the King Devick as one component of the evaluation.
Our practical experience shows that the test is well accepted by the young athletes, and it’s difficult to “game” the system. We emphasize the importance of proper baseline testing to the athlete and have found very few who intentionally take a long time to do the baseline test. Plus there are well established ranges for “normal” and if an athlete deviates from the normal range we investigate further.
As we head into fall sports seasons for schools and leagues I’d like to remind everyone of some basic safety principles. First, make sure you spend some time on preventive planning! If you’re a club or league be sure to have an emergency action plan and practice it in advance. Make sure your coaches are properly trained in injury recognition, especially for the common injuries specific to your sport as well as concussion recognition. Hire an ATC for tournaments, or for your club if you can afford that. Pay very close attention to field equipment conditions (e.g. goal post properly secured). And finally, I’d strongly recommend an AED kept at a central location.