Research Article| Volume 22, SUPPLEMENT 1, S34-S38, August 2019

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The King–Devick test is not sensitive to self-reported history of concussion but is affected by English language skill

Published:August 23, 2018DOI:



      Head injuries, including concussion, are a concern in many sports. Current validated concussion assessment protocols such are problematic with suggestions that an oculomotor examination, such as the King–Devick (K–D) test, could be included. This research explores the role of the K–D test in snowsport concussion research.


      Experienced snowsport participants were recruited through a western Canadian resort (n = 75).


      Participants completed a questionnaire that included their history of prior serious head impacts and were assessed via the computer-based K–D test in English.


      Of the 75 participants, 23 (69%) reported at least one previous serious head impact. English was the not primary language for seven participants.
      Independent sample t-tests revealed: significant differences in the K–D average saccade scores for those who had broken their helmets, with or without a serious head injury (̄ x ¯  = 171.23, SD = 12.9) and those who had not broken a helmet (̄ x ¯  = 186.61, SD = 20.18; t (70) = − 2.53, p = .014, twotailed) and significant differences in the K–D time for those whose native language is English (̄ x ¯  = 47.9, SD = 6.3) and those where English was not their first language (̄ x ¯  = 53.3, SD = 7.4; t(73)=.48, p = .04), but no significant difference for their saccade velocities: English (̄ x ¯  = 183.64, SD = 20.0) versus those where English is a second or third language (̄ x ¯  = 188.44, SD = 20.1; t(70) = −.56, p = .576).


      For subjects whose first language is not English, such as in many snowsport resorts, the K–D test may need to be conducted in a person’s native language to provide a valid assessment based upon the time to complete the task.


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        • Dickson T.J.
        • Trathen S.
        • Terwiel F.A.
        • et al.
        Head injury trends and helmet use in skiers and snowboarders in Western Canada, 2008–09 to 2012–13: an ecological study.
        Scand J Med Sci Sports. 2017; 27: 236-244
        • Waddington G.
        • Trathen S.
        • Dickson T.J.
        • et al.
        A sport concussion assessment tool (SCAT2) for use in snowsports: can the balance component of the tool be improved?.
        in: Snow Sports Trauma and Safety: Conference Proceedings of the International Society for Skiing Safety. 21st Volume. Springer International Publishing, Cham2017
        • Echemendia R.J.
        • Broglio S.P.
        • Davis G.A.
        • et al.
        What tests and measures should be added to the SCAT3 and related tests to improve their reliability, sensitivity and/or specificity in sideline concussion diagnosis? A systematic review.
        Br J Sports Med. 2017; 51: 895-901
        • Echemendia R.J.
        • Meeuwisse W.
        • McCrory P.
        • et al.
        The sport concussion assessment tool 5th edition (SCAT5).
        Br J Sports Med. 2017;
        • Costa-Scorse B.
        • Hopkins W.
        • Bahr R.
        Evaluation of ski-binding-boot system safety using torque testing.
        in: Johnson R.J. Shealy J.E. Greenwald R.M. Skiing Trauma and Safety: STP1582. ASTM International, West Conshohocken, PA2015
        • Siesmaa E.J.
        • Clapperton A.J.
        • Twomey D.
        Hospital-treated snow sport injury in Victoria, Australia: a summary of 2003–2012.
        Wild Environ Med. 2018; 29: 194-202
        • Bianchi G.
        • Brügger O.
        • Niemann S.
        Skiing and Snowboarding in Switzerland: Trends in Injury and Fatality Rates Over Time.
        Springer International Publishing, Cham2017: 29-39
        • Galetta K.M.
        • Liu M.
        • Leong D.F.
        • et al.
        The King–Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature.
        Concussion. 2016; 1
        • ASAA
        Press Release: Helmet Usage Continues to Trend Higher in Snowsports.
        Australian Ski Areas Association (ASAA), 2017
        • Canadian Ski Council
        Helmet Use Data, All Canada, 2008/9–2012/13: Adhoc Report.
        Canadian Ski Council, 2014
      1. Australian Ski Areas Association. Alpine Responsibility Code. 19th January 2011.

      2. Canada West Ski Areas Association. Policy — Alpine Responsibility Code. 19 January 2016.

        • Worksafe BC
        Ski helmets are required.
        Information Sheet. Worksafe BC, Vancouver, BC2013
      3. CBC News. Brain Injury Association of Canada’s Richard Kinar Talks About the Need for Ski Helmet Manufacturers to Conform to Mandatory Canadian Safety Standards 2012.

        • Ruedl G.
        • Kopp M.
        • Burtscher M.
        Is there a need for a ski helmet mandatory for children?.
        Scand J Med Sci Sports. 2012; 22: 448-450
      4. Snow Sport Helmet Act. Nova Scotia, Canada; 2011.

        • Dhawan P.
        • Starling A.
        • Tapsell L.
        • et al.
        King–Devick test identifies symptomatic concussion in real-time and asymptomatic concussion over time. (S11. 003).
        Neurology. 2014; 82 (S11.003–S011.003)
        • Leong D.F.
        • Balcer L.J.
        • Galetta S.L.
        • et al.
        The King–Devick test for sideline concussion screening in collegiate football.
        J Optom. 2015; 8: 131-139
        • 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
        • Fuller G.W.
        • Cross M.J.
        • Stokes K.A.
        • et al.
        King–Devick concussion test performs poorly as a screening tool in elite rugby union players: a prospective cohort study of two screening tests versus a clinical reference standard.
        Br J Sports Med. 2018; (Published Online First: 21 March 2018)
        • King D.
        • Gissane C.
        • Hume P.A.
        • et al.
        The King–Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand.
        J Neurol Sci. 2015; 351: 58-64
        • King D.
        • Hume P.A.
        • Gissane C.
        • et al.
        Use of the King–Devick test for sideline concussion screening in junior rugby league.
        J Neurol Sci. 2015; 357: 75-79
        • Molloy J.H.
        • Murphy I.
        • Gissane C.
        The King–Devick (K–D) test and concussion diagnosis in semi-professional rugby union players.
        J Sci Med Sport. 2017; 20: 708-711
        • Seidman D.H.
        • Burlingame J.
        • Yousif L.R.
        • et al.
        Evaluation of the King–Devick test as a concussion screening tool in high school football players.
        J Neurol Sci. 2015; 356: 97-101
        • Dickson T.J.
        • Faulks P.
        Exploring overseas snowsport participation by Australian skiers and snowboarders.
        Tourism Rev. 2007; 62: 7-14
        • Nordström A.
        • Nordström P.
        • Ekstrand J.
        Sports-related concussion increases the risk of subsequent injury by about 50% in elite male football players.
        Br J Sports Med. 2014; 48: 1447-1450
        • Xu-Wilson M.
        • Zee D.S.
        • Shadmehr R.
        The intrinsic value of visual information affects saccade velocities.
        Exp Brain Res. 2009; 196: 475-481
        • Naidu D.
        • Mrazik M.
        • Borza C.
        • et al.
        Sideline concussion assessment: the King–Devick test in Canadian professional football.
        J Neurotraum. 2018; (Published Online:30 Apr 2018)
        • McCrory P.
        • Meeuwisse W.
        • Johnston K.
        • et al.
        Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008.
        Br J Sports Med. 2009; 43 (i76)
        • McLaughlin B.
        • Rossman T.
        • McLeod B.
        Second language learning: an information-processing perspective.
        Lang Learn. 1983; 33: 135-158
        • Dempsey K.
        • Birkemeier J.
        • Hudson T.
        • et al.
        Visual performance of non-native versus native English speakers on a sideline concussion screen: an objective look at eye movement recordings (I13. 002).
        Neurology. 2016; 86 (I13. 002)