Comparison and utility of King-Devick and ImPACT® composite scores in adolescent concussion patients

J Neurol Sci. 2013 Nov 15;334(1-2):148-53. doi: 10.1016/j.jns.2013.08.015. Epub 2013 Aug 16.


The King-Devick (KD) oculomotor test has recently been advocated for sideline diagnosis of concussion. Although visual processing and performance are often impaired in concussion patients, the utility of KD as a concussion diagnostic tool is not validated.

Purpose: To examine the diagnostic value of KD, by comparing KD with post-concussion symptom scale (PCSS) and ImPACT® composite scores. We hypothesized that KD would be correlated with visual motor speed/memory (VMS, VIS) and reaction time (RT), because all require cognitive visual processing. We also expected parallel changes in KD and PCSS across recovery.

Methods: Thirty-five concussed individuals (12-19 y; 18 females, 17 males) were evaluated with PCSS, ImPACT® composite and KD scores over four clinical visits (V).

Results: KD times improved with each visit (ΔV1-V2: 7.86±11.82; ΔV2-V3: 9.17 ± 11.07; ΔV3-V4: 5.30 ± 7.87 s) and paralleled improvements in PCSS (ΔV1-V2: 8.97 ± 20.27; ΔV2-V3: 8.69 ± 14.70; ΔV3-V4: 6.31 ± 7.71), RT (ΔV1-V2: 0.05 ± 0.21; ΔV2-V3: 0.09 ± 0.19; ΔV3-V4 0.03 ± 0.07) and VMS (ΔV1-V2: -5.27 ± 6.98; ΔV2-V3: -2.61 ± 6.48; ΔV3-V4: -2.35 ± 5.22). Longer KD times were associated with slower RT (r = 0.67; P<0.0001) and lower VMS (r = -0.70; P<0.0001), respectively.

Conclusion: Cognitive visual performance testing using KD has utility in concussion evaluation. Validation would further establish KD as an effective ancillary tool in longitudinal concussion management and research.

Keywords: Diffuse axonal injury; Neuropsychological tests; Oculomotor dysfunction; Post-concussion syndrome; Return to play; Traumatic brain injury; Visual-motor deficits.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Adolescent
  • Athletic Injuries / diagnosis*
  • Brain Concussion / diagnosis*
  • Brain Concussion / physiopathology
  • Child
  • Eye Movement Measurements*
  • Female
  • Humans
  • Male
  • Neuropsychological Tests
  • Predictive Value of Tests
  • Psychomotor Performance
  • Reaction Time
  • Severity of Illness Index*
  • Young Adult