Last week's announcement that a foundation named in honor of the late Chicago Bear Dave Duerson had donated a King-Devick test kit to each of Chicago Public School's 80 high school football programs for use in assessing athletes for suspected concussion on the sports sideline, and that the foundation will work with CPS and the K-D Test manufacturer to implement system-wide testing, was welcome news.
So too was that the Dave Duerson Family Foundation, thru individual and corporate sponsors, plans to roll out its program in other cities in the U.S.
As MomsTEAM has been reporting since it burst on the concussion scene two years ago, the K-D Test has shown promise in three early studies - one of mixed martial arts athletes, a second of U.S. college athletes, and a third of New Zealand rugby players - in rapidly and reliably assessing an athlete for suspected concussion so that he or she can either be allowed to return to game or practice action or referred for a more complete evaluation using other concussion assessment tools, such as SCAT2.
The New Zealand study also found, unexpectedly, that the test had the added benefit of being able to identify players who had not shown, or reported, any signs or symptoms of a concussion, but who were later found to have had suffered a meaningful head injury. The K-D test thus has the potential, if administered to athletes after every game or practice, to help identify mild traumatic brain injuries that would otherwise go undetected, either because the player failed - as is so often the case - to self-report suffering symptoms or because they did not exhibit signs of concussion that could be observed by game officials or sideline personnel. 1
To be sure, K-D has generated a lot of positive buzz. Some, including consumer advocate Ralph Nader's group League of Fans, have likened the discovery that a test, invented by two Chicago-area optometrists twenty-five years ago and long used to test vision and reading, had the potential to provide rapid and accurate sideline screening of concussion to finding concussion's "missing link": a simple, easy-to-use test that anyone, even someone without any medical training, could use to determine whether an athlete is concussed.
One of the news reports, by the local ABC affiliate, even went so far as to quote a high school football player, who had suffered a concussion two seasons ago, as proclaiming that the test allowed for a concussion to be "diagnosed on the sideline [so] you know right away and there's no guessing."
First of all, since when is a high school student qualified to make such a sweeping statement? It was sloppy journalism for the television station to use him a source, and conveyed, I submit, the wrong impression that K-D was one-stop shopping as far as concussion diagnosis is concerned.
Second, the fact is that scientific validation of the K-D Test, while extremely promising, is still in its early stages, with only three peer-reviewed studies so far. The New Zealand rugby study demonstrated that it was helpful in sideline assessment for concussion for high school athletes, but it has not yet been validated in youth sports setting. 2 Indeed, I am currently working with a high school football team in Oklahoma which is using the K-D Test as a component of a comprehensive concussion management program that MomsTEAM helped them design (as the press release issued by the Chicago Public Schools, to its credit, correctly notes, the K-D Test "does not replace any other assessment for concussion, but serves as a complement." )
In other words, the K-D test shows promise as another tool in the concussion assessment toolbox, not the only tool.
It does not diagnose concussion.
It does not take the guesswork out of making a concussion diagnosis. As I know from working with and talking to countless concussion experts over the past twelve years, the fact is that, despite all of the research on concussions over the last decade, diagnosing mild traumatic brain injury is still, and likely will be for the foreseeable future, largely a matter of clinical judgment. Simply put, there is a lot we know about concussions and how to disagnose them, but there is a lot we don't know and have yet to find out.
The bottom line: there is no magic bullet when it comes to concussion diagnosis. King-Devick appears to be a simple, rapid, easy-to-use, and reliable test to use as one way to determine on the sports sideline whether to allow an athlete to return to the action or be referred for additional testing and, administered after every game or practice, may be a way of combatting, at least in part, the problem of chronic under-reporting of concussions.
Every stakeholder in youth and high school sports, whether they be parent, athlete, coach, athletic trainer, team doctor, or administrator, needs to understand that, as far as concussion identification, evaluation, diagnosis and managment is concerned, the best approach is to employ an "all of the above" strategy. K-D testing can be, and likely will be, an important part of that strategy, but my advice, just as the CPS recognized, is that it isn't time to put all our concussion eggs into the K-D basket.
Brooke de Lench is Founder and Publisher of MomsTEAM.com and the author of Home Team Advantage: The Critical Role of Mothers in Youth Sports.
Updated August 27, 2012 as follows:
1. This paragraph is new.
2. The original blog stated that I was not aware of any peer-reviewed study that validated use of the K-D Test at the high school level. On closer examination of the New Zealand rugby study, it did include a group of U17 rugby players with an average age of 16.4 years.