Sideline Testing in Youth and Collegiate Athletes: What Does Vision Add to the Concussion Puzzle? (I1-4A)

OBJECTIVE: Vision encompasses nearly 50[percnt] of the brain’s pathways, yet is not represented in current sideline testing protocols for sports-related concussion. We examined the King-Devick (K-D) test, a vision-based measure of rapid number naming, as a complement to the Sport Concussion Assessment Tool, 3rd Edition (SCAT3/Child-SCAT3) in youth and collegiate athletes. BACKGROUND: Identification of rapid yet simple diagnostic tests for concussion is critical. Rapid tests must be interpreted in the context of developmental status and age, and capture all relevant aspects of concussion, including vision. DESIGN/METHODS: Members of a youth ice hockey and football league and collegiate athletes from NYU and Long Island University (LIU) participated in a prospective study to examine sideline tests, including K-D, Standardized Assessment of Concussion, (SAC, cognitive component of SCAT3/Child-SCAT3) and timed-tandem-gait test (balance). RESULTS: Youth and collegiate athletes (n=342, age 14.7±4.9 years, range 5-23) underwent pre-season testing during the fall of 2014. Higher (worse) time scores for the vision-based K-D test were associated with lower (worse) scores for the SAC, particularly the Orientation (p=0.003) and Immediate Memory components (p=0.01, linear regression accounting for age). K-D scores correlated significantly yet moderately with scores for balance (p=0.003). Athlete age was most strongly correlated with K-D scores (r=-0.79, p<0.0001) compared to SAC (r=0.51, p<0.0001) and timed-tandem (r=-0.49, p<0.0001). CONCLUSIONS: The K-D test, a vision-based measure that requires saccades and other eye movements, captures aspects of brain function that are not entirely captured by current sideline testing for balance and cognition. At the same time, associations of K-D scores with working memory and orientation suggest that closely related anatomical structures, such as the dorsolateral prefrontal cortex, underlie saccades and memory. K-D scores showed the greatest associations with age in this young athlete cohort, suggesting that vision may a key domain for assessing developmental aspects of brain function. Disclosure: Dr. Bohm has nothing to disclose. Dr. Hasanaj has nothing to disclose. Dr. Rizzo has nothing to disclose. Dr. Serrano has nothing to disclose. Dr. Nolan has nothing to disclose. Dr. Moehringer has nothing to disclose. Dr. Webb has nothing to disclose. Dr. Civitano has nothing to disclose. Dr. Cardone has nothing to disclose. Dr. Silverio has nothing to disclose. Dr. Galetta has received personal compensation for activities with Biogen Idec, Genzyme, and Vaccinex. Dr Balcer received personal compensation from Biogen Idec and consulting for Biogen Idec, Vaccinex and Genzyme. She is on a clinical trial advisory board for Biogen-Idec.,