Department of Neuroscience, University at Buffalo, SUNY, Buffalo, NY 14214, United States.
Department of Neuroscience, University at Buffalo, SUNY, Buffalo, NY 14214, United States; UBMD Department of Orthopedics and Sports Medicine, University at Buffalo, SUNY, Buffalo, NY 14214, United States.
J Neurol Sci. 2019 Mar 15;398:91-97. doi: 10.1016/j.jns.2018.12.020. Epub 2018 Dec 22.
This study investigated the diagnostic and prognostic value of the King-Devick (K-D) test in conjunction with treadmill testing in adolescents after sport-related concussion (SRC) in an outpatient concussion management clinic without baseline measures.
Prospective cohort.
The K-D test was administered pre- and post-exercise on a graded treadmill test to acutely concussed (AC, <10 days from injury, n = 46, 15.4 ± 2.1 years) participants for 2 clinic visits (1 week apart) and to matched controls (MC, n = 30, 15.8 ± 1.4 years) for 2 visits (1 week apart). Initial K-D test times were compared between MC and AC. Changes in times from pre- to post- exercise during a treadmill test were compared for MC and AC and from Visit 1 to Visit 2. Smooth pursuits and repetitive saccades were compared with initial visit K-D test performance.
Comparison of pre-exercise K-D test times at Visit 1 distinguished MC from AC (46.1 ± 9.2 s vs. 53.7 ± 13.0 s, p = .007). Comparison of pre- and post-exercise K-D test times revealed significant improvements for MC (46.1 ± 9.2 s vs. 43.1 ± 8.5 s, p < .001) and AC who recovered by Visit 2 (Fast Recovery Group [FRG], n = 23, 50.4 ± 10.0 s vs. 47.3 ± 9.8 s, p = .002). No significant difference was seen in pre- and post-exercise K-D test times on Visit 1 for AC who took longer than 2 weeks to recover (Slow Recovery Group [SRG], n = 23, 57.0 ± 15.0 s vs. 56.0 ± 16.3 s, p = .478). At Visit 1, AC had more abnormal smooth pursuits than MC (17% vs. 3%, non-significant, p = .064). AC, however, had significantly more abnormal repetitive saccades than MC (37% vs. 3%, p = .001) and AC with abnormal repetitive saccades took significantly longer to complete the Visit 1 pre-exercise K-D test than AC with normal repetitive saccades (58.6 ± 16.0 s vs 50.8 ± 10.2 s, p = .049).
The study supports utility of the K-D test as part of outpatient concussion assessment. Lack of improvement in K-D test performance after an exercise test may be an indicator of delayed recovery from SRC.
本研究在无基线测量的情况下，在门诊脑震荡管理诊所中，调查了 King-Devick (K-D) 测试与跑步机测试相结合在运动相关脑震荡 (SRC) 后青少年中的诊断和预后价值。
前瞻性队列研究。
K-D 测试在两次就诊时（相隔一周）在急性脑震荡（AC，<10 天从受伤开始，n=46，15.4±2.1 岁）参与者进行运动前和运动后测试，以及在两次就诊时（相隔一周）匹配对照组（MC，n=30，15.8±1.4 岁）。比较 MC 和 AC 的初始 K-D 测试时间。比较 MC 和 AC 在跑步机测试期间从预运动到后运动的时间变化，以及从第 1 次就诊到第 2 次就诊的时间变化。将平滑追踪和重复扫视与初始就诊的 K-D 测试表现进行比较。
在第 1 次就诊时，比较 MC 和 AC 的预运动 K-D 测试时间，发现 MC 与 AC 之间存在显著差异（46.1±9.2 秒 vs. 53.7±13.0 秒，p=0.007）。比较 K-D 测试的预运动和后运动时间，MC 和 AC 都有明显的改善，其中 FRG（n=23，50.4±10.0 秒 vs. 47.3±9.8 秒，p=0.002）在第 2 次就诊时恢复，而 AC（Slow Recovery Group [SRG]，n=23，57.0±15.0 秒 vs. 56.0±16.3 秒，p=0.478）在 2 周以上才恢复。在第 1 次就诊时，AC 的平滑追踪异常比 MC 多（17%比 3%，无统计学意义，p=0.064）。然而，AC 的重复扫视异常比 MC 多（37%比 3%，p=0.001），且重复扫视异常的 AC 完成第 1 次就诊前的 K-D 测试时间明显长于重复扫视正常的 AC（58.6±16.0 秒 vs 50.8±10.2 秒，p=0.049）。
该研究支持 K-D 测试作为门诊脑震荡评估的一部分的效用。跑步机测试后 K-D 测试表现无改善可能是 SRC 后恢复延迟的一个指标。
