What is the purpose and proper use of the SCAT (Sport Concussion Assessment Tool) 6 in evaluating athletes suspected of having a concussion?

The SCAT6 Concussion Assessment Tool: Purpose and Proper Use

The Sport Concussion Assessment Tool (SCAT6) is a standardized instrument designed for the sideline evaluation of athletes with suspected concussion, providing a comprehensive assessment that helps clinicians make informed decisions about removal from play, diagnosis, and return-to-play recommendations. 1

Purpose of the SCAT6

• The SCAT serves as an objective and standardized assessment tool for concussion, developed during the Second International Conference on Concussion in Sport in 2004, now in its sixth iteration (SCAT6) 2
• It is most effective when administered within 72 hours of injury, with diminishing utility up to 7 days post-injury 1
• The tool helps differentiate between concussed and non-concussed athletes in the acute phase of injury 1
• SCAT is not intended as a standalone return-to-play determination tool beyond 7 days after injury 1

Components of the SCAT Assessment

The SCAT6 includes multiple assessment domains:

• Symptom evaluation: A comprehensive checklist where athletes self-report symptoms and their severity on a scale of 0-6 3
• Cognitive assessment: Includes immediate memory tests, concentration tests, and delayed recall 3
• Neurological screening: Evaluates basic neurological function 3
• Balance examination: Tests postural stability under different stance conditions 3
• Coordination testing: Assesses motor coordination 3

Proper Administration Protocol

Immediate Sideline Assessment

• Any athlete with suspected concussion should be immediately removed from play for evaluation 3
• The SCAT6 should be administered by a healthcare professional trained in concussion management 3
• Initial assessment should include ruling out more severe injuries requiring emergency care, particularly cervical spine injuries in unconscious athletes 3
• Loss of consciousness (LOC) occurs in less than 10% of concussions but may indicate more significant injury if it lasts longer than 30 seconds 3

Assessment Sequence

1. Symptom evaluation: Have the athlete complete the symptom form independently, circling subjective values for each symptom 3
2. Cognitive assessment: Administer memory tests, including immediate recall of word lists and concentration tasks 3
3. Balance testing: Conduct the Modified Balance Error Scoring System (mBESS) with different stance positions 3
4. Delayed recall: Test the athlete's ability to recall previously presented information 3

Interpretation and Decision-Making

• Total symptom severity score is a strong predictor of recovery in collegiate athletes 4
• Symptom burden typically decreases approximately 1% per hour in the acute phase post-concussion 4
• Compare results to baseline measurements when available, particularly at collegiate and professional levels 5
• Consider pre-existing conditions that may affect baseline scores (e.g., attention-deficit disorder, depression) 3

Common Pitfalls and Limitations

• Ceiling effects exist on the 5-word list learning and concentration subtests 1
• Test-retest reliability shows limitations in temporal stability 1
• Limited data exists for pre-adolescents, women, diverse sport types, and para-athletes 1
• The SCAT should not be used as the sole determinant for return-to-play decisions beyond the acute phase 1
• Athletes should never return to play while symptomatic at rest or with exertion, even if SCAT scores improve 3

Follow-up Recommendations

• Athletes with concussion should rest both physically and cognitively until symptoms resolve at rest and with exertion 3
• For office-based follow-up assessment (3-30 days post-injury), consider using the Sport Concussion Office Assessment Tool (SCOAT6), which includes additional elements like vestibular ocular motor screening and mental health screening 6
• Any pediatric or adolescent athlete with concussion should be evaluated by a healthcare professional with experience in concussion management before returning to play 3
• Signs and symptoms typically resolve in 7-10 days in most cases, though some athletes may take weeks to months to recover 3

Special Considerations

• Pediatric and adolescent athletes generally have a longer recovery course than college and professional athletes 3
• Athletes should never return to play on the same day of concussion, even if they become asymptomatic 3
• Consider retirement from contact or collision sports for athletes with multiple concussions or prolonged symptoms 3