How should a standardized assessment of concussion (SAC) score be interpreted and managed?

Standardized Assessment of Concussion (SAC) Score Interpretation and Management

The Standardized Assessment of Concussion (SAC) should be used as part of a comprehensive concussion evaluation protocol, with scores indicating cognitive deficits requiring immediate removal from play, followed by physical and cognitive rest until symptoms resolve both at rest and with exertion. 1

Understanding the SAC

• The SAC is a brief neuropsychological test battery designed for rapid sideline evaluation of concussion, assessing attention and memory function 1
• The SAC is one component of the Sport Concussion Assessment Tool (SCAT), which also includes symptom evaluation, neurological screening, balance examination, and coordination testing 2
• Standard orientation questions (time, place, person) have been shown to be less reliable than memory assessment in concussion evaluation 1

Interpreting SAC Scores

• Lower SAC scores compared to baseline indicate potential cognitive deficits related to concussion 2, 3
• SAC scores should be compared to the individual's baseline when available, as this provides the most accurate assessment of change 1, 2
• When baseline scores are unavailable, comparison to normative data or control groups can help identify potential deficits 3
• Consider pre-existing conditions that may affect baseline scores, such as attention-deficit disorder or depression 1, 2

Management Based on SAC Results

• Any athlete with suspected concussion and abnormal SAC scores should be immediately removed from play for further evaluation 1
• Athletes should never return to play on the same day of concussion, even if they become asymptomatic or SAC scores improve 1, 2
• Physical and cognitive rest is recommended until symptoms resolve both at rest and with exertion 1
• Teachers and school administrators should work with students to modify workloads to avoid symptom exacerbation 1

Follow-up Protocol

• Any athlete with concussion should be evaluated by a healthcare professional with experience in concussion management before returning to play 1
• Signs and symptoms typically resolve in 7-10 days in most cases, though some athletes may take weeks to months to recover 1
• Pediatric and adolescent athletes generally have a longer recovery course than college and professional athletes, warranting a more conservative approach 1, 2
• Follow-up assessments should include repeated SAC testing to monitor cognitive recovery 2, 4

Integration with Other Assessment Tools

• The SAC should not be used in isolation but as part of a multifaceted assessment including symptom checklists and balance testing 1, 4
• Symptom reporting has been shown to be more sensitive than SAC scores alone in detecting concussion effects 4
• Balance testing using the Modified Balance Error Scoring System (mBESS) provides complementary information about postural stability 2, 4
• The Postconcussion Symptom Scale should be administered alongside the SAC to capture the full spectrum of concussion effects 1

Special Considerations

• Consider retirement from contact or collision sports for athletes with a history of multiple concussions or with prolonged symptoms 1
• The SAC has also been validated as a potential screening tool for insufficient effort in medical examinations, which may be relevant in certain clinical contexts 5
• Pediatric patients may show different patterns of SAC performance compared to adults, requiring age-appropriate interpretation 3

Common Pitfalls to Avoid

• Relying solely on SAC scores without considering symptom reports or balance assessment 4
• Allowing return to play based only on improved SAC scores while symptoms persist 1
• Failing to consider pre-existing conditions that may affect baseline cognitive performance 1, 2
• Using standard orientation questions (time, place, person) instead of more sensitive memory assessment components 1
• Not providing adequate physical and cognitive rest during the recovery period 1