Is there a checklist for concussion diagnosis, such as the Sports Concussion Assessment Tool (SCAT)?

Concussion Diagnosis Checklist

Yes, standardized checklists exist for concussion diagnosis, with the Sport Concussion Assessment Tool 5th Edition (SCAT5) being the most current evidence-based tool for athletes aged 13 and older, and the Child SCAT5 for children aged 5-12 years. 1, 2

Structured Assessment Components

The concussion evaluation should include these specific elements:

Symptom Checklist

Use a standardized graded symptom checklist to objectively assess and track symptom severity over serial evaluations. 3, 4 Key symptoms to document include:

• Physical symptoms: Headache, dizziness, nausea, balance problems, visual changes/blurred vision, sensitivity to light or noise, seeing stars or flashing lights, ringing in ears 3, 5
• Cognitive symptoms: Memory problems (retrograde/anterograde amnesia), concentration difficulties, confusion/disorientation, slowed reaction time, difficulty answering questions 3, 5
• Emotional/behavioral symptoms: Irritability, anxiety, mood disturbances, inappropriate emotions (laughing/crying), personality changes 3, 5
• Sleep-related symptoms: Sleep disturbances, drowsiness, sleepiness 3, 5

Cognitive Screening

Brief neuropsychological test batteries assessing attention and memory are practical and effective for acute sideline assessment. 3 Specific validated tools include:

• Standardised Assessment of Concussion (SAC) 3
• Maddock's questions for memory assessment 3
• Immediate and delayed memory testing (standard orientation questions like time/place/person are unreliable compared to memory assessment) 3

Balance Testing

Balance disturbance is a specific indicator of concussion, though not highly sensitive. 4 Include:

• Double stance errors (particularly sensitive in children) 6
• Tandem stance testing 6

Neurological Examination

Physical signs requiring documentation include: 3, 5

• Loss of consciousness/impaired conscious state
• Poor coordination or balance
• Gait unsteadiness
• Vacant stare/glassy eyed appearance
• Slurred speech
• Concussive convulsion/impact seizure
• Inappropriate playing behavior

Critical Red Flags Requiring Emergency Evaluation

Any of these findings mandate immediate emergency department evaluation, not just sideline management: 5, 7

• Loss of consciousness
• Worsening or severe headache
• Repeated vomiting
• Altered mental status or deteriorating neurological status
• Seizure activity
• Visual changes
• Signs of skull fracture (Battle's sign, raccoon eyes, hemotympanum, CSF leak) 5

Key Implementation Points

Any athlete with a single concussion symptom must be immediately removed from play and cannot return to activity that same day, regardless of whether symptoms improve. 5, 4 This is non-negotiable.

Loss of consciousness occurs in less than 10% of concussions and should not be relied upon to diagnose concussion. 5, 4 Its absence does not rule out concussion.

Athletes frequently minimize symptoms to return to play, particularly males, so athlete self-report alone cannot be trusted. 5 Serial monitoring every 5 minutes until improvement is recommended, with continued monitoring for several days to detect delayed symptoms. 5

Validation Evidence

The SCAT5 and Child SCAT5 can effectively differentiate concussed from non-concussed patients, particularly through symptom number and severity. 6 The tools were developed through systematic review and expert consensus at the 5th International Consensus Conference on Concussion in Sport in Berlin (2016). 1, 2

Baseline testing maximizes clinical utility of neuropsychological assessment, though most concussions can be managed appropriately without neuropsychological testing. 3, 4 When used, computerized neuropsychological testing should be interpreted by healthcare professionals trained in the specific test and familiar with its limitations. 4