Sport Concussion Assessment Tool - 5th Edition
Downloaded from http://bjsm.bmj.com/ on April 27, 2017 - Published by group.bmj.comBJSM Online First, published on April 26, 2017 as 10.1136/bjsports-2017-097506SCAT5To download a clean version of the SCAT tools please visit the journal online T5)SCAT5SPORT CONCUSSION ASSESSMENT TOOL — 5TH EDITION DEVELOPED BY THE CONCUSSION IN SPORT GROUPFOR USE BY MEDICAL PROFESSIONALS ONLYsupported byPatient detailsName:DOB:Address:ID number:Examiner:Date of Injury:Time:WHAT IS THE SCAT5?Key pointsThe SCAT5 is a standardized tool for evaluating concussionsdesigned for use by physicians and licensed healthcareprofessionals1. The SCAT5 cannot be performed correctlyin less than 10 minutes. Any athlete with suspected concussion should be REMOVEDFROM PLAY, medically assessed and monitored fordeterioration. No athlete diagnosed with concussionshould be returned to play on the day of injury.If you are not a physician or licensed healthcare professional,please use the Concussion Recognition Tool 5 (CRT5). TheSCAT5 is to be used for evaluating athletes aged 13 yearsand older. For children aged 12 years or younger, pleaseuse the Child SCAT5.Preseason SCAT5 baseline testing can be useful forinterpreting post-injury test scores, but is not required forthat purpose.Detailed instructions for use of the SCAT5 areprovided on page 7. Please read through these instructionscarefully before testing the athlete. Brief verbal instructionsfor each test are given in italics. The only equipment requiredfor the tester is a watch or timer.This tool may be freely copied in its current form for distribution to individuals, teams, groups and organizations.It should not be altered in any way, re-branded or sold forcommercial gain. Any revision, translation or reproductionin a digital form requires specific approval by the Concussion in Sport Group.Recognise and RemoveA head impact by either a direct blow or indirect transmissionof force can be associated with a serious and potentially fatalbrain in ury. f there are significant concerns, including anyof the red flags listed in Box , then activation of emergencyprocedures and urgent transport to the nearest hospitalshould be arranged. If an athlete is suspected of having a concussion andmedical personnel are not immediately available, theathlete should be referred to a medical facility for urgentassessment. Athletes with suspected concussion should not drinkalcohol, use recreational drugs and should not drive a motorvehicle until cleared to do so by a medical professional. Concussion signs and symptoms evolve over time and itis important to consider repeat evaluation in the assessment of concussion. The diagnosis of a concussion is a clinical judgment,made by a medical professional. The SCAT5 should NOTbe used by itself to make, or exclude, the diagnosis ofconcussion. An athlete may have a concussion even iftheir SCAT5 is “normal”.Remember: The basic principles of first aid danger, response, airway,breathing, circulation) should be followed. Do not attempt to move the athlete (other than that requiredfor airway management) unless trained to do so. Assessment for a spinal cord injury is a critical part of theinitial on-field assessment. Do not remove a helmet or any other equipment unlesstrained to do so safely. Concussion in Sport Group 6SCAT5in Sport Group 2017Davis GA, et al. Br J SportsMed 2017;0:1–8.1Copyright Article author (or their employer) 2017. Produced by BMJ Publishing Group Ltd under licence.1
Downloaded from http://bjsm.bmj.com/ on April 27, 2017 - Published by group.bmj.com1Name:DOB:IMMEDIATE OR ON-FIELD ASSESSMENTThe following elements should be assessed for all athletes whoare suspected of having a concussion prior to proceeding to theneurocognitive assessment and ideally should be done on-field afterthe first first aid / emergency care priorities are completed.If any of the “Red Flags“ or observable signs are noted after a director indirect blow to the head, the athlete should be immediately andsafely removed from participation and evaluated by a physician orlicensed healthcare professional.Consideration of transportation to a medical facility should be atthe discretion of the physician or licensed healthcare professional.The GCS is important as a standard measure for all patients and canbe done serially if necessary in the event of deterioration in consciousstate. The Maddocks questions and cervical spine exam are criticalsteps of the immediate assessment; however, these do not need tobe done serially.STEP 1: RED FLAGSRED FLAGS: Neck pain ortenderness Double vision Weakness or tingling/burning in arms or legs Severe or increasingheadacheID number:Examiner:Date:STEP 4: EXAMINATIONGLASGOW COMA SCALE (GCS)3Time of assessmentDate of assessmentBest eye response (E)No eye opening111Eye opening in response to pain222Eye opening to speech333Eyes opening spontaneously444 Seizure or convulsionBest verbal response (V) Loss of consciousnessNo verbal response111 Deterioratingconscious stateIncomprehensible sounds222Inappropriate words333Confused444Oriented555No motor response111Extension to pain222Abnormal flexion to pain333Flexion / Withdrawal to pain444Localizes to pain555Obeys commands666Does the athlete report that their neck is pain free at rest?YNIf there is NO neck pain at rest, does the athlete have a fullrange of ACTIVE pain free movement?YNIs the limb strength and sensation normal?YN Vomiting Increasingly restless,agitated or combativeBest motor response (M)STEP 2: OBSERVABLE SIGNSWitnessedAddress:Observed on VideoLying motionless on the playing surfaceYNBalance / gait difficulties / motor incoordination: stumbling, slow /laboured movementsYNDisorientation or confusion, or an inability to respond appropriatelyto questionsYNBlank or vacant lookYNFacial injury after head traumaYNGlasgow Coma score (E V M)STEP 3: MEMORY ASSESSMENTMADDOCKS QUESTIONS2“I am going to ask you a few questions, please listen carefully andgive your best effort. First, tell me what happened?”CERVICAL SPINE ASSESSMENTMark Y for correct answer / N for incorrectWhat venue are we at today?YNWhich half is it now?YNWho scored last in this match?YNWhat team did you play last week / game?YNDid your team win the last game?YNIn a patient who is not lucid or fullyconscious, a cervical spine injury shouldbe assumed until proven otherwise.Note: Appropriate sport-specific questions may be substituted.2 Concussion in Sport Group 6SCAT5in Sport Group 2017Davis GA, et al. Br J SportsMed 2017;0:1–8.2
Downloaded from http://bjsm.bmj.com/ on April 27, 2017 - Published by group.bmj.comOFFICE OR OFF-FIELD ASSESSMENTPlease note that the neurocognitive assessment should be done in adistraction-free environment with the athlete in a resting state.Name:DOB:Address:STEP 1: ATHLETE BACKGROUNDID number:Examiner:port / team / school:Date:ate / time of in ury:Years of education completed:2Age:ender: M / F / therSTEP 2: SYMPTOM EVALUATIONominant hand: left / neither / rightThe athlete should be given the symptom form and asked to read this instructionparagraph out loud then complete the symptom scale. For the baseline assessment,the athlete should rate his/her symptoms based on how he/she typically feels and forthe post injury assessment the athlete should rate their symptoms at this point in time.How many diagnosed concussions has theathlete had in the past?:Please Check:When was the most recent concussion?:Post-InjuryPlease hand the form to the athleteHow long was the recovery (time to being cleared to play)from the most recent concussion?:Baseline(days)noneHas the athlete ever been:Hospitalized for a head injury?Yesiagnosed / treated for headache disorder or migraines?iagnosed with a learning disability / dyslexia?iagnosed with A/A?YesYesYesiagnosed with depression, anxietyor other psychiatric disorder?YesCurrent medications? If yes, please �Pressure in head”0123456Neck Pain0123456Nausea or vomiting0123456Dizziness0123456Blurred vision0123456Balance problems0123456Sensitivity to light0123456Sensitivity to noise0123456Feeling slowed down0123456Feeling like “in a fog“0123456“Don’t feel right”0123456ifficulty concentrating0123456ifficulty remembering0123456Fatigue or low energy0123456Confusion0123456Drowsiness0123456More rvous or Anxious0123456Trouble falling asleep(if applicable)0123456of 22Total number of symptoms:Symptom severity score:of 132Do your symptoms get worse with physical activity?YNDo your symptoms get worse with mental activity?YNIf 100% is feeling perfectly normal, whatpercent of normal do you feel?If not 100%, why?Please hand form back to examiner Concussion in Sport Group 6SCAT5in Sport Group 2017Davis GA, et al. Br J SportsMed 2017;0:1–8.33
Downloaded from http://bjsm.bmj.com/ on April 27, 2017 - Published by group.bmj.com3Name:STEP 3: COGNITIVE SCREENINGDOB:Standardised Assessment of Concussion (SAC)4Address:ORIENTATIONID number:Examiner:What month is it?01What is the date today?01What is the day of the week?01What year is it?01What time is it right now? (within 1 hour)01DIGITS BACKWARDSof 5Please circle the Digit list chosen (A, B, C, D, E, F). Administer at therate of one digit per second reading DOWN the selected column.Orientation scoreCONCENTRATIONI am going to read a string of numbers and when I am done, you repeat them back to mein reverse order of how I read them to you. For example, if I say 7-1-9, you would say 9-1-7.IMMEDIATE MEMORYThe Immediate Memory component can be completed using thetraditional 5-word per trial list or optionally using 10-words per trialto minimise any ceiling effect. All 3 trials must be administered irrespective of the number correct on the first trial. Administer at the rateof one word per second.Please choose EITHER the 5 or 10 word list groups and circle the specific word list chosenfor this test.I am going to test your memory. I will read you a list of words and when I am done, repeatback as many words as you can remember, in any order. For Trials 2 & 3: I am going to repeatthe same list again. Repeat back as many words as you can remember in any order, even ifyou said the word before.Score (of 5)ListDate:Alternate 5 word listsTrial 1 Trial 2 Trial llarHoneyMirrorSaddleAnchorImmediate Memory Scoreof 15Time that last trial was completedConcentration Number Lists (circle one)List AList BList 5-69-2-6-5-1-4YN1List DList EList 3-83-1-7-8-2-6YN1Score (of 10)ListAlternate 10 word listsTrial 1 Trial 2 Trial 3Digits eCarpetSaddleBubbleJacketArrowPepperCottonMovieof 4GMONTHS IN REVERSE ORDERHNow tell me the months of the year in reverse order. Start with the last month and go backward.So you’ll say December, November. Go ahead.Dec - Nov - Oct - Sept - Aug - Jul - Jun - May - Apr - Mar - Feb - JanIDollarHoneyMirrorSaddle0 1Months Scoreof 1Concentration Total Score (Digits Months)of 5AnchorImmediate Memory Scoreof 30Time that last trial was completed4 Concussion in Sport Group 6SCAT5in Sport Group 2017Davis GA, et al. Br J SportsMed 2017;0:1–8.4
Downloaded from http://bjsm.bmj.com/ on April 27, 2017 - Published by group.bmj.com4Name:STEP 4: NEUROLOGICAL SCREENDOB:See the instruction sheet (page 7) for details oftest administration and scoring of the tests.Address:ID number:Can the patient read aloud (e.g. symptom checklist and follow instructions without difficulty?YNDoes the patient have a full range of painfree PASSIVE cervical spine movement?YNWithout moving their head or neck, can the patient lookside-to-side and up-and-down without double vision?YNan the patient perform the finger nosecoordination test normally?YNCan the patient perform tandem gait normally?YNExaminer:Date:5STEP 5: DELAYED RECALL:The delayed recall should be performed after 5 minutes haveelapsed since the end of the Immediate Recall section. Score 1pt. for each correct response.BALANCE EXAMINATIONModified Balance Error Scoring System (mBESS) testing5Which foot was tested(i.e. which is the non-dominant foot)eftRightDo you remember that list of words I read a few times earlier? Tell me as many wordsfrom the list as you can remember in any order.Testing surface hard floor, field, etc.Time StartedFootwear (shoes, barefoot, braces, tape, etc.)ConditionPlease record each word correctly recalled. Total score equals number of words recalled.ErrorsDouble leg stanceof 10Single leg stance (non-dominant foot)of 10Tandem stance (non-dominant foot at the back)of 10Total Errorsof 30Total number of words recalled accurately:of 5orof 106STEP 6: DECISIONDate and time of injury:Date & time of assessment:If the athlete is known to you prior to their injury, are they different from their usual self?DomainYesNoUnsureNot Applicable(If different, describe why in the clinical notes section)Symptomnumber (of 22)Concussion Diagnosed?YesSymptom severityscore (of 132)NoUnsureNot ApplicableIf re-testing, has the athlete improved?Orientation (of 5)Immediate memoryYesof 15of 15of 15of 30of 30of 30Concentration (of 5)euro examUnsureNot ApplicableI am a physician or licensed healthcare professional and I have personallyadministered or supervised the administration of this AbnormalName:Title:Balance errors (of 30)Delayed RecallNoof 5of 5of 5of 10of 10of 10Registration number (if applicable):Date:SCORING ON THE SCAT5 SHOULD NOT BE USED AS A STAND-ALONEMETHOD TO DIAGNOSE CONCUSSION, MEASURE RECOVERY ORMAKE DECISIONS ABOUT AN ATHLETE’S READINESS TO RETURN TOCOMPETITION AFTER CONCUSSION. Concussion in Sport Group 6SCAT5in Sport Group 2017Davis GA, et al. Br J SportsMed 2017;0:1–8.55
Downloaded from http://bjsm.bmj.com/ on April 27, 2017 - Published by group.bmj.comCLINICAL NOTES:Name:DOB:Address:ID number:Examiner:Date:CONCUSSION INJURY ADVICE(To be given to the person monitoring the concussed athlete)Clinic phone number:This patient has received an injury to the head. A careful medicalexamination has been carried out and no sign of any seriouscomplications has been found. Recovery time is variable acrossindividuals and the patient will need monitoring for a further period by a responsible adult. Your treating physician will provideguidance as to this timeframe.Patient’s name:If you notice any change in behaviour, vomiting, worsening headache, double vision or excessive drowsiness, please telephoneyour doctor or the nearest hospital emergency departmentimmediately.Healthcare Provider:ate / time of in ury:ate / time of medical review:Other important points:Initial rest: Limit physical activity to routine daily activities (avoidexercise, training, sports) and limit activities such as school,work, and screen time to a level that does not worsen symptoms.1) Avoid alcohol2) Avoid prescription or non-prescription drugswithout medical supervision. pecifically: Concussion in Sport Group 2017a) Avoid sleeping tabletsb) o not use aspirin, anti-inflammatory medicationor stronger pain medications such as narcotics3) Do not drive until cleared by a healthcare professional.4) eturn to play/sport requires clearanceby a healthcare professional.6Davis GA, et al. Br J Sports Med 2017;0:1–8. doi:10.1136/bjsports-2017-097506SCAT5Contact details or stamp
Downloaded from http://bjsm.bmj.com/ on April 27, 2017 - Published by group.bmj.comINSTRUCTIONSWords in Italics throughout the SCAT5 are the instructions given to the athlete by the clinicianSymptom ScaleThe time frame for symptoms should be based on the type of test being administered. At baseline it is advantageous to assess how an athlete “typically” feelswhereas during the acute/post-acute stage it is best to ask how the athlete feelsat the time of testing.The symptom scale should be completed by the athlete, not by the examiner. nsituations where the symptom scale is being completed after exercise, it shouldbe done in a resting state, generally by approximating his/her resting heart rate.For total number of symptoms, maximum possible isexcept immediately postin ury, if sleep item is omitted, which then creates a maximum of .For ymptom severity score, add all scores in table, maximum possible isx, except immediately post in ury if sleep item is omitted, which then createsa maximum of x.Immediate MemoryThe Immediate Memory component can be completed using the traditional 5-wordper trial list or, optionally, using 10-words per trial. The literature suggests thatthe Immediate Memory has a notable ceiling effect when a 5-word list is used. Insettings where this ceiling is prominent, the examiner may wish to make the taskmore difficult by incorporating two word groups for a total ofwords per trial.n this case, the maximum score per trial iswith a total trial maximum of .Choose one of the word lists (either 5 or 10). Then perform 3 trials of immediatememory using this list.one error is recorded but the athlete should quickly return to the testing position, andcounting should resume once the athlete is set. Athletes that are unable to maintainthe testing procedure for a minimum of five seconds at the start are assigned thehighest possible score, ten, for that testing condition.OPTION: For further assessment, the same 3 stances can be performed on a surfaceof medium density foam e.g., approximately cm x cm x cm .Balance testing – types of errors1. Hands lifted offiliac crest2. Opening eyes3. Step, stumble, or fall5. Lifting forefoot or heel4. Moving hip into 30degrees abduction6. Remaining out of testposition 5 sec“I am now going to test your balance. Please take your shoes off (if applicable), roll upyour pant legs above ankle (if applicable), and remove any ankle taping (if applicable).This test will consist of three twenty second tests with different stances.“(a) Double leg stance:“The first stance is standing with your feet together with your hands on your hipsand with your eyes closed. You should try to maintain stability in that position for 20seconds. I will be counting the number of times you move out of this position. I willstart timing when you are set and have closed your eyes.“(b) Single leg stance:“I am going to test your memory. I will read you a list of words and when I am done,repeat back as many words as you can remember, in any order.” The words must beread at a rate of one word per second.“If you were to kick a ball, which foot would you use? [This will be the dominantfoot] Now stand on your non-dominant foot. The dominant leg should be held inapproximately 30 degrees of hip flexion and 45 degrees of knee flexion. Again, youshould try to maintain stability for 20 seconds with your hands on your hips and youreyes closed. I will be counting the number of times you move out of this position. Ifyou stumble out of this position, open your eyes and return to the start position andcontinue balancing. I will start timing when you are set and have closed your eyes.“Trials 2 & 3 MUST be completed regardless of score on trial 1 & 2.(c) Tandem stance:Trials 2 & 3:Score 1 pt. for each correct response. Tot
Davis GA, et al. Br J Sports Med 2017;0 1. .File Size: 451KB
concussion test is a tool or device used to check a What is a concussion test? person's level of functioning after a suspected concussion. There are several types of concussion tests, including neurocognitive, balance, vestibular ocular, motion sensors, and more. These tests do not diagnose concussion, but rather note deficits in
This policy is aligned with the Canadian Guideline on Concussion in Sport. . the 5th International conference on concussion in sport held in Berlin, Oct 2016. British Journal of Sports Medicine 2017 0:1-10. This policy is aligned with the Canadian Guideline on Concussion in Sport. . medical
3. onsite medical assessment 14 4. medical assessment 16 5. concussion management 17 6. multidisciplinary concussion care 20 7. return to sport 21. canadian sport concussion pathway 23 guideline development process . evidence stakeholder consultation updates to this guideline. appendix: documen
Consensus Statement on Concussion in Sport . The detailed clinical assessment of concussion is outlined in the SCAT2 form, which is an appendix to this document. The suspected diagnosis of concussion can include one . psychological test batteries that assess attention and memory
Davis GA, et al. Br J Sports Med 2017;51 Concussion in Sport Group 2017 Concussion in Sport Group 2017 2017; H
Furthermore, a detailed concussion his-tory is an important part of the evalua-tion both in the injured athlete and when conducting a pre-participation examina-tion. The detailed clinical assessment of concussion is outlined in the SCAT2 form (see p 85). The suspected diagnosis of concussion can include one or more of the following clinical .
Concussion in Sport in 2008 included a . Sport Concussion Assessment Tool 2 (SCAT2) for standardized assessment by medical and health professionals (team physicians, certified athletic trainers, neuropsychologists) of sports concussion in athletes ages 10 years and older.
used in the evaluation of concussion; however, none is specifically validated for such use.31–41 SCAT2 includes one such symptom evaluation scheme.7 Increasing evidence suggests that concussion rating scales based on athlete self-report of multiple symptoms are a more reliable and practical way of detecting concussion
