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What is the Sport Concussion Assessment Tool 6 (SCAT6)?

This is an excerpt from Examination of Musculoskeletal Injuries 5th Edition With HKPropel Access by Sandra J. Shultz & Tamara C. Valovich McLeod.

Sport Concussion Assessment Tool. The Sport Concussion Assessment Tool 6 (SCAT6) is the most recent iteration of the SCAT and serves as a standardized tool for acute detection of concussion.12 This tool was developed for individuals ages 13 and older, and a pediatric version is available for ages 8-12 years.13 It includes an immediate assessment component for sideline use and an off-field assessment for post-event evaluations. The SCAT6 is intended to be used for evaluations within the first week following a concussion and has the highest sensitivity within the first 72 h. It combines several assessment domains known to be affected by concussion. Using a cluster of assessments improves the sensitivity and specificity versus individual assessments. For example, the combination of a symptom assessment, modified Balance Error Scoring System, and Standardized Assessment of Concussion was found to have sensitivities between 61% and 55% during the first 72 h.14 In collegiate athletes, the combination of symptom, balance, and cognitive assessments increased the sensitivity to 100% (over individual sensitivities ranging from 55% to 97%).15

The immediate injury assessment portion of the SCAT6 includes the Glasgow Coma Scale to determine level of consciousness (Table 19.2), coordination (the finger-to-nose coordination test), oculomotor screen (see Active ROM of Eye Movement, figure 19.8, and video 19.3), and the Maddocks questions to assess immediate memory (table 19.3). A positive finding with any of these special tests warrants immediate removal from play and a more thorough evaluation by a health care provider.

Glasgow Coma Scale

Finger-to-Nose Coordination Test

Other names for test: None
Used to assess: Coordination and oculomotor function
Patient position: Seated, one arm out stretched to 90° shoulder flexion and elbows and fingers extended
Clinician position: Standing at patient’s side
Clinician’s stabilizing hand position: N/A
Clinician’s test hand position: N/A
Action performed: Patient performs five repetitions of bringing their index finger to their nose and back to the outstretched arm position, repeating with the other arm; if the patient can complete with their eyes open, repeat the assessment with eyes closed
Positive result: Unable to complete task
Accuracy: SN = N/A P = N/A LR = N/A −LR = N/A

Maddock’s Questions for Immediate Memory Recall

Persistent Postconcussion Symptoms
As previously noted, the symptoms associated with sport-related concussion typically resolve within the first 28 days. However, in 16% to 33% of individuals, symptoms may persist longer than 28 days.8,9 The Predicting Persistent Post-Concussive Problems in Pediatrics (5P) clinical risk score may be useful in identifying patients at risk for PPCS.31 The 5P clinical risk score incorporates findings from several demographic, symptom, and balance domains and has been validated in emergency department, outpatient sports medicine, and secondary school athletic training settings.9,31,32 Table 19.6 outlines the components and scoring of the clinical risk score. Each component score is summed and patients classified as low risk (≤ 3 points), moderate risk (4-8 points), or high risk (≥ 9 points) for PPCS. The most common persistent symptoms are headache, dizziness, tinnitus, fatigue, difficulties with memory and concentration, decreased academic performance, insomnia, intolerance to exercise and alcohol, and emotional symptoms such as depression, irritability, frustration, anxiety, and an inability to cope with daily stress.5,33 These patients are best managed by a multidisciplinary health care team with experience in sport-related concussion. Various concussion treatments, including vestibular therapy, ocular rehabilitation, and cognitive-behavioral therapy, may be useful, and clinicians should refer to these specialists for collaborative care.34 These people may require appropriate academic and occupational accommodations to reduce cognitive loads until fully recovered.5

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