Sport Concussion Assessment Tool

This tool represents a standardized method of evaluating people after

concussion in sport. This tool has been produced as part of the Summary and

Agreement Statement of the Second International Symposium on Concussion

in Sport, Prague 2004

For more information see the .Summary and Agreement Statement of the

Second International Symposium on Concussion in Sport. in the: Clinical

Journal of Sport Medicine 2005; British Journal of Sports Medicine 2005;

Neurosurgery 2005; Physician and Sportsmedicine 2005; this tool may be

copied for distribution to teams, groups and organizations.

Sports concussion is defined as a complex pathophysiological

process affecting the brain, induced by traumatic

biomechanical forces. Several common features that

incorporate clinical, pathological and biomechanical injury

constructs that may be utilized in defining the nature of a

concussive head injury include:

1. Concussion may be caused either by a direct blow to

the head, face, neck or elsewhere on the body with an

.impulsive. force transmitted to the head.

2. Concussion typically results in the rapid onset of

short-lived impairment or neurological function that

resolves spontaneously.

3. Concussion may result in neuropathological changes

but the acute clinical symptoms largely reflect a

functional disturbance rather than structural injury.

4. Concussion results in a graded set of clinical

syndromes that may or may not involve loss of

consciousness. Resolution of the clinical and

cognitive symptoms typically follows a sequential


5. Concussion is typically associated with grossly

normal structural neuroimaging studies.

Post Concussion Symptoms

Ask the athlete to score themselves based on how they feel

now. It is recognized that a low score may be normal for

some athletes, but clinical judgment should be exercised to

determine if a change in symptoms has occurred following the

suspected concussion event.

It should be recognized that the reporting of symptoms may

not be entirely reliable. This may be due to the effects of a

concussion or because the athlete.s passionate desire to return

to competition outweighs their natural inclination to give an

honest response.

If possible, ask someone who knows the athlete well about

changes in affect, personality, behavior, etc.

Remember, concussion should be suspected in the presence

of ANY ONE or more of the following:

Symptoms (such as headache), or

Signs (such as loss of consciousness), or

Memory problems

Any athlete with a suspected concussion should be monitored

for deterioration (i.e., should not be left alone) and should not

drive a motor vehicle.

The SCAT Card (Sport Concussion Assessment Tool)

What is a concussion? A concussion is a disturbance in the function

of the brain caused by a direct or indirect force to the head. It results

in a variety of symptoms (like those listed below) and may, or may

not, involve memory problems or loss of consciousness.

How do you feel? You should score yourself on the

following symptoms, based on how you feel now.

Post Concussion Symptom Scale

None Moderate Severe

Headache 0 1 2 3 4 5 6

.Pressure in head. 0 1 2 3 4 5 6

Neck Pain 0 1 2 3 4 5 6

Balance problems/dizzy 0 1 2 3 4 5 6

Nausea or vomiting 0 1 2 3 4 5 6

Vision problems 0 1 2 3 4 5 6

Hearing problems/ringing 0 1 2 3 4 5 6

.Don.t feel right. 0 1 2 3 4 5 6

Feeling .dinged./.dazed. 0 1 2 3 4 5 6

Confusion 0 1 2 3 4 5 6

Feeling slowed down 0 1 2 3 4 5 6

Feeling like .in a fog. 0 1 2 3 4 5 6

Drowsiness 0 1 2 3 4 5 6

Fatigue or low energy 0 1 2 3 4 5 6

More than emotional 0 1 2 3 4 5 6

Irritability 0 1 2 3 4 5 6

Difficulty concentrating 0 1 2 3 4 5 6

Difficulty remembering 0 1 2 3 4 5 6

(follow up symptoms only)

Sadness 0 1 2 3 4 5 6

Nervous or anxious 0 1 2 3 4 5 6

Trouble falling asleep 0 1 2 3 4 5 6

Sleeping more than usual 0 1 2 3 4 5 6

Sensitivity to light 0 1 2 3 4 5 6

Sensitivity to noise 0 1 2 3 4 5 6

Other: 0 1 2 3 4 5 6

What should I do?

Any athlete suspected of having a concussion should be

removed from play, and told to seek medical evaluation.

Signs to watch for:

Problems could arise over the first 24-48 hours. You should

not be left alone and must go to a hospital at once if you:

Have a headache that gets worse

Are very drowsy or can.t be awakened (woken up)

Can.t recognize people or places

Have repeated vomiting

Behave unusually or seem confused; are very irritable

Have seizures (arms and legs jerk uncontrollably)

Have weak or numb arms or legs

Are unsteady on your feet; have slurred speech

Remember, it is better to be safe. Consult your doctor after

a suspected concussion.

What can I expect?

Concussion typically results in the rapid onset of short-lived

impairment that resolves spontaneously over time. You can

expect that you will be told to rest until you are fully

recovered (that means resting your body and your mind).

Then, your doctor will likely advise that you go through a

gradual increase in exercise over several days (or longer)

before returning to sport.

The SCAT Card (Sport Concussion Assessment Tool)

Medical Evaluation

Name: _______________________ Date: ________

Sport/Team: __________________ Mouth guard? Y N


Was there loss of consciousness/unresponsiveness? Y N

Was there seizure or convulsive activity? Y N

Was there a balance problem / unsteadiness? Y N


Modified Maddocks questions (check if athlete answers correctly)

At what venue are we? ____ Which half is it? ____

Who scored last? ____

What team did we play last? ____: Did we win last

game? ____


Total number of positive symptoms (from reverse side of the card) = _____

4) COGNITIVE ASSESSMENT (5 word recall)

(Examples) Immediate Delayed

Word 1 _____ cat ________ ________

Word 2 _____ pen ________ ________

Word 3 _____ shoe ________ ________

Word 4 _____ book ________ ________

Word 5 _____ car ________ ________

Months in reverse order:


Digits Backwards (check correct)

5-2-8 3-9-1 _____

6-2-9-4 4-3-7-1 _____

8-3-2-7-9 1-4-9-3-6 _____

7-3-9-1-4-2 5-1-8-4-6-8 _____

Ask delayed 5-word recall now


Pass Fail

Speech ____ ____

Eye Motion and Pupils ____ ____

Pronator Drift ____ ____

Gait Assessment ____ ____

Any neurologic screen abnormality necessitates formal

neurologic or hospital assessment


Athletes should not be returned to play the same day of injury.

When returning athletes to play they should follow a stepwise

symptom-limited program, with stages of progression. For example:

1. rest until asymptomatic (physical and mental rest)

2. light aerobic exercise (e.g stationary cycle)

3. sport-specific training

4. non-contact training drills (start light resistance training)

5. full contact training after medical clearance

6. return to competition (game play)

There should be approximately 24 hours (or longer) for each stage

and the athlete should return to stage 1 if symptoms recur.

Resistance training should only be added in the later stages.

Medical clearance should be given before return to play.


The side of the card is for the use of medical doctors, physical

therapists, or athletic therapists. In order to maximize the

information gathered from the card, it is strongly suggested that all

athletes participating in contact sports complete a baseline evaluation

prior to the beginning of their competitive season. This card is a

suggested guide only for sports concussion and is not meant to assess

more severe forms of brain injury. Please give a COPY of this card

to the athlete for their information and to guide follow up



Assess for each of these items and circle Y (yes) or N (no).


Select any 5 words (an example is given). Avoid choosing

related words such as .dark. and .moon. which can be

recalled by means of word association. Read each word at a

rate of one word per second. The athlete should not be

informed of the delayed testing of memory (to be done after

the reverse months and/or digits). Choose a different set of

words each time you perform a follow-up exam with the same


Concentration / Attention:

Ask the athlete to recite the months of the year in reverse

order, starting with a random month. Do not start with

December or January. Circle any months not recited in the

correct sequence. For digits backwards, if correct, go to the

next string length. If correct, read trial 2. Stop after incorrect

on both trials.

Neurologic Screening:

Trained medical personnel must administer this examination.

These individuals might include medical doctors,

physiotherapists or athletic therapists. Speech should be

assessed for fluency and lack slurring. Eye motion should

reveal no diplopia in any of the 4 planes of movement

(vertical, horizontal and both diagonal planes). The pronator

drift is performed by asking the patient to hold both arms in

front of them, palms up, with eyes closed. A positive test is

pronating the forearm, dropping the arm, or drift away from

midline. For gait assessment ask the patient to walk away

from you, turn and walk back.

Return to Play:

A structured, graded exertion protocol should be developed,

individualized on the basis of sport, age, and the concussion

history of the athlete. Exercise or training should be

commenced only after the athlete is clearly asymptomatic with

physical and cognitive rest. Final decision for clearance to

return to competition should ideally be made by a medical