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Sport Concussion Assessment Tool (SCAT-3) or (SCAT-5)
Availability
The instrument is freely available here: Sport Concussion Assessment Tool
Classification
Core: Sport-Related Concussion (SRC) Acute (time of injury until 72 hours) and Sport-Related Concussion (SRC) Subacute (after 72 hours to 3 months)   
 
  • Core: One of Core Symptoms Checklists should be collected: Automated Neuropsychological Assessment Metrics (ANAM), Axon Sports Computerized Cognitive Assessment Tool (CCAT), CNS Vital Signs, Child Sport Concussion Assessment Tool (Child-SCAT), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Post Concussion Symptom Inventory (PCSI), Post Concussion Symptoms Scale (PCS-S), Sport Concussion Assessment Tool (SCAT-3) or (SCAT-5), Standardized Symptoms Questionnaire (RPQ), or Post Concussion Symptom Inventory (PCSI)  
 
Supplemental-Highly Recommended: Sport-Related Concussion (SRC) Persistent/Chronic (3 months and greater post concussion) for post concussive TBI related symptoms.
 
SCAT-3 or SCAT-5 Subtest Classifications:
  • Balance Error Scoring System (BESS): Core - Acute (time of injury until 72 hours)
  • Post-Concussion Symptom Inventory (PCSI): Core - Acute (time of injury until 72 hours), Subacute (after 72 hours to 3 months) and Persistent/Chronic (3 months and greater post concussion)
  • Standardized Assessment of Concussion (SAC): Core - Acute (time of injury until 72 hours) Supplemental-Highly Recommended - Subacute (after 72 hours to 3 months)
Short Description of Instrument
The SCAT-3 (or SCAT-5) is a standardized tool for evaluating injured athletes for concussion and can be used in athletes aged 13 years and older. The SCAT-3 (or SCAT-5) was developed through concensus at the 2012 (and 2016 for SCAT-5) Concussion in Sport Group meeting. It consists of the Glasgow Coma Scale, Maddocks’ questions, a Symptom Evaluation, the Standardized Assessment of Concussion (a cognitive assessment of orientation, immediate memory, concentration, and delayed recall), neck examination (for SCAT-3), neurological screening (for SCAT-5), a balance examination modified BESS, and Coordination Examination (for SCAT-3). The SCAT-3 (or SCAT-5)  can be used to inform the medical provider’s clinical examination.   
 
Sport-Related Concussion-Specific:   
 
Advantages: Packages the most commonly recommended and implemented concussion assessments. Designed as a assessment of multiple domains associated with concussion, including assessments of symptoms (Post-concussion Symptom Inventory [PCSI]), Glasgow Coma Scale (GCS), modified Balance Error Scoring System (mBESS: balance test), Standardized Assessment of Concussion (SAC: brief cognitive test), and Maddocks questions (orientation to place/time). Post-injury scores can be compared to baseline levels, but not required   
 
Limitations: Not sensitive to post-concussion decrements beyond 48–72 hours post-injury. Should not be administered to those under the age of 13, but a child version of the SCAT-3 is available. SCAT-5 is not available. Not designed for sub-acute time period or to monitor recovery or determined return to play/sport. Lacks established clincial cut-offs in the absence of baseline scores. Subtests – BESS, SAC have limited utility after the first 72 hrs- more appropriate as an acute measurement.  
 
Subpopulation: Adolescent to Adult/Pediatric version also available and should be included.  
 
Limitations: Age Range: 13+
Scoring
The SCAT-3 and 5 has no total score, but each section has the following ranges: Glasgow Coma Scale (3 to 15), Maddocks’ questions (0 to 5), a Symptom Evaluation (0 to 22 for total symptoms; 0 to 132 for symptom severity), the Standardized Assessment of Concussion (0 to 30; modified version 0 to 50), neck examination (unscored) (for SCAT-3), modified BESS (0 to 30; modified version 0 to 50), and Coordination Examination (0 to 1) (for SCAT-3).
Rationale/Justification
The SCAT-3 (or SCAT-5) is administered in interview-format to an athlete with suspicion of sustaining a concussion. the SCAT-3 (or SCAT-5) is designed for use and interpretation by appropriately trained medical professionals.  
 
Preseason baseline testing can be performed to allow comparison with post-injury scores, but is not required. There are no overall scoring criteria, but sensitivity and specificity scores are available for the components. The SCAT-3 (or SCAT-5) loses sensitivity to post-injury changes within 48 to 72 hours.
References
Sport concussion assessment tool - 5th edition. Br J Sports Med. 2017 Apr 26. pii: bjsports-2017-097506SCAT5. doi: 10.1136/bjsports-2017-097506SCAT5.  
 
McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, Cantu RC, Cassidy D, Echemendia RJ, Castellani RJ, Davis GA, Ellenbogen R, Emery C, Engebretsen L, Feddermann-Demont N, Giza CC, Guskiewicz KM, Herring S, Iverson GL, Johnston KM, Kissick J, Kutcher J, Leddy JJ, Maddocks D, Makdissi M, Manley GT, McCrea M, Meehan WP, Nagahiro S, Patricios J, Putukian M, Schneider KJ, Sills A, Tator CH, Turner M, Vos PE. Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017 [In Press]. SCAT3. Br J Sports Med. 2013 Apr;47(5):259.  
 
Additional References:
 
Chin EY, Nelson LD, Barr WB, McCrory P, McCrea MA. Reliability and Validity of the Sport Concussion Assessment Tool-3 (SCAT3) in High School and Collegiate Athletes. Am J Sports Med. 2016;44(9):2276–2285.  
 
Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, Makdissi M, Sullivan SJ, Broglio SP, Raftery M, Schneider K, Kissick J, McCrea M, Dvorak J, Sills AK, Aubry M, Engebretsen L, Loosemore M, Fuller G, Kutcher J, Ellenbogen R, Guskiewicz K, Patricios J, Herring S. The Sport Concussion Assessment Tool 5th Edition (SCAT5). Br J Sports Med. 2017 Apr 26. pii: bjsports-2017-097506. doi: 10.1136/bjsports-2017-097506. [In Press].  
 
Guskiewicz KM. Assessment of postural stability following sport-related concussion. Curr Sports Med Rep. 2003;2(1):24–30.
 
Maddocks DL, Dicker GD, Saling MM. The assessment of orientation following concussion in athletes. Clin J Sport Med. 1995;5(1):32–35.  McCrea M. Standardized mental status assessment of sports concussion. Clin J Sport Med. 2001;11(3):176–181.
 
McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorák J, Echemendia RJ, Engebretsen L, Johnston K, Kutcher JS, Raftery M, Sills A, Benson BW, Davis GA, Ellenbogen RG, Guskiewicz K, Herring SA, Iverson GL, Jordan BD, Kissick J, McCrea M, McIntosh AS, Maddocks D, Makdissi M, Purcell L, Putukian M, Schneider K, Tator CH, Turner M. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47(5):250–258.  
 
Schneiders AG, Sullivan SJ, Gray AR, Hammond-Tooke GD, McCrory PR. Normative values for three clinical measures of motor performance used in the neurological assessment of sports concussion. J Sci Med Sport. 2010;13(2):196–201.
 
Schneiders AG, Sullivan SJ, Kvarnström J, Olsson M, Ydén T, Marshall S. The effect of footwear and sports-surface on dynamic neurological screening for sport-related concussion. J Sci Med Sport. 2010;13(4):382–386.
 
Thomas RE, Alves J, Vaska MM, Magalhães R. SCAT2 and SCAT3 scores at baseline  and after sports-related mild brain injury/concussion: qualitative synthesis with weighted means. BMJ Open Sport Exerc Med. 2016;2(1):e000095
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