Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review

Abstract

ObjectivesTo systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6).Data sourcesSystematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation.Eligibility criteria(1) Original research articles, cohort studies, case–control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC.Data extractionSeparate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool.ResultsOut of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test–retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children.ConclusionSupport exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes.PROSPERO registration numberCRD42020154787.

Diagnosis of Sports-Related Concussion Using Symptom Report or Standardized Assessment of Concussion

“…Although the accuracy decreased, the number of athletes in each group was relatively small and the confidence intervals overlapped. A recent systematic review of the SCAT, which included reporting on 14 acceptable or high-quality studies on SAC score and timing of exam, noted that the greatest differences in standard mean difference of total 5-word SAC score was in the first 24 hours after injury, which is supported by our findings. Larger groups at different time points may help inform at what time point the SAC should no longer be used as an aid to diagnosis.…”

Are Sex Differences in Collegiate and High School Sports-Related Concussion Reflected in the Guidelines? A Scoping Review

“…It will be interesting to observe whether longer word lists will yield more comprehensive results when assessing SRC in females. Demographic differences were also observed by the CISG when creating SCAT6 [ 94 ], and further work is required to fully investigate sex differences in concussion assessment with SCAT6.…”

The spectrum of acute and chronic consequences of neurotrauma in professional and amateur boxing – A call to action is advocated to better understand and prevent this phenomenon

“…The recognition, evaluation, diagnosis, and management of sport-related concussion is complex. A concussion should be suspected every time one of the aforementioned clinical domains is affected; the athlete should then be removed from play and undergo prompt sideline evaluation using the Sport Concussion Assessment Tool 6 (SCAT6) or any other equivalent tool ( Hall et al, 2005 ; Echemendia et al, 2023a , 2023b ; Scorza and Cole, 2019 ).…”