What tests and measures should be added to the SCAT3 and related tests to improve their reliability, sensitivity and/or specificity in sideline concussion diagnosis? A systematic review

Abstract

Objectives Several iterations of the Sport Concussion Assessment Tool (SCAT) have been published over the past 16 years. Our goal was to systematically review the literature related to the SCAT and provide recommendations for improving the tool. To achieve this goal, five separate but related searches were conducted and presented herein. Design Systematic literature review. Data sources Medline, Embase, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, SPORTDiscus and PubMed. Eligibility criteria Original, empirical, peer-reviewed findings published in English and included sports-related concussion (SRC). Review papers, case studies, editorials and conference proceedings/abstracts were excluded. The age range for the ChildSCAT was 5-12 years and for the Adult SCAT was 13 years and above. Results Out of 2961 articles screened, a total of 96 articles were included across the five searches. Searches were not mutually exclusive. The final number of articles included in the qualitative synthesis for each search was 21 on Adult SCAT, 32 on ChildSCAT, 21 on sideline, 8 on video/observation and 14 on oculomotor. Summary/conclusions The SCAT is the most widely accepted and deployable sport concussion assessment and screening tool currently available. There is some degree of support for using the SCAT2/SCAT3 and ChildSCAT3 in the evaluation of SRC, with and without baseline data. The addition of an oculomotor examination seems indicated, although the most valid method for assessing oculomotor function is not clear. Video-observable signs of concussion show promise, but there is insufficient evidence to warrant widespread use at this time. InTRODuCTIOnThe Concussion In Sport Group (CISG) introduced the Sport Concussion Assessment Tool (SCAT) 1 to provide a multifaceted standardised assessment of concussion. The SCAT combined previously separate subcomponents of a clinical evaluation, for example, symptoms (graded symptom checklist), cognitive function (five-word immediate recall/ delayed recall), the modified Maddocks questions 2 and neurological screening, in one tool. The SCAT was revised as an instrument to be used by medical professionals and was renamed to SCAT2. 3 The revision was based on a review of the empirical literature, which added the Glasgow Coma Scale (GCS) )4 , a cognitive test (Standardized Assessment of Concussion, SAC 5 6 ) and a measure of balance (modified Balance Error Scoring System, 7 mBESS). The SCAT2 was revised as the SCAT3 in 2013, 8 and a new tool for children (under 13) was developed, the ChildSCAT3. The SCAT3 included physical or objective signs of concussion in addition to loss of consciousness (LOC) and balance problems, added a foam condition to the BESS, and included a 'concussion injury advice' section. 9This study presents the results of a systematic review of the scientific literature assessing the utility of the SCAT3 and sets forth recommendations for improving the tool. MATERIAlS AnD METhODSThe searc...

What domains of clinical function should be assessed after sport-related concussion? A systematic review

“…One explanation might be that athletes included in the review might have been already symptom-free when performing the BESS test. Studies not included in our review but represented in the review on sideline assessment by Echemendia and colleagues80 indicate the mBESS/BESS appears useful immediately after injury (eg, 24 hours) in differentiating concussed versus non-concussed athletes, but the ability to differentiate decreases significantly after 3–5 days post injury. The SOT identified abnormal findings in at least one system (vestibular, visual or somatosensory) in every third athlete.…”

The Sport Concussion Assessment Tool 5th Edition (SCAT5): Background and rationale

“…Overall, the graded symptom checklist, SAC and BESS/mBESS were found to be most useful immediately postinjury in differentiating concussed from non-concussed athletes when using either intraindividual or normative baseline/postinjury comparisons. The diagnostic utility of the SCAT and its components appears to decrease significantly after 3–5 days postinjury, which suggests that the tool may have differential utility in helping to diagnose concussion and tracking recovery versus assisting return to play decision making 15. As such, the tool appears to be clinically useful in screening evaluations and making the diagnosis of SRC but has a more limited role in tracking recovery and assisting the return to play/sport decision.…”

The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): Background and rationale

“…The Child SCAT5 incorporates changes that address some of the limitations identified in the systematic review10 and provides additional evaluative tools (eg, RNS).…”

“…A systematic review of the SCAT3 and Child SCAT3 was performed10 and the evidence was synthesised to inform the expert panel convened to improve these tools. The panel unanimously agreed that a child-specific version of the SCAT is required.…”