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BJSM Online First, published on April 26, 2017 as 10.1136/bjsports-2017-097492childscat5
To download a clean version of the SCAT tools please visit the journal online (http://dx.doi.org/10.1136/bjsports-2017-097492childscat5)

Child SCAT5SPORT CONCUSSION ASSESSMENT TOOL©

FOR CHILDREN AGES 5 TO 12 YEARSFOR USE BY MEDICAL PROFESSIONALS ONLY
supported by

Patient details
Name:
DOB:
Address:
ID number:
Examiner:
Date of Injury:

Time:

WHAT IS THE CHILD SCAT5?

Key points

The Child SCAT5 is a standardized tool for evaluatingconcussions designed for use by physicians and licensed
healthcare professionals1.

• Any athlete with suspected concussion should be REMOVEDFROM PLAY, medically assessed and monitored for
deterioration. No athlete diagnosed with concussion
should be returned to play on the day of injury.

If you are not a physician or licensed healthcare professional,
please use the Concussion Recognition Tool 5 (CRT5). The
Child SCAT5 is to be used for evaluating Children aged 5 to
12 years. For athletes aged 13 years and older, please use
the SCAT5.
Preseason Child SCAT5 baseline testing can be useful forinterpreting post-injury test scores, but not required for that
purpose. Detailed instructions for use of the Child SCAT5 areprovided on page 7. Please read through these instructions
carefully before testing the athlete. Brief verbal instructions
for each test are given in italics. The only equipment required
for the tester is a watch or timer.

• If the child is suspected of having a concussion and medical
personnel are not immediately available, the child should
be referred to a medical facility for urgent assessment.
• Concussion signs and symptoms evolve over time and it
is important to consider repeat evaluation in the assessment of concussion.
• The diagnosis of a concussion is a clinical judgment,
made by a medical professional. The Child SCAT5 should
NOT be used by itself to make, or exclude, the diagnosisof concussion. An athlete may have a a concussion even
if their Child SCAT5 is “normal”.

This tool may be freely copied in its current form for distribution to individuals, teams, groups and organizations.
It should not be altered in any way, re-branded or sold forcommercial gain. Any revision, translation or reproduction
in a digital form requires specific approval by the Concussion in Sport Group.

Remember:

Recognise and Remove• Assessment for a spinal cord injury is a critical part of theinitial on-field assessment.

A head impact by either a direct blow or indirect transmissionof force can be associated with a serious and potentially fatal
brain injury. If there are significant concerns, including anyof the red flags listed in Box 1, then activation of emergency
procedures and urgent transport to the nearest hospitalshould be arranged.

• Do not remove a helmet or any other equipment unlesstrained to do so safely.

• The basic principles of first aid (danger, response, airway,
breathing, circulation) should be followed.
• Do not attempt to move the athlete (other than that required
for airway management) unless trained to do so.

© Concussion in Sport Group 2017Child SCAT5© Concussionin Sport Group 2017
Davis GA, et al. Br J Sports
Med 2017;0:1–8.
doi:10.1136/bjsports-2017-097492childscat5

Copyright Article author (or their employer) 2017. Produced by BMJ Publishing Group Ltd under licence.

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1

Name:

IMMEDIATE OR ON-FIELD ASSESSMENT

DOB:
Address:

The following elements should be assessed for all athletes whoare suspected of having a concussion prior to proceeding to theneurocognitive assessment and ideally should be done on-field after
the first first aid / emergency care priorities are completed.
If any of the “Red Flags“ or observable signs are noted after a direct
or indirect blow to the head, the athlete should be immediately andsafely removed from participation and evaluated by a physician or
licensed healthcare professional.
Consideration of transportation to a medical facility should be at
the discretion of the physician or licensed healthcare professional.
The GCS is important as a standard measure for all patients and canbe done serially if necessary in the event of deterioration in conscious
state. The cervical spine exam is a critical step of the immediate
assessment, however, it does not need to be done serially.

STEP 1: RED FLAGSRED FLAGS:•

Neck pain or
tenderness•

Double vision•

Weakness or tingling/burning in arms or legs•

Severe or increasing
headache•

Seizure or convulsion•

Loss of consciousness•

Deteriorating
conscious state•

Vomiting•

Increasingly restless,agitated or combative

ID number:
Examiner:
Date:

Incomprehensible sounds

2

2

2

Inappropriate words

3

3

3

Confused444Oriented

55

5No motor response

1

1

1

Extension to pain

2

2

2

Abnormal flexion to pain

3

3

3

Flexion / Withdrawal to pain

4

4

4

Localizes to pain

5

5

5

Obeys commands

6

6

6

Does the athlete report that their neck is pain free at rest?

YN

If there is NO neck pain at rest, does the athlete have a fullrange of ACTIVE pain free movement?

YN

Is the limb strength and sensation normal?

Y

N

Best motor response (M)Glasgow Coma score (E + V + M)

CERVICAL SPINE ASSESSMENT

STEP 2: OBSERVABLE SIGNS
Witnessed 

In a patient who is not lucid or fully conscious, a cervicalspine injury should be assumed until proven otherwise.

Observed on Video 

Lying motionless on the playing surface

Y

N

Balance / gait difficulties / motor incoordination: stumbling, slow /laboured movements

Y

N

Disorientation or confusion, or an inability to respond appropriately
to questions

Y

N

Blank or vacant lookY

N

Facial injury after head trauma

Y

N

OFFICE OR OFF-FIELD ASSESSMENT
STEP 1: ATHLETE BACKGROUND
Please note that the neurocognitive assessment should be done in a distraction-freeenvironment with the athlete in a resting state.
Sport / team / school:
Date / time of injury:
Years of education completed:
Age:
Gender: M / F / Other

STEP 3: EXAMINATIONGLASGOW COMA SCALE (GCS)2

Dominant hand: left / neither / right
How many diagnosed concussions has theathlete had in the past?:

Time of assessment

When was the most recent concussion?:

Date of assessment

How long was the recovery (time to being cleared to play)from the most recent concussion?:(days)

Best eye response (E)No eye opening

1

1

1

Eye opening in response to pain

2

2

2

Eye opening to speech33Eyes opening spontaneously

44

Has the athlete ever been:
Hospitalized for a head injury?

Yes

No

3

Diagnosed / treated for headache disorder or migraines?

Yes

No

4

Diagnosed with a learning disability / dyslexia?

Yes

No

Best verbal response (V)Diagnosed with ADD / ADHD?

Yes

No

No verbal response

Diagnosed with depression, anxiety or other psychiatric disorder?

Yes

No

1

1

1

Current medications? If yes, please list:2

© Concussion in Sport Group 2017Child SCAT5© Concussionin Sport Group 2017
Davis GA, et al. Br J Sports
Med 2017;0:1–8.
doi:10.1136/bjsports-2017-097492childscat5

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STEP 2: SYMPTOM EVALUATION
The athlete should be given the symptom form and asked to read this instruction paragraph out
loud then complete the symptom scale. For the baseline assessment, the athlete should rate his/her symptoms based on how he/she typically feels and for the post injury assessment the athlete
should rate their symptoms at this point in time.

To be done in a resting state
Please Check: Baseline 

DOB:
Address:
ID number:

Post-Injury

Examiner:
Date:

2Child Report3

Name:

Not at all/Never

A little/
RarelySomewhat/
Sometimes

A lot/ Often

I have headaches

0

1

2

3

Parent Report

I feel dizzy

0

1

2

3

The child:

Not at all/Never

A little/
RarelySomewhat/
Sometimes

A lot/ Often

I feel like the room is spinning

0

1

2

3

has headaches

0

1

2

3

I feel like I’m going to faint

0

1

2

3

feels dizzy

0

1

2

3

Things are blurry when
I look at them

0

1

2

3

has a feeling that theroom is spinning

0

1

2

3

I see double

0

1

2

3

feels faint

0

1

2

3

I feel sick to my stomach

0

1

2

3

has blurred vision

0

1

2

3

My neck hurts

0

1

2

3

has double vision

0

1

2

3

I get tired a lot

0

1

2

3

experiences nausea

0

1

2

3

I get tired easily

0

1

2

3

has a sore neck

0

1

2

3

I have trouble paying attention

0

1

2

3

gets tired a lot

0

1

2

3

I get distracted easily

0

1

2

3

gets tired easily

0

1

2

3

I have a hard time concentrating

0

1

2

3

has trouble sustaining attention

0

1

2

3

I have problems remembering what people tell me

0

1

2

3

is easily distracted

0

1

2

3

I have problems
following directions

0

1

2

3

has difficulty concentrating

0

1

2

3

I daydream too much

0

1

2

3

has problems remembering what he/she is told

0

1

2

3

I get confused

0

1

2

3

has difficulty following
directions

0

1

2

3

I forget things

0

1

2

3

tends to daydream

0

1

2

3

I have problems finishing things

0

1

2

3

gets confused

0

1

2

3

I have trouble figuring things out

0

1

2

3

is forgetful

0

1

2

3

It’s hard for me tolearn new things

0

1

2

3

has difficulty completing tasks

0

1

2

3

Total number of symptoms:of 21

has poor problem solving skills

0

1

2

3

Symptom severity score:of 63

has problems learning

0

1

2

3

Do the symptoms get worse with physical activity?

Y

N

Do the symptoms get worse with trying to think?

Y

N

Overall rating for child to answer:
Very badOn a scale of 0 to 10 (where 10 isnormal), how do you feel now?

Very good0 1 2 3 4 5 6 7 8 9 10

If not 10, in what way do you feel different?:

Total number of symptoms:of 21

Symptom severity score:of 63

Do the symptoms get worse with physical activity?

Y

N

Do the symptoms get worse with mental activity?

Y

N

Overall rating for parent/teacher/coach/carer to answer
On a scale of 0 to 100% (where 100% is normal), how would you rate the child now?

If not 100%, in what way does the child seem different?

© Concussion in Sport Group 2017Child SCAT5© Concussionin Sport Group 2017
Davis GA, et al. Br J Sports
Med 2017;0:1–8.
doi:10.1136/bjsports-2017-097492childscat5

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Name:

STEP 3: COGNITIVE SCREENING

DOB:

Standardized Assessment of Concussion - Child Version (SAC-C)4

Address:

IMMEDIATE MEMORY

ID number:

The Immediate Memory component can be completed using the
traditional 5-word per trial list or optionally using 10-words per trial
to minimise any ceiling effect. All 3 trials must be administered irrespective of the number correct on the first trial. Administer at the rateof one word per second.

Examiner:

Please choose EITHER the 5 or 10 word list groups and circle the specific word list chosen
for this test.
I am going to test your memory. I will read you a list of words and when I am done, repeatback as many words as you can remember, in any order. For Trials 2 & 3: I am going to repeat
the same list again. Repeat back as many words as you can remember in any order, even if
you said the word before.

Score (of 5)
List

Alternate 5 word lists

Date:

CONCENTRATIONDIGITS BACKWARDS
Please circle the Digit list chosen (A, B, C, D, E, F). Administer at therate of one digit per second reading DOWN the selected column.
I am going to read a string of numbers and when I am done, you repeat them back to me
in reverse order of how I read them to you. For example, if I say 7-1-9, you would say 9-1-7.

Trial 1 Trial 2 Trial 3A

FingerPenny

Blanket

Lemon

InsectB

Candle

Paper

Sugar

Sandwich

Wagon

C

Baby

MonkeyPerfumeSunset

Iron

D

Elbow

Apple

CarpetSaddleBubbleE

JacketArrow

Pepper

CottonMovie

F

DollarHoney

Mirror

SaddleAnchorImmediate Memory Score

Concentration Number Lists (circle one)of 15

Time that last trial was completed

Score (of 10)
List

Alternate 10 word lists
Trial 1 Trial 2 Trial 3

G

H

I

FingerPenny

Blanket

Lemon

InsectCandle

Paper

Sugar

Sandwich

Wagon

Baby

MonkeyPerfumeSunset

Iron

Elbow

Apple

CarpetSaddleBubbleList A

List B

List C

5-2

4-1

4-9

Y

N

0

4-1

9-4

6-2

Y

N

1

4-9-3

5-2-6

1-4-2

Y

N

0

6-2-9

4-1-5

6-5-8

Y

N

1

3-8-1-4

1-7-9-5

6-8-3-1

YN

0

3-2-7-94-9-6-8

3-4-8-1

YN

1

6-2-9-7-1

4-8-5-2-7

4-9-1-5-3

YN

0

1-5-2-8-6

6-1-8-4-3

6-8-2-5-1YN

1

7-1-8-4-6-2

8-3-1-9-6-4

3-7-6-5-1-9

Y

N

0

5-3-9-1-4-8

7-2-4-8-5-6

9-2-6-5-1-4

Y

N

1

List D

List E

List F

2-7

9-2

7-8

Y

N

0

5-9

6-1

5-1

Y

N

1

7-8-2

3-8-2

2-7-1

Y

N

0

9-2-6

5-1-8

4-7-9

Y

N

1

4-1-8-3

2-7-9-3

1-6-8-3YN

0JacketArrow

Pepper

CottonMovie

9-7-2-3

2-1-6-9-3-9-2-4

YN

1

DollarHoney

Mirror

SaddleAnchor

1-7-9-2-6

4-1-8-6-9

2-4-7-5-8

YN

0

4-1-7-5-2

9-4-1-7-5

8-3-9-6-4

YN

1

2-6-4-8-1-7

6-9-7-3-8-2

5-8-6-2-4-9

Y

N

0

8-4-1-9-3-5

4-2-7-3-9-8

3-1-7-8-2-6

Y

N

1

Immediate Memory Score
Time that last trial was completedof 30

Digits Score:of 5

DAYS IN REVERSE ORDER
Now tell me the days of the week in reverse order. Start with the last day and go backward.
So you’ll say Sunday, Saturday. Go ahead.
Sunday - Saturday - Friday - Thursday - Wednesday - Tuesday - Monday

4

0 1

Days Score

of 1

Concentration Total Score (Digits + Days)of 6© Concussion in Sport Group 2017Child SCAT5© Concussionin Sport Group 2017
Davis GA, et al. Br J Sports
Med 2017;0:1–8.
doi:10.1136/bjsports-2017-097492childscat5

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4

Name:

STEP 4: NEUROLOGICAL SCREEN

DOB:

See the instruction sheet (page 7) for details of
test administration and scoring of the tests.

Address:
ID number:

Can the patient read aloud (e.g. symptom checklist) and follow instructions without difficulty?

Y

N

Does the patient have a full range of painfree PASSIVE cervical spine movement?

YN

Without moving their head or neck, can the patient lookside-to-side and up-and-down without double vision?

YN

Can the patient perform the finger nose
coordination test normally?

YN

Can the patient perform tandem gait normally?

Y

N

Examiner:
Date:

5

STEP 5: DELAYED RECALL:BALANCE EXAMINATION

The delayed recall should be performed after 5 minutes haveelapsed since the end of the Immediate Recall section. Score 1
pt. for each correct response.

Modified Balance Error Scoring System (BESS) testing5
Which foot was tested(i.e. which is the non-dominant foot) Left Right

Do you remember that list of words I read a few times earlier? Tell me as many words
from the list as you can remember in any order.

Testing surface (hard floor, field, etc.)

Time Started

Footwear (shoes, barefoot, braces, tape, etc.)
Condition

Please record each word correctly recalled. Total score equals number of words recalled.

ErrorsDouble leg stanceof 10Single leg stance (non-dominant foot, 10-12 y/o only)of 10

Tandem stance (non-dominant foot at back)of 10

Total Errors

5-9 y/oof 20

10-12 y/oTotal number of words recalled accurately:

of 30

of 5

or

of 10

6

STEP 6: DECISION
Date and time of injury:

Date & time of assessment:

If the athlete is known to you prior to their injury, are they different from their usual self?

Domain Yes  No  Unsure  Not Applicable(If different, describe why in the clinical notes section)

Symptom numberChild report (of 21)
Parent report (of 21)

Concussion Diagnosed?
 Yes  No  Unsure  Not Applicable

Symptom severity score
Child report (of 63)
Parent report (of 63)
Immediate memory

If re-testing, has the athlete improved?
 Yes  No  Unsure  Not Applicable
of 15

of 15

of 15

of 30

of 30

of 30

NormalAbnormal

NormalAbnormal

NormalAbnormalConcentration (of 6)
Neuro exam
Balance errors(5-9 y/o of 20)(10-12 y/o of 30)
Delayed Recall

I am a physician or licensed healthcare professional and I have personallyadministered or supervised the administration of this Child SCAT5.
Signature:
Name:
Title:

of 5

of 5

of 5

of 10

of 10

of 10

Registration number (if applicable):
Date:

SCORING ON THE CHILD SCAT5 SHOULD NOT BE USED AS A STANDALONE METHOD TO DIAGNOSE CONCUSSION, MEASURE RECOVERY OR
MAKE DECISIONS ABOUT AN ATHLETE’S READINESS TO RETURN TO
COMPETITION AFTER CONCUSSION.
© Concussion in Sport Group 2017Child SCAT5© Concussionin Sport Group 2017
Davis GA, et al. Br J Sports
Med 2017;0:1–8.
doi:10.1136/bjsports-2017-097492childscat555

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Name:
DOB:
Address:
ID number:
Examiner:
Date:

For the Neurological Screen (page 5), if the child cannot read, ask
him/her to describe what they see in this picture.

CLINICAL NOTES:

Concussion injury advice for thechild and parents/carergivers(To be given to the person monitoring the concussed child)This child has had an injury to the head and needs to be carefully
watched for the next 24 hours by a responsible adult.
If you notice any change in behavior, vomiting, dizziness, worsening
headache, double vision or excessive drowsiness, please call an
ambulance to take the child to hospital immediately.

Clinic phone number:
Patient’s name:Date / time of injury:
Date / time of medical review:
Healthcare Provider:

Other important points:
Following concussion, the child should rest for at least 24 hours.
• The child should not use a computer, internet or play video
games if these activities make symptoms worse.
• The child should not be given any medications, including
pain killers, unless prescribed by a medical doctor.
• The child should not go back to school
until symptoms are improving.
• The child should not go back to sport or play
until a doctor gives permission.

© Concussion in Sport Group 2017

Contact details or stamp6

Child SCAT5© Concussionin Sport Group 2017
Davis GA, et al. Br J Sports
Med 2017;0:1–8.
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INSTRUCTIONS
Words in Italics throughout the Child SCAT5 are the instructions given to the athlete by the clinician
A stopwatch or watch with a second hand is required for this testing.

Symptom Scale
In situations where the symptom scale is being completed after exercise, it should still
be done in a resting state, at least 10 minutes post exercise.
At Baseline

On the day of injury

On all subsequent days

• The child is to complete
the Child Report,
according to how he/she feels today, and• The child is to complete
the Child Report,
according to how he/she feels now.

• The child is to complete
the Child Report,
according to how he/she feels today, and• If the parent is present,
and has had time toassess the child on the
day of injury, the parent
completes the Parent
Report according to how
the child appears now.

• The parent/carer is tocomplete the Parent
Report according to how
the child has been overthe previous 24 hours.

• The parent/carer is tocomplete the Parent
Report according to
how the child has beenover the previous week.

For Total number of symptoms, maximum possible is 21
For Symptom severity score, add all scores in table, maximum possible is 21 x 3 = 63

Standardized Assessment of Concussion Child Version (SAC-C)
Immediate Memory
Choose one of the 5-word lists. Then perform 3 trials of immediate memory using this list.
Complete all 3 trials regardless of score on previous trials.
“I am going to test your memory. I will read you a list of words and when I am done, repeatback as many words as you can remember, in any order.” The words must be read at a
rate of one word per second.
OPTION: The literature suggests that the Immediate Memory has a notable ceiling effectwhen a 5-word list is used. (In younger children, use the 5-word list). In settings where thisceiling is prominent the examiner may wish to make the task more difficult by incorporating
two 5–word groups for a total of 10 words per trial. In this case the maximum score pertrial is 10 with a total trial maximum of 30.
Trials 2 & 3 MUST be completed regardless of score on trial 1 & 2.
Trials 2 & 3: “I am going to repeat the same list again. Repeat back as many words as you
can remember in any order, even if you said the word before.“
Score 1 pt. for each correct response. Total score equals sum across all 3 trials. Do NOT
inform the athlete that delayed recall will be tested.

Concentration
Digits backward“I am now going to test your balance. Please take your shoes off, rollup your pants above your ankle (if applicable), and remove any ankle
taping (if applicable). This test will consist of two different parts.“
OPTION: For further assessment, the same 3 stances can be performed on asurface of medium density foam (e.g., approximately 50cm x 40cm x 6cm).
(a) Double leg stance:
The ﬁrst stance is standing with the feet together with hands on hips and with eyes
closed. The child should try to maintain stability in that position for 20 seconds. You
should inform the child that you will be counting the number of times the child moves outof this position. You should start timing when the child is set and the eyes are closed.
(b) Tandem stance:
Instruct or show the child how to stand heel-to-toe with the non-dominant footin the back. Weight should be evenly distributed across both feet. Again, thechild should try to maintain stability for 20 seconds with hands on hips and eyes
closed. You should inform the child that you will be counting the number of times
the child moves out of this position. If the child stumbles out of this position,
instruct him/her to open the eyes and return to the start position and continuebalancing. You should start timing when the child is set and the eyes are closed.
(c) Single leg stance (10-12 year olds only):“If you were to kick a ball, which foot would you use? [This will be the dominant foot]Now stand on your other foot. You should bend your other leg and hold it up (showthe child). Again, try to stay in that position for 20 seconds with your hands on yourhips and your eyes closed. I will be counting the number of times you move out of thisposition. If you move out of this position, open your eyes and return to the start position
and keep balancing. I will start timing when you are set and have closed your eyes.“

Balance testing – types of errors
1. Hands lifted off
iliac crest
2. Opening eyes

3. Step, stumble, or fall

5. Lifting forefoot or heel

4. Moving hip into > 30
degrees abduction

6. Remaining out of test
position > 5 sec

Each of the 20-second trials is scored by counting the errors, or deviations from theproper stance, accumulated by the child. The examiner will begin counting errors
only after the child has assumed the proper start position. The modified BESS is
calculated by adding one error point for each error during the 20-second tests. The
maximum total number of errors for any single condition is 10. If a child commits
multiple errors simultaneously, only one error is recorded but the child should quickly
return to the testing position, and counting should resume once subject is set. Children
who are unable to maintain the testing procedure for a minimum of five seconds atthe start are assigned the highest possible score, ten, for that testing condition.

Tandem Gait

Choose one column only, from List A, B, C, D, E or F, and administer those digits as follows:

Instruction for the examiner - Demonstrate the following to the child:“I am going to read you some numbers and when I am done, you say them back to me
backwards, in reverse order of how I read them to you. For example, if I say 7-1, you wouldsay 1-7.”

The child is instructed to stand with their feet together behind a starting line (the testis best done with footwear removed). Then, they walk in a forward direction as quickly
and as accurately as possible along a 38mm wide (sports tape), 3 metre line with analternate foot heel-to-toe gait ensuring that they approximate their heel and toe on eachstep. Once they cross the end of the 3m line, they turn 180 degrees and return to thestarting point using the same gait. Children fail the test if they step off the line, have aseparation between their heel and toe, or if they touch or grab the examiner or an object.

If correct, circle “Y” for correct and go to next string length. If incorrect, circle “N” for the
first string length and read trial 2 in the same string length. One point possible for eachstring length. Stop after incorrect on both trials (2 N’s) in a string length. The digits should
be read at the rate of one per second.

Days of the week in reverse order“Now tell me the days of the week in reverse order. Start with Sunday and go backward. So
you’ll say Sunday, Saturday ... Go ahead”
1 pt. for entire sequence correct

Delayed Recall
The delayed recall should be performed after at least 5 minutes have elapsed since theend of the Immediate Recall section.
“Do you remember that list of words I read a few times earlier? Tell me as many words fromthe list as you can remember in any order.“Circle each word correctly recalled. Total score equals number of words recalled.

Neurological Screen
Reading
The child is asked to read a paragraph of text from the instructions in the Child SCAT5.
For children who can not read, they are asked to describe what they see in a photographor picture, such as that on page 6 of the Child SCAT5.

Finger to Nose
The tester should demonstrate it to the child.
“I am going to test your coordination now. Please sit comfortably on the chair with youreyes open and your arm (either right or left) outstretched (shoulder ﬂexed to 90 degrees
and elbow and ﬁngers extended). When I give a start signal, I would like you to perform ﬁve
successive ﬁnger to nose repetitions using your index ﬁnger to touch the tip of the nose as
quickly and as accurately as possible.”
Scoring: 5 correct repetitions in < 4 seconds = 1
Note for testers: Children fail the test if they do not touch their nose, do not fully extend
their elbow or do not perform five repetitions.

References
1.

McCrory et al. Consensus Statement On Concussion In Sport – The 5th International
Conference On Concussion In Sport Held In Berlin, October 2016. British Journalof Sports Medicine 2017 (available at www.bjsm.bmj.com)

2.

Jennett, B., Bond, M. Assessment of outcome after severe brain damage: a practicalscale. Lancet 1975; i: 480-484

3.

Ayr, L.K., Yeates, K.O., Taylor, H.G., Brown, M. Dimensions of postconcussive
symptoms in children with mild traumatic brain injuries. Journal of the International
Neuropsychological Society. 2009; 15:19–30

4.

McCrea M. Standardized mental status testing of acute concussion. Clinical Journalof Sports Medicine. 2001; 11: 176-181

5.

Guskiewicz KM. Assessment of postural stability following sport-related concussion.
Current Sports Medicine Reports. 2003; 2: 24-30

Modified Balance Error Scoring System (mBESS)5 testing
These instructions are to be read by the person administering the Child SCAT5, and eachbalance task should be demonstrated to the child. The child should then be asked to copy
what the examiner demonstrated.
Each of 20-second trial/stance is scored by counting the number of errors. The Thisbalance testing is based on a modified version of the Balance Error Scoring System (BESS)5.

© Concussion in Sport Group 2017Child SCAT5© Concussionin Sport Group 2017
Davis GA, et al. Br J Sports
Med 2017;0:1–8.
doi:10.1136/bjsports-2017-097492childscat5

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CONCUSSION INFORMATION
If you think you or a teammate has a concussion, tell your coach/trainer/
parent right away so that you can be taken out of the game. You or yourteammate should be seen by a doctor as soon as possible. YOU ORYOUR TEAMMATE SHOULD NOT GO BACK TO PLAY/SPORT THAT DAY.

Signs to watch for
Problems can happen over the first 24-48 hours. You or your teammate should not
be left alone and must go to a hospital right away if any of the following happens:• New headache, orheadache gets worse• Feeling sick to yourstomach or vomiting• Neck pain thatgets worse• Acting weird/strange,
seems/feels confused, • Is unsteady walking
or standingor is irritable• Becomes sleepy/
drowsy or can’t
be woken up• Cannot recognise
people or places• Has any seizures(arms and/or legs
jerk uncontrollably)• Has weakness,
numbness or tingling(arms, legs or face)• Talking is slurred• Cannot understandwhat someone issaying or directions

Graduated Return to School Strategy
Concussion may affect the ability to learn at school. The child may needto miss a few days of school after a concussion, but the child’s doctor
should help them get back to school after a few days. When going backto school, some children may need to go back gradually and may need tohave some changes made to their schedule so that concussion symptoms
don’t get a lot worse. If a particular activity makes symptoms a lot worse,then the child should stop that activity and rest until symptoms get better.
To make sure that the child can get back to school without problems, it isimportant that the health care provider, parents/caregivers and teachers
talk to each other so that everyone knows what the plan is for the childto go back to school.
Note: If mental activity does not cause any symptoms, the child may
be able to return to school part-time without doing school activities athome first.
Goal ofeach step

Mental Activity

Activity at each step

1. Daily activities
that do notgive the childsymptoms

Typical activities that the childdoes during the day as long as
they do not increase symptoms(e.g. reading, texting, screentime). Start with 5-15 minutes at
a time and gradually build up.

Gradualreturn totypicalactivities.

2. Schoolactivities

Homework, reading or othercognitive activities outside of
the classroom.

Increase
tolerance
to cognitivework.

The athlete should not return to play/sport the day of injury.

3. Return toschoolpart-time

Gradual introduction of schoolwork. May need to start witha partial school day or withincreased breaks during the day.

Increaseacademic
activities.

NOTE: An initial period of a few days of both cognitive (“thinking”) andphysical rest is recommended before beginning the Return to Sport
progression.

4. Return toschoolfull-time

Gradually progress school
activities until a full day can be
tolerated.

Return to fullacademic
activities andcatch up on
missed work.

Consult your physician or licensed healthcare professional after asuspected concussion. Remember, it is better to be safe.

Graduated Return to Sport Strategy
After a concussion, the child should rest physically and mentally for a
few days to allow symptoms to get better. In most cases, after a few
days of rest, they can gradually increase their daily activity level as longas symptoms don’t get worse. Once they are able to do their usual daily
activities without symptoms, the child should gradually increase exercise
in steps, guided by the healthcare professional (see below).

Exercise step

Functional exercise
at each step

Goal of each step

1. Symptomlimited activity

Daily activities that do
not provoke symptoms.

Gradual reintroduction of work/school
activities.

2. Light aerobic
exerciseWalking or stationary
cycling at slow to medium
pace. No resistancetraining.

Increase heart rate.

3. Sport-specificexercise

Running or skating drills.
No head impact activities.

Add movement.

4. Non-contact
training drills

Harder training drills, e.g.,
passing drills. May start
progressive resistancetraining.

Exercise, coordination, andincreased thinking.

5. Full contact
practice

Following medical clearance, participate in normal
training activities.

Restore confidence and assess
functional skills bycoaching staff.

6. Return toplay/sport

Normal game play.

If the child continues to have symptoms with mental activity, some otherthings that can be done to help with return to school may include:• Starting school later, only
going for half days, or going
only to certain classes• More time to finish
assignments/tests• Quiet room to finish
assignments/tests• Not going to noisy areas
like the cafeteria, assembly
halls, sporting events, musicclass, shop class, etc.

• Taking lots of breaks duringclass, homework, tests• No more than one exam/day• Shorter assignments• Repetition/memory cues
• Use of a student helper/tutor• Reassurance from teachersthat the child will be supported
while getting better

The child should not go back to sports until they are back to school/
learning, without symptoms getting significantly worse and no longer
needing any changes to their schedule.

There should be at least 24 hours (or longer) for each step of the progression.
If any symptoms worsen while exercising, the athlete should go back to
the previous step. Resistance training should be added only in the laterstages (Stage 3 or 4 at the earliest). The athlete should not return tosport until the concussion symptoms have gone, they have successfully
returned to full school/learning activities, and the healthcare professional
has given the child written permission to return to sport.
If the child has symptoms for more than a month, they should ask to bereferred to a healthcare professional who is an expert in the managementof concussion.

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© Concussion in Sport Group 2017Child SCAT5© Concussionin Sport Group 2017
Davis GA, et al. Br J Sports
Med 2017;0:1–8.
doi:10.1136/bjsports-2017-097492childscat5

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Sport concussion assessment tool forchildrens ages 5 to 12 years
Br J Sports Med published online April 26, 2017

Updated information and services can be found at:
http://bjsm.bmj.com/content/early/2017/04/26/bjsports-2017-097492c
hildscat5.citation

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