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BJSM Online First, published on April 26, 2017 as 10.1136/bjsports-2017-097506SCAT5
To download a clean version of the SCAT tools please visit the journal online (http://dx.doi.org/10.1136/bjsports-2017-097506SCAT5)SCAT5SPORT CONCUSSION ASSESSMENT TOOL — 5TH EDITION©

DEVELOPED BY THE CONCUSSION IN SPORT GROUPFOR USE BY MEDICAL PROFESSIONALS ONLY
supported by

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

Time:

WHAT IS THE SCAT5?

Key points

The SCAT5 is a standardized tool for evaluating concussions
designed for use by physicians and licensed healthcare
professionals1. The SCAT5 cannot be performed correctlyin less than 10 minutes.

• 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
SCAT5 is to be used for evaluating athletes aged 13 years
and older. For children aged 12 years or younger, please
use the Child SCAT5.
Preseason SCAT5 baseline testing can be useful forinterpreting post-injury test scores, but is not required forthat purpose.Detailed instructions for use of the 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.
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.

Recognise and Remove
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.

• If an athlete is suspected of having a concussion andmedical personnel are not immediately available, theathlete should be referred to a medical facility for urgent
assessment.
• Athletes with suspected concussion should not drink
alcohol, use recreational drugs and should not drive a motor
vehicle until cleared to do so by a medical professional.
• 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 SCAT5 should NOT
be used by itself to make, or exclude, the diagnosis ofconcussion. An athlete may have a concussion even if
their SCAT5 is “normal”.
Remember:• 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.
• Assessment for a spinal cord injury is a critical part of theinitial on-field assessment.
• Do not remove a helmet or any other equipment unlesstrained to do so safely.

© Concussion in Sport Group 2017
SCAT5
Concussiondoi:10.1136/bjsports-2017-097506SCAT5
in Sport Group 2017
Davis GA, et al. Br J Sports
Med ©
2017;0:1–8.

1

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Name:

IMMEDIATE OR ON-FIELD ASSESSMENT

DOB:

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 Maddocks questions and cervical spine exam are criticalsteps of the immediate assessment; however, these do 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
headacheID number:
Examiner:
Date:

STEP 4: EXAMINATIONGLASGOW COMA SCALE (GCS)3
Time of assessment
Date of assessment

Best eye response (E)No eye opening

1

1

1

Eye opening in response to pain

2

2

2

Eye opening to speech

3

3

3

Eyes opening spontaneously

4

4

4

•

Seizure or convulsion

Best verbal response (V)•Loss of consciousness

No verbal response

1

1

1

•

Deteriorating
conscious state

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

•

Vomiting•

Increasingly restless,agitated or combative

Best motor response (M)STEP 2: OBSERVABLE SIGNS
Witnessed 

Address:

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

Glasgow Coma score (E + V + M)

STEP 3: MEMORY ASSESSMENTMADDOCKS QUESTIONS2“I am going to ask you a few questions, please listen carefully andgive your best effort. First, tell me what happened?”

CERVICAL SPINE ASSESSMENT

Mark Y for correct answer / N for incorrect
What venue are we at today?

Y

N

Which half is it now?

YN

Who scored last in this match?

Y

N

What team did you play last week / game?

YN

Did your team win the last game?

YN

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

Note: Appropriate sport-specific questions may be substituted.

2

© Concussion in Sport Group 2017
SCAT5
Concussiondoi:10.1136/bjsports-2017-097506SCAT5
in Sport Group 2017
Davis GA, et al. Br J Sports
Med ©
2017;0:1–8.

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OFFICE OR OFF-FIELD ASSESSMENT
Please note that the neurocognitive assessment should be done in a
distraction-free environment with the athlete in a resting state.

Name:
DOB:
Address:

STEP 1: ATHLETE BACKGROUND

ID number:
Examiner:

Sport / team / school:

Date:

Date / time of injury:
Years of education completed:

2

Age:
Gender: M / F / Other

STEP 2: SYMPTOM EVALUATION

Dominant hand: left / neither / right

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 forthe post injury assessment the athlete should rate their symptoms at this point in time.

How many diagnosed concussions has theathlete had in the past?:

Please Check: When was the most recent concussion?:

Post-Injury

Please hand the form to the athlete

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

Baseline (days)none

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

Yes

Diagnosed / treated for headache disorder or migraines?

Diagnosed with a learning disability / dyslexia?

Diagnosed with ADD / ADHD?

Yes

Yes

Yes

Diagnosed with depression, anxiety
or other psychiatric disorder?

Yes

Current medications? If yes, please list:

No

No

No

No

No

mild

moderatesevereHeadache

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

Nausea or vomiting

0

1

2

3

4

5

6

Dizziness

0

1

2

3

4

5

6

Blurred vision

0

1

2

3

4

5

6

Balance problems

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

Feeling slowed down

0

1

2

3

4

5

6

Feeling like “in a fog“

0

1

2

3

4

5

6

“Don’t feel right”

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

Fatigue or low energy

0

1

2

3

4

5

6

Confusion

0

1

2

3

4

5

6

Drowsiness

0

1

2

3

4

5

6

More emotional

0

1

2

3

4

5

6

Irritability

0

1

2

3

4

5

6

Sadness

0

1

2

3

4

5

6

Nervous or Anxious

0

1

2

3

4

5

6

Trouble falling asleep(if applicable)

0

1

2

3

4

5

6

Total number of symptoms:of 22

Symptom severity score:of 132

Do your symptoms get worse with physical activity?

YN

Do your symptoms get worse with mental activity?

YN

If 100% is feeling perfectly normal, whatpercent of normal do you feel?
If not 100%, why?

Please hand form back to examiner© Concussion in Sport Group 2017
SCAT5
Concussiondoi:10.1136/bjsports-2017-097506SCAT5
in Sport Group 2017
Davis GA, et al. Br J Sports
Med ©
2017;0:1–8.

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Name:

STEP 3: COGNITIVE SCREENING

DOB:

Standardised Assessment of Concussion (SAC)4

Address:

ORIENTATION

ID number:
Examiner:

What month is it?

0

1

What is the date today?

0

1

What is the day of the week?

0

1

What year is it?

0

1

What time is it right now? (within 1 hour)

0

1

DIGITS BACKWARDS

of 5

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.

Orientation score

CONCENTRATION

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.

IMMEDIATE MEMORYThe 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.
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

Date:

Alternate 5 word lists
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

of 15Time that last trial was completedConcentration Number Lists (circle one)
List A

List B

List C

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

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

1-6-8-3

YN

0

9-7-2-3

2-1-6-93-9-2-4

YN

1

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

4-2-7-9-3-8

3-1-7-8-2-6

Y

N

1

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

CarpetSaddleBubbleJacketArrow

Pepper

CottonMovie

DollarHoney

Mirror

SaddleDigits Score:

MONTHS IN REVERSE ORDER
Now tell me the months of the year in reverse order. Start with the last month and go backward.
So you’ll say December, November. Go ahead.
Dec - Nov - Oct - Sept - Aug - Jul - Jun - May - Apr - Mar - Feb - Jan

0 1

Months Score

of 1

Concentration Total Score (Digits + Months)of 5

AnchorImmediate Memory Score

of 4

of 30

Time that last trial was completed4

© Concussion in Sport Group 2017
SCAT5
Concussiondoi:10.1136/bjsports-2017-097506SCAT5
in Sport Group 2017
Davis GA, et al. Br J Sports
Med ©
2017;0:1–8.

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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 (mBESS) 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)of 10

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

Total Errors

of 30

Total number of words recalled accurately:

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
number (of 22)

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

Symptom severity
score (of 132)

If re-testing, has the athlete improved?

Orientation (of 5)
Immediate memory

 Yes  No  Unsure  Not Applicable
of 15

of 15

of 15

of 30

of 30

of 30

NormalAbnormal

NormalAbnormal

NormalAbnormalConcentration (of 5)
Neuro exam

Signature:
Name:
Title:

Balance errors (of 30)
Delayed Recall

I am a physician or licensed healthcare professional and I have personallyadministered or supervised the administration of this SCAT5.

of 5

of 5

of 5

of 10

of 10

of 10

Registration number (if applicable):
Date:

SCORING ON THE SCAT5 SHOULD NOT BE USED AS A STAND-ALONEMETHOD TO DIAGNOSE CONCUSSION, MEASURE RECOVERY OR
MAKE DECISIONS ABOUT AN ATHLETE’S READINESS TO RETURN TO
COMPETITION AFTER CONCUSSION.
© Concussion in Sport Group 2017
SCAT5
Concussiondoi:10.1136/bjsports-2017-097506SCAT5
in Sport Group 2017
Davis GA, et al. Br J Sports
Med ©
2017;0:1–8.

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CLINICAL NOTES:

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

CONCUSSION INJURY ADVICE(To be given to the person monitoring the concussed athlete)Clinic phone number:This patient has received an injury to the head. A careful medical
examination has been carried out and no sign of any serious
complications has been found. Recovery time is variable acrossindividuals and the patient will need monitoring for a further period by a responsible adult. Your treating physician will provide
guidance as to this timeframe.

Patient’s name:

If you notice any change in behaviour, vomiting, worsening headache, double vision or excessive drowsiness, please telephone
your doctor or the nearest hospital emergency department
immediately.

Healthcare Provider:

Date / time of injury:
Date / time of medical review:

Other important points:
Initial rest: Limit physical activity to routine daily activities (avoid
exercise, training, sports) and limit activities such as school,
work, and screen time to a level that does not worsen symptoms.
1) Avoid alcohol
2) Avoid prescription or non-prescription drugs
without medical supervision. Specifically:© Concussion in Sport Group 2017a) Avoid sleeping tabletsb) Do not use aspirin, anti-inflammatory medication
or stronger pain medications such as narcotics
3) Do not drive until cleared by a healthcare professional.
4) Return to play/sport requires clearance
by a healthcare professional.

6

SCAT5
Concussiondoi:10.1136/bjsports-2017-097506SCAT5
in 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 SCAT5 are the instructions given to the athlete by the clinician
Symptom Scale
The time frame for symptoms should be based on the type of test being administered. At baseline it is advantageous to assess how an athlete “typically” feels
whereas during the acute/post-acute stage it is best to ask how the athlete feelsat the time of testing.
The symptom scale should be completed by the athlete, not by the examiner. In
situations where the symptom scale is being completed after exercise, it should
be done in a resting state, generally by approximating his/her resting heart rate.
For total number of symptoms, maximum possible is 22 except immediately post
injury, if sleep item is omitted, which then creates a maximum of 21.
For Symptom severity score, add all scores in table, maximum possible is 22 x 6= 132, except immediately post injury if sleep item is omitted, which then createsa maximum of 21x6=126.

Immediate Memory
The Immediate Memory component can be completed using the traditional 5-word
per trial list or, optionally, using 10-words per trial. The literature suggests that
the Immediate Memory has a notable ceiling effect when a 5-word list is used. In
settings where this ceiling 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 per trial is 10 with a total trial maximum of 30.
Choose one of the word lists (either 5 or 10). Then perform 3 trials of immediate
memory using this list.

one error is recorded but the athlete should quickly return to the testing position, andcounting should resume once the athlete is set. Athletes that are unable to maintainthe testing procedure for a minimum of five seconds at the start are assigned thehighest possible score, ten, for that testing condition.
OPTION: For further assessment, the same 3 stances can be performed on a surfaceof medium density foam (e.g., approximately 50cm x 40cm x 6cm).

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“I am now going to test your balance. Please take your shoes off (if applicable), roll up
your pant legs above ankle (if applicable), and remove any ankle taping (if applicable).
This test will consist of three twenty second tests with different stances.“(a) Double leg stance:“The first stance is standing with your feet together with your hands on your hips
and with your eyes closed. You should try to maintain stability in that position for 20
seconds. I will be counting the number of times you move out of this position. I will
start timing when you are set and have closed your eyes.“(b) Single leg stance:“I am going to test your memory. I will read you a list of words and when I am done,
repeat back as many words as you can remember, in any order.” The words must beread at a rate of one word per second.

“If you were to kick a ball, which foot would you use? [This will be the dominantfoot] Now stand on your non-dominant foot. The dominant leg should be held in
approximately 30 degrees of hip flexion and 45 degrees of knee flexion. Again, you
should try to maintain stability for 20 seconds with your hands on your hips and youreyes closed. I will be counting the number of times you move out of this position. If
you stumble out of this position, open your eyes and return to the start position andcontinue balancing. I will start timing when you are set and have closed your eyes.“

Trials 2 & 3 MUST be completed regardless of score on trial 1 & 2.

(c) Tandem stance:

Trials 2 & 3:

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.

“Now stand heel-to-toe with your non-dominant foot in back. Your weight should beevenly distributed across both feet. Again, you should try to maintain stability for 20
seconds with your hands on your hips and your eyes closed. I will be counting thenumber of times you move out of this position. If you stumble out of this position,
open your eyes and return to the start position and continue balancing. I will starttiming when you are set and have closed your eyes.”

Concentration

Tandem Gait

Digits backward

Participants are instructed to stand with their feet together behind a starting line(the test is 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 metreline with an alternate foot heel-to-toe gait ensuring that they approximate their heel
and toe on each step. Once they cross the end of the 3m line, they turn 180 degrees
and return to the starting point using the same gait. Athletes fail the test if they
step off the line, have a separation between their heel and toe, or if they touch or
grab the examiner or an object.

Complete all 3 trials regardless of score on previous trials.

“I am going to repeat the same list again. Repeat back as many words as you canremember in any order, even if you said the word before.“

Choose one column of digits from lists A, B, C, D, E or F and administer those digits
as follows:
Say: “I am going to read a string of numbers and when I am done, you repeat themback 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.”
Begin with first 3 digit string.

Finger to Nose

If correct, circle “Y” for correct and go to next string length. If incorrect, circle “N” forthe first string length and read trial 2 in the same string length. One point possible
for each string 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.

Months in reverse order“I am going to test your coordination now. Please sit comfortably on the chair withyour eyes open and your arm (either right or left) outstretched (shoulder flexed to
90 degrees and elbow and fingers extended), pointing in front of you. When I givea 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, and then return to the starting
position, as quickly and as accurately as possible.”“Now tell me the months of the year in reverse order. Start with the last month andgo backward. So you’ll say December, November ... Go ahead”

References

1 pt. for entire sequence correct

1.

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

The delayed recall should be performed after 5 minutes have elapsed since the endof the Immediate Recall section.

2.

Maddocks, DL; Dicker, GD; Saling, MM. The assessment of orientation following
concussion in athletes. Clinical Journal of Sport Medicine 1995; 5: 32-33“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.“3.

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

4.

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

5.

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

Delayed Recall

Score 1 pt. for each correct response

Modified Balance Error Scoring System (mBESS)5 testingThis balance testing is based on a modified version of the Balance Error Scoring
System (BESS)5. A timing device is required for this testing.
Each of 20-second trial/stance is scored by counting the number of errors. The
examiner will begin counting errors only after the athlete has assumed the proper
start position. The modified BESS is calculated by adding one error point for eacherror during the three 20-second tests. The maximum number of errors for any
single condition is 10. If the athlete commits multiple errors simultaneously, only

© Concussion in Sport Group 2017
SCAT5
Concussiondoi:10.1136/bjsports-2017-097506SCAT5
in Sport Group 2017
Davis GA, et al. Br J Sports
Med ©
2017;0:1–8.

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CONCUSSION INFORMATION
Any athlete suspected of having a concussion should be removed fromplay and seek medical evaluation.

Signs to watch for
Problems could arise over the first 24-48 hours. The athlete should not beleft alone and must go to a hospital at once if they experience:• Worsening
headache• Drowsiness orinability to be
awakened• Inability torecognize peopleor places• Repeated vomiting• Unusual behaviouror confusion
or irritable• Seizures (armsand legs jerk
uncontrollably)• Weakness or
numbness inarms or legs
• Unsteadinesson their feet.
• Slurred speechConsult your physician or licensed healthcare professional after a suspected concussion. Remember, it is better to be safe.

Rest & Rehabilitation
After a concussion, the athlete should have physical rest and relative
cognitive rest for a few days to allow their symptoms to improve. In mostcases, after no more than a few days of rest, the athlete should gradually
increase their daily activity level as long as their symptoms do not worsen.
Once the athlete is able to complete their usual daily activities without
concussion-related symptoms, the second step of the return to play/sport
progression can be started. The athlete should not return to play/sportuntil their concussion-related symptoms have resolved and the athlete
has successfully returned to full school/learning activities.
When returning to play/sport, the athlete should follow a stepwise,
medically managed exercise progression, with increasing amounts ofexercise. For example:

Graduated Return to Sport Strategy
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.

Graduated Return to School Strategy
Concussion may affect the ability to learn at school. The athlete mayneed to miss a few days of school after a concussion. When going backto school, some athletes may need to go back gradually and may need tohave some changes made to their schedule so that concussion symptoms
do not get worse. If a particular activity makes symptoms worse, then theathlete should stop that activity and rest until symptoms get better. To
make sure that the athlete can get back to school without problems, it isimportant that the healthcare provider, parents, caregivers and teachers
talk to each other so that everyone knows what the plan is for the athlete
to go back to school.
Note: If mental activity does not cause any symptoms, the athlete may
be able to skip step 2 and return to school part-time before doing school
activities at home first.
Goal ofeach step

Mental Activity

Activity at each step

1. Daily activities
that donot givethe athlete
symptoms

Typical activities that the athlete
does 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.

3. Return toschoolpart-time

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

Increaseacademic
activities.

4. Return toschoolfull-time

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

Return to fullacademic
activities andcatch up on
missed work.

If the athlete continues to have symptoms with mental activity, someother accomodations that can 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 athlete 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.

In this example, it would be typical to have 24 hours (or longer) for eachstep of the progression. If any symptoms worsen while exercising, theathlete should go back to the previous step. Resistance training should
be added only in the later stages (Stage 3 or 4 at the earliest).
Written clearance should be provided by a healthcare professional before
return to play/sport as directed by local laws and regulations.

8© Concussion in Sport Group 2017
SCAT5
Concussiondoi:10.1136/bjsports-2017-097506SCAT5
in Sport Group 2017
Davis GA, et al. Br J Sports
Med ©
2017;0:1–8.

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Downloaded from http://bjsm.bmj.com/ on December 1, 2017 - Published by group.bmj.com

Sport concussion assessment tool - 5theditionBr J Sports Med published online April 26, 2017

Updated information and services can be found at:
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