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
Objectives Several iterations of the Sport Concussion Assessment Tool ( SCAT ) have been published over the past 16 years .
Our goal was to systematic ally review the literature related to the SCAT and provide recommendations for improving the tool .
Adding Vision to Concussion Testing: A Prospective Study of Sideline Testing in Youth and Collegiate Athletes
Background : Sports-related concussion commonly affects the visual pathways . Current sideline protocol s test cognition and balance but do not include assessment s of visual performance . We investigated how adding a vision-based test of rapid number naming could increase our ability to identify concussed athletes on the sideline at youth and collegiate levels . Methods : Participants in this prospect i ve study included members of a youth ice hockey and lacrosse league and collegiate athletes from New York University and Long Isl and University . Athletes underwent preseason baseline assessment s using : 1 ) the King – Devick ( K-D ) test , a < 2-minute visual performance measure of rapid number naming , 2 ) the St and ardized Assessment of Concussion ( SAC ) , a test of cognition , and 3 ) a timed t and em gait test of balance .  The SAC and timed t and em gait are components of the currently used Sport Concussion Assessment Tool , 3rd Edition ( SCAT3 and Child-SCAT3 ) . In the event of a concussion during the athletic season , injured athletes were retested on the sideline/rink-side . Nonconcussed athletes were also assessed as control participants under the same testing conditions . Results : Among 243 youth ( mean age 11 ± 3 years , range 5–17 ) and 89 collegiate athletes ( age 20 ± 1 years , range 18–23 )  , baseline time scores for the K-D test were lower ( better ) with increasing participant age ( P < 0.001 , linear regression models ) . Among 12 athletes who sustained concussions during their athletic season , K-D scores worsened from baseline by an average of 5.2 seconds ; improvement by 6.4 seconds was noted for the nonconcussed controls ( n = 14 ) . The  vision-based K-D test  showed the greatest capacity to distinguish concussed vs control athletes based on changes from preseason baseline to postinjury ( receiver operating characteristic [ ROC ] curve areas from logistic regression models , accounting for age = 0.92 for K-D , 0.87 for timed t and em gait , and 0.68 for SAC ; P = 0.0004 for comparison of ROC curve areas ) . Conclusions : Adding a vision-based performance measure to cognitive and balance testing enhances the detection capabilities of current sideline concussion assessment . This observation in patients with mild traumatic brain injury reflects the common involvement and widespread distribution of brain pathways dedicated to vision
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
Objectives Several iterations of the Sport Concussion Assessment Tool ( SCAT ) have been published over the past 16 years .
Our goal was to systematic ally review the literature related to the SCAT and provide recommendations for improving the tool .