SCAT5 Offers More Guidance for Concussion Management

Ruth McDonald, MD
Vice President and Associate Chief Medical Officer, Medical Operations
Seattle Children’s

Each year, somewhere between 1.1 million and 1.7 million kids sustain a sports- or recreation-related concussion.

The SCAT5 (Sport Concussion Assessment Tool), released in 2017, provides improved guidance for immediate on-field assessment, clinical follow up, and guidance for return to school, work and play.

The SCAT5 is for athletes 13 years and older. The Child SCAT5, for 5 to 12 year olds, removes items that are difficult young kids at baseline (like standing on one leg or reading words aloud).

Among the helpful aspects of the updated tool are:

  1. A four-step evaluation for on-field assessment or the initial in-office assessment (the utility of this evaluation decreases after 3 to 5 days) on the first page.
  2. The athlete/patient is to read aloud the symptom checklist during clinical follow up and assess each symptom currently and how it compares to baseline.
  3. The new tool adds more words to the immediate and delayed recall.
  4. The strategies for gradual return to school and return to play help providers and parents work with schools and coaches.

A few things to keep in mind
There is insufficient evidence that complete rest – which had long been a cornerstone of concussion management – is helpful. Returning to normal rhythms of school (with appropriate modifications) and light, straight-line activities (like walking) as long as symptoms do not worsen, are the current recommendations. The SCAT5 has guidance for this.

Student athletes should be back to school full-time without additional accommodations beyond their baseline prior to clearance for return to competition.

The severity of the initial symptoms is the most consistent predictor of prolonged or persistent symptoms. Most concussions in kids resolve in less than two weeks, with the vast majority resolving by 4 weeks.

The first concussion is a risk factor for future concussions in the same way that one ankle sprain makes subsequent ankle sprains more likely.

Contact sports aren’t the only risk of brain injury or concussion: There are greater risks for TBI from riding a bicycle, walking on the street, or being in an automobile accident than playing high school football.

When to refer
Refer to a specialist or ED for immediate evaluation for:

  • Worsening headache
  • Drowsiness or inability to be awakened
  • Inability to recognize people or places
  • Repeated vomiting
  • Unusual behavior or confusion or irritability
  • Seizures (arms and legs jerk uncontrollably)
  • Unsteadiness on feet
  • Slurred speech
  • Focal neurological findings

You might also refer to a specialist for symptoms that last more than four weeks, significant comorbidities or at your discretion.

Kids and teens need to be active throughout their childhoods and later lives to be healthy. Ensuring a full recovery of the current concussion is the best prevention for a future concussion or head injury.