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Evidence-based approach to revising the SCAT2: introducing the SCAT3
  1. Kevin M Guskiewicz1,
  2. Johna Register-Mihalik2,
  3. Paul McCrory3,
  4. Michael McCrea4,
  5. Karen Johnston5,
  6. Michael Makdissi6,
  7. Jiří Dvořák7,
  8. Gavin Davis8,
  9. Willem Meeuwisse9
  1. 1Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
  2. 2Clinical Research Unit, Emergency Services Institute, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
  3. 3The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
  4. 4Brain Injury Research Institute, Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Wisconsin, USA
  5. 5Neurosurgeon, Division of Neurosurgery, University of Toronto; Concussion Management Program Athletic Edge Sports Medicine, Toronto, Canada
  6. 6The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Campus, Melbourne, Australia
  7. 7FIFA Medical Assessment and Research Center, Zurich, Switzerland
  8. 8Department of Neurosurgery, Austin and Cabrini Hospitals & The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
  9. 9Sport Injury Prevention Research Centre, Kinesiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Kevin M Guskiewicz, Department of Exercise and Sport Science, Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700 USA; gus{at}email.unc.edu

Abstract

The Sport Concussion Assessment Tool 2 (SCAT2), which evolved from the 2008 Concussion in Sport Group (CISG) Consensus meeting, has been widely used internationally for the past 4 years. Although the instrument is considered very practical and moderately effective for use by clinicians who manage concussion, the utility and sensitivity of a 100-point scoring system for the SCAT2 has been questioned. The 2012 CISG Consensus Meeting provided an opportunity for several of the world's leading concussion researchers and clinicians to present data and to share experiences using the SCAT2. The purpose of this report is to consider recommendations by the CISG, and to review the current literature to identify the most sensitive and reliable concussion assessment components for inclusion in a revised version—the SCAT3. Through this process, it was determined that important clinical information can be ascertained in a streamlined manner through the use of a multimodal instrument such as the SCAT3. This test battery should include an initial assessment of injury severity using the Glasgow Coma Scale, immediately followed by observing and documenting concussion signs. Once this is complete, symptom endorsement and symptom severity, neurocognitive function and balance function should be assessed in any athlete suspected of sustaining a concussion. There is no evidence to support the use of a composite/total score; however, there is good evidence to support the use of each component (scored independently) in a revised assessment tool.

  • Athletics
  • Concussion
  • Contact sports
  • Head injuries
  • Neurology

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