Context and Objective Decision rules such as the Canadian CT Head Rule (CCHR), for adults, and PECARN rule, for children/adolescents, are used in emergency settings (ER-rules) to assess traumatic brain injuries (TBI). These ER-rules have a high sensitivity (99% for PECARN and 98% for CCHR) and near perfect negative predictive value that allow to rule out more severe TBI and enable management without obtaining brain imaging (CT scan). The objective was to identify what criteria would need to be added to the SCAT5 to achieve the sensitivity of the ER-rules.

Design Criteria-based comparative analysis of the SCAT5 with the CCHR and PECARN rules used in emergency room settings.

Outcomes The presence (yes or no) and comparative ‘face-value’ sensitivity (lower, identical or higher) of the SCAT5 criteria were compared to those found in the ER-rules.

Results Loss of consciousness, vomiting, severe/increasing headache, and seizure are SCAT ‘red flags’ with similar or higher sensitivity compared to ER-rules criteria. Several of the ER-rules criteria are covered by the Glasgow coma scale (GCS), but only deterioration of the GCS score is considered a ‘red flag’ in the SCAT5. Persistent retrograde amnesia for more than 30 minutes is not listed as a red flag in the SCAT5. Coagulopathy, severity of the mechanism of injury, and signs of skull fractures are not mentioned in the SCAT5.

Conclusion This analysis identifies potential evidence-informed signs and symptoms that could improve the sensitivity of the ‘red flags’ listed in the SCAT to rule out more severe forms of TBI.