Table 1

The Strength of Recommendation Taxonomy (SORT) classification of included studies

TopicSORTRecommendations
Global symptom scalesB
C
PCSS to assess concussive symptoms in ≥13 years and HBI for 8–12 years (to mirror SCAT6 and Child SCAT6)
Include additional symptoms to qualify nature of symptoms
Balance/postural stabilityB
B
B
mBESS as part of SCAT in initial time period (3–5 days); 4 point errors for each component as diagnostic cut point
Timed tandem gait (3 m) distinguishes concussed versus controls
Dual tasking gait discriminates up to 7–14 days; mark 3 m line for tandem gait with 1 of the following tasks:
(1) backward spelling of a 5 letter word; (2) serial subtraction by 7 from a 2 digit number or (3) reciting months in reverse. For children (<12 years): (1) spelling a 4 letter word backwards; (2) serial 3 subtractions; or (3) days of the week backwards.
CognitionB
B
CNTs most useful in early time period and degrade in ability to discriminate concussed and controls at 7–14 days
Divided attention tasks may assist in discrimination of concussed/control
Emerging TechnologyCHighly variable, not widely available, costly and of uncertain additional benefit
Vestibulo-ocularBVOMS useful as screening tool in subacute time period (0–10 days); only vertical VOR and VMS portion of VOMS at days 8–14; include 4-item version of the VOMS (mVOMS) (smooth pursuits, horizontal saccades, horizontal VOR, VMS)
Depression/anxietyCScreening for depression/anxiety using established tools; include PHQ-2, GAD-7 and ASSQ
Exercise stress testsBBCTT or BCBT can be used to differentiate concussed and controls 5–10 days after concussion and recommended as an optional inclusion
Multifaceted assessmentBMultifaceted physical examination to differentiate concussed and controls (including neurological screen, OM, cervical spine assessment, HTT, dynamic balance (including tandem gait), mBESS, neurocognitive testing) up to 10–14 days postinjury
SCAT5/Child SCAT5BMost useful early following concussion (<3–5 days) and can be used in absence of baseline test
Divided attentionBDiscriminates between concussed athletes and controls
  • ASSQ, athlete sleep screening questionnaire; BCBT, Buffalo Concussion Bike Test; BCTT, Buffalo Concussion Treadmill Test; CNT, computerised neurocognitive tool; GAD-7, generalised anxiety disorder 7-item; HBI, health and behaviour inventory score; HTT, head thrust test; mBESS, modified Balance Error Scoring System; OM, oculomotor; PCSS, Post-Concussion Symptom Scale; PHQ-2, patient health questionnaire 2; SCAT5, Sport Concussion Assessment Tools 5; VMS, visual motion sensitivity; VOMS, vestibular ocular motor screening; VOR, vestibular ocular reflex.