Topic | SORT | Recommendations |
Global symptom scales | B 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 stability | B 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. |
Cognition | B 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 Technology | C | Highly variable, not widely available, costly and of uncertain additional benefit |
Vestibulo-ocular | B | VOMS 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/anxiety | C | Screening for depression/anxiety using established tools; include PHQ-2, GAD-7 and ASSQ |
Exercise stress tests | B | BCTT or BCBT can be used to differentiate concussed and controls 5–10 days after concussion and recommended as an optional inclusion |
Multifaceted assessment | B | Multifaceted 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 SCAT5 | B | Most useful early following concussion (<3–5 days) and can be used in absence of baseline test |
Divided attention | B | Discriminates 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.