Introduction: The Need for a Reliable Concussion Test

When someone sustains a potential concussion, having a quick and reliable evaluation method is crucial. That’s where the SCAT6 comes in. The Sport Concussion Assessment Tool – 6th Edition (SCAT6) is the latest gold standard for sideline concussion screening. It’s been endorsed by the international consensus on concussion in sport, updated in 2022 at the Amsterdam conference.

But what exactly does the SCAT6 evaluate? Who is it for? And how should clinicians and coaches use it?

In this article, we’ll walk through what the SCAT6 includes, how it differs from past versions, and its role in the broader concussion management protocol.

Note: As this is a quick look at SCAT6, see our full deep-dive by Matheau Denner here. 

 

What is the SCAT6?

The SCAT6 is a standardized clinical tool designed to screen for signs and symptoms of concussion immediately after a suspected injury. It’s intended for use by healthcare professionals within the first 72 hours post-injury.

The SCAT6 is NOT a diagnostic tool. It’s a screening tool that helps determine whether an athlete or individual requires further evaluation and removal from play.

Who is it for?

  • Athletes aged 13 and older (for younger children, the Child SCAT6 is used)
  • Healthcare professionals and sports medicine staff on the sidelines
  • NOT meant for self-diagnosis or untrained use

Components of the SCAT6

The SCAT6 includes multiple domains of assessment, which together give a comprehensive snapshot of a person’s neurological status. Here’s what it includes:

1. Red Flag Screening

Before anything else, the SCAT6 begins by identifying signs that require emergency medical attention, such as:

  • Worsening headache
  • Repeated vomiting
  • Increasing confusion or agitation
  • Seizure activity
  • Weakness or numbness
  • Deteriorating consciousness

These red flags indicate a potential brain bleed or more serious injury that requires immediate ER referral.

2. Observable Signs

Assesses for signs witnessed by staff or teammates:

  • Lying motionless
  • Balance/gait disturbance
  • Confusion
  • Blank or vacant stare

3. Symptom Checklist

Athletes rate the presence and severity of 22 symptoms, including:

  • Headache
  • Dizziness
  • Nausea
  • Feeling slowed down
  • Light or noise sensitivity
  • Fatigue

4. Cognitive Screening

Evaluates memory, orientation, and concentration. Includes:

  • Immediate memory (word recall)
  • Orientation (e.g., date, time, location)
  • Digits backward test
  • Months in reverse order

5. Neurological Exam

Includes assessments of:

  • Balance (tandem stance)
  • Coordination (finger-to-nose)
  • Pupil reactivity

6. Delayed Recall

  • Athlete is asked to recall the same word list from earlier to test short-term memory retention.

7. Standardized Assessment of Concussion (SAC) Score

  • Combines multiple cognitive tests into a composite score.

What’s New in the SCAT6?

The SCAT6 includes several updates over the SCAT5:

  • Better sensitivity for subtle cognitive impairments
  • Revised balance testing procedures
  • Added digital versions and integrations with apps
  • More specific instructions for administration and interpretation

These changes improve the tool’s accuracy, especially for identifying athletes who may not show overt signs immediately.

Limitations of the SCAT6

While the SCAT6 is a powerful tool, it has important limitations:

  • Must be used within 72 hours — not validated beyond that window
  • Should only be administered by trained professionals
  • Doesn’t rule out concussion if negative — further evaluation is still needed
  • Not designed for return-to-play clearance

A negative SCAT6 does not mean the athlete is concussion-free — it means further clinical evaluation is still warranted.

How the SCAT6 Fits Into a Broader Concussion Protocol

The SCAT6 is just the first step in a comprehensive concussion management process. Here’s how it fits:

  1. Initial Sideline Screening → SCAT6 to determine if athlete needs removal from play
  2. Follow-Up Evaluation → In-clinic testing (vestibular, vision, cervical, exertion)
  3. Recovery Monitoring → Use of Concussion Tracker App or EMR systems
  4. Return-to-Play Protocol → Gradual exertion-based stages, per latest guidelines

Related Reading

 

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Citations
  1. McCrory P, Feddermann-Demont N, Dvořák J, et al. What is the definition of sports-related concussion: a systematic review. Br J Sports Med. 2017;51(11):877–887.
  2. Echemendia RJ, Meeuwisse W, McCrory P, et al. The Sport Concussion Assessment Tool 6 (SCAT6): Expert working group review and consensus. Br J Sports Med. 2023;57(3):170–177.
  3. Davis GA, Purcell L, Schneider KJ, et al. The Child SCAT6: A standardized tool for evaluating concussion in children. Br J Sports Med. 2023;57(3):188–192.