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GUIDELINE ALERT: NEW 'mandatory' assessment tool for concussions updated this year.


Not yet in print: SCAT 5 now available

SNAP SAMP:

  1. List NINE red flags for a pediatric patient with concussion that indicate higher likelihood for neurosurgical intervention.

  2. List FIVE important recommendations to make when counseling a patient with concussion regarding return to school.

  3. List FIVE important recommendations to make

when counseling a patient with concussion regarding return to sport.

  1. List the 11 “R”s of Sport-Related Concussion management.

Answers are in the blog below or the linked articles.

I was recently told by a sports medicine expert that when he consults on medico-legal cases related to concussion, the first thing he checks for is whether the doctor used a Sport Concussion Assessment Tool (SCAT) questionnaire - what he considers to be a mandatory part of concussion care.

If you are up to date with your concussion management, you are evaluating and following up with your patients using the SCAT3 - until now.

The British Medical Journal of Sports Medicine has just released the latest version, the SCAT5, available online as it has not yet been printed.

No, you didn’t miss the SCAT4

Before discussing the changes, you must be asking what happened to the SCAT4 since the previous edition of the SCAT was the SCAT3. The SCAT5 is the next version, and no, there was no SCAT4 - the number 5 comes from the “5th International Consensus Conference on Concussion in Sport” where the SCAT5 was developed.

What’s changed?

The SCAT5 is actually two tools, the SCAT5 and the Child SCAT5. Changes for the child version are detailed in the consensus statement, and some of these changes include:

  • RED FLAGS of concussion on Page 2

  • Addition of a Rapid Neurological Screen (RNS)

  • Updated information on the Return to School

Alliteration Aids Awareness and Appropriate Action

The adult version consensus statement includes an updated definition of concussion, and the alliteration fans on the guideline writing team summarize the management into the 11 Rs of sport-related concussion:

Recognise; Remove; Re-evaluate; Rest; Rehabilitation; Refer; Recover; Return to sport; Reconsider; Residual effects and sequelae; Risk reduction.

Key points from the consensus statement:

  • Recommend prevention and baseline SCAT5 testing for athletes

  • Know the definition of persistent symptoms: >10-14 days in adults, >4 weeks in children, and how to manage these

  • List appropriate referrals for a patient with persistent symptoms, including multidisciplinary care by experts in psychological, cervical, and vestibular rehabilitation and neuropsychological testing

  • Diagnosis is still based on clinical assessment and ruling out sinister diagnoses that mimic concussion (such as neck injury or brain bleed). Biomarkers are being researched but not yet recommended for mainstream use.

EXAM TIP: On an exam, don’t forget to say you would remove the concussed athlete from sport! Sometimes the most obvious points are the most easily missed.

Download the Child SCAT5 here.

Download the SCAT5 here.

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