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What it measures:

The SCAT 3 tool is used to assess concussions in athletes who are aged 13 years or older. The test has 8 subcomponents that are measured in the following order:

1. Glascow Coma Scale (GCS): Assesses level of consciousness;
Score range = 3 points (worst)–15 points (best)

2. Maddocks Score: Assesses orientation to time and place

3. Post-Concussion Symptom Scale (PCSS): Assesses concussion symptom severity;
Symptom severity = 0 points (best)–132 points (worst);
Total number of symptoms = 0 points (best)–22 points (worst)

4. Standard Assessment of Concussion (SAC): Assesses orientation, immediate memory, and concentration abilities;
Orientation score = 0 points (worst)–5 points (best)
Immediate memory score = 0 points (worst)–15 (best)
Concentration score = 0 points (worst)–5 (best)

5. Neck Examination: Assesses neck ROM, tenderness, and upper/lower extremity strength and sensation;6. Qualitative findings based on range of motion, tenderness, upper and lower limb
sensation strength

6. Modified Balance Error Scoring System (mBESS):
Number of errors for double-leg stance, single-leg stance (nondominant foot), tandem
stance (nondominant foot behind); test tandem in seconds (best of 4 trials)

7. Coordination examination (finger-to-nose test):
Out of 1, list which arm was tested

8. SAC delayed recall: Patient asked to recall the list of words given earlier;
Delayed recall score = 0 points (worst)–5 points (best)

The Child-Scat3 tool is used to evaluate concussions in athletes aged 5 to 13 years. There are 9 areas tested.1 Some are the same as the SCAT3 and some are specific to the Child-Scat (3).

1. Glasgow Coma Scale (GCS): same as SCAT3

2. Child-Maddocks Score: same as SCAT3

3. Child Report: Reviews total number of symptoms (maximum 20) and severity of symptoms (maximum 60) as stated by the child. For each possible symptom and severity, child will rate on a scale of 0 (never)–3 (often).

4. Parent Report: Reviews total number of symptoms (maximum 20) and severity of symptoms (maximum 60) as stated by the parent of the child. For each possible symptom and severity, parent will rate on a scale of 0 (never)–3 (often)

5. Standardized Assessment of Concussion - Child Version (SAC-C): Questions and activities that assess the child’s orientation, immediate memory, and concentration. Best score for this section is 25. Listed below is how to perform each of the 3 assessments. Orientation: 4 questions, each worth 1 point when answered correctly, for a total of 4 at best; Immediate memory: Child must repeat 5 words for 3 trials, receiving 1 point each time they get the word right for a total of 15 points at best; Concentration: Child is given a list of 5 different sequences of numbers they must repeat backward. For each sequence the child can repeat backward, they receive 1 point; child must also say the days of the week in reverse order correctly for 1 point. End total is 6 points at best.

6. Neck Examination: same as SCAT3

7. Modified Balance Error Scoring System (mBESS) Testing: same as SCAT3, without performing single-leg stance

8. Coordination Exam: same as SCAT3

9. SAC Delayed Recall: same as SCAT3

Target Population:

This summary contains information on the use of the SCAT 3 in patients or clients aged 13 years or older, and the Child-SCAT3 in patients or clients aged 5-12 years, with a possible concussion.

In the previous version of the SCAT (SCAT 2), the total score was reported; however, the total score is not reported in the SCAT 3. The data provided for this document was taken from studies conducted on the individual subcomponents of the SCAT 3. Note that the data from each subcomponent are reported individually below.

The Post-Concussion Symptom Scale is specific to the SCAT 2 and SCAT 3; however, there is little to no evidence regarding the use of this specific scale to evaluate concussion symptoms. There are several other scales that are used for postconcussion symptom evaluation. The scale that was most similar to the PCSS in the literature was the Post-Concussion Scale (PCS). (1) This was determined by examining the similarities between the symptom qualifiers. The PCSS in the SCAT 3 contains 22 items based on a 7-point Likert scale, and the PCS contains 21 items based on a 7-point Likert scale. Due to the lack of nonnormative data on the PCSS, some of the data in this document on symptom severity refers to the PCS.

The SCAT 3 also contains a modified version of the BESS. The modified BESS that is part of the SCAT 3 only includes assessment of balance on a firm surface. The BESS includes assessment of balance in double leg, single leg, and tandem stance on both a firm surface and a foam surface.

The Child-Scat3 is the first modification of the SCAT intended for children. A Child SCAT5 was released in April 2017, but there has not been research done to date to assess it and this summary will not contain information regarding the Child SCAT5. The Child-Scat3 was introduced following the 4th International Conference on Concussions in Sport in Zurich, Switzerland, in 2012 for children younger than 12 years of age. The Child-Scat3 creates a less demanding SAC concentration subsection and age-appropriate modifications in symptom wording. (3) Several areas of the SCAT2 have been modified to create the Child-Scat3 to make the test more appropriate for children. These modifications are outlined in the ‘Measures’ section above.

Clinical Insights

The Child-Scat3 is a reliable and appropriate concussion tool for individuals 5-12 years of age. During a study comparing baseline scores among middle and high school student athletes using the SCAT2, 12-year-old athletes had the lowest percentage of correct responses for the concentration 5 digit, 6 digit string, and months backward tasks compared to the older age groups. A linear trend in percentage of correct responses was evident in these tasks as the ages increased. With this information, Child-Scat3 was found to be a justified approach to assessing concussions among younger children.3 Child-Scat3 would be a suitable tool to have in an elementary and middle school setting for students, especially for student athletes who engage in contact sports.

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