CISG Tools
The New Generation Of Sport Concussion Tools
The CISG continues to commit to updating assessment and concussion recognition tools that are freely available. The new generation of sport concussion tools, namely the Concussion Recognition Tool (CRT6), Sport Concussion Assessment Tool (SCAT6®), and the Child Sport Concussion Assessment Tool (Child SCAT6®) have been developed based on a comprehensive systematic review and consensus processes, and were approved as part of the 2022 Amsterdam Consensus Conference. In order to enhance the utility of the tools beyond the acute phase of injury, a Sport Concussion Office Assessment Tool 6 (SCOAT6™) was developed for use in the subacute stages (post-72 hours) of concussion in adolescents and adults, with the Child SCOAT6™ serving the 8-12 age group. The SCOAT tools are intended for use by licensed healthcare providers in an office environment and are an extension of the SCAT6®, which assists in the evaluation of multiple functional domains to guide the clinician in comprehensive multimodal concussion assessment and management.
Electronic Application Platforms
A free CISG SCAT6® concussion testing app for iOS and Android devices (click to view and download)
Interested in Translating/Adapting the new Tools?
Please note that the SCAT® tools, including the SCOAT, may not be translated, adapted or digitized without approval from CISG/BJM. Please see the documents below to learn about the process required for obtaining permission:
- Translating and Adapting the SCAT® tools to Languages other than English (click to view)
- Application Procedure for CISG Approval for Reproduction or Adaptation of the CISG Tools (click to view)
- Example Translation/Adaptation Proposal: CISG SCAT6 Tools (click to view)
SCAT6® Tools Translations
Persian (پارسی) SCAT6® (link to view), Detailed Instructions (link to view)
Translation/adaptation by: Bahar Hassanmirzaei, MD., PhDC; Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway. Zohreh Haratian, MD.; IFMARK, FIFA Medical Center of Excellence, Tehran, Iran
German (Deutsche) CRT6 (link to view)
Translation/adaptation by: Dr. Nina Feddermann, BrainCare and Sports Neuroscience University Hospital and University Zurich, Switzerland
Simplified Chinese (简体中文) SCAT6® (link to view)
Authors: Jiayi Liu, Zhanyu Huang, Zengyu Wang, Xiaoyu Wang, JTSportech Research Institute of Sport Sciences (JTRISS), China.
Rui Zhao, School of Physical Education, Yunnan Agricultural University, Yunnan, China.
Jinyun Cai, School of Health Sciences and Social Work, Griffith University, Australia.
Menglin Zhu, Shanshen Wellness and Performance Center, Ningbo, China.
Joseph A. Stone, Martyn Rothwell, Sport and Human Performance Research Centre, Sheffield Hallam University, Sheffield, UK.
Zhuobing Chen, Sports Centre, Xi’an Jiaotong University, Shaanxi, China
Minhao Hong, College of Foreign Languages, Beihang University, China
Sport Concussion Assessment Tool (SCAT6®)
The SCAT® is a standardized tool for the evaluation of sport concussion that has been designed for use by healthcare professionals. The CISG introduced the SCAT® in 2002 to provide a multidimodal standardized assessment of concussion. The SCAT® combined pre-existing tools and measures to create a tool with separate subcomponents including, symptoms (graded symptom checklist), the Standardized Assessment of Concussion (SAC), the modified Maddocks questions and neurological screening. Following a review of the scientific literature, the SCAT® was revised as a tool to be used by medical professionals and was renamed to SCAT2®, which added the Glasgow Coma Scale (GCS), and a measure of balance (modified Balance Error Scoring System, mBESS). The SCAT2® was revised as the SCAT3® in 2013, and a new tool for children (under 13) was developed, the Child SCAT3®. The SCAT3® included physical or objective signs of concussion in addition to loss of consciousness (LOC) and balance problems, added a foam condition to the BESS, and included a concussion injury advice section.
The next version of the SCAT® was the SCAT5®. This version of the tool was labeled “5” instead of “4” to coincide with the 5th Consensus Conference and used to consistently label all associated tools (SCAT5®, Child SCAT5®, CRT5). This version of the tools contained many improvements including the addition of a state/trait distinction using the symptom checklist, a screening measure for reading ability, additional observational signs, addition of a 10 versus 5 word list learning task, a refined neurological screen and enhanced instructions. The latest version of the SCAT® is the SCAT6® which was developed in association with the 6th International Consensus Conference in Amsterdam. The introductory papers for the SCAT6®, Child SCAT6®, SCOAT6TM, Child SCOAT6TM and CRT6TM are presented below.
Child Sport Concussion Assessment Tool (SCAT6®)
The SCAT® tools were developed for acute evaluation of athletes with suspected sport-related concussion (SRC). The most recent iterations, the SCAT5® and SCAT6®, were developed for use in athletes ages 13 years and older. The Child SCAT3® was introduced in 2012 for use in children ages 5-12 years. This was revised in 2016 with the introduction of the Child SCAT5®. The Child SCAT5® followed a similar format to the SCAT3®, but included components that were validated for use in children ages 5-12 years.
The Child SCAT6® was introduced following the 6th Consensus Conference in Amsterdam, 2022. The Child SCAT6® is for use in the acute period following SRC in children ages 8-12 years, and the SCAT6® is for use in adolescents and adults ages 13 years and over. The Child SCAT6® includes many of the improvements contained within the SCAT6® and some improvements specific to the Child SCAT6®, including improved order and format of the symptom checklists, the addition of a timed component to the Days in Reverse Order, inclusion of all 3 stances of the mBESS, addition of optional balance assessment on a foam surface, introduction of timed tandem gait and complex tandem gait, with the option of dual task tandem gait, and improved and updated Return to Learn and Return to Sport recommendations. The Instructions for the Child SCAT6® are contained in a separate downloadable document, and should be read prior to administration of the Child SCAT6®.
Concussion Recognition Tool (CRT6®)
The Pocket SCAT2® was published in 2009 to provide a tool for the layperson to help recognize the signs and symptoms of sport concussion in all age groups and to provide guidance for removing an athlete from play/sport and to seek medical attention. The Pocket SCAT2® was comprised of concussion symptoms, a brief assessment of basic memory and balance testing. The Pocket SCAT2® was revised by the CISG in 2012 following the 4th International Consensus Conference and renamed the Pocket Concussion Recognition Tool (Pocket CRT). The Pocket CRT maintained the focus on use by laypersons and expanded the tool to include more complete information for identifying possible concussions using visible or observable signs of possible concussion (e.g., loss of consciousness or lack of responsiveness; balance problems or motor incoordination; confusion) and symptoms (e.g., headache, dizziness, visual disturbances). The basic memory function questions were retained from the Pocket SCAT2®.
The transition from the Pocket CRT to the CRT5 occurred in 2017 with a greater emphasis on the goals of the CRT5 (to recognize and remove); an expressed statement that the CRT5 is not to be used to diagnose concussion; an expansion of the Red Flags section including emphasis on calling an ambulance; Instruction that the presence of any red flag requires immediate medical attention; clarification that if no red flags are present, continued use of the tool is warranted; a list of visible signs and symptoms of concussion that is consistent with the SCAT5®; a list of symptoms divided into different types (e.g., somatic, cognitive, emotional) to facilitate identification of possible concussion, and language appropriate for both adults and children; change from Memory Function to ‘Awareness’ questions with instructions that the questions should only be used in athletes more than 12 years of age; Emphasis added on explicit instruction that any athlete suspected of concussion should be immediately removed from play and should not return to activity until assessed medically; and cautions issued regarding acute management and restrictions on behaviors (e.g., drinking alcohol, driving, use of drugs).
The Sport Concussion Office Assessment Tool 6 (SCOAT6™)
The Sport Concussion Office Assessment Tool 6 (SCOAT6) is a clinical screening, evaluation, and management guidance tool for sport-related concussion (SRC) that incorporates the essential domains for comprehensive concussion care. The SCOAT was designed for use by healthcare professionals in the sub-acute phase of injury, typically from 72 hours (3 days) – 1 month after injury. The SCOAT was developed for use with individuals ages 13 through adulthood; a pediatric version, the Child SCOAT6, is for use with children, ages 8-12. The Child SCOAT6 has modifications that incorporate the input of a parent/guardian. The SCOAT and Child SCOAT are most effectively used when compared to the SCAT6® completed within 72 hours of the injury.
The SCOAT and Child SCOAT contain:
- Athlete demographic details
- Description of the current injury
- History of previous head injuries, neurological and psychological disorders
- Relevant family history
- The post-concussion symptom scale
- Measures of orthostatic vital signs
- Cervical spine evaluation
- Neurological examination
- Cognitive tests (including links to expanded 15-word lists)
- The Balance Error Scoring System (Bess and mBESS)
- Timed simple, complex and dual task tandem gait tests
- A modified vestibular-ocular motor screening test (mVOMS)
- Mental health screening measures (anxiety, depression and sleep)
- Recording of neuropsychological test results
- Record of graded aerobic exercise test results
- Summary of the findings and management plan
The Child Sport Concussion Office Assessment Tool 6 (Child SCOAT6™)
The Sport Concussion Office Assessment Tool 6 (Child SCOAT6) is a clinical screening, evaluation, and management guidance tool for sport-related concussion (SRC) that incorporates the essential domains for comprehensive concussion care. The SCOAT was designed for use by healthcare professionals in the sub-acute phase of injury, typically from 72 hours (3 days) – 1 month after injury. The SCOAT was developed for use with individuals ages 13 through adulthood; a pediatric version, the Child SCOAT6, is for use with children, ages 8-12. The Child SCOAT6 has modifications that incorporate the input of a parent/guardian. The SCOAT and Child SCOAT are most effectively used when compared to the SCAT6® completed within 72 hours of the injury.
The SCOAT and Child SCOAT contain:
- Athlete demographic details
- Description of the current injury
- History of previous head injuries, neurological and psychological disorders
- Relevant family history
- The post-concussion symptom scale
- Measures of orthostatic vital signs
- Cervical spine evaluation
- Neurological examination
- Cognitive tests (including links to expanded 15-word lists)
- The Balance Error Scoring System (Bess and mBESS)
- Timed simple, complex and dual task tandem gait tests
- A modified vestibular-ocular motor screening test (mVOMS)
- Mental health screening measures (anxiety, depression and sleep)
- Recording of neuropsychological test results
- Record of graded aerobic exercise test results
- Summary of the findings and management plan