Updates to sports concussion assessment tool now addresses children under 12

Football helmet of the late Owen Thomas, a former University of Pennsylvania football player, brought to a hearing on H.R 6172, the Protecting Student Athletes from Concussions Act by his mother, Rev. Katherine E. Brearley, Ph.D. Creative Commons/Flickr

Football helmet of the late Owen Thomas, a former University of Pennsylvania football player, brought to a hearing on H.R 6172, the Protecting Student Athletes from Concussions Act, by his mother, Rev. Katherine E. Brearley, Ph.D. Creative Commons/Flickr

Concussions are always a hot topic around here, and parents are constantly asking me how to evaluate kids on the sidelines for concussions.

So, I want to share with our readers the most updated concussion assessment tool, the SCAT3.

In March of this year, the Consensus Statement on Concussion in Sport updated and released the SCAT3. It’s an international standardized tool for evaluating athletes, ages 13 and up, for concussions.

And for the first time, they also released a C-SCAT for evaluating concussions in children 12 and under.

Today, I had the chance to speak with WAKR host Ray Horner about the specifics of this test and what parents and coaches need to know about it.

Below is an audio file and transcript of our discussion.

Horner: Our good friend, Dr. Joe Congeni, onboard with us right now. Joe, do you remember where you were when Lenny Barker (former starting pitcher) threw his perfect game this date in 1981?

Dr. Congeni: Oh I do, so much. I had a ticket for the game.

Horner: You did?

Dr. Congeni: And I couldn’t go. I went up to graduation at Notre Dame and I missed that game. Wow.

Dr. Joe Congeni

Dr. Joe Congeni

Horner: Ahhh, okay. We just talked to one of our listeners who was there. I mean, he knew the whole lineup, all the key plays. He definitely knew what was going on in that game. Well, what do you have for us today, Joe?

Dr. Congeni: Well, Ray, new international guidelines came out. I’ve been talking about this every two years now.

[Medical professionals] met in Zurich, Switzerland, (at the Consensus Conference on Concussion in Sport) and they came out in March of 2013 with some new guidelines on treatment, management of concussions. You know, a hot topic for us, of course.

A lot of people are surprised on the sideline [and ask], “How do we assess these things?” It’s like, is there an X-ray test? You know, how is it done? Is there some instantaneous test that we can tell [whether someone has a concussion]? Sometimes it’s obvious, but a lot of times it’s not all together clear.

There is a tool that was updated again this year. It’s called the Sport Concussion Assessment Tool. It’s known by people on the sidelines as the SCAT test, and this is called SCAT3.

For the first time, they have a C-SCAT, it’s being called, a child version for 12 and under. So, the questions are a little bit easier for a C-SCAT, Child SCAT.

It takes about 15 minutes and it’s very detailed and it’s a lot of questions looking at the function of the brain. And so when we do this test, you can’t do it on the sidelines.

It’s very hard to do it in a loud place. A lot of times you want to go back in the locker room or the training room to go over this test. I was going to give you a little bit of an idea.

Again, this year, they added some other components that make it longer and longer, but it takes the trainer a good 15 minutes to go through this test with people.

The first part is what’s called the Maddock Score, and it’s just orientation stuff, like what half is it now? Who scored last in the game? What team did you play last week?

The second part is what are your symptoms now? And it’s not like the old days, Ray, of just “Hey, do you feel okay?”

There are 22 symptoms that athletes have to rate right now from a score of zero to six, starting with headache, pressure in the head, dizziness, blurred vision, sensitivity to light, sensitivity to noise, and on and on.

It’s a lot of questions, 22 questions about what are the symptoms that you feel.

Then, we get into some of the memory questions. They start with pretty easy ones: What month is it? What day is it today? What day of the week?

Then, we ask [the athlete to remember] 5 words immediately, and then we ask it again in 10 minutes.

There are different lists of these 5 things that we ask you to remember, like the first list: elbow, apple, carpet, saddle, bubble. And, we ask the athlete to repeat those back … again in 10 minutes when we’re done testing.

The one for concentration is stating the months in reverse order. When I give talks, I have people do it. So, for instance, Ray, would you like to try that starting with May?

Horner: May, April, March, February, January.

Congeni: And keep going.

Horner: Oh. December, November, October, September, August, July, June.

Congeni: Alright, so, not too bad and you got through that very quickly. The one for the kids, the C-SCAT, is just [asking for] days in reverse order, starting with Wednesday, Tuesday, Monday. So, it’s going through that to see if kids can concentrate.

There’s a part [where you ask for] digits backward, where I’ll read off 4 or 5 digits and then you give them to me backwards. So, 5, 3, 9, 1, 4, 8.

Horner: … I pass.

Congeni: [laughter] Then, we check the neck, and then we do a balance exam. So, you stand with your feet together and close your eyes. Then, you stand on one leg, your non-dominate leg, close your eyes and we have them hold that for 5 seconds.

Then, we have them stand in tandem stance, one foot in front of the other.

Then, the coordination exam is a finger-to-nose test. Then, we go back and ask you those 5 words that we gave you earlier.

This sideline assessment, Sport Concussion Assessment Tool, SCAT3, was updated this year. Right now, that’s the gold standard that’s being used to test athletes, and there’s a scoring system at the end to see if they have a concussion.

[Lastly], we go over with them how to treat a concussion initially. Make sure that overnight somebody’s with you in case it worsens. Make sure that you’re followed up. You cannot return to play until you’ve been assessed medically now — that’s the new law as of a month ago.

So, people ask, “What kind of questions do you guys ask?” I just wanted to review today the Sport Concussion Assessment Tool.

Horner: Sounds pretty thorough and sounds pretty good, as well. Joe, thanks for the time. Good stuff this morning. We’ll catch up with you again next week.

Congeni: Alright, Ray, have a great week.

Horner: You too. Dr. Joe Congeni from Sports Medicine Center at Akron Children’s Hospital.

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About Dr. Joe Congeni - Director of Sports Medicine

Dr. Joe Congeni is the Director, Sports Medicine; Clinical Co-Director, Center for Orthopedics and Sports Medicine at Akron Children's Hospital. For the past 25 years, Dr. Congeni has been the “go to” source for national and local media looking for information about pediatric sports medicine.

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