title: The Sport Concussion Assessment Tool: a systematic review.
abstract: OBJECTIVE Over the last 2 decades, sport-related concussion (SRC) has garnered significant attention. Even with increased awareness and athlete education, sideline recognition and real-time diagnosis remain crucial. The need for an objective and standardized assessment of concussion led to the eventual development of the Sport Concussion Assessment Tool (SCAT) during the Second International Conference on Concussion in Sport in 2004, which is now in its third iteration (SCAT3). In an effort to update our understanding of the most well-known sideline concussion assessment, the authors conducted a systematic review of the SCAT and the evidence supporting its use to date. METHODS English-language titles and abstracts published between 1995 and October 2015 were searched systematically across 4 electronic databases and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines adapted for the review of a heterogeneous collection of study designs. Peer-reviewed journal articles were included if they reported quantitative data on any iteration of the SCAT, Standardized Assessment of Concussion (SAC), or modified Balance Error Scoring System (mBESS) data at baseline or following concussion in an exclusively athlete population with any portion older than 13 years of age. Studies that included nonathletes, only children less than 13 years old, exclusively BESS data, exclusively symptom scale data, or a non-SCAT-related assessment were excluded. RESULTS The database search process yielded 549 abstracts, and 105 full-text articles were reviewed with 36 meeting criteria for inclusion. Nineteen studies were associated with the SAC, 1 was associated with the mBESS exclusively, and 16 studies were associated with a full iteration of the SCAT. The majority of these studies (56%) were prospective cohort studies. Male football players were the most common athletes studied. An analysis of the studies focused on baseline differences associated with age, sex, concussion history, and the ability to detect an SRC. CONCLUSIONS Looking toward the upcoming Concussion in Sport Group meeting in fall 2016, one may expect further revision to the SCAT3. However, based on this systematic review, the authors propose further, in-depth study of an already comprehensive concussion test, with acute, diagnostic, as well as long-term use.
authors.affiliation: Vanderbilt Sports Concussion Center, and.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Yengo-Kahn
authors.affiliation: Vanderbilt Sports Concussion Center, and.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Hale
authors.affiliation: Vanderbilt Sports Concussion Center, and.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Zalneraitis
authors.affiliation: Vanderbilt Sports Concussion Center, and.|Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.affiliation: Vanderbilt Sports Concussion Center, and.|Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Allen K
authors.initials: AK
authors.lastname: Sills
authors.affiliation: Vanderbilt Sports Concussion Center, and.|Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Solomon
mesh_terms: D001265:Athletic Injuries / Q000175:diagnosis / Q000453:epidemiology*; D001924:Brain Concussion / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D006801:Humans; D009483:Neuropsychological Tests; D011446:Prospective Studies; D013177:Sports; D013997:Time Factors
keywords: AUC = area under the curve; GCS = Glasgow Coma Scale; NFL = National Football League; NHL = National Hockey League; PCSS = Post-Concussion Symptom Scale; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; ROC = receiver operating characteristic; SAC = Standardized Assessment of Concussion; SCAT = Sport Concussion Assessment Tool; SRC = sport-related concussion; Sport Concussion Assessment Tool; Standardized Assessment of Concussion; TBI = traumatic brain injury; mBESS = modified Balance Error Scoring System; mTBI = mild TBI; modified Balance Error Scoring System; sideline assessment; sport-related concussion