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Sport Concussion Assessment Tool
For Adolescents (13 years +) & Adults

What is the SCAT6? Key Points

The SCAT6 is a standardised tool for evaluating concussions • Any athlete with suspected concussion should be REMOVED
designed for use by Health Care Professionals (HCPs). The FROM PLAY, medically assessed, and monitored for injury-
SCAT6 cannot be performed correctly in less than 10-15 minutes. related signs and symptoms, including deterioration of their
Except for the symptoms scale, the SCAT6 is intended to be clinical condition.
used in the acute phase, ideally within 72 hours (3 days), and • No athlete diagnosed with concussion should return to play
up to 7 days, following injury. If greater than 7 days post-injury, on the day of injury.
consider using the SCOAT6/Child SCOAT6. • If an athlete is suspected of having a concussion and medical
personnel are not immediately available, the athlete should
The SCAT6 is used for evaluating athletes aged 13 years be referred (or transported if needed) to a medical facility for
and older. For children aged 12 years or younger, please assessment.
use the Child SCAT6. • Athletes with suspected or diagnosed concussion should not
If you are not an HCP, please use the Concussion take medications such as aspirin or other anti-inflammatories,
Recognition Tool 6 (CRT6). sedatives or opiates, drink alcohol or use recreational drugs
and should not drive a motor vehicle until cleared to do so by
Preseason baseline testing with the SCAT6 can be helpful for a medical professional.
interpreting post-injury test scores but is not required for that • Concussion signs and symptoms may evolve over time; it is
purpose. Detailed instructions for use of the SCAT6 are provided important to monitor the athlete for ongoing, worsening, or
as a supplement. Please read through these instructions carefully the development of additional concussion-related symptoms.
before testing the athlete. Brief verbal instructions for each test • The diagnosis of concussion is a clinical determination made
are given in blue italics. The only equipment required for the by an HCP.
examiner is athletic tape and a watch or timer. • The SCAT6 should NOT be used by itself to make, or
exclude, the diagnosis of concussion. It is important to note
This tool may be freely copied in its current form for that an athlete may have a concussion even if their SCAT6
distribution to individuals, teams, groups, and organizations. assessment is within normal limits.
Any alteration (including translations and digital re-
formatting), re-branding, or sale for commercial gain is not Remember
permissible without the expressed written consent of BMJ.
• The basic principles of first aid should be followed: assess
danger at the scene, athlete responsiveness, airway,
Recognise and Remove breathing, and circulation.
A head impact by either a direct blow or indirect transmission of • Do not attempt to move an unconscious/unresponsive
force to the head can be associated with serious and potentially athlete (other than what is required for airway management)
unless trained to do so.
fatal consequences. If there are significant concerns, which may
include any of the Red Flags listed in Box 1, the athlete requires • Assessment for a spinal and/or spinal cord injury is a critical
urgent medical attention, and if a qualified medical practitioner part of the initial on-field evaluation. Do not attempt to assess
is not available for immediate assessment, then activation the spine unless trained to do so.
of emergency procedures and urgent transport to the nearest • Do not remove a helmet or any other equipment unless
hospital or medical facility should be arranged. trained to do so safely.

Completion Guide

Orange: Optional part of assessment

For use by Health Care Professionals Only SCAT6TM

Developed by: The Concussion in Sport Group (CISG)

Supported by:

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Sport Concussion Assessment Tool 6 - SCAT6TM

Sport Concussion Assessment Tool

For Adolescents (13 years +) & Adults

Athlete Name: ID Number:

Date of Birth: Date of Examination: Date of Injury:

Time of Injury: Sex: Male Female Prefer Not To Say Other

Dominant Hand: Left Right Ambidextrous Sport/Team/School:

Current Year in School (if applicable): Years of Education Completed (Total):

First Language: Preferred Language:

Examiner:

Concussion History
How many diagnosed concussions has the athlete had in the past?:

When was the most recent concussion?:

Primary Symptoms:

How long was the recovery (time to being cleared to play) from the most recent concussion?: (Days)

Immediate Assessment/Neuro Screen (Not Required at Baseline)

The following elements should be used in the evaluation of all athletes who are suspected of having a concussion prior to proceeding to
the cognitive assessment, and ideally should be completed “on-field” after the first aid/emergency care priorities are completed.
If any of the observable signs of concussion are noted after a direct or indirect blow to the head, the athlete should be immediately and
safely removed from participation and evaluated by an HCP.
The Glasgow Coma Scale is important as a standard measure for all patients and can be repeated over time to monitor deterioration of
consciousness. The Maddocks questions and cervical spine exam are also critical steps of the immediate assessment.

For use by Health Care Professionals only

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Sport Concussion Assessment Tool 6 - SCAT6TM

Step 1: Observable Signs Box 1: Red Flags

Witnessed Observed on Video • Neck pain or tenderness
• Seizure or convulsion
• Double vision
Lying motionless on playing surface Y N • Loss of consciousness
• Weakness or tingling/burning in more than 1
Falling unprotected to the surface Y N arm or in the legs
• Deteriorating conscious state
Balance/gait difficulties, motor
incoordination, ataxia: stumbling, slow/ Y N • Vomiting
laboured movements • Severe or increasing headache
Disorientation or confusion, staring or • Increasingly restless, agitated or combative
limited responsiveness, or an inability Y N • GCS <15
to respond appropriately to questions • Visible deformity of the skull
Blank or vacant look Y N

Step 3: Cervical Spine Assessment

Facial injury after head trauma Y N
In a patient who is not lucid or fully conscious, a cervical spine
injury should be assumed and spinal precautions taken.
Impact seizure Y N
Does the athlete report neck pain at rest? Y N
High-risk mechanism of injury (sport-
Y N
dependent) Is there tenderness to palpation? Y N

If NO neck pain and NO tenderness, does

Step 2: Glasgow Coma Scale the athlete have a full range of ACTIVE Y N
pain free movement?
Typically, GCS is assessed once. Additional scoring columns
are provided for monitoring over time, if needed. Are limb strength and sensation normal? Y N

Time of Assessment:

Date of Assessment:
Step 4: Coordination & Ocular/Motor Screen

Coordination: Is finger-to-nose normal for

Best Eye Response (E) Y N
both hands with eyes open and closed?
No eye opening 1 1 1
Ocular/Motor: Without moving their head or
Eye opening to pain 2 2 2 neck, can the patient look side-to-side and Y N
up-and-down without double vision?
Eye opening to speech 3 3 3
Are observed extraocular eye movements
Eyes opening spontaneously 4 4 4 normal? If not, describe: Y N

Best Verbal Response (V)

No verbal response 1 1 1

Incomprehensible sounds 2 2 2
Step 5: Memory Assessment Maddocks Questions1
Inappropriate words 3 3 3
Say “I am going to ask you a few questions, please listen
Confused 4 4 4
carefully and give your best effort. First, tell me what
Oriented 5 5 5 happened?”
Modified Maddocks questions (Modified appropriately for each
Best Motor Response (V) sport; 1 point for each correct answer)

No motor response 1 1 1 What venue are we at today? 0 1

Extension to pain 2 2 2
Which half is it now? 0 1
Abnormal flexion to pain 3 3 3
Who scored last in this match? 0 1
Flexion/withdrawal to pain 4 4 4
What team did you play last week / game? 0 1
Localized to pain 5 5 5
Did your team win the last game? 0 1
Obeys commands 6 6 6
Maddocks Score /5

Glasgow Coma Score (E + V + M)

Note: Appropriate sport-specific questions may be substituted

For use by Health Care Professionals only

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Sport Concussion Assessment Tool 6 - SCAT6TM

Off-Field Assessment
Please note that the cognitive assessment should be done in a distraction-free environment with the athlete in a resting state after
completion of the Immediate Assessment/Neuro Screen.

Step 1: Athlete Background

Has the athlete ever been:

Hospitalised for head injury? (If yes, describe Diagnosed with attention deficit hyperactivity
Y N Y N
below) disorder (ADHD)?
Diagnosed/treated for headache disorder or Diagnosed with depression, anxiety, or other
Y N Y N
migraine? psychological disorder?
Diagnosed with a learning disability/dyslexia? Y N

Notes: Current medications? If yes, please list:

Step 2: Symptom Evaluation

Baseline: Suspected/Post-injury: Time elapsed since suspected injury: mins/hours/days
The athlete will complete the symptom scale (below) after you provide instructions. Please note that the instructions are different for
baseline versus suspected/post-injury evaluations.
Baseline: Say “Please rate your symptoms below based on how you typically feel with “1” representing a very mild symp-
tom and “6” representing a severe symptom.”
Suspected/Post-injury: Say “Please rate your symptoms below based on how you feel now with “1” representing a very
mild symptom and “6” representing a severe symptom.”
PLEASE HAND THE FORM TO THE ATHLETE

Symptom Rating
Headaches 0 1 2 3 4 5 6 Do your symptoms get worse with physical activity? Y N
Pressure in head 0 1 2 3 4 5 6
Do your symptoms get worse with mental activity? Y N
Neck pain 0 1 2 3 4 5 6
Nausea or vomiting 0 1 2 3 4 5 6 If 100% is feeling perfectly normal, what percent of normal
Dizziness 0 1 2 3 4 5 6 do you feel?
Blurred vision 0 1 2 3 4 5 6
Balance problems 0 1 2 3 4 5 6
If not 100%, why?
Sensitivity to light 0 1 2 3 4 5 6
Sensitivity to noise 0 1 2 3 4 5 6
Feeling slowed down 0 1 2 3 4 5 6
Feeling like “in a fog” 0 1 2 3 4 5 6
“Don’t feel right” 0 1 2 3 4 5 6
Difficulty concentrating 0 1 2 3 4 5 6
Difficulty remembering 0 1 2 3 4 5 6
Fatigue or low energy 0 1 2 3 4 5 6
Confusion 0 1 2 3 4 5 6
Drowsiness 0 1 2 3 4 5 6
More emotional 0 1 2 3 4 5 6
Irritability 0 1 2 3 4 5 6
Sadness 0 1 2 3 4 5 6
Nervous or anxious 0 1 2 3 4 5 6
Trouble falling asleep (if applicable) 0 1 2 3 4 5 6

PLEASE HAND THE FORM BACK TO THE EXAMINER

Once the athlete has completed answering all symptom items, it may be useful for the clinician to revisit items that were endorsed positively to gather
more detail about each symptom.

Total number of symptoms: of 22 Symptom severity score: of 132

For use by Health Care Professionals only

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Sport Concussion Assessment Tool 6 - SCAT6TM

Step 3: Cognitive Screening (Based on Standardized Assessment of Concussion; SAC)2

Orientation

What month is it? 0 1

What is the date today? 0 1

What is the day of the week? 0 1

What year is it? 0 1

What time is it right now? (within 1 hour) 0 1

Orientation Score of 5

Immediate Memory
All 3 trials must be administered irrespective of the number correct on Trial 1. Administer at the rate of one word per second.
Trial 1: Say “I am going to test your memory. I will read you a list of words and when I am done, repeat back as many words
as you can remember, in any order.”

Trials 2 and 3: Say “I am going to repeat the same list. Repeat back as many words as you can remember in any order, even
if you said the word before in a previous trial.”

Word list used: A B C Alternate Lists

List A Trial 1 Trial 2 Trial 3 List B List C

Jacket 0 1 0 1 0 1 Finger Baby

Arrow 0 1 0 1 0 1 Penny Monkey

Pepper 0 1 0 1 0 1 Blanket Perfume

Cotton 0 1 0 1 0 1 Lemon Sunset

Movie 0 1 0 1 0 1 Insect Iron

Dollar 0 1 0 1 0 1 Candle Elbow

Honey 0 1 0 1 0 1 Paper Apple

Mirror 0 1 0 1 0 1 Sugar Carpet

Saddle 0 1 0 1 0 1 Sandwich Saddle

Anchor 0 1 0 1 0 1 Wagon Bubble

Trial Total

Immediate Memory Score of 30 Time Last Trial Completed:

For use by Health Care Professionals only

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Sport Concussion Assessment Tool 6 - SCAT6TM

Step 3: Cognitive Screening (Continued)

Concentration

Digits Backward:
Administer at the rate of one digit per second reading DOWN the selected column. If a string is completed correctly, move on to
the string with next higher number of digits; if the string is completed incorrectly, use the alternate string with the same number of
digits; if this is failed again, end the test.

Say “I’m going to read a string of numbers and when I am done, you repeat them back to me in reverse order of how I read
them to you. For example, if I say 7-1-9, you would say 9-1-7. So, if I said 9-6-8 you would say? (8-6-9)”

Digit list used: A B C

List A List B List C

4-9-3 5-2-6 1-4-2 Y N

0 1
6-2-9 4-1-5 6-5-8 Y N

3-8-1-4 1-7-9-5 6-8-3-1 Y N

0 1
3-2-7-9 4-9-6-8 3-4-8-1 Y N

6-2-9-7-1 4-8-5-2-7 4-9-1-5-3 Y N

0 1
1-5-2-8-6 6-1-8-4-3 6-8-2-5-1 Y N

7-1-8-4-6-2 8-3-1-9-6-4 3-7-6-5-1-9 Y N

0 1
5-3-9-1-4-8 7-2-4-8-5-6 9-2-6-5-1-4 Y N

Digits Score of 4

Months in Reverse Order:

Say “Now tell me the months of the year in reverse order as QUICKLY and as accurately as possible. Start with the last
month and go backward. So, you’ll say December, November… go ahead”

Start stopwatch and CIRCLE each correct response:

December November October September August July June May April March February January

Time Taken to Complete (secs): Number of Errors:

1 point if no errors and completion under 30 seconds

Months Score: of 1

Concentration Score (Digits + Months) of 5

Step 4: Coordination and Balance Examination

Modified Balance Error Scoring System (mBESS)3 testing

(see detailed administration instructions)

Foot Tested: Left Right (i.e. test the non-dominant foot)

Testing Surface (hard floor, field, etc.):

Footwear (shoes, barefoot, braces, tape etc.):

OPTIONAL (depending on clinical presentation and setting resources): For further assessment, the same 3 stances can be
performed on a surface of medium density foam (e.g., approximately 50cm x 40cm x 6cm) with the same instructions and scoring.

For use by Health Care Professionals only

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Sport Concussion Assessment Tool 6 - SCAT6TM

Step 4: Coordination and Balance Examination (Continued)

Modified BESS (20 seconds each) On Foam (Optional)

Double Leg Stance: of 10 Double Leg Stance: of 10

Tandem Stance: of 10 Tandem Stance: of 10

Single Leg Stance: of 10 Single Leg Stance: of 10

Total Errors: of 30 Total Errors: of 30

Note: If the mBESS yields normal findings then proceed to the Tandem Gait/Dual Task Tandem Gait.
If the mBESS reveals abnormal findings or clinically significant difficulties, Tandem Gait is not necessary at this time.
Both the Tandem Gait and optional Dual Task component may be administered later in the office setting as needed (see SCOAT6).

Timed Tandem Gait

Place a 3-metre-long line on the floor/firm surface with athletic tape. The task should be timed. Please complete all 3 trials.

Say “Please walk heel-to-toe quickly to the end of the tape, turn around and come back as fast as you can without
separating your feet or stepping off the line.”

Single Task:

Time to Complete Tandem Gait Walking (seconds)

Trial 1 Trial 2 Trial 3 Average 3 Trials Fastest Trial

Dual Task Gait (Optional. Timed Tandem Gait must be completed first)
Place a 3-metre-long line on the floor/firm surface with athletic tape. The task should be timed.

Say “Now, while you are walking heel-to-toe, I will ask you to count backwards out loud by 7s. For example, if we started
at 100, you would say 100, 93, 86, 79. Let’s practise counting. Starting with 93, count backward by sevens until I say
“stop”.” Note that this practice only involves counting backwards.

Dual Task Practice: Circle correct responses; record number of subtraction counting errors.

Task Errors Time

Practice 93 86 79 72 65 58 51 44

Say “Good. Now I will ask you to walk heel-to-toe and count backwards out loud at the same time. Are you ready? The
number to start with is 88. Go!”

Dual Task Cognitive Performance: Circle correct responses; record number of subtraction counting errors.
Time
Task Errors
(circle fastest)

Trial 1 88 81 74 67 60 53 46 39 32 25 18 11 4

Trial 2 90 83 76 69 62 55 48 41 34 27 20 13 6

Trial 3 98 91 84 77 70 63 56 49 42 35 28 21 14

Alternate double number starting integers may be used and recorded below.

Starting Integer: Errors: Time:

For use by Health Care Professionals only

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Sport Concussion Assessment Tool 6 - SCAT6TM

Step 4: Coordination and Balance Examination (Continued)

Were any single- or dual-task, timed tandem gait trials not completed due to walking errors or other reasons?

Yes No

If yes, please explain why:

Step 5: Delayed Recall

The Delayed Recall should be performed after at least 5 minutes have elapsed since the end of the Immediate Memory section:
Score 1 point for each correct response.
Say “Do you remember that list of words I read a few times earlier? Tell me as many words from the list as you can
remember in any order.”

Time started:

Word list used: A B C Alternate Lists

List A Score List B List C

Jacket 0 1 Finger Baby

Arrow 0 1 Penny Monkey

Pepper 0 1 Blanket Perfume

Cotton 0 1 Lemon Sunset

Movie 0 1 Insect Iron

Dollar 0 1 Candle Elbow

Honey 0 1 Paper Apple

Mirror 0 1 Sugar Carpet

Saddle 0 1 Sandwich Saddle

Anchor 0 1 Wagon Bubble

Delayed Recall Score of 10

Total Cognitive Score

Orientation: of 5

Immediate Memory: of 30

Concentration: of 5

Delayed Recall: of 10

Total: of 50

If the athlete was known to you prior to their injury, are they different from their usual self?

Yes No Not applicable (If different, describe why In the clinical notes section)

For use by Health Care Professionals only

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Sport Concussion Assessment Tool 6 - SCAT6TM

Step 6: Decision
Domain Date: Date: Date:
Neurological Exam (Acute Injury Normal/Abnormal Normal/Abnormal Normal/Abnormal
evaluation only)
Symptom number (of 22)

Symptom Severity (of 132)

Orientation (of 5)

Immediate Memory (of 30)

Concentration (of 5)

Delayed Recall (of 10)

Cognitive Total Score (of 50)

mBESS Total Errors (of 30)

Tandem Gait fastest time

Dual Task fastest time

Disposition
Concussion diagnosed?

Yes No Deferred

Health Care Professional Attestation

I am an HCP and I have personally administered or supervised the administration of this SCAT6.
Name:

Signature: Title/Speciality:

Registration/License number (if applicable): Date:

Additional Clinical Notes

Note: Scoring on the SCAT6 should not be used as a stand-alone method to diagnose concussion, measure recovery, or make decisions
about an athlete’s readiness to return to sport after concussion. Remember: An athlete can score within normal limits on the SCAT6 and
still have a concussion.

For use by Health Care Professionals only

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