Concussion assessments: SCAT5, SCAT6, and CSX

A head impact by either a direct blow or indirect transmission of force can be associated with a serious and potentially fatal brain injury. Therefore, any athlete with a suspected concussion must be immediately removed from play to undergo a concussion test commonly referred to as the Sports Concussion Assessment Tool, or SCAT. Concussion signs and symptoms may evolve over time and failure to conduct a concussion assessment can lead to long-term cognitive and physical injuries.

What is the SCAT?

The Sports Concussion Assessment Tool (SCAT) is a standardised tool designed to diagnose a concussion sustained during a sports-related incident. The SCAT is intended to be used by physicians and licensed healthcare professionals as an immediate on-field neurological assessment followed by an off-field cognitive assessment. The SCAT is for use in people aged 12 years and older and requires a minimum of 10 minutes to be performed correctly. For children under the age of 12, the Child SCAT is recommended.

The difference between SCAT5 and SCAT6

SCAT assessments are regularly revised and updated by the Concussion in Sport Group (CISG). When the latest scientific evidence and data emerges, CISG experts analyse and discuss these insights and update the assessment tool. In 2023, the Sport Concussion Assessment Tool 5 (SCAT5) was replaced by the revised SCAT6. The upgrade saw an enhanced athlete demographic section, revised immediate assessment, new coordination and motor screen, addition of a timed component, removal of the read aloud instructions of the symptom scale and much more. 

SCAT6 concussion protocols

The SCAT outlines a number of steps required to evaluate the signs and symptoms of a concussion. Each step is critical and must be completed in order. The immediate assessment should take place “on field” after the first aid/emergency care priorities are completed. 

Step 1 evaluates the observable signs of concussion such as balance difficulties, a facial or head injury, disorientation and confusion. 

Step 2 conducts the Glasgow Coma Scale—which scores eye, verbal and motor responses out of 15. The levels of response are scored over numerous categories ranging from 1 for no response, up to normal values of 4 (eye-opening response), 5 (verbal response) and 6 (motor response). 

Step 3 assesses the cervical spine for pain, tenderness, range of movement and strength.

Step 4 evaluates the athletes coordination and ocular/motor abilities.

Step 5 is an orientation assessment using Maddock's Questions. One point is given for each correct answer, scoring the athlete’s memory on a scale of 0 of 5.

During the on field assessment, there are a number of red flags that call for escalation and immediate transport to hospital. These can range from concussion symptoms such as double vision, severe headache, or vomiting, to more serious signs like; a Glasgow Coma Scale score less than 15, a Maddocks Questions score of less than 5, abnormal coordination, neck pain, seizures, tingling/burning in more than one arm or leg and loss of consciousness. 

The off-field assessment consists of six steps and should be conducted in a distraction-free environment after completion of the immediate assessment. 

Step 1 analyses the athlete’s background, including previous hospitalisations and diagnoses.

Step 2 evaluates the symptoms of concussion and involves the athlete rating their symptoms on a scale of 0 to 6, providing the healthcare provider with a symptom severity score out of 132. 

Step 3 covers cognitive screening and includes orientation, immediate and working memory questions.

Step 4 examines the athlete’s coordination and balance, with a modified BESS test and timed tandem gait task. 

Step 5 requires the athlete to recall the words used during the immediate memory questions of step 3. This task should be performed at least 5 minutes after step 3. 

Step 6 is conducted by the healthcare professional and requires them to tally the various scores from steps 1-5 and decide on the concussion diagnosis.


At HIT-IQ we have developed a comprehensive concussion management platforms called CSX It is an easy-to-use mobile application designed to undertake SCAT assessments and provide valuable healthcare and medical intervention. Using the latest SCAT concussion management protocols, CSX streamlines the entire concussion management process 

The CSX software allows you to quickly and centrally run sideline assessments, comparing them in real-time to baseline, simultaneously with colleagues, quickly check an athlete's status pre-training, and immediately generate reports for you and any stakeholders. With the soon to be integration of SCAT 6, medical professionals will be able to quickly and reliably perform all SCAT 6 assessment modules with ease.

As of 2023, the SCAT6 is the most up-to-date sports concussion assessment tool. Coupled with our CSX platform, the concussion management process can be streamlined to ensure all protocols are adhered to and athletes are provided with the highest standard of care.

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