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Sport Concussion Assessment Tool 6 (SCAT6): What It Is and How It's Used
Sport Concussion Assessment Tool 6 (SCAT6): What It Is and How It's Used
What the SCAT6 concussion tool is, what it checks, its limits, and how Australian return-to-sport guidelines work after a sport concussion.
Pinnacle Physiotherapy Performance
The Sport Concussion Assessment Tool 6 (SCAT6) is a standardised tool health care professionals use to assess a suspected sport-related concussion in people aged 13 and over. It is designed for the acute phase, ideally within 72 hours (3 days) of the injury and up to 7 days. Children aged 12 and under are assessed with the Child SCAT6. The SCAT6 helps a clinician make a diagnosis, but it doesn't make one on its own, and it isn't a do-it-yourself test for parents, coaches or teammates.
Where the SCAT6 came from
The SCAT6 was developed alongside the consensus statement from the 6th International Conference on Concussion in Sport, held in Amsterdam in October 2022. Sports Medicine Australia notes the consensus statement was released on 14 July 2023, and the SCAT6 itself was published in the British Journal of Sports Medicine.
According to the University of Michigan Concussion Center, the international expert group chose the tool's components after reviewing more than 420 published papers.
In Australia, the Australian Institute of Sport (AIS) Concussion and Brain Health Position Statement 2024 describes the SCAT6 as the most widely used concussion assessment tool in the Australian sport sector. It also says the tool is most useful for diagnosis in the first 72 hours.
What the SCAT6 includes
The SCAT6 has two broad parts.
The immediate (on-field) assessment
World Rugby sets out the immediate assessment and neuro screen in this order:
red flags and observable signs
the Glasgow Coma Scale
a cervical spine (neck) assessment
a coordination and ocular/motor screen
memory questions, known as the Maddocks questions.
The AIS position statement describes this on-field section as including a brief history of the injury, a Glasgow Coma Score and the Maddocks questions.
The off-field assessment
The AIS position statement says the rest of the SCAT6 is done off the field, either in the medical room or in a consulting room once someone has been referred for a suspected concussion. The University of Michigan summary lists a screen for injuries more serious than concussion, a symptom evaluation, a cognitive assessment, and a coordination and balance examination.
The symptom checklist covers 22 possible symptoms. They include headache, "pressure in head", neck pain, nausea or vomiting, dizziness, blurred vision, balance problems, sensitivity to light and noise, feeling slowed down, feeling "in a fog", difficulty concentrating or remembering, fatigue, irritability, feeling more emotional, and trouble falling asleep.
The SCAT6 form states that it can't be done properly in less than 10 to 15 minutes. It's a structured clinical assessment, not a quick sideline check.
What the SCAT6 can't do
A few limitations come up again and again in the sources:
It doesn't diagnose concussion by itself. World Rugby states that "clinical diagnosis remains the gold standard" and that the SCAT6 supports the clinical judgement of a medical practitioner or health care professional.
A normal result doesn't rule concussion out. Clinical guidance on the tool notes that a negative SCAT6 still calls for further clinical evaluation.
It isn't a return-to-play clearance. The same guidance says the SCAT6 isn't designed to clear an athlete to go back to sport.
It's for professionals. The SCAT6 is marked "for use by Health Care Professionals only". People without health training are directed to the Concussion Recognition Tool instead.
After the first few days: the SCOAT6
The SCAT6 is built for the acute phase. If it's been more than 7 days since the injury, World Rugby suggests using the Sport Concussion Office Assessment Tool 6 (SCOAT6), or the Child SCOAT6 for children aged 12 and under.
The SCOAT6 is designed for use in a clinic from 72 hours (3 days) after a sport-related concussion. The form states that diagnosing concussion is a clinical decision, and that the different parts of the SCOAT6 can help guide individual management. Along with symptom and cognitive testing, the SCOAT6 form includes sections such as orthostatic vital signs (blood pressure and heart rate lying down and then standing), an anxiety screen and a sleep screen. Its instructions also include a modified vestibular/ocular-motor screen.
An article in the RACGP's Australian Journal of General Practice notes that treatment and rehab should be based on the specific symptoms that persist after a concussion, and that repeated SCOAT6 tests often show what's needed.
Return to sport in Australian youth and community sport
The SCAT6 is one step in a longer process. The Australian Concussion Guidelines for Youth and Community Sport were released in February 2024 by the AIS in partnership with Sports Medicine Australia. They apply to people under 19 and to community sport, where health practitioners are less likely to be on hand.
Under the Graded Return to Sport Framework, as reported when the guidelines were launched:
light exercise can start 24 to 48 hours after a concussion
anyone under 19, and anyone without a dedicated health care practitioner guiding their recovery, needs to be symptom-free for 14 days before returning to contact training. That's 14 days from when symptoms go, not from the injury.
the minimum before returning to competitive contact sport is 21 days from the concussion
if someone has more than two concussions in 12 months, missing a season of contact or collision sport should be considered.
The guidelines also put returning to school or work ahead of returning to competitive contact sport. The AIS sums up the approach in its message: "If in doubt, sit them out".
When to get urgent medical help
The 2019 Concussion in Sport Australia position statement lists signs that should prompt an immediate trip to an emergency department:
neck pain
increasing confusion, agitation or irritability
repeated vomiting
a seizure
weakness, or tingling or burning in the arms or legs
reduced consciousness
a severe or worsening headache
unusual behaviour.
If any of these signs appear, call 000 or go straight to an emergency department rather than waiting for a sport-specific assessment.
Where a physio fits in
The SCAT6 is for health care professionals, and the 2024 Australian guidelines were developed with input from doctors and physiotherapists. Guidance based on the AIS framework says a medical practitioner, such as a sport and exercise physician or sports doctor, diagnoses concussion. Once a concussion has been diagnosed, rehab is matched to the symptoms that persist, and those symptoms are checked over time with tools such as the SCOAT6.
Pinnacle Physiotherapy Performance offers concussion physio and sports injury rehab from our physio clinic in Burleigh Heads. Physio care after a concussion should sit alongside medical review and your sport's return-to-play requirements, not replace them.
If you'd like to talk about concussion rehab or a sports injury, you're welcome to get in touch with our team.
Sources
A Perspective on the 6th International Conference on Sports Concussion - PMC
Sport Concussion Office Assessment Tool For Adults & Adolescents (13 years +)
Assessment and management of sport related concussion in general practice
Australian sporting body releases concussion guidelines for all junior, community sport - ABC News
New guidelines for concussion in youth and community sport as 2024 seasons kick off
The Sport Concussion Assessment Tool 6 (SCAT6) is a standardised tool health care professionals use to assess a suspected sport-related concussion in people aged 13 and over. It is designed for the acute phase, ideally within 72 hours (3 days) of the injury and up to 7 days. Children aged 12 and under are assessed with the Child SCAT6. The SCAT6 helps a clinician make a diagnosis, but it doesn't make one on its own, and it isn't a do-it-yourself test for parents, coaches or teammates.
Where the SCAT6 came from
The SCAT6 was developed alongside the consensus statement from the 6th International Conference on Concussion in Sport, held in Amsterdam in October 2022. Sports Medicine Australia notes the consensus statement was released on 14 July 2023, and the SCAT6 itself was published in the British Journal of Sports Medicine.
According to the University of Michigan Concussion Center, the international expert group chose the tool's components after reviewing more than 420 published papers.
In Australia, the Australian Institute of Sport (AIS) Concussion and Brain Health Position Statement 2024 describes the SCAT6 as the most widely used concussion assessment tool in the Australian sport sector. It also says the tool is most useful for diagnosis in the first 72 hours.
What the SCAT6 includes
The SCAT6 has two broad parts.
The immediate (on-field) assessment
World Rugby sets out the immediate assessment and neuro screen in this order:
red flags and observable signs
the Glasgow Coma Scale
a cervical spine (neck) assessment
a coordination and ocular/motor screen
memory questions, known as the Maddocks questions.
The AIS position statement describes this on-field section as including a brief history of the injury, a Glasgow Coma Score and the Maddocks questions.
The off-field assessment
The AIS position statement says the rest of the SCAT6 is done off the field, either in the medical room or in a consulting room once someone has been referred for a suspected concussion. The University of Michigan summary lists a screen for injuries more serious than concussion, a symptom evaluation, a cognitive assessment, and a coordination and balance examination.
The symptom checklist covers 22 possible symptoms. They include headache, "pressure in head", neck pain, nausea or vomiting, dizziness, blurred vision, balance problems, sensitivity to light and noise, feeling slowed down, feeling "in a fog", difficulty concentrating or remembering, fatigue, irritability, feeling more emotional, and trouble falling asleep.
The SCAT6 form states that it can't be done properly in less than 10 to 15 minutes. It's a structured clinical assessment, not a quick sideline check.
What the SCAT6 can't do
A few limitations come up again and again in the sources:
It doesn't diagnose concussion by itself. World Rugby states that "clinical diagnosis remains the gold standard" and that the SCAT6 supports the clinical judgement of a medical practitioner or health care professional.
A normal result doesn't rule concussion out. Clinical guidance on the tool notes that a negative SCAT6 still calls for further clinical evaluation.
It isn't a return-to-play clearance. The same guidance says the SCAT6 isn't designed to clear an athlete to go back to sport.
It's for professionals. The SCAT6 is marked "for use by Health Care Professionals only". People without health training are directed to the Concussion Recognition Tool instead.
After the first few days: the SCOAT6
The SCAT6 is built for the acute phase. If it's been more than 7 days since the injury, World Rugby suggests using the Sport Concussion Office Assessment Tool 6 (SCOAT6), or the Child SCOAT6 for children aged 12 and under.
The SCOAT6 is designed for use in a clinic from 72 hours (3 days) after a sport-related concussion. The form states that diagnosing concussion is a clinical decision, and that the different parts of the SCOAT6 can help guide individual management. Along with symptom and cognitive testing, the SCOAT6 form includes sections such as orthostatic vital signs (blood pressure and heart rate lying down and then standing), an anxiety screen and a sleep screen. Its instructions also include a modified vestibular/ocular-motor screen.
An article in the RACGP's Australian Journal of General Practice notes that treatment and rehab should be based on the specific symptoms that persist after a concussion, and that repeated SCOAT6 tests often show what's needed.
Return to sport in Australian youth and community sport
The SCAT6 is one step in a longer process. The Australian Concussion Guidelines for Youth and Community Sport were released in February 2024 by the AIS in partnership with Sports Medicine Australia. They apply to people under 19 and to community sport, where health practitioners are less likely to be on hand.
Under the Graded Return to Sport Framework, as reported when the guidelines were launched:
light exercise can start 24 to 48 hours after a concussion
anyone under 19, and anyone without a dedicated health care practitioner guiding their recovery, needs to be symptom-free for 14 days before returning to contact training. That's 14 days from when symptoms go, not from the injury.
the minimum before returning to competitive contact sport is 21 days from the concussion
if someone has more than two concussions in 12 months, missing a season of contact or collision sport should be considered.
The guidelines also put returning to school or work ahead of returning to competitive contact sport. The AIS sums up the approach in its message: "If in doubt, sit them out".
When to get urgent medical help
The 2019 Concussion in Sport Australia position statement lists signs that should prompt an immediate trip to an emergency department:
neck pain
increasing confusion, agitation or irritability
repeated vomiting
a seizure
weakness, or tingling or burning in the arms or legs
reduced consciousness
a severe or worsening headache
unusual behaviour.
If any of these signs appear, call 000 or go straight to an emergency department rather than waiting for a sport-specific assessment.
Where a physio fits in
The SCAT6 is for health care professionals, and the 2024 Australian guidelines were developed with input from doctors and physiotherapists. Guidance based on the AIS framework says a medical practitioner, such as a sport and exercise physician or sports doctor, diagnoses concussion. Once a concussion has been diagnosed, rehab is matched to the symptoms that persist, and those symptoms are checked over time with tools such as the SCOAT6.
Pinnacle Physiotherapy Performance offers concussion physio and sports injury rehab from our physio clinic in Burleigh Heads. Physio care after a concussion should sit alongside medical review and your sport's return-to-play requirements, not replace them.
If you'd like to talk about concussion rehab or a sports injury, you're welcome to get in touch with our team.
Sources
A Perspective on the 6th International Conference on Sports Concussion - PMC
Sport Concussion Office Assessment Tool For Adults & Adolescents (13 years +)
Assessment and management of sport related concussion in general practice
Australian sporting body releases concussion guidelines for all junior, community sport - ABC News
New guidelines for concussion in youth and community sport as 2024 seasons kick off
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