Echemendia RJ, Burma JS, Bruce JM, Davis GA, Giza CC, Guskiewicz KM, Naidu D, Black AM, Broglio S, Kemp S, Patricios JS, Putukian M, Zemek R, Arango-Lasprilla JC, Bailey CM, Brett BL, Didehbani N, Gioia G, Herring SA, Howell D, Master CL, Valovich McLeod TC, Meehan WP 3rd, Premji Z, Salmon D, van Ierssel J, Bhathela N, Makdissi M, Walton SR, Kissick J, Pardini J, and Schneider KJ
Objectives: To systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6)., Data Sources: Systematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation., Eligibility Criteria: (1) Original research articles, cohort studies, case-control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC., Data Extraction: Separate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool., Results: Out of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test-retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children., Conclusion: Support exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes., Prospero Registration Number: CRD42020154787., Competing Interests: Competing interests: CMB reports affiliations with the Cleveland Browns (National Football League) and Cleveland Monsters (American Hockey League), a board position in the Sports Neuropsychology Society, and occasional expert consulting fees. AMB reports receiving an honorarium for administrative aspects of the concussion consensus reviews and grant funding from Social Sciences and Humanities Research Council. She is also a Sport Information Resource Centre board member and Canadian Athletic Therapists Association committee member. BLB reports grants from the National Institute on Aging and National Institute of Neurological Disorders and Stroke and travel support for professional conferences. JMB reports is a part-time employee of the National Hockey League and a member of the NHL/NHLPA Concussion subcommittee. He is the neuropsychology consultant to Major League Soccer's Sporting KC and has served as a consultant to EyeGuide. JSB is supported by the University of Calgary, the Natural Sciences and Engineering Research Council (CGSD3-559333-2021), and an honorarium for the methods author work associated with Reviews two and four. GAD is a member of the Scientific Committee of the 6th International Consensus Conference on Concussion in Sport; an honorary member of the AFL Concussion Scientific Committee; Section Editor, Sport and Rehabilitation, NEUROSURGERY; and has attended meetings organised by sporting organisations including the NFL, NRL, IIHF, IOC and FIFA; however has not received any payment, research funding or other monies from these groups other than for travel costs. RJE is a paid consultant for the National Hockey League and co-chair of the National Hockey League/National Hockey League Players' Association Concussion Subcommittee, Major League Soccer’s Concussion Committee and the US Soccer Federation. He provides expert testimony in matters related to mild traumatic brain injury and reports a grant from Boston Children’s Hospital (subaward from the National Football League) and travel support for the CIS conference and other professional conferences, an unpaid board member of CISG and a member of the Scientific Committee of the 6th International Consensus Conference on Concussion in Sport. He has served in leadership roles (unpaid) in professional organisations. CCG discloses the following: Grants/Research Support: Hit-IQ (2022-2023); NIH NINDS (R01 NS110757 2019-2024); NINDS (U54 NS121688 2021-2026); UCLA Brain Injury Research Center, UCLA Steve Tisch BrainSPORT program, Easton Clinic for Brain Health Clinical Consultant (provide clinical care to athletes): NBA, NFL-Neurological Care Program, NHL/NHLPA, Los Angeles Lakers Advisory Board (non-compensated): Major League Soccer, National Basketball Association, US Soccer Federation. Advisory Board (compensated): Highmark Interactive; Medicolegal: One or two cases annually. Stock Shareholder: Highmark Interactive stock options (2018). Book royalties – Blackwell/Wiley Publishing: Prioritized Neurological Differential Diagnosis. GG Reports grant funding from CDC TEAM and OnTRACK grants, NIMH APNA grant, royalties from PAR, consulting fees from NFL Baltimore Ravens, Zogenix International and Global Pharma Consultancy, and travel support for professional meetings. He is a member of USA Football Medical Advisory Panel. KMG reports compensation from National Collegiate Athletic Association for other services and grants from Boston Children’s Hospital (subaward from the National Football League). SH is co-founder and senior advisor, The Sports Institute at UW Medicine (unpaid), Centers for Disease Control and Prevention and National Center for Injury Prevention and Control Board Pediatric Mild Traumatic Brain Injury Guideline Workgroup (unpaid), CISG (travel support), NCAA Concussion Safety Advisory Group (unpaid), Team Physician, Seattle Mariners, Former Team Physician, Seattle Seahawks, occasional payment for expert testimony, travel support for professional meetings. DH reports research support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development, the National Institute of Neurological Disorders And Stroke, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, 59th Medical Wing Department of the Air Force, MINDSOURCE Brain Injury Network, the Tai Foundation and the Colorado Clinical and Translational Sciences Institute (UL1 TR002535‐05) and he serves on the Scientific/Medical Advisory Board of Synaptek. Concussion research grant support from Football Research. MM reports grants/contracts from Florey Institute of Neuroscience and Mental Health, consulting fees from AFL, Olympic Park Sports Medicine Centre, Cabrini and Epworth Health, World Rugby, Hawthorn Football Club and AFL Doctors Association. He has received travel support for attending professional conferences, has/had leadership roles in CISG, International Consensus Conference in Sport meeting and Australian Rugby Union, a shareholder in Olympic Park Sports Medicine Centre, and honorary research associations with several university groups. SK reports that he is Medical Services Director, Rugby Football Union. CLM reports no financial COI. She holds leadership positions with several organisations: American College of Sports Medicine, American Medical Society for Sports Medicine, Pediatric Research in Sports Medicine, Council on Sports Medicine and Fitness, American Academy of Pediatrics, Untold Foundation, Pink Concussions, Headway Foundation and the editorial boards of Journal of Adolescent Health, Frontiers in Neuroergonomics, Exercise, Sport and Movement. WPM receives royalties from ABC-Clio publishing, Springer International and Wolters Kluwer. His research is funded by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and a grant from the National Football League. DN receives consulting fees from the CFL and travel support for professional conferences. He is a team physician for the NHL and CFL. He is CMO for the CFL and a member of NHL and CFL committees. JP Editor BJSM (honorarium). Member of World Rugby Concussion Advisory Group (unpaid). Independent Concussion Consultant for World Rugby (fee per consultation) Medical consultant to South African Rugby (unpaid). Co-chair of the Scientific Committee, 6th International Conference on Concussion in Sport (unpaid). Board member of the Concussion in Sport Group (unpaid). Scientific Board member, EyeGuideTM (unpaid). MP reports receiving a travel stipend for attending CIS meeting and other professional conferences, grant funds from NCAA-CARE 2.0, royalties from Netters’ Sports Medicine, consulting fees from Major League Soccer as CMO and occasional expert testimony. She is a member of several professional boards and advisory panels. KJS has received grant funding from the Canadian Institutes of Health Research, National Football League Scientific Advisory Board, International Olympic Committee Medical and Scientific Research Fund, World Rugby, Mitacs Accelerate, University of Calgary with funds paid to her institution and not to her personally. She is an Associate Editor of BJSM (unpaid) and has received travel and accommodation support for meetings where she has presented. She is coordinating the writing of the systematic reviews that will inform the 6th International Consensus on Concussion in Sport, for which she has received an educational grant to assist with the administrative costs associated with the writing of the reviews. She is a member of the AFL Concussion Scientific Committee (unpaid position) and Brain Canada (unpaid positions). She works as a physiotherapy consultant and treats athletes of all levels of sport from grass roots to professional. JvI reports CIHR Postdoctoral Fellowship Award, UOMBRI Grant, travel stipend from CTRC and Founder of R2P Concussion Management. TCVM is a paid member of the NFL Head, Neck and Spine Committee and an unpaid member of the USA Swimming Concussion Task Force. SRW reports honoraria and travel support for professional meetings and leadership positions in World Federation of Athletic Training and Therapy and Outcomes, International Traumatic Brain Injury Research Initiative. DS reports grants from World Rugby, New Zealand Rugby Foundation and Otago Science into Action. JK, NB, JCA-L, ZP: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)