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• Response: Who should undertake the SCOAT6?
  Jon S Patricios, Gavin A Davis
  Published on: 7 July 2023
• Who should undertake the SCOAT6?
  Neil Heron
  Published on: 6 July 2023

• Published on: 7 July 2023

  Response: Who should undertake the SCOAT6?

  • Jon S Patricios, Sport and Exercise Medicine Physician Wits Sport and Health (WiSH), University of the Witwatersrand, Johannesburg, South Africa
  • Other Contributors:
    • Gavin A Davis, Neurosurgeon

  Response: Who should undertake the SCOAT6?

  Thank you for your interest in the Sports Concussion Office Assessment Tools, the SCOAT6 and Child SCOAT6. These tools were developed to guide clinicians internationally, using evidence-based components.1 The evidence shows that concussion in children, adolescents and adults affects multiple clinical domains, and the office assessment must address the clinically relevant domains, which will be different in each concussed individual. Using the symptom scales, and interview with the patient, the clinician can identify which clinical domains are endorsed. This guides the clinician towards the appropriate components of the Child SCOAT6 / SCOAT6. Incorporated into the tools are Green “recommended” sections and Orange “optional” sections, to assist the time-challenged clinician in focusing on the most relevant modalities.2,3

  Developing the Office tools was a balancing act that primarily considered producing a thorough, multimodal assessment tool but one that was also easy to use and not too lengthy. For instance, we could not ignore research supporting the value of the VOMS but opted for the recently validated modified VOMS which is a validated briefer version.4,5

  The scientifically derived clinical reality is that the office assessment of concussed athletes requires a multimodal assessment. Trying to perform a proper multimodal assessment in a 10-minute time period is neither appropriate nor realistic. The concu...

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  Response: Who should undertake the SCOAT6?

  Thank you for your interest in the Sports Concussion Office Assessment Tools, the SCOAT6 and Child SCOAT6. These tools were developed to guide clinicians internationally, using evidence-based components.1 The evidence shows that concussion in children, adolescents and adults affects multiple clinical domains, and the office assessment must address the clinically relevant domains, which will be different in each concussed individual. Using the symptom scales, and interview with the patient, the clinician can identify which clinical domains are endorsed. This guides the clinician towards the appropriate components of the Child SCOAT6 / SCOAT6. Incorporated into the tools are Green “recommended” sections and Orange “optional” sections, to assist the time-challenged clinician in focusing on the most relevant modalities.2,3

  Developing the Office tools was a balancing act that primarily considered producing a thorough, multimodal assessment tool but one that was also easy to use and not too lengthy. For instance, we could not ignore research supporting the value of the VOMS but opted for the recently validated modified VOMS which is a validated briefer version.4,5

  The scientifically derived clinical reality is that the office assessment of concussed athletes requires a multimodal assessment. Trying to perform a proper multimodal assessment in a 10-minute time period is neither appropriate nor realistic. The concussion diagnostic screen, the SCAT6/Child SCAT6, used within the first 72 hours post-concussion and up to a week, is designed to take 10-15 minutes to implement. The more comprehensive SCOAT6/Child SCOAT6 requires longer appointments with a single clinician, or alternatively, the assessment may be performed by multiple HCPs over several sessions, such as the physiotherapist performing the balance and VOMS assessment. We maintain that a multisystem evaluation remains the most appropriate in the setting of SRC but appreciate real-life clinical scenarios. The tools were developed as the gold standard. It would be more reasonable for health administrations to provide resources to enable practitioners sufficient time to complete the assessment with the tool, rather than compromise the tool to accommodate under-resourced GP practices in some countries. We acknowledge restraints on time, resources and expertise across a range of HCPs and referred to this in the Systematic Review and accompanying editorials introducing the tools.6,7

  We are currently endeavouring to develop an electronic version of the SCOAT6 tools which should assist the HCP conducting the assessment and simplify recording of the results.

  Finally, as with the SCAT6, the SCOAT6 and Child SCOAT6 contain individually validated elements, but require validation as a combined tool in different clinical and cultural settings and these findings are likely to help evolve the tool in future versions. These changes may include abbreviating any aspects that are found to be redundant.

  1. Patricios JS, Schneider GM, van Ierssel J, et al. Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool 6 (SCOAT6) Br J Sports Med 2023;57:651-667.
  2. Child SCOAT6 Br J Sports Med 2023;57:672-688
  3. Sport Concussion Office Assessment Tool 6 (SCOAT6). Br J Sports Med 2023;57:651-667.
  4. Ferris LM, Kontos AP, Eagle SR, et al. Predictive accuracy of the sport concussion assessment tool 3 and vestibular/ocular-motor screening, individually and in combination: a national collegiate athletic association-department of defence concussion assessment, research and education Consortium analysis. Am J Sports Med 2021;49:1040–8.
  5. Ferris LM, Kontos AP, Eagle SR, et al. Optimizing VOMS for identifying acute concussion in collegiate athletes: findings from the NCAA-DoD care consortium. Vision Res 2022;200:108081.
  6. Patricios JS, Davis GA, Ahmed OH, et al. Introducing the Sport Concussion Office Assessment Tool 6 (SCOAT6). Br J Sports Med 2023;57:648–650
  7. Davis, GA, Patricios, JS, Purcell, L et al. (2023). Introducing the Child Sport Concussion Office Assessment Tool 6 (Child SCOAT6). Br J Sports Med 2023. 57. 668-671. 10.1136/bjsports-2023-106858.

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  Conflict of Interest:
  JSP is an Editor of BJSM for which he receives a honorarium. He is an unpaid consultant to the World Rugby Concussion Advisory Group for which he also serves as an Independent Concussion Advisor (fee per consultation). Other unpaid positions include being medical advisor to South African Rugby, Co-chair of the Scientific Committee, 6th International Conference on Concussion in Sport (travel and accommodation subsidised), Board member of the CISG and a Scientific Advisory Board Member of EyeGuide. GAD is a member of the Scientific Committee of the Sixth International 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 sport organisations including 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

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• Published on: 6 July 2023

  Who should undertake the SCOAT6?

  • Neil Heron, Sport and exercise medicine consultant / GP / Clinical Lecturer Queen’s University Belfast, Northern Ireland; Keele University, England.

  Dear Authors,

  Great work on putting together the SCOAT6 and this is a really helpful piece for the office sport medicine doctors. However, what about the community healthcare teams, eg General Practitioners, GPs, what tool should they be using? Particularly bearing in mind the time constraints of community health contacts, eg GP consults in the UK are most often limited to 10 minutes. What can we expect non-specialist sport medicine doctors to do to help make the concussion diagnosis and therefore initiate appropriate management promptly? Should we be making a SCATgp?

  Conflict of Interest:
  None declared.

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