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SCAT 6 the Latest and Greatest?

Jeffrey Cunningham, MD

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Learning Objectives

When it iis appropriate to Use SCAT 6 vs SCOAT 6

Differences between SCAT 5 and SCAT 6

Utility of Child SCAT 6 and Child SCOAT 6

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Latest Definitions

  • Sport related concussion is a traumatic brain injury caused by a direct blow to the head, neck, or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise-related activities

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Even More Latest Definitions

  • This initiates a neurotransmitter and metabolic cascade with possible axonal injury, blood flow change and inflammation affecting the brain. Symptoms and signs may present immediately or evolve over minutes or hours

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Warning !!

  • That was only a conceptiual definition and does not provide diagnostic criteria
  • (thanks for nothing)

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Prevention

Rule changes such as limiting checking at younger ages

Mouthgaurds

Neuromuscular training

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SCAT 6

Designed to assist in the evaluation of athletes within the first 72 hours of injury

Can be used up to 5-7 days postinjury

Clinical utility appears to diminish after 72 hours

Except for symptoms these tools may not be appropriate for use in return to sport beyond 7 days

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Rest and Exercise

  • Relative rest (not strict) which includes activities of daily living and reduced screen time for up to the first 2 days after injury
  • Can return to light intensity activity during the initial 24-28 hours such as walking as long as no more than mildy exacerbating symptoms

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Rest and Exercise

  • Reduced screen usage in the first 48 hours is warranted
  • May not be effective beyond that time frame
  • 2-10 days recommend prescribing subsymptom threshold aerobic exercise with an increase of no more thatn two points on a 0-10 scale

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SCOAT 6

Designed for 72 hours-30 days

Requires further Eval to understand the validity and clinical utility.

Ages

    • SCOAT 6/ SCAT 6: >12 yo
    • Child SCOAT 6/ Child SCAT 6: 8-12

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Differences

Requires minimum of 10-15 min to be performed correctly

To be used within 72hrs and up to 7 days post injury

New coordination and ocular/motor screen

Addition of timed component to the months in reverse

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More Different

Revised recognize and remove section

Revised immediate assessment/ neurological screen section

Enhanced Red Flags section

Revised coordination and balance examination including an optional dual-task tandem gait

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Goodbye Different

Removal of Read Aloud instructions of the symptom scale

Removal of the immediate memory 5-word list option

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Problems

Tests themselves may be limited by ceiling effects, test-retest reliability and other psychometric issues

Concussion is known to be time limited with resolution occring relatively quickley with no or very weak signal to track creating a moving target

Concussion is a non-specific diagnosis

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SCAT 6

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SCAT 6

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SCAT 6

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SCAT 6

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SCAT 6

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SCAT 6

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Thoughts

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Work Cited

  • PatriciosJS, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022, BJSM 2023;57: 695-711
  • Echemendia RJ, et al. Introducing the Sport Concussion Assessment Tool 6 (SCAT6), BJSM June 2023; 57: 619-620
  • Patricios JS, et al. Beyond acute concussion assessment to office management: a systematic review informint the development of a Sport Concussion Office Assessment Tool (SCOAT6) for adults and children, BJSM 2023; 57: 737-748
  • Echemendia RJ, etal, SCAT6, BJSM June 2023; 57: 622-630

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Questions from Me

The SCAT 6 and the Child Scat 6 are best used in what time frame?

a. Within 24 hours of injury

b. Within 48 hours of injury

c. Within 72 hours of injury

d. Within 96 hours of injury

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Questions from Me

What are some ways to prevent concussion?

a. Mouthguards

b. Rule changes

c. Neuromuscular training

d. Helmets

e. All the above

f. None of the above

g. A, B, and C

h. A and C

i. B and D

j. C and D

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Questions from Me

What is the minimum age for SCAT 6 and Child SCAT 6?

a. Scat >12/ child Scat 8-12

b. Scat >10 / child Scat 5-10

c. Scat > 15/ child Scat 6-15

d. Scat > 6/ child Scat 4-6

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Questions From You