Applying the SCAT6 for Concussion Assessments in Grassroots Sport
- Train Direct
- May 8
- 5 min read
Concussion remains one of the most important medical issues in grassroots sport. Whether in rugby, football, hockey, cycling, martial arts or community-level cricket, early recognition and appropriate management of concussion can reduce the risk of prolonged symptoms and serious complications. The introduction of the Sport Concussion Assessment Tool 6 (SCAT6) represents a significant update in the assessment of suspected sport-related concussion and provides clinicians with a structured, evidence-informed approach to
sideline and early post-injury evaluation.
The SCAT6 emerged from the Amsterdam 2022 International Consensus Conference on Concussion in Sport and replaced the previous SCAT5 framework. It is designed for athletes aged 13 years and older and is intended for use by trained healthcare professionals. Child SCAT6 is available for younger athletes.
The Importance of Concussion Recognition in Grassroots Sport
Grassroots sport presents unique challenges for concussion management. Unlike elite environments, community clubs often lack pitch-side doctors, advanced diagnostic equipment or formal concussion protocols. Coaches, volunteers and parents may be responsible for recognising injuries and initiating medical referral.
This creates a risk that concussion symptoms may be missed, minimised or misunderstood. Athletes frequently continue playing despite symptoms such as headache, dizziness, confusion or visual disturbance. In youth sport particularly, delayed recognition may prolong recovery and increase vulnerability to further injury.
By applying the SCAT6 for Concussion Assessments in Grassroots Sport we help address issues by providing a structured and standardised assessment pathway. While it does not replace clinical judgement or formal medical evaluation, it improves consistency in how suspected concussion is assessed and documented.
What is the SCAT6?
The SCAT6 is a multimodal concussion assessment tool designed for acute assessment following a suspected concussion. It combines symptom evaluation, cognitive screening, neurological examination and balance testing into a single framework.
The assessment includes:
Immediate or on-field assessment
Observable signs and red flags
Glasgow Coma Scale screening
Cervical spine assessment
Symptom checklist
Cognitive testing
Memory and concentration tasks
Neurological examination
Balance assessment
Delayed recall testing
The tool is most useful within the first 72 hours after injury, although its clinical utility reduces beyond the first week.
Who Should Use the SCAT6?
A key principle of the SCAT6 is that it is intended for trained healthcare professionals only. This may include:
Doctors
Physiotherapists
Sports therapists with appropriate training
Athletic trainers
Advanced paramedics
The Concussion Recognition Tool 6 (CRT6) is intended instead for non-medical personnel such as coaches, referees and parents.
In grassroots settings, this distinction is particularly important. Many community clubs do not have healthcare professionals present at matches or training sessions. In such situations, coaches and volunteers should focus on recognising potential concussion and removing the athlete from play rather than attempting to perform a SCAT6 independently.
Applying the SCAT6 in Practice
Initial Recognition and Removal
The first priority is recognising a suspected concussion. Any athlete who has sustained a blow to the head, face, neck or body with force transmitted to the head should be assessed if symptoms or signs are present.
Common indicators include:
Loss of consciousness
Confusion
Balance disturbance
Behavioural change
Memory problems
Headache
Visual symptoms
Nausea
Slow responses
If concussion is suspected, the athlete should be removed from play immediately. “If in doubt, sit them out” remains a central principle in concussion management.
Immediate Assessment
The SCAT6 begins with identifying emergency red flags, including:
Neck pain
Repeated vomiting
Seizure activity
Deteriorating consciousness
Double vision
Significant agitation or confusion
The presence of these signs requires urgent medical escalation.
The clinician then proceeds through cognitive and neurological assessment components.
The revised SCAT6 includes improvements to memory testing, balance evaluation and dual-task gait assessment compared with earlier versions.
Symptom Evaluation
Athletes rate symptoms across a range of domains, including:
Physical symptoms
Cognitive symptoms
Emotional symptoms
Sleep-related symptoms
The SCAT6 symptom checklist uses a graded severity scale, helping clinicians monitor symptom burden over time. Importantly, symptom scores alone should not determine diagnosis or return-to-play decisions.
Cognitive and Balance Testing
The cognitive assessment evaluates orientation, immediate memory and concentration. Balance testing assesses postural stability and coordination, which are commonly impaired after concussion.
In grassroots sport, environmental factors such as noise, weather and lack of private space can affect assessment quality. Ideally, SCAT6 should be completed in a quiet environment and take at least 10–15 minutes to administer properly.
Strengths of the SCAT6 in Grassroots Settings
The SCAT6 offers several advantages for community sport:
Standardisation
It provides a consistent framework that improves documentation and communication between clinicians, clubs and families.
Comprehensive Assessment
The tool evaluates multiple domains affected by concussion rather than relying solely on symptom reporting.
Evidence-Informed Practice
The SCAT6 reflects current international consensus and contemporary research on sport-related concussion.
Education and Awareness
Its widespread adoption promotes better concussion awareness among grassroots organisations and encourages safer sporting cultures.
Limitations and Challenges
Despite its value, the SCAT6 has important limitations.
It Does Not Diagnose Concussion Alone
A normal SCAT6 does not exclude concussion. Clinical judgement remains essential.
Training Requirements
The assessment requires appropriate training and experience. In many grassroots settings, access to trained personnel remains limited.
Resource Constraints
Community clubs may lack quiet assessment areas, medical support or follow-up pathways.
Time Pressures
Grassroots matches often operate with limited staffing and rapid game turnover, reducing opportunities for detailed assessment.
Potential Underreporting
Athletes may intentionally minimise symptoms to continue playing, particularly in competitive environments.
The Role of Education in Grassroots Sport
Effective concussion management depends not only on assessment tools but also on education. Clubs should ensure that:
Coaches understand concussion recognition
Parents are aware of symptom progression
Athletes understand reporting responsibilities
Return-to-play protocols are established
Medical referral pathways are clear
The SCAT6 should form part of a wider concussion management strategy rather than functioning as an isolated assessment tool.
Return to Sport Considerations
The Amsterdam consensus statement emphasises a graduated return-to-sport approach following concussion. Athletes should only progress through recovery stages when symptoms remain stable or improve.
In grassroots sport, pressure to return quickly may be significant. Clear protocols and medical oversight are therefore essential. No athlete diagnosed with concussion should return to play on the same day.
Summary - Applying the SCAT6 for Concussion Assessments in Grassroots Sport
The SCAT6 represents a valuable advancement in the assessment of sport-related concussion and provides a structured framework for healthcare professionals working within grassroots sport. Its evidence-based, multidimensional approach supports safer decision-making and improved recognition of concussion.
However, successful implementation depends on education, access to trained clinicians and a sporting culture that prioritises player welfare over immediate competition. In community sport particularly, the SCAT6 should be viewed as one component of a broader concussion management system that includes recognition, removal from play, medical assessment, graduated recovery and ongoing education.
As awareness of concussion continues to grow, the consistent application of tools such as the SCAT6 can help improve athlete safety and support better long-term outcomes across all levels of sport.
Concussion Recognition Tools
The CRT6 (Concussion Recognition Tool) is designed for use by non-healthcare professionals, including coaches, teachers, parents and volunteers, to help identify and manage a suspected concussion immediately after an injury. It is intended as a recognition tool only and should not be used to diagnose concussion.
The Child SCAT6 (Sport Concussion Assessment Tool) is a standardised concussion assessment tool intended for use by appropriately trained healthcare professionals. It is specifically designed for assessing children aged 8 to 12 years following a suspected concussion.
The SCAT6 (Sport Concussion Assessment Tool) is a standardised assessment tool used by trained healthcare professionals to evaluate suspected concussion in athletes aged 13 years and over.
Both versions of the SCAT6 require sufficient time to complete properly and should not be rushed. A full assessment typically takes between 10 and 15 minutes. With the exception of symptom monitoring, the SCAT6 is intended for use during the acute phase of injury, ideally within the first 72 hours and up to seven days following the suspected concussion.
If you would like tailored advice or want to book training for your organisation, then visit www.traindirect.co.uk to learn more or contact our team to discuss your training requirements.
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