With the NFL Wild Card Weekend almost upon us, the talk of head injuries could never be higher. Professional athletes are evaluated by multiple physicians when at risk for a concussion, but what do you do when you have that 16 year old who hit his head playing basketball and now has a headache and some nausea? Most of us would say get some mental rest, don’t do activities until symptoms have resolved for about 24 hours, return if it worsens. But what about on that 3rd repeat visit after the negative imaging?
Most sports use the SCAT assessment tool for in clinic and sideline evaluations, and is a tool that can be used by you on your shift as well if necessary. What is a SCAT? It is a thorough assessment including symptom evaluation, cognitive screening and memory testing, concentration testing, a neurological exam, and finally a point system to determine severity of concussion and next best steps. This is an effective tool and can be used to evaluate patients longitudinally for improvement. An example SCAT is below, but be forewarned that this test cannot be performed in less than 10 minutes if done correctly.
Bottom Line: Some head injuries leading to concussions could use a severity score (SCAT) to determine next best steps as well as track improvement and may be helpful to do in the ED to facilitate better outpatient care.
“SCAT 5.” British Journal of Sports Medicine, vol. 22, no. 4, 26 Apr. 2017, bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf.
Hergenroeder, Albert. “Factors Associated With Concussion-like Symptom Reporting in High School Athletes.” UpToDate, 2017.