SCAT6 Is Leading the Field—So Why Do So Many Still Question It?
By David Bartlett, Chief Operating Officer at Your Brain Health and Welsh Fire Physiotherapist.
When an athlete sustains a potential concussion, the decisions made in the moments that follow are critical. Healthcare Professionals and medical staff are often required to act quickly, using the best tools available to assess injury severity and guide next steps. The SCAT6 (Sport Concussion Assessment Tool, 6th Edition) has emerged as the leading sideline and clinical evaluation tool—but is it truly the best we have?
The Evolution of Concussion Assessment
Concussion assessment has come a long way. Decades ago, decisions were based largely on observation and subjective judgment. The introduction of structured tools like the SCAT series from the Concussion in Sport Group (CISG) transformed this landscape—bringing standardised protocols, objective criteria, and evidence-informed decision-making into both sideline and clinical environments.
The latest iteration from the 2022 consensus meeting, SCAT6, incorporates years of research and expert feedback. It’s no longer just a checklist; it’s a comprehensive, multi-domain assessment tool covering symptoms, cognitive and neurological function, balance, and more. Updates like the 10-word recall task address previous concerns about sensitivity, particularly in elite athletes.
The Strengths of SCAT6
SCAT6 is widely used as the go-to concussion assessment tool for the acute phase of injury. It encourages a holistic view of the athlete, prompting clinicians to consider symptom progression, cognitive status, and observable signs rather than relying on any one domain.
It also reinforces a culture of athlete safety. The emphasis on standardised removal-from-play protocols and serial assessments helps mitigate the risks associated with premature return-to-play decisions.
Persistent Limitations
Despite its strengths, SCAT6 is not without limitations. It remains a tool—not a diagnostic verdict—and is dependent on the clinical judgment and skill of the person administering it. Its validated window of utility is confined to the first 72 hours post-injury, limiting its role in ongoing management.
That distinction—tool, not diagnosis—is crucial, yet often misunderstood. Many research studies still use SCAT6 outcomes as de facto diagnostic criteria for inclusion or exclusion, despite the fact that SCAT6 was never intended to serve as a standalone diagnostic standard. This creates inconsistencies in the literature and can contribute to overreliance on thresholds that were meant to guide, not define, clinical decision-making.
Practical barriers also persist. The tool’s comprehensiveness can be a double-edged sword in time-pressured environments. Administering SCAT6 efficiently requires training, familiarity, and ideally, baseline data—which not all settings can support.
Historically, one of the major constraints has been the lack of a digital format. Paper-based assessments can be cumbersome, prone to inconsistencies, and difficult to integrate into broader EMR systems or performance tracking platforms.
That’s why the arrival of a digital SCAT6 is a significant step forward. Digitisation streamlines administration, enables structured data capture, supports longitudinal tracking, and reduces variability in how the tool is used across clinicians and environments. In real-world terms, this means faster workflows, cleaner data, and more reliable follow-up over time.
Where Does SCAT6 Fit Within the Broader Landscape?
SCAT6 offers a robust and integrative approach, integrating other tools—such as the Standardised Assessment of Concussion (SAC), Balance Error Scoring System (BESS), and simple symptom checklists. However, it is not designed to function in isolation. It should be seen as part of a clinician’s broader toolkit, not a substitute for comprehensive evaluation or clinical reasoning.
It’s also important to acknowledge gaps in evidence for certain populations—children under 13, para athletes, and female athletes, for example—where normative data is still evolving. Ongoing research and future iterations of the SCAT will need to address these limitations more fully, although in 2022 the CISG also released the Child SCAT6.
A Tool That Keeps Improving
So, is SCAT6 the best we have? For the acute assessment of sport-related concussion, it is certainly the most complete tool currently available. And with the shift to digital formats, some of its practical limitations are being actively addressed—making it more accessible, efficient, and clinically useful.
But like any tool, its effectiveness depends on context, competence, and careful application. SCAT6 should support—not replace—clinical judgment. As our understanding of concussion continues to evolve, so too must our tools and technologies.
For now, SCAT6 stands at the forefront of concussion assessment. And with modern platforms like ScreenIT offering digitally integrated SCAT6, we’re better positioned than ever to provide timely, informed, and athlete-centered care.