Standardized Assessment of Concussion: A Valuable Tool for Sideline Evaluation

When an athlete shows any signs of a concussion, he should be medically evaluated on the field or sideline, with particular attention given to ruling out a cervical spine injury.  Once the first aid issues are addressed, then an assessment of the athlete's mental status can be made by athletic trainers, coaches, and sideline medical personnel using the Standardized Assessment Of Concussion (SAC).

The SAC takes approximately 5 minutes to administer and includes measures of:

• Orientation (month, date, day of week, year, time)

• Immediate memory (recall of 5 words in 3 separate trials)

• Neurologic screening

  • Loss of consciousness (occurrence, duration)

  • Amnesia (either retrograde or anterograde) (recollection of events pre- and post-injury)

  • Strength

  • Sensation

  • Coordination

• Concentration (reciting numbers backwards; months in reverse order)

• Exertional maneuvers (jumping jacks, sit-ups)

• Delayed recall (5 words)

Recent studies have shown that the use of the SAC has value in helping sports medicine professionals in the diagnosis and management of concussion in athletes on the sport sideline, particularly in identifying concussions in the 90% of cases where there is no loss of consciousness or other obvious signs of concussion.

Follow-up testing required

The SAC is designed for rapid concussion evaluation on the sidelines. Like other brief neuropsychological test batteries that assess attention and memory function, the SAC is not meant to replace comprehensive neuropsychological testing  or used as a stand-alone tool for the ongoing management of sports concussions. It is also important to remember that symptoms may not appear until several hours after injury.¹

Baseline test data increases effectiveness

As with other neuropsychological testing tools, the value of the SAC in concussion assessment is maximized when individual baseline test data is available because, without such baselines, the athlete's postinjury performance on neuropsychological testing and other concussion assessment measures, such as the SAC, must be interpreted by comparison with a generalized "normal" based on a large population sample.

1. Concussion Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008.