A Review of the SAC (Standardized Assessment of Concussion) — Brain Injury Awareness Month



We are back to finish out Brain Injury Awareness Month looking at another component of the SCAT6. Today we are going to tackle what I consider to be the “OG” version of the SCAT, otherwise known as the SAC, or the Standardized Assessment of Concussion. We certainly love acronyms in sports medicine, don’t we? Let’s take the deep dive.


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Links from this Episode:

— Dr. Mark Halstead: On the WebOn X


— McCrea M, Kelly JP, Kluge J, Ackley B, Randolph C. Standardized assessment of concussion in football players. Neurology. 1997 Mar;48(3):586-8. doi: 10.1212/wnl.48.3.586. PMID: 9065531. https://pubmed.ncbi.nlm.nih.gov/9065531/


— McCrea M, Kelly JP, Randolph C, Kluge J, Bartolic E, Finn G, Baxter B. Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete. J Head Trauma Rehabil. 1998 Apr;13(2):27-35. doi: 10.1097/00001199-199804000-00005. PMID: 9575254. https://pubmed.ncbi.nlm.nih.gov/9575254/


— McCrea M. Standardized Mental Status Testing on the Sideline After Sport-Related Concussion. J Athl Train. 2001 Sep;36(3):274-279. PMID: 12937496; PMCID: PMC155418. https://pubmed.ncbi.nlm.nih.gov/12937496/


— Daniel JC, Nassiri JD, Wilckens J, Land BC. The implementation and use of the standardized assessment of concussion at the U.S. Naval Academy. Mil Med. 2002 Oct;167(10):873-6. PMID: 12392259. https://pubmed.ncbi.nlm.nih.gov/12392259/


— McCrea M, Guskiewicz KM, Marshall SW, Barr W, Randolph C, Cantu RC, Onate JA, Yang J, Kelly JP. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003 Nov 19;290(19):2556-63. doi: 10.1001/jama.290.19.2556. PMID: 14625332. https://pubmed.ncbi.nlm.nih.gov/14625332/


— Valovich McLeod TC, Perrin DH, Guskiewicz KM, Shultz SJ, Diamond R, Gansneder BM. Serial administration of clinical concussion assessments and learning effects in healthy young athletes. Clin J Sport Med. 2004 Sep;14(5):287-95. doi: 10.1097/00042752-200409000-00007. PMID: 15377968. https://pubmed.ncbi.nlm.nih.gov/15377968/


— Grubenhoff JA, Kirkwood M, Gao D, Deakyne S, Wathen J. Evaluation of the standardized assessment of concussion in a pediatric emergency department. Pediatrics. 2010 Oct;126(4):688-95. doi: 10.1542/peds.2009-2804. Epub 2010 Sep 6. PMID: 20819901. https://pubmed.ncbi.nlm.nih.gov/20819901/


— Zimmer A, Piecora K, Schuster D, Webbe F. Sport and team differences on baseline measures of sport-related concussion. J Athl Train. 2013 Sep-Oct;48(5):659-67. doi: 10.4085/1062-6050-48.5.06. Epub 2013 Aug 16. PMID: 23952044; PMCID: PMC3784368. https://pubmed.ncbi.nlm.nih.gov/23952044/


— Chin EY, Nelson LD, Barr WB, McCrory P, McCrea MA. Reliability and Validity of the Sport Concussion Assessment Tool-3 (SCAT3) in High School and Collegiate Athletes. Am J Sports Med. 2016 Sep;44(9):2276-85. doi: 10.1177/0363546516648141. Epub 2016 Jun 8. PMID: 27281276. https://pubmed.ncbi.nlm.nih.gov/27281276/


— Snedden TR, Brooks MA, Hetzel S, McGuine T. Normative Values of the Sport Concussion Assessment Tool 3 (SCAT3) in High School Athletes. Clin J Sport Med. 2017 Sep;27(5):462-467. doi: 10.1097/JSM.0000000000000389. PMID: 27606952. https://pubmed.ncbi.nlm.nih.gov/27606952/


— Young CC, Jacobs BA, Clavette K, Mark DH, Guse CE. Serial sevens: not the most effective test of mental status in high school athletes. Clin J Sport Med. 1997 Jul;7(3):196-8. PMID: 9262887. https://pubmed.ncbi.nlm.nih.gov/9262887/


Timestamps from this Episode:

00:00 SAC is a standardized assessment for concussion. It was developed after the publication of guidelines by the American Academy of Neurology, Colorado Medical Society, and Cantu guidelines. These guidelines included individual grading scales and led to the development of the SAC tool for evaluation.

05:41 Comparison of concussion assessment in athletes using orientation and Maddox questions; follow-up study by McCray and others.

08:55 Concussed athletes showed significant differences in SAC scores compared to uninjured controls, particularly in orientation, immediate memory, concentration, and delayed recall.

11:21 Study examines recovery time for football player concussions.

17:11 Females perform better than males in sports studies, with some factors like concussion history, learning disabilities, ADHD, and native language affecting performance.

23:32 Questioning the effectiveness and interpretation of SCAT 2, particularly in the absence of a baseline for comparison and concerns over false assumptions based on norms.

24:49 Evolution of SCAT from 2 to 5

29:44 Tool for concussion assessment updated with modifications.

31:12 Dr. Halstead’s invites future participation in podcast.


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Dr. Mark Halstead - Host of The Pediatric Sports Medicine Podcast - St. Louis, MOMark Halstead: 

Dr. Mark Halstead received his medical degree from the University of Wisconsin Medical School. He stayed at the University of Wisconsin for his pediatric residency, followed by a year as the chief resident. Following residency, he completed a pediatric and adult sports medicine fellowship at Vanderbilt University. He has been an elected member to the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness and the Board of Directors of the American Medical Society for Sports Medicine (AMSSM). He has served as a team physician or medical consultant to numerous high schools, Vanderbilt University, Belmont University, Washington University, St. Louis Cardinals, St. Louis Blues, St. Louis Athletica, and St. Louis Rams. He serves and has served on many local, regional and national committees as an advisor for sports medicine and concussions. Dr. Halstead is a national recognized expert in sport-related concussions and pediatric sports medicine.

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