What is a Head Injury Assessment? The Sport Clinician’s Guide
Everything clinicians working in sport need to know — from sideline recognition through clinic follow-up, the tools used at each stage, and why digital delivery is changing how HIA is done.
What is a Head Injury Assessment?
A head injury assessment (HIA) is a structured clinical evaluation conducted after a suspected head knock in sport. It is not a single test — it is a process, running from immediate sideline recognition through acute clinical evaluation to ongoing recovery monitoring.
A Process, Not a Single Test
HIA spans three distinct phases: immediate recognition at the moment of injury, acute assessment in the first 72 hours, and ongoing follow-up in the clinic. Each phase uses different tools, performed by different people, at different timepoints. Understanding this continuum is essential for managing concussion safely in sport.
Internationally Standardised
The clinical tools used across professional sport are standardised by the Concussion in Sport Group (CISG) — a collaboration of world-leading researchers convened through the Amsterdam Consensus Conferences. CISG-approved tools include SCAT6 (acute assessment), SCOAT6 (office follow-up), and CRT6 (sideline recognition). Major sporting bodies including FIFA, World Rugby, and the AFL mandate their use.
HIA is a clinical support tool, not a diagnostic test. Concussion diagnosis remains a clinical judgement integrating mechanism of injury, symptom presentation, and examination findings across the continuum of assessment.
HIA in Sport: AFL, NRL, and Beyond
Each sporting code names its protocol differently, but the underlying clinical assessment tools are the same. CISG-approved assessments — SCAT6 for acute evaluation, SCOAT6 for follow-up — form the clinical backbone across professional sport globally.
| Sport / Code | Protocol Name | Clinical Tools Used | Key Timepoints |
|---|---|---|---|
| AFL | AFL HIA (Head Injury Assessment) | SCAT6 (acute), SCOAT6 (follow-up) | HIA1 (immediate), HIA2 (1h), HIA3 (36h) |
| NRL | NRL Head Injury Assessment | SCAT6 (acute), SCOAT6 (follow-up) | Sideline + within 1 hour + clinical follow-up |
| World Rugby | World Rugby HIA Protocol | SCAT6 (HIA1, HIA2), SCOAT6 (HIA3+) | HIA1 (immediate), HIA2 (same day), HIA3 (48h) |
| Football (Soccer) | FIFA Concussion Protocol | SCAT6 (acute), SCOAT6 (follow-up) | Sideline evaluation + clinical follow-up |
| All contact sports | CISG Graduated Return-to-Sport | SCAT6, SCOAT6, CRT6 | 6-stage protocol, minimum 1 week |
Whether an organisation calls it an HIA, a Head Injury Assessment, or a Concussion Assessment Protocol, the clinical assessments used are the same CISG-approved tools. What differs between codes is the timing, the number of formal assessment windows, and the return-to-play decision chain.
The HIA Clinical Continuum
Three assessment phases. Three different tools. Each designed for a specific timepoint in the concussion management pathway.
Phase 1: Immediate
CRT6
Concussion Recognition Tool 6
0 – 15 minutes
Designed for coaches, parents, and teammates — anyone on the sideline. CRT6 identifies when an athlete should be removed from play and assessed by a healthcare professional. It is not a diagnostic tool.
Who: Anyone on the sideline
Purpose: Recognition, removal from play
Phase 2: Acute Assessment
SCAT6
Sport Concussion Assessment Tool 6
0 – 72 hours
The CISG gold standard for acute concussion assessment. Covers symptom evaluation, cognitive screening, neurological examination, and balance testing. Requires a licensed healthcare professional.
Who: Licensed healthcare professionals
Purpose: Acute assessment, diagnosis support
Phase 3: Follow-Up
SCOAT6
Sport Concussion Office Assessment Tool 6
72 hours – 30 days
The office-based follow-up tool. Covers extended neurological examination, mental health screening (GAD-7, PHQ-2), modified VOMS, vestibular assessment, and return-to-sport planning.
Who: Licensed healthcare professionals
Purpose: Recovery monitoring, return-to-sport
Why Digital HIA Delivery Matters
Sport environments are high-pressure and fast-moving. Manual paper-based HIA introduces risk at every stage — from scoring errors to missing files. Digital delivery removes these failure points.
Scoring Without Error
Manual SCAT6 scoring requires tallying multiple domain scores under sideline pressure. Digital assessment auto-scores every domain in real time — symptom count, severity total, cognitive composite, and balance errors — eliminating calculation mistakes and ensuring results are immediately available for clinical decision-making.
Baseline Comparison Built In
SCAT6 has no fixed pass/fail thresholds — interpretation depends heavily on comparison against the individual's pre-injury baseline. Digital platforms store baseline assessments and surface instant domain-by-domain comparison at the point of injury, so clinicians see exactly how far each score has deviated from the athlete's own normal.
Instant PDF Reports
Return-to-play decisions need a paper trail. Digital HIA platforms generate a structured PDF report immediately after assessment — ready to share with the team doctor, club, and league medical officer. No transcription, no lost forms, no reconstructed notes from memory.
The Full Continuum in One Platform
Managing the transition from acute SCAT6 to follow-up SCOAT6 on paper means tracking across different forms and locations. A single digital platform covers the full HIA continuum — SCAT6, SCOAT6, and baseline testing — with all assessments for each athlete in one place, accessible from any device.
ScreenIT is the only platform with written CISG authorisation for both SCAT6 and SCOAT6 — the complete acute and follow-up concussion assessment suite. Used by sports medicine professionals across AFL, rugby, and community sport. Free for healthcare professionals. Try digital SCAT6 →
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Free for healthcare professionals. CISG-approved. SCAT6, SCOAT6, and baseline testing in one platform.
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