What is SCOAT6? The Sport Concussion Office Assessment Tool
Everything healthcare professionals need to know about the Sport Concussion Office Assessment Tool 6 – the internationally standardised tool for evaluating and managing sport-related concussion from 72 hours to 30 days post-injury. For a broader overview of head injury assessment in sport — including how SCOAT6 fits within AFL, NRL, and international protocols — see our Head Injury Assessment guide.
What is SCOAT6?
The Sport Concussion Office Assessment Tool 6 (SCOAT6) is the first internationally consensus-driven standardised tool specifically designed for evaluating sport-related concussion in the subacute phase - typically 72 hours to 30 days after injury. It is intended for use by licensed healthcare professionals in a controlled office or clinic environment.
Filling a Decades-Long Gap
Before SCOAT6, no standardised tool existed for clinical follow-up after acute sideline assessment. The concept was first proposed in 2012 by Jon Patricios and colleagues, who argued that the SCAT was inadequate for serial office examinations. A decade later, the 6th International Conference on Concussion in Sport (Amsterdam, October 2022) finally delivered a consensus tool - informed by systematic review of 9,913 studies, with 127 meeting inclusion criteria across 12 clinical domains.
Why '6' When There Was No SCOAT5?
The number aligns with the 6th International Conference on Concussion in Sport, not a predecessor version. There was no SCOAT1 through SCOAT5. The tool was developed alongside SCAT6 and follows the same conference numbering convention - ensuring clinicians understand these are companion tools from the same consensus process. Explore the full assessment library.
What does SCOAT6 assess?
SCOAT6 assesses concussion recovery across multiple clinical domains including symptoms, cognition, balance, gait, vestibular-ocular function, and mental health screening. The tool uses a colour-coded completion guide — blue for first-assessment components, green for recommended sections, and orange for optional screening — to help clinicians prioritise their evaluation.
Core Assessment (Recommended)
Symptom Evaluation (PCSI)
22 symptoms rated 0–6, max severity 132. Designed for comparison across time points: before injury, at time of injury, and current consultation.
Verbal Cognitive Tests
10-word immediate memory (with optional 15-word extension for high-performing athletes). Digits backward and months in reverse.
Neurological Examination
Standard neurological screen and coordination assessment.
Modified Balance (mBESS)
Double, single, and tandem stances for 20 seconds each on firm surface.
Timed Tandem Gait
Heel-to-toe walking, fastest time recorded.
Complex and Dual-Task Gait
More demanding gait assessment plus walking while counting backward by 7s (adjusted to individual's maths ability).
Modified VOMS
4 subtests: smooth pursuits (2 horizontal, 2 vertical), horizontal saccades (10 per direction), VOR horizontal (10 reps at 180 bpm metronome), visual motion sensitivity (5 reps, 80-degree rotation at 50 bpm). After each subtest: headache, dizziness, nausea, and fogginess rated for symptom provocation.
Extended Office Domains (New - Not in SCAT6)
Orthostatic Vital Signs
Blood pressure and heart rate supine vs standing. Clinically significant if symptoms present AND systolic BP drop of 20mmHg or more, diastolic drop of 10mmHg or more, or HR increase over 30bpm.
Cervical Spine Assessment
Evaluation of cervical dysfunction and tenderness to palpation. Critical for differentiating cervical from concussion pathology.
Graded Aerobic Exercise Test
Contraindications screened first. Links to Buffalo Concussion Treadmill Test (BCTT). Exercise prescription at 80% of maximum symptom-free heart rate.
Optional Screening
GAD-7 (Generalised Anxiety Disorder)
7 items scored 0–3. Cut-points: 5 mild, 10 moderate, 15 severe. Further evaluation recommended when ≥10.
PHQ-2 (Depression Screen)
2 items, score 0–6. Optimal cut-point of 3 flags likely major depressive disorder. PHQ-9 can be used for further evaluation.
ASSQ (Athlete Sleep Screening)
Sleep Disorder Score: 0–4 normal, 5–7 mild, 8–10 moderate, 11–17 severe.
Computerised Neurocognitive Test Results
Section for recording ImPACT or equivalent standardised computerised testing results.
How is SCOAT6 scored and interpreted?
SCOAT6 produces domain-specific scores. No single score or threshold diagnoses concussion - clinicians interpret results in the context of injury mechanism, baseline data, medical history, and clinical picture.
Symptom Scores
Tracking Recovery
Number (0–22): How many of the 22 symptoms are present.
Severity (0–132): Each symptom rated 0–6. Track across time points – before injury, at injury, and current consultation – to assess trajectory.
Cognitive & Motor Scores
Multiple Domains
Immediate Memory: Words recalled out of 10 or 15.
Delayed Recall, Digits Backward, Months in Reverse: Cognitive processing measures.
mBESS Errors (0–30), Tandem Gait (seconds), Dual-Task Gait: Motor assessment.
Vestibular-Ocular & Screening
Extended Domains
mVOMS: Provocation scores for headache, dizziness, nausea, fogginess after each of 4 subtests.
PHQ-2 (≥3 flags depression), GAD-7 (≥10 flags moderate anxiety), ASSQ Sleep Disorder Score thresholds guide referral decisions.
Interpretation Approaches
Normative data comparison: Comparing to population norms by age and sex. Risk: may misclassify individuals who naturally score at extremes.
Baseline comparison (preferred): Comparing to the athlete’s own pre-injury data. Overcomes individual variation that normative data cannot account for. Note: SCOAT6-specific normative data are still being established.
A landmark 2025 study by Kontos et al. (UPMC, n=134 concussed + 67 controls, ages 13–29, within 3–30 days post-SRC) found: Acceptable to outstanding utility (AUC 0.73–0.91): PCSI symptoms, modified VOMS, timed tandem gait. Unacceptable utility (AUC <0.70): Verbal cognitive tests, orthostatic vital signs, mBESS. This suggests clinicians should prioritise symptoms, vestibular-ocular assessment, and timed gait when interpreting SCOAT6 results. Source: Kontos AP et al. Sports Medicine (2025). doi:10.1007/s40279-025-02256-9
When should you use SCOAT6 instead of SCAT6?
SCOAT6 should be used instead of SCAT6 when more than 72 hours have passed since a suspected concussion. While SCAT6 is designed for acute sideline and early clinic assessment (0–72 hours), SCOAT6 is the standardised office follow-up tool for recovery monitoring from 72 hours to 30 days and beyond. The two tools share intentional overlap for seamless clinical transitions.
SCAT6
0–72 hours
Sideline / acute clinic
Concussion detection and acute evaluation
SCOAT6
72h–30 days
Office / clinic
Recovery monitoring, management guidance, rehabilitation targeting
CRT6
Immediately
Sideline
Recognition by non-medical personnel
Child SCOAT6
72h–30 days
Office / clinic
Office follow-up for ages 8–12
What SCOAT6 Adds Beyond SCAT6
Modified VOMS (4 vestibular-ocular subtests with symptom provocation)
Mental health screening (GAD-7 anxiety, PHQ-2 depression) – learn more about what SMHAT-1 is and how it supports mental health assessment
Sleep screening (ASSQ)
Orthostatic vital signs
Cervical spine evaluation
Graded aerobic exercise testing
Return-to-learn guidance
Computerised neurocognitive test recording
The Transition Point
SCAT6’s clinical utility diminishes after 72 hours.
If SCAT6 was not administered within 7 days of suspected injury, proceed directly with SCOAT6.
The first 10 words of the SCOAT6 memory list can be directly compared to SCAT6 results.
Symptom evaluation uses the same format for longitudinal comparison.
Built for Serial Monitoring
Unlike SCAT6 (designed for single acute evaluation), SCOAT6 is designed for repeated administration across the recovery period.
Each domain tracks trajectory: Are symptoms improving? Is balance returning? Are vestibular-ocular symptoms resolving?
Serial assessment provides evidence base for return-to-sport clearance decisions.
Why was SCOAT6 created?
SCOAT6 was created because clinicians had no standardised tool for office-based concussion follow-up after the acute SCAT assessment window. Before SCOAT6, each clinician used their own combination of symptom checklists, balance tests, and clinical judgment beyond 72 hours post-injury. The Concussion in Sport Group (CISG) developed SCOAT6 through systematic reviews of 9,913 studies to fill this critical gap in the concussion assessment pathway.
The Problem
After acute SCAT assessment, clinicians had no standardised office tool. The SCAT's utility beyond 72 hours was limited - especially for cognitive subtests. Each clinician used their own combination of symptom checklists, balance tests, and clinical judgment. This inconsistency made it difficult to compare results across clinicians, clinics, or time points.
The Solution
The CISG recognised that concussion management extends well beyond the sideline. They conducted systematic reviews across 7 databases (MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, CINAHL, SPORTDiscus, Web of Science) from 2001–2022. Of 9,913 studies screened, 127 met inclusion criteria. The resulting SCOAT6 addresses autonomic function, dual gait testing, vestibular-ocular screening, and mental health - all areas where evidence supported inclusion.
How is SCOAT6 used in clinical practice?
SCOAT6 is used in clinical practice as a serial monitoring tool administered at office visits from 72 hours to 30 days post-concussion and beyond. Clinicians typically conduct the first SCOAT6 assessment at the initial office follow-up (day 3–7), then repeat it at subsequent visits to track recovery across symptoms, cognition, balance, and vestibular-ocular function. The tool guides rehabilitation targeting and provides evidence to support return-to-sport clearance decisions.
Clinical Timeline
Injury - Day 0
CRT6
Recognition and removal from play by coaches, parents, or trainers.
Acute - Day 0–3
SCAT6
Acute assessment by healthcare professional. Sideline or clinic setting.
First Office Visit - Day 3–7
SCOAT6
Office follow-up, comparison to SCAT6 baseline. Full multimodal assessment.
Recovery Monitoring - Day 7–30
Serial SCOAT6
Track recovery, guide rehabilitation, identify specific treatment targets.
Persistent Symptoms - Beyond Day 30
SCOAT6 + Specialist Referral
Comprehensive review for the 10–20% with persistent symptoms. Specialist referral as needed.
Clearance - Variable
RTS Protocol
Graduated return-to-sport completed. Medical clearance given for full participation.
Administration typically takes 25–45 minutes depending on which optional components are included. The Italian validation study (Baioccato et al., 2025) found an average of 24.5 minutes for core components. University at Buffalo CE programmes train clinicians to conduct evidence-based evaluations within 20–30 minutes by prioritising the highest-utility components (symptoms, mVOMS, timed tandem gait).
What is the return-to-sport protocol after concussion?
The return-to-sport protocol after concussion follows a graduated six-stage strategy embedded within SCOAT6. Athletes progress from relative rest (24–48 hours) through light aerobic exercise, sport-specific drills, non-contact training, full-contact practice, and finally competition — with a minimum of 24 hours at each stage and medical clearance required before head-impact activities.
Graduated Return-to-Sport Strategy
Stage 1
Relative Rest
24–48 hours. Symptom-limited activity. Light intensity only. Begin return-to-learn.
Stage 2
Light Aerobic Exercise
Walking, swimming, stationary cycling below symptom threshold. No resistance training. Can be used as treatment.
Stage 3
Sport-Specific Exercise
Running drills, sport-specific activities. No head-impact activities. Progressive intensity increase.
Stage 4
Non-Contact Training
More complex drills. Add resistance training. Requires HCP authorisation.
Stage 5
Full-Contact Practice
Following medical clearance. Normal training including body contact.
Stage 6
Return to Competition
Full sport participation. Minimum one week from Stage 1 to Stage 6.
RTL and RTS can occur in parallel. Student-athletes should complete full RTL before completing RTS. Academic support should address environmental, physical, curricular, and testing accommodations. Not all athletes will need a formal RTL strategy.
Current evidence no longer supports complete rest beyond 24–48 hours. The SCOAT6 graded aerobic exercise test enables clinicians to safely prescribe sub-symptom-threshold exercise. The BCTT helps quantify exercise capacity and establish safe prescriptions at 80% of maximum symptom-free heart rate. Patients who exercise to maximum without symptom provocation should be evaluated for cervical spine, vestibular, or temporomandibular dysfunction rather than physiologic concussion.
Minimum 24 hours per stage – if no symptom exacerbation, progress the next day. If symptoms arise, drop back to previous stage, rest 24 hours, then retry. Stages 1–3 are treatment (early activity and exercise); Stages 4–6 are the RTS progression. Stages 4–6 require HCP clearance before progressing to head-impact risk. Most sport-related concussions in adults resolve within 2–4 weeks; recovery may be longer in children and adolescents (Amsterdam Consensus, 2023).
Where can you access SCOAT6?
You can access SCOAT6 as a free paper PDF from the British Journal of Sports Medicine (June 2023, Vol 57, Issue 11), which may be freely copied for clinical distribution. For a digital version with automated scoring and guided workflows, ScreenIT offers an authorised digital SCOAT6 with CISG approval — free for unlimited assessments.
Paper SCOAT6 (PDF)
The official SCOAT6 was published in the British Journal of Sports Medicine (June 2023, Vol 57, Issue 11) and may be freely copied in its current form for distribution to individuals, teams, and organisations.
Any alteration – including translations and digital reformatting – requires written consent from BMJ. This protects the clinical validity of the assessment.
Digital SCOAT6 (ScreenIT)
ScreenIT has written CISG authorisation for the digital SCOAT6 – same validated items as the official published version, with automated scoring, guided workflows, integrated metronome for mVOMS, and instant PDF reports.
Free for unlimited SCOAT6 assessments.
Frequently Asked Questions About SCOAT6
What is the difference between SCOAT6 and SCAT6?
SCAT6 is for acute assessment (0–72 hours post-injury), SCOAT6 is for office follow-up (72 hours to 30 days). SCOAT6 adds vestibular-ocular screening (mVOMS), mental health assessment (GAD-7, PHQ-2), sleep screening (ASSQ), orthostatic vital signs, cervical spine evaluation, and graded aerobic exercise testing. Both are CISG tools from the 2022 Amsterdam Consensus.
Was there a SCOAT5?
No. SCOAT6 is the first standardised office concussion assessment tool. The “6” aligns with the 6th International Conference on Concussion in Sport (Amsterdam 2022), not a predecessor version. The concept was first proposed in 2012, but no consensus tool was adopted until 2023.
Who can administer SCOAT6?
Licensed healthcare professionals trained in concussion assessment. This includes sports medicine physicians, neurologists, physiotherapists, and other qualified clinicians. The tool is not designed for non-medical personnel (use CRT6 for sideline recognition by coaches, parents, or trainers).
How long does SCOAT6 take to administer?
Full assessment: 25–45 minutes depending on which optional components are included. Core recommended components average 24.5 minutes (Baioccato et al., 2025 Italian validation). Clinicians can prioritise high-utility components (symptoms, mVOMS, timed tandem gait) for more efficient evaluation within 20–30 minutes.
Can I use SCOAT6 without a prior SCAT6?
Yes. If a SCAT6 was not administered within 7 days of suspected injury, proceed directly with SCOAT6. However, having SCAT6 results improves interpretation by providing an acute-phase comparison point. The first 10 words of the SCOAT6 memory list can be directly compared to SCAT6 results.
What does the modified VOMS assess in SCOAT6?
Four subtests: smooth pursuits (2 horizontal, 2 vertical), horizontal saccades (10 per direction), vestibulo-ocular reflex at 180 bpm metronome, and visual motion sensitivity (5 repetitions at 80-degree rotation). After each subtest, the athlete rates symptom provocation for headache, dizziness, nausea, and fogginess. The 2025 Kontos study found mVOMS has strong clinical utility (AUC 0.73–0.91).
Does SCOAT6 include mental health screening?
Yes. The GAD-7 screens for generalised anxiety disorder (cut-point ≥10 for moderate anxiety) and the PHQ-2 screens for depression (cut-point ≥3 flags likely major depressive disorder). These are optional but recommended, as mental health conditions are common after concussion and can significantly affect recovery trajectory.
Can SCOAT6 be used for return-to-sport clearance?
SCOAT6 includes the graduated return-to-sport strategy and provides systematic evidence to support clearance decisions. However, no single tool determines clearance – clinical judgment integrating symptom resolution, cognitive recovery, balance normalisation, exercise tolerance, and overall clinical picture is required.
Is there a Child SCOAT6?
Yes. The Child SCOAT6 is designed for ages 8–12 and incorporates parent/guardian input, age-appropriate language, and modified assessment scales. It was published alongside the adult SCOAT6 in BJSM 2023.
Is SCOAT6 available digitally?
The paper version is freely available from BJSM. Digital versions require BMJ/CISG authorisation to protect clinical validity. ScreenIT has this official approval and offers a free digital SCOAT6 with automated scoring across 16+ components, guided workflows, integrated metronome for mVOMS, and instant PDF reports.
Which SCOAT6 components are most clinically useful?
The 2025 Kontos et al. study (n=201, ages 13–29) found that symptoms (PCSI), modified VOMS, and timed tandem gait showed acceptable-to-outstanding discriminative ability (AUC 0.73–0.91). Verbal cognitive tests, orthostatic vital signs, and mBESS showed lower utility (AUC <0.70) in the subacute phase. A multidomain approach combining multiple tools remains recommended.
How do I interpret SCOAT6 results?
Compare domain-specific scores against baseline (preferred) or normative data by age and sex. No single score diagnoses concussion. Interpret in the context of injury mechanism, medical history, and clinical picture. Track trajectory across serial assessments rather than relying on single-point results. SCOAT6-specific normative data are still being established.
The IOC’s SMHAT-1 extends mental health screening beyond concussion assessment – screening anxiety, depression, sleep, substance use, and disordered eating in athletes.
Evidence & References
Primary Sources
SCOAT6 Full Tool: British Journal of Sports Medicine (2023), Vol 57, Issue 11
Introducing SCOAT6: Patricios JS et al. BJSM 2023;57(11):648
Systematic Review: Patricios JS, Schneider GM, van Ierssel J et al. BJSM 2023;57(11):737–748
Amsterdam Consensus: Patricios JS, Schneider KJ, Dvorak J et al. BJSM 2023;57(11):695–711
Clinical Utility: Kontos AP, Zynda AJ, Trbovich AM et al. Sports Medicine (2025)
Italian Validation: Baioccato V et al. Italian Journal of Pediatrics (2025);51:109
Child SCOAT6: Davis GA et al. BJSM 2023
Content last reviewed: February 2026. Based on SCOAT6 published June 2023 (BJSM Vol 57, Issue 11).
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