A normative study of the sport concussion assessment tool (SCAT2) in children and adolescents

Recent clinical practice parameters encourage systematic use of concussion surveillance/management tools that evaluate participating athletes at baseline and after concussion. Office-based tools (Sports Concussion Assessment Tool; SCAT2) require accurate baseline assessment to maximize utility but no normative data exist for children on the SCAT2, limiting identification of "normal" or "impaired" score ranges. The purpose of this study was to develop child and adolescent baseline norms for the SCAT2 to provide reference values for different age groups. A community-based approach was implemented to compile baseline performance data on the SCAT2 in 761 children aged 9 to 18 to create age- and sex-graded norms. Findings indicate a significant age effect on SCAT2 performance such that older adolescents and teenagers produced higher (better) total scores than younger children (ages 9 to 11) driven by age differences on individual components measuring cognition (SAC), postural stability (BESS), and symptom report. Females endorsed greater numbers of symptoms at baseline than males. Normative data tables are presented. Findings support the SCAT2 as a useful clinical tool for assessing baseline functioning in teenagers, but suggest clinical utility may be limited in children under age 11. Follow-up studies after incident concussion are needed to confirm this assumption.