Sports concussion screening is a check for signs that an athlete may have a brain injury after a hit or sudden jolt. A trained professional asks about symptoms and the injury, then may check memory, attention, balance, coordination, and other brain functions. Screening helps guide next steps, but it cannot always confirm or rule out a concussion on its own. A suspected concussion means no same-day return to play.
Concussion screening can happen on the sidelines immediately after an injury or during a medical appointment afterward. The process depends on when the injury occurred, the athlete's age, the symptoms being reported, and the findings of the initial assessment. Some athletes need a brief check followed by medical evaluation, while others require a more detailed examination.
What does sports concussion screening involve?
Sports concussion screening looks for changes that may occur after a blow to the head, a collision, or a forceful movement that causes the brain to move inside the skull. An athlete does not have to lose consciousness for a concussion to be possible. Screening also considers symptoms that appear later, since someone may seem well immediately after an impact and develop problems over the following hours or days.
The Concussion in Sport Group provides standardized tools for recognizing and assessing sports-related concussions. These include tools for identifying a possible concussion and more detailed assessments intended for healthcare professionals. Screening is one part of the evaluation process, not a standalone test that can reliably determine whether an athlete is safe to continue playing.
What happens immediately after a suspected concussion?
If a concussion is suspected during practice or competition, the athlete should stop participating immediately. A coach, athletic trainer, team physician, or another responsible person may notice a change in behavior, trouble maintaining balance, confusion, or difficulty answering questions. The athlete may also report symptoms such as a headache or dizziness. Continuing to play while a possible concussion is being assessed is not appropriate.
According to the CDC's HEADS UP guidance, an athlete with a suspected concussion should be removed from sports and kept out for the rest of that day. The athlete should receive an evaluation from a healthcare professional, and return-to-sport decisions should be made by a qualified healthcare professional. A quick sideline check should not be used as permission to return to the game.
If the athlete is unresponsive, has a seizure, develops worsening symptoms, or shows signs of a potentially serious head injury, emergency medical care may be needed rather than routine sideline screening. When a serious head or neck injury is suspected, unnecessary movement should be avoided while emergency assistance is arranged.
What questions will the screener ask?
The initial assessment usually begins with questions about what happened and how the athlete feels. The healthcare professional may ask the athlete, teammates, coaches, or witnesses to describe the collision or fall. If the athlete cannot remember the event clearly, information from someone who saw the injury can be especially useful.
Questions may cover:
- How the injury happened and whether the head or body was struck.
- Whether the athlete lost consciousness or had a gap in memory.
- Whether symptoms began immediately or appeared later.
- Whether there have been previous concussions or other head injuries.
- Whether the athlete takes medicines or has relevant medical conditions.
- Whether symptoms are changing, worsening, or interfering with ordinary activities.
The athlete may be asked about experiences such as headache, dizziness, nausea, blurred vision, sensitivity to light or noise, difficulty concentrating, unusual tiredness, or feeling mentally foggy. Changes in sleep, mood, or behavior may also be relevant. These experiences can help guide the assessment, but no single symptom or combination of symptoms establishes the diagnosis by itself.
How are memory, balance, and brain function checked?
A healthcare professional may perform a neurological examination to check how different parts of the nervous system are functioning. Depending on the circumstances, this can include checking vision, hearing, strength, sensation, coordination, reflexes, and balance. The professional may also observe how the athlete walks or responds to instructions. Neck movement and other physical findings may be considered when the injury mechanism makes them relevant.
According to Mayo Clinic's guidance on concussion diagnosis, assessment may include a neurological examination and tests of thinking skills, including memory and concentration. The healthcare professional may ask the athlete to remember information, answer questions about recent events, follow instructions, or complete simple thinking tasks. These checks help identify changes that could be related to the injury.
Balance and coordination assessments may involve standing in different positions, walking in a straight line, or performing other controlled movements. Some evaluations also examine how eye movements and head movements affect symptoms. The specific tasks depend on the assessment tool, the athlete's age, and the circumstances of the injury. An athlete should not be asked to perform a balance task that could put them at risk of falling.
What are SCAT6 and Child SCAT6?
The Sport Concussion Assessment Tool 6, known as SCAT6, is a standardized assessment designed for healthcare professionals evaluating suspected sports-related concussion. It brings together several types of information, including symptoms, memory and thinking tasks, neurological screening, and balance assessment. It can help organize the initial evaluation, but its findings must be considered alongside the injury history and clinical examination.
The Child SCAT6 is designed for children aged 8 to 12 years, while SCAT6 is intended for adolescents and adults aged 13 years and older. Younger children may need an assessment adapted to their developmental stage, communication skills, and ability to describe how they feel. Parents or caregivers can provide useful information about changes in behavior, sleep, eating, play, or usual activity.
The Concussion in Sport Group's assessment guidance distinguishes these healthcare-professional tools from the Concussion Recognition Tool, which helps non-medical people recognize a possible concussion and understand when medical attention is needed. The tools serve different purposes, and neither should be treated as a simple pass-or-fail test for deciding whether an athlete can safely continue playing.
Does concussion screening include a CT scan or MRI?
Most athletes evaluated for a concussion do not automatically need a brain scan. A healthcare professional first considers the injury, symptoms, medical history, and examination findings. Imaging may be recommended when there is concern about a more serious injury, such as bleeding inside the skull or another complication that needs investigation.
A CT scan may be considered when concerning features are present, including a worsening headache, repeated vomiting, seizures, or other signs that suggest a more serious brain injury. An MRI may be used in selected circumstances, depending on the clinical question. These scans look for structural problems, but a normal scan does not necessarily exclude a concussion. The decision to order imaging belongs to the treating healthcare professional.
Is preseason baseline concussion testing necessary?
Some sports programs offer baseline testing before the season begins. This records information about an athlete's usual symptoms, memory, concentration, or balance so that later results can sometimes be compared with the athlete's earlier performance. A baseline assessment may provide useful context, but it does not prevent a concussion and cannot guarantee that a later injury will be identified.
Preseason baseline testing is different from screening after a collision. It is not a diagnosis, and a baseline result should never be used as the only basis for deciding whether an athlete can return to sport. Testing quality, the athlete's age, and the way results are interpreted all matter.
The American Academy of Pediatrics' review of pediatric sports concussion recommendations states that routine mandatory baseline testing is not recommended for all children. It may be considered for certain older competitive athletes or athletes with disabilities when suitable resources are available. Requirements can also differ among sports organizations and local rules.
Which warning signs require emergency care?
A suspected concussion sometimes occurs alongside a more serious head injury. Certain changes need immediate medical attention rather than waiting for a routine appointment. Seek emergency care if an athlete develops any of the following after a head impact or forceful jolt:
- A headache that becomes worse or does not go away.
- Repeated vomiting or a seizure.
- Increasing confusion, unusual agitation, or difficulty recognizing people or places.
- Slurred speech, new weakness, numbness, or reduced coordination.
- Unequal pupil sizes or double vision.
- Increasing drowsiness, difficulty waking, or inability to stay awake.
- Loss of consciousness or another sudden and concerning change in responsiveness.
The CDC's concussion signs and symptoms guidance identifies these types of changes as danger signs that warrant immediate emergency medical care. Do not leave an athlete with concerning symptoms alone or allow them to drive themselves for assessment.
Can an athlete return to play after screening?
A normal-looking sideline assessment does not always rule out a concussion. Symptoms may emerge later, and early findings can change over time. If there is reasonable concern about a concussion, the athlete should remain out of sport and receive the appropriate medical evaluation. Parents, coaches, teammates, and athletic trainers can help by sharing observations and reporting any changes that occur after the initial check.
If a concussion is diagnosed, returning to sport involves a gradual, medically supervised process rather than an immediate return to full competition. The athlete generally progresses from regular daily activities to light exercise, more demanding exercise, sport-specific activities, non-contact training, full practice when appropriate, and finally competition. Each stage must be completed safely before advancing.
According to the CDC's return-to-sports guidance, each step generally takes at least 24 hours. If symptoms return or new symptoms develop, the athlete should stop the activity and contact the healthcare professional overseeing recovery. Full return to sport requires medical approval and completion of the progression according to the applicable clinical and sports guidelines.
How can athletes and families prepare for screening?
Preparation does not require memorizing symptoms or practicing the tests. It is more helpful to provide an accurate account of the injury and explain any changes noticed afterward. Be honest about symptoms, even if they seem minor or interfere with a planned game. Athletes should not hide difficulties with memory, balance, vision, or concentration to avoid missing a competition.
Bring relevant medical information when practical, including a list of medicines, a history of previous concussions, and details of any ongoing symptoms. Parents and caregivers should share observations when an athlete is too young to describe the experience clearly or has trouble remembering what happened. Ask the healthcare professional what signs to monitor, when follow-up is needed, and which activities should be avoided until the next assessment.
Sports concussion screening is intended to identify a possible injury, guide further evaluation, and support safer decisions about activity. Early recognition and an appropriate medical assessment help ensure that the athlete receives care suited to the injury and does not return to sport before it is safe.