Evolving the SCAT5 for ruling out higher severity traumatic brain injuries-Can decision rules developed for emergency settings help?

Decision rules (e.g. Canadian CT Head Rule (CCHR) for adults and PECARN rule for children/adolescents) are used in emergency settings (ER rules) to assess traumatic brain injuries (TBI). The rules have a high sensitivity and near perfect negative predictive value that help to rule out more severe TBI. Which criteria should be added to the Sport Concussion Assessment Tool 5 (SCAT5) to reach the sensitivity of the ER rules and improve the utility of the SCAT5 for screening for higher severity head and brain injuries? : We performed a comparative analysis of the SCAT5 with the CCHR and PECARN rules. We compared the presence (yes or no) and comparative "face value" sensitivity (lower, identical, or higher) of the SCAT5 criteria to the ER rules criteria. Loss of consciousness, vomiting, severe/increasing headache, and seizure are SCAT "red flags" with similar or higher sensitivity compared to ER rules criteria. Five criteria had lower sensitivity or where absent from the SCAT. ER rules include any abnormality on the Glasgow coma scale (GCS <15), but only a "deterioration of the state of consciousness" is considered a "red flag" in the SCAT5. Persistent retrograde amnesia for more than 30 minutes, age >65, severity of the mechanism of injury, and signs of skull fractures are not mentioned in the SCAT5. : We identified 5 criteria that could inform the evolution the SCAT5 to improve its ability to rule out more severe TBI in a sideline assessment context.