How is a clinic symptom checklist different from a sideline checklist like SCAT6?

A sideline tool like SCAT6 is designed for same-day, acute assessment and loses sensitivity for tracking recovery beyond the first several days. A clinic checklist — commonly built around SCOAT6 — adds vestibulo-ocular, cervical, and modifying-factor items suited to follow-up visits over the following weeks.

Should the symptom checklist be scored 0–6 or yes/no?

Most validated instruments use a 0–6 severity scale per symptom rather than yes/no, because a severity score lets you track a total symptom score over time and see whether a patient is trending toward expected recovery or toward persistent symptoms.

Does a normal symptom checklist rule out the need for imaging?

No. Imaging decisions are driven by a separate red-flag screen and validated decision rules (the Canadian CT Head Rule in adults, PECARN in children), not by the symptom checklist score. A patient can have a low symptom score and still meet a red-flag criterion that warrants imaging.

How often should the checklist be re-administered?

There's no single mandated cadence, but common practice checks in at roughly 1 week and again at 2–4 weeks if recovery is on track, with more frequent (weekly to biweekly) checks and multidisciplinary referral if symptoms persist past the expected window. See Concussion Follow-Up Schedule for detail.

When should mood or sleep screening be added to the checklist?

Add validated mood (PHQ-9, GAD-7) and sleep (PSQI) instruments when the symptom checklist flags emotional or sleep-related items as elevated, or routinely for any patient with symptoms persisting beyond the expected recovery window, given the elevated risk of new or worsened depression and anxiety after TBI.

What Belongs on a Clinician Concussion Symptom Checklist?

A clinician-facing concussion symptom checklist should cover four categories: a standardized symptom inventory (physical, cognitive, emotional, sleep-related), a red-flag screen for emergent imaging, a functional/vestibulo-ocular screen, and a recovery-timeline marker so serial checklists show trajectory, not just a single time point. Standardized tools like SCAT6/Child SCAT6 and SCOAT6 anchor most validated versions.

Why a Checklist Alone Isn't the Assessment

A symptom checklist is a data-collection instrument, not a diagnosis. It tells you what the patient is experiencing and how that's trending, but it doesn't replace a clinical exam, a red-flag screen, or a decision about return-to-play (RTP), return-to-learn (RTL), or imaging. The value of a checklist comes from consistency: using the same structured instrument at the same intervals so a clinician can see whether a patient is improving on the expected curve or drifting into persistent post-concussion symptoms (PPCS). The 6th International Consensus Statement on Concussion in Sport (Amsterdam, 2023) and CDC HEADS UP clinical guidance are the two frameworks most checklists in U.S. practice are built around.

Core Symptom Domains to Include

A clinically useful checklist should score symptoms across four domains rather than a single undifferentiated list:

Physical/somatic: headache, dizziness, nausea, visual disturbance, light/noise sensitivity, balance problems, fatigue, neck pain.
Cognitive: feeling "foggy" or "slowed down," difficulty concentrating, difficulty remembering, mental fatigue with cognitive tasks.
Emotional: irritability, sadness, nervousness, feeling "more emotional" than usual — these overlap with formal mood screening (see below) but belong in the symptom checklist itself because they're part of the acute clinical picture.
Sleep-related: trouble falling asleep, sleeping more or less than usual, drowsiness during the day.

Most validated pediatric and adult tools (the SCAT6 symptom checklist and its office follow-up counterpart, SCOAT6) use a 0–6 severity scale per item rather than a simple yes/no, which is what allows a total symptom score to be tracked over time and compared visit-to-visit.

Red-Flag Items That Must Sit at the Top

Every clinician checklist should screen for red flags separately from routine symptom severity, since these drive an emergent-imaging decision rather than a routine follow-up plan. Items commonly included: worsening headache, repeated vomiting, seizure activity, focal neurologic deficit, declining level of consciousness, unequal or nonreactive pupils, slurred speech, increasing confusion or agitation, new weakness or numbness, "worst headache of life," and signs of basilar skull fracture (raccoon eyes, Battle sign, CSF drainage from nose or ear). In adults, the Canadian CT Head Rule formalizes several of these into a validated imaging decision tool; pediatric imaging decisions should instead follow PECARN criteria. Age over 65 and anticoagulant or antiplatelet use are additional imaging triggers regardless of symptom severity. For a fuller breakdown, see Concussion Red Flags: When to Image.

Functional and Vestibulo-Ocular Screening Items

Amsterdam consensus guidance and the SCOAT6 office tool both emphasize that a symptom checklist should be paired with a brief functional screen, because symptom self-report alone under-detects vestibular and oculomotor dysfunction — one of the more sensitive predictors of prolonged recovery. A well-built clinic checklist should prompt for:

A brief cervical spine screen (whiplash-associated neck symptoms are common and treatable).
A vestibulo-ocular motor screen (VOMS) or at minimum a smooth-pursuit/saccade/convergence check.
A balance screen (modified BESS or equivalent).
Orthostatic vitals, since orthostatic intolerance can mimic or worsen post-concussive symptoms.

These items don't need to be exhaustive at every visit, but the checklist template should have a place for them so they aren't silently skipped in a busy follow-up visit.

Timing: When to Use Which Version

Sideline/acute: SCAT6 (age 13+) or Child SCAT6 (ages 5–12) — includes red flags, a symptom checklist, brief cognitive screen, and balance testing. Not designed for serial monitoring past the first several days; sensitivity drops off after roughly 3–5 days.
Clinic follow-up: SCOAT6, which layers in the vestibulo-ocular, cervical, and modifying-factor history not captured on the sideline tool. This is the appropriate template for the 1-week and 2–4 week follow-up visits.
Interval/between-visit monitoring: a symptom checklist administered on a set cadence (see Concussion Follow-Up Schedule) so the clinician sees a trend line rather than reconstructing the trajectory retrospectively from memory at each visit.

Modifying Factors Worth Capturing Once, Not Every Visit

A checklist template should have a one-time intake section for factors that predict a longer recovery, so the clinician doesn't have to re-derive risk at every visit: prior concussion history, migraine or headache disorder, psychiatric history (anxiety, depression), learning disability or ADHD, and — in pediatric patients — female sex, which is associated with a longer expected recovery window in Amsterdam pediatric guidance. High acute symptom burden and early dizziness/vestibular symptoms are themselves risk markers worth flagging prominently on the intake version of the checklist.

Where Mood and Sleep Screening Fit In

The core symptom checklist captures emotional and sleep items at a screening level, but a positive signal there should trigger a validated instrument rather than a clinical guess. Practices commonly pair the concussion checklist with the PHQ-9 for depression, GAD-7 for anxiety, and the PSQI for sleep quality — particularly for patients with symptoms persisting beyond the expected 2–4 week (adult) or 4-week (pediatric) window. Note that several PHQ-9 items (fatigue, sleep, concentration) overlap with core concussion symptoms, which can inflate scores; interpret mood-screen results in that context rather than treating an elevated score as automatically diagnostic. See Screening for Depression After TBI for more detail.

Sample Checklist Structure

A workable clinician template, organized top to bottom in the order it should be used:

Red-flag screen (go/no-go for emergent imaging)
Physical/somatic symptom items (0–6 severity scale)
Cognitive symptom items
Emotional symptom items
Sleep-related items
Total symptom score (sum, trackable over time)
Brief functional screen (VOMS/oculomotor, cervical, balance)
Modifying-factor flags (one-time or as-needed update)
RTP/RTL stage and next-step plan

How Kavera Handles This

The PCSS is the checklist, and in Kavera it goes to the patient's phone every week instead of a clipboard every few weeks. Scores band by cluster and plot against the first visit, and every completed checklist is a documented monitoring day toward 98978. Self-Serve practices run this with their own staff. On Managed, Juliet Mott's team runs it and bills it under your credentials.