17 “if in doubt, sit them out” or in the consulting room after a referral for suspected concussion has been made. A Child SCAT5 was also updated at the Berlin 2016 meeting of the Concussion in Sport Group. It is a modified version of the SCAT5 for children aged 5 – 12 years. The key differences are that the symptom evaluation is written in language more appropriate for this age group and the severity score is marked out of three rather than six. The Child SCAT5 also includes a parent’s report of symptoms and severity. The cognitive assessment is slightly simplified and the balance testing excludes the single leg stance. It has recently been suggested that the SCAT5 tool and other guidelines should also include modifications for use with disabled athletes39,40 . The Concussion Recognition Tool 5 (CRT5) is a simplified summary of the key signs and symptoms that should raise concern about a possible concussion11,12 . The tool is designed for use by any member of the community, unlike the SCAT5 which is only intended for use by medical professionals. The tool is aimed at identifying concussions. Once a possible concussion is identified, the card advises that the person must be removed from sport immediately and not be allowed to return to activity until they are assessed medically. This tool also lists ‘red flags’ that should prompt emergency medical review. Many other assessment tools are currently available. The King-Devick test measures eye movement impairment, and a number of prospective case-control studies have indicated high sensitivity and specificity13,14 . Balance tests such as the Balance Error Scoring System (BESS) also show potential for concussion assessment, primarily in the acute stage14,41 . Neurocognitive testing may also assist in the diagnosis and monitoring of concussion41 . Such testing is increasingly becoming computer-based. There are several products available for quantitative neurocognitive testing. These products aim to quantify various aspects of cognitive function including speed of psychomotor processing, learning and memory, vigilance and attention. Neurocognitive testing provides a more objective assessment of neurological function than scoring of patient-reported symptoms, which are often under-reported42 This testing is also more detailed than the abbreviated cognitive component of the SCAT5. As with other diagnostic tools, it should not be used in isolation but may form part of the clinical history and examination. Computerised neuropsychological tests such as ImPACT (impacttest.com) or Axon (axonsports.com) are validated for use in concussion and are an easily accessible resource for use in clinics. A fee is usually charged to the patient for each test undertaken. Management There is broad agreement regarding key principles of concussion management policies by organisations including the Concussion in Sport Group, the American Academy of Neurology, the Centre for Disease Control and sporting organisations. Acute assessment of the concussed athlete at the time of injury should observe normal protocols of first aid treatment. Where the athlete is unconscious or incapable of providing intelligible responses, cervical spine injury should be assumed and treated appropriately with in-line stabilisation, until cervical spine injury can be excluded. Attention to airway, breathing and circulation should be followed as per accepted first aid protocols. Athletes suspected or confirmed of sustaining a concussion should be removed from the sporting environment and should not be allowed to return to physical activity until they have been assessed by a medical practitioner. Referral to a medical practitioner should occur as a matter of priority. Where suspicion remains or concussion is confirmed, the athlete must not return to sport on the day of injury. Given that concussion is an evolving injury, the athlete should be observed by a responsible adult for several hours following the concussion. Symptoms suggesting requirement for urgent medical review include deteriorating neurological function, neck pain, worsening nausea, vomiting, worsening headache and loss of consciousness. Any athlete with a suspected or confirmed concussion should not be allowed to drive and should remain in the company of a responsible adult. They should be advised to avoid alcohol and avoid medications unless medically prescribed. Concussed athletes should specifically avoid aspirin, anti-inflammatory medications, sleeping tablets or sedating pain medication. Any athlete with suspected or confirmed concussion should be referred immediately to the nearest emergency