Dell Children’s Medical Center of Central Texas
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On-Field Concussion Evaluation Tool

Mental Status Exam

*Repeat every 5-15 minutes.*

Orientation:

Where are we at today? Who are we playing against?

What is the date/day today?

What period of the game are we in? 1st half/2nd half?

What is the score? Which team scored last?

Did we win the last game?

Immediate Word Memory Recall:

Give the athlete a list of 3-5 words to recall. Instruct them to remember these words.

Pizza - Shoe - Truck - Green - Dog

Concentration:

Recite the months of the year in reverse order. (Make sure they know them forwards)

Dec-Nov-Oct-Sept-Aug-Jul-Jun-May-Apr-Mar-Feb-Jan

Recite the following sequences in reverse order.

2-7-9 (972), 3-8-1-4 (4183), 6-2-9-5-1 (15926)

Delayed Word Memory Recall:

Ask the athlete to recall the words from earlier, in any order.

Concussion Center
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