0	1	2
Age of patient *	5 to <8 years	8 to <13 years	13 to <18 years
Sex of patient *	Male		Female
How long did the patient’s previous concussion last? *	No previous concussion or Recovery in less than 1 week	Recovery took 1 week or longer
Does the patient have a history of migraines? *	No	Yes
Did the patient answer questions more slowly than normal as compared to before the injury? *	No	Yes
On the BESS Tandem stance balance testing, how many errors did the patient have in 20 seconds? *	0-3 errors	4 or more errors, or could not complete the balance testing
Does the patient have a headache? *	No	Yes
Does the patient have sensitivity to noise? *	No	Yes
Is the patient more fatigued? *	No		Yes