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Military Acute Concussion Evaluation (MACE)

 

The Military Acute Concussion Evaluation, or MACE, is a standardized mental status exam that is used to evaluate mild TBI, or concussion, in a combat or other deployed setting. This screening tool was developed to evaluate a person with a suspected concussion, and is used to identify symptoms of a mild TBI.

The MACE form consists of four sections:

  • Concussion Screening – includes a description of the injury event and screening questions about loss of consciousness (LOC), alteration of consciousness (AOC), and post-traumatic amnesia (PTA). If any of the screening questions are answered “yes,” the evaluator continues with the other portions of MACE.
  • Cognitive Exam – assigns scores for orientation, immediate memory, concentration, and delayed recall. The scores are totaled out of 30 possible points and reported at the end of the MACE form.
  • Neurological Exam – tests for normal or abnormal pupil response to light, speech fluency and word finding, grip strength and pronator drift (an indicator of muscle weakness and compensation), and balance. Normal results are reported as “Green” and abnormal results are reported as “Red” at the end of the MACE form.
  • Symptom Screening – screens for symptoms including headache, dizziness, memory problems, balance problems, nausea/vomiting, difficulty concentrating, irritability, visual disturbances, and ringing in the ears. It also asks about concussion history in the past 12 months. Having no symptoms is reported as “A” and having one or more symptoms is reported as “B” at the end of the MACE form.

MACE results are reported using the score from the cognitive exam, the color from the neurological exam, and the letter from the symptom screening. For example, a result of 24/Red/B would mean a cognitive score of 24 out of 30, an abnormal neurological response, and the presence of one or more symptoms. Future MACE scores can be used to determine whether the patient’s cognitive function has improved or worsened over time.

To be most effective, all service members experiencing a concussive injury should have the MACE administered within the first 24 hours of the event in order to make certain that they receive proper care in a timely fashion. The MACE, in combination with a medical exam, can be used to help determine if it is safe for a service member to return to duty or if further medical monitoring and supervision is required.