Professional Documents
Culture Documents
1. Definitions
Traumatic brain injury
Post-traumatic amnesia
Glasgow Coma Scale
Abbreviated Westmead PTA Scale
Westmead PTA Scale
Classification of traumatic brain injury
2. Precautions/Contraindications
3. Equipment
4. Standard Requirements
5. Procedure
Determining the appropriate PTA scale to use based on GCS score
Monash Health Procedure for the assessment and management of PTA in TBI and referral
pathways
Screening using the AWPTAS (MILD TBI)
Guidelines to assist with decision-making in ED for admission of TBI patients to the wards of
Monash Health
Screening using the WPTAS (MODERATE TO SEVERE TBI)
Complicating factors when assessing PTA
Discharge planning
Decision-making-capacity
PTA documentation and communication
Supporting and managing symptoms of PTA
6. Related documentation
7. Background
8. Key standards, guidelines or legislation
9. References
10. Keywords
TARGET AUDIENCE and SETTING
This procedure applies to all staff working with adult patients presenting to Monash Health with suspected or
confirmed traumatic brain injury (closed head injury) in the acute setting.
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PURPOSE
This document was created to provide evidence-based information on the definition of PTA, and current clinical
practice guidelines for the standardised assessment and management of PTA in the context of traumatic brain
injury.
This procedure was created to ensure a consistent interdisciplinary approach to the care of patients experiencing
PTA, in alignment with the National Safety and Quality Health Services (NSQHS) Standard 5: Comprehensive
Care.
This procedure does not cover the medical and surgical management of closed head injury. Please follow the
appropriate unit, hospital and state processes for the primary management of traumatic brain injury.
DEFINITIONS
Traumatic brain injury (TBI): Brain injury caused by an external mechanical force such as a blow to the
head, concussive force, acceleration-deceleration force or projectile missile.
Post-traumatic amnesia (PTA): Immediate stage of recovery after a TBI when the person has emerged
from loss of consciousness or coma but remains confused.
Glasgow Coma Scale (GCS): A neurological scale that provides a reliable and objective way of recording
the conscious state of the patient. The GCS is a 15-point scale
The Abbreviated Westmead Post Traumatic Amnesia Scale (A-WPTAS): Screening tool used to examine
PTA in people with mild TBI
The Westmead Post Traumatic Amnesia Scale (WPTAS): Screening tool used to examine PTA in adults
with moderate to severe TBI
Refer to BACKGROUND for full clinical definitions, descriptions and the importance of assessment of PTA.
Source: Guidelines for the NSW Compulsory Third Party Scheme and Lifetime Care and Support Scheme (2013) created by clinical working
party review. This has been based on the combination of numerous classifications systems including the original index of severity based
on GCS score (Teasdale & Jennett, 1974) and PTA duration index (Jennett & Teasdale, 1981 as referenced in Stein, 1996) and combined
criteria as seen in The Mayo Classification System (Malec et al., 2007).
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of Health, 2011). Symptoms of a mild TBI must be separated from other factors that can result in alterations in
cognition and mental state, such as substance use, medications and psychological trauma.
The majority of individuals who sustain a mild TBI make a full recovery within days and weeks after the injury,
and persisting symptoms are referred to as ‘post concussive syndrome’ (McHugh et al, 2006; NSW Ministry of
Health Guidelines, 2011; Ontario Neurotrauma Foundation Guidelines, 2013). Excessive focus on, or failing to
validate, transient symptoms of mild TBI can lead to delays and complications in recovery and adjustment
processes in this patient group.
PRECAUTIONS/CONTRAINDICATIONS
Staff to maintain personal safety at all times. If the patient is agitated and the safety of staff a concern at any
time, consider abandoning the clinical contact until a more appropriate time. Refer to other relevant Monash
Health procedures and guidelines:
Code grey, aggressive, violent patient escalation: Implementation tool
Delirium in hospital: Clinical guideline
Acute behavioural disturbance: Clinical guideline
Preventing falls and harm from falls
EQUIPMENT
STANDARD REQUIREMENTS
When undertaking any clinical interaction with a patient, staff are expected to:
Perform routine hand hygiene. Refer to the Hand Hygiene Procedure.
Introduce themselves to the Patient and Carer/ Family if in attendance, as per standard clinical practice.
Check patient identification. Refer to the Patient Identification Procedure.
Obtain consent for participation.
Document interaction in the electronic medical record or health record using black pen; including date,
time, signature and designation.
It is expected that staff are familiar with the relevant procedures and know when to undertake each step. Staff
who are expected to undertake this procedure regularly must ensure they have completed all relevant training.
PROMPT Doc No: SNH0004137 v6.0
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Assessment and Management of Post-Traumatic Amnesia in Acute Procedure
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PROCEDURE
Figure 1. Determining the appropriate PTA scale to use based on GCS score
(Source: Adapted from Macquarie University, Sydney Australia, Department of Psychology Education Module)
*Please note that this flowchart assists with determining the appropriate PTA scale to utilise ONLY, it not guide other aspects of clinical
management of the patient.
* Testing considerations:
Review the patients file and liaise with treating team regarding the patient’s behaviour and most
appropriate time of day for test administration
Where possible, ensure the testing environment is quiet and free from distractions (i.e.
radios/televisions). Remove clocks and orientation boards prior to commencement of the assessment
The A-WPTAS & WPTAS are screening measures only and not diagnostic tools. Screening scores must
not be interpreted as an absolute, and clinical judgement is always required
Drug and/or alcohol intoxication is not a preclusion for assessment but ought to be factored into the
clinical assessment and decision making
The patient can provide answers via verbal responses, writing, pointing to printed answers, indicating
“yes” or “no” when prompted, or via interpreter
Further information on testing considerations can be found in the background section.
PROMPT Doc No: SNH0004137 v6.0
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Figure 2. Procedure for the assessment and management of PTA in TBI and referral pathways
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1. SCREENING USING THE A-WPTAS (FOR MILD TBI ONLY)
Indications:
When the patient’s initial and current GCS is between 13 and15 (with points lost only for disorientation/
verbal component of the GCS)
Administered in ED or after acute injury, as soon as possible, and when feasible with consideration of
the patient’s presentation and ability to co-operate (e.g. agitation or combativeness)
Only to be used within the first 24 hours of sustaining a brain injury*
Administration:
Refer to the ‘Interactive View’ on EMR for full administration and scoring instructions. Questions are to be asked
in the order they appear on the test forms and then scored accordingly
1.1. The A-WPTAS is initially scored out of 15 at time 1 (T1) as the first administration is the GCS only. The three
pictures are presented at this administration point and recall of the pictures is included in subsequent
administrations, i.e. time 2 (T2) and onwards.
1.2. All subsequent administrations are therefore scored out of 18 (GCS assessment + memory recall
component).
1.3. Administer the A-WPTAS hourly (or as close to hourly as practical) until a perfect score of 18/18 is achieved,
whereby the test is considered to be ‘passed’. Do not exceed the T5 administration time point.
1.4. A patient is deemed to be ‘out of PTA’ when first scoring 18/18. The A-WPTAS can subsequently be ceased
and no further cognitive testing is required.
1.5. If a patient does not pass the A-WPTAS (i.e. does not achieve a score of 18/18) four times in succession, i.e.
at time 5 (T5), the patient remains in PTA and must be investigated/monitored further as per standard TBI clinical
management guidelines.
1.6. Failure of the A-WPTAS: If the patient does not pass the A-WPTAS in ED, they are to be admitted to the SSU
for a 24-hour period of monitoring (irrespective of normal CT scan results). Referral is made to an ED care-
coordinator or occupational therapist for further cognitive investigation and discharge planning.
During normal business hours the occupational therapist aligned to the treating unit in ED can prioritise the
referral and undertake further assessment, as indicated. After hours occupational therapy service in ED is not
available and weekend service is limited. Outside of normal business hours referrals are made to an ED care-
coordinator.
1.7. Determining the presence of PTA at 24 hours post-injury: The A-WPTAS can be re-administered prior to
discharge from the SSU to determine the presence of PTA, if this cannot otherwise be ascertained by
multidisciplinary review, including occupational therapy input. This re-administration must be conducted within
24-hours of the injury and using a new A-WPTAS entry in the EMR.
If the patient is still demonstrating active PTA symptoms 24-hours after the sustained injury time point and has
not been clinically improving, the brain injury is no longer considered to be mild in severity (refer to table 1 for
TBI classifications). Admission to an acute ward is now indicated. Table 2 provides clinical guidelines to aid in
deciding on the admitting unit.
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Table 2. Guidelines to assist with decision-making in ED for admission of TBI patients to the wards of Monash
Health.
No surgical intervention
required
At the point of admission to a medical unit/ward, the occupational therapist aligned to the unit must commence
the full Westmead PTA scale (WPTAS) as per standard protocol.
1.8. Delayed hospital presentations: If a patient presents to ED with a GCS ≥ 13 and greater than 24 hours after
the sustained injury, do not administer the A-WPTAS (the A-WPTAS was designed only for use <24 hrs after
injury). Following medical review and diagnosis, however, continue managing the patient as a mild TBI as per
Point 4. Discharge planning (listed below).
1.9. Guidelines for consideration of CT scanning of the brain for suspected mild TBI in ED
Various clinical decision rules for CT scanning of adults with mild TBI are available. The following
recommendations have been obtained from the adult trauma clinical practice guidelines for the initial
management of closed head injury in adults, 2nd Edition (NSW Ministry of Health, 2011). These guidelines have
been adapted from the Canadian CT Head rule (Stiell et al., 2001).
Those who are at an increased risk of clinically significant lesions, require acute neurosurgical intervention, or
require prolonged observation, must have early CT of the brain if they have any of the following features:
GCS <15 at two hours post injury (including those with an abnormal GCS due to drug or alcohol ingestion)
Focal neurological deficit
Clinical suspicion of a skull fracture
Vomiting
Known coagulopathy or bleeding disorder and/or use of anti-platelet or anticoagulant medications
Age > 65
Prolonged loss of consciousness (>5min)
Witnessed seizure
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Post traumatic seizure
Clinical judgement is also required in instances where there has been any of the following:
A large scalp haematoma or laceration
Associated multi-systems injuries which may distract from subtle neurological sings, and/or where
analgesia, procedural sedation or general anaesthesia has been used
A particularly dangerous mechanism to the injury (e.g. pedestrian/cyclist vs vehicle; ejection from
vehicle; fall >1m; or focal blunt trauma to the head)
Pre-existing neurological/neurosurgical conditions making clinical assessment difficult
Delayed hospital presentation or representation with persistence of symptoms or new symptoms
No clinical decision rule is perfect and decisions for CT scanning must always be made in conjunction with clinical
evaluation and would not override clinical judgment. Consultation must occur with the neurosurgical service.
Also refer to the Monash Health clinical guideline on minor head injury - patients on anticoagulant or antiplatelet
therapy.
Indications:
When initial GCS on presentation was less than 13
When the A-WPTAS was not-passed at the T5 administration time point and PTA is ongoing and present
24 hours after the injury and the person is admitted to a ward
When the patient has regained consciousness and can communicate intelligibly
Administration:
Refer to the WPTAS PowerForm on EMR for full administration and scoring instructions. Questions are to be
asked in the order they appear on the form and then scored accordingly
2.1. Administered once daily (every 24 hours) by the same person, at the same time of day (where possible).
Typically conducted by the ward occupational therapist
2.2. The WPTAS is scored out of 7 on day 1 (first administration time point), as questions relating to recall of the
name and face of the examiner and recall of the picture cards can only occur after initial learning of this
information
2.3. The WPTAS is scored out of 12 on day 2 and subsequent days
2.4. Continue the WPTAS assessment over weekends and public holidays. If the occupational therapists are
unavailable, an alternate appropriately trained staff member would continue the assessment of the WPTAS, i.e.
nursing staff, ANUMs and/or trained medical practitioners.
2.5. The period of PTA may be deemed over on the first of 3 consecutive days of a score of 12/12. However, this
must not be interpreted as an absolute rule. Use clinical judgement to cease administration of the WPTAS prior
to 3 consecutive days of scoring 12/12 if the patient does not display behavioural manifestations of PTA.
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3. Complicating factors when assessing PTA
Complicating factors and confounders can be present in the screening of PTA. Sub-optimal screening results may
be due to factors other than PTA. These include the following:
Pre-existing acquired brain Injury or intellectual disability
Non-English speaking background and cultural differences
Previous level of education
Drug &/or alcohol history: Recent usage, withdrawal or detoxification
Medications affecting alertness (specially opioids or psycho-active medication)
Speech and language deficits (pre-existing or new)
Participation factors: e.g. unwillingness to engage in assessment, frustration, agitation, anxiety
Psychiatric conditions
Dementia and/or delirium
Physical condition of the patient (e.g. pain)
Vision and hearing difficulties (ensure aids are used)
In such instances the WPTAS or A-WPTAS may not be the most appropriate tool to use, and alternative or
adjunctive screening measures is to be considered by appropriately trained ward staff. Examples of alternative
measures include the Galveston Orientation and Amnesia Test (GOAT) and/or the Orientation Log (O-Log).
Referral to neuropsychology can assist in these instances.
Determination of the presence of PTA must not be solely based on a screening results alone and ought to be a
combination of screening and information regarding the patient’s behavioural and psychological function as
witnessed by family and staff. If the patient’s PTA score is not improving, consider referral to neuropsychology
prior to terminating PTA assessment. The neuropsychologist can assist in identifying ‘non-PTA factors’ that may
be accounting for the patient’s clinical presentation.
Neuropsychology services are only available during business hours and not on weekends.
4. Discharge planning
Accurate assessment and management of PTA requires an interdisciplinary approach, and careful and higher-
level discharge planning. Interdisciplinary input includes:
Neuropsychology to establish the presence of PTA, if this has been difficult to ascertain
Neuropsychology for formal cognitive assessment and management of TBI symptoms, once PTA has
resolved (this may occur as an outpatient or via inpatient rehabilitation)
Occupational therapy for functional cognitive assessment and management
Speech pathology if speech, language, cognitive-communication and/or swallowing issues are present
Physiotherapy for rehabilitation of motor and sensory impairments, spasticity management and support
of respiratory function as required
Social work to support patients and their families
Consultation-Liaison Psychiatry and Addiction Medicine services for patients with co-morbid or pre-
existing psychiatric conditions, behaviour disturbance, and/or substance use history
Rehabilitation and Aged Care Liaison Services (RALS) for consideration for inpatient
rehabilitation/subacute admission, as necessary
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4.1. Appropriate discharge destination
Optimally, patients in active PTA are not discharged home, but if so, they are discharged into the care
of a responsible adult with sufficient education for management
The treating medical team, in consultation with the allied health team, have responsibility for
determining the patients’ appropriateness for discharge
If the patient is still experiencing PTA, and once medically stable, they can be transferred to subacute or
a referral made to a specialist inpatient ABI unit. A complete handover of the patient’s PTA assessments
to the subacute ward is required, in addition to their management plan
If a patient in PTA absconds from hospital, the treating team must contact the police and next of kin
immediately
5. Decision-making capacity
Patients in PTA are typically NOT capable of making their own decisions due to being in a confusional
state. If a patient is in PTA and wishes to self- discharge against medical advice, and cannot be redirected,
a Code Grey must be called and staff must obtain security support to attempt to maintain the patient in
a safe environment with supervision
If there is doubt around the patient’s PTA status (e.g. end stage PTA) the treating medical team is
required to make a decision as to whether the patient is able to competently self-discharge. This decision
usually involves consultation with key staff involved in the patient’s care. Referral to neuropsychology
can be made to assess decision-making capacity formally, if this is not clear from a medical perspective
In instances of more complex decision-making capacity or consent, refer to Consent to Medical
Treatment: Operational Policy and also consult with the Office of Public Advocate and Monash Health
Legal Office (as needed). In some cases, consultation or referral to Social Work and/or neuropsychology
may be necessary.
6. Third party interview and/or access to a patient experiencing PTA within the hospital setting
All police, media and third-party requests to access a patient and/or their personal health information are
required to go through the hospital Legal Office and/or Medical Information Unit of Health Information Services.
Refer to Privacy Release of Information: Procedure
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Include a summary of errors made and the patient’s presenting behaviours during the assessment
Document implications of the PTA score and implications for ED/ward management and discharge
planning and update the treating team regularly
Once you have appropriately assessed and documented PTA for moderate to severe TBI patients
(typically on the ward), provide carers and families with written and verbal education regarding PTA.
Refer to: Post Traumatic Amnesia: Information for patients, families and carers. Document in the
progress note that you have done so.
Once you have appropriately assessed and documented mild traumatic brain injury (typically in ED)
and/or after a fall or new injury during a hospital admission, provide patients, carers and families with
written and verbal education regarding mild TBI. Refer to: Mild traumatic brain Injury: Information for
patients, families and carers. Document in the progress notes and discharge papers that you have done
so.
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Modify interventions and rehabilitation/therapy sessions that rely heavily on memory and recall of
information. Consider implementing memory techniques such as procedural or errorless learning to
facilitate therapy sessions during active PTA (refer to Trevena-Peters et al., 2017. Efficacy of Activities of
Daily Living Retraining During Posttraumatic Amnesia: A Randomized Controlled Trial. Archives of
physical medicine and rehabilitation).
8.4. Patient safety – As per National Safety and Quality Health Service (NSQHS) standards:
Avoid indwelling catheters
Minimise falls risk (refer to Monash Health Falls Prevention Procedure for full details: Preventing falls
and harm from falls
Identify and respond to triggers that may lead to increased agitation, distress or confusion
Minimise mechanical and pharmacological restraints, where possible
Consider utilising a patient attendant if the patient is at risk of absconding
Consider using alert bracelets/arm bands for wandering patients
RELATED DOCUMENTATION
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BACKGROUND
*The amnesia of PTA arises due to neurological disruption and is not due to any possible psychological trauma
that may be associated with the injury event. The duration of PTA is defined as the time following the TBI
(including coma period) until resumption of normal and continuous day-to-day memory functions. The interval
of PTA can last from a few minutes to many weeks, or even months, depending on the severity of the injury
(Levin et al., 1979; Schacter & Crovitz, 1977).
The following lists the potential behavioural manifestations or signs and symptoms of active PTA:
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Confusion and disorientation: impaired attention and concentration, impaired memory and reduced
recall of information - this can fluctuate over time
Irritability and agitation: Aggression, restlessness, altered sleep patterns, non-compliance with
treatment and care
Altered thought processes: Reduced insight and reduced flexibility of thought
Odd beliefs: Beliefs that appear to be delusional/unreasonable, inaccurate memories which may lead to
confabulation and fixation
Other behaviour changes: Wandering, inappropriate behaviour or impulsivity.
(Arciniegas et al., 2010; Demery, Hanlon & Bauer, 2001; Johnson, 2001; Weinstein & Lyerly, 1968)
Notes:
The Monash Health procedure for assessment and management of TBI symptoms focuses on the anterograde
amnesia component of PTA. It must be noted that this is one of the possible acute cognitive disturbances arising
from TBI, but not the only one.
Certain factors can complicate the assessment of PTA (refer to point 3 under the Procedure). Additionally,
identifying the end point of PTA can also be difficult and complex. In more severe cases of TBI, the end point of
PTA cannot readily be determined as symptoms represent persisting, and possible permanent, cognitive deficits
as a consequence of the injury. Therefore, coordinated PTA assessment and management is vital in ensuring
optimal outcomes for this patient group. A multidisciplinary team approach is key in identifying and managing
symptoms of PTA.
Predictor of injury severity: Duration of PTA, when measured using objective assessment scales, is a reliable and
sensitive predictor of severity of traumatic brain injury. Conversely, subjective reports or a history taken
retrospectively, is a less reliable indicator of PTA duration
Impact on rehabilitation outcomes: As patients in PTA have difficulty retaining new information, rehabilitation that
relies on explicit memory recall and new learning is not typically undertaken during the acute or active stages of PTA.
It is therefore essential to be aware of the presence of active PTA to guide rehabilitation goals and progress
Longer-term impacts: Accurate assessment of PTA assists in identifying whether a mild TBI/concussion has occurred.
Research indicates that TBI patients who receive information, support and advice post-injury demonstrate
significantly less cognitive and psychological symptoms, and social morbidity in the longer term (King, Crawford,
Wenden, Moss & Wade, 1997; Wade, King, Wenden, Crawford & Caldwell, 1998)
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component of PTA (Meares & Shores, 2017). Therefore, screening measures of PTA have been implemented in
clinical practice to address this gap, particularly relevant for mild TBI when the GCS can be normal or return to
normal quite quickly.
The Westmead Post Traumatic Amnesia Scale (WPTAS) is the most commonly used adult PTA screening tool
within Australia and New Zealand (Marshman et al., 2013). The WPTAS is a 12-item screening scale originally
created by Professor Arthur Shores, Neuropsychologist, and colleagues in 1986, and adapted and used in clinical
practice in 2009. This is an objective assessment of PTA examining the person’s orientation and ability to
consistently remember and retain information from one day to another. The WPTAS, therefore, enables daily
prospective evaluation of PTA (Tate, Pfaff & Jurjevic, 2000). This assessment tool is suitable for use with a
moderate to severe TBI diagnostic group only, and has been validated for closed head injury, and not penetrating
or open head injuries. PTA testing with this measure begins when the patient has regained consciousness and
can communicate intelligibly and is conducted DAILY. The patient may be able to communicate via speech,
writing, pointing to printed answers or by indicating “yes” or “no” when prompted.
PTA may be deemed to be over on the first day of 3 consecutive days of a score of 12/12 on the WPTAS. Obtaining
a ‘perfect’ score (12/12) on three consecutive days, ensures that the person has consistently maintained
adequate memory function, rather than brief periods of sound memory followed by further confusion or
amnesia. However, this criteria must not be used as a hard-and-fast rule, and scores must not be interpreted as
an absolute, with clinical judgement required in every case.
The Abbreviated Westmead Post Traumatic Amnesia Scale (A-WPTAS) was created by Shores and Lammel in
2007 as a way of measuring length of PTA during the acute stage of a mild TBI within 24 hours of the initial injury.
The A-WPTAS is an extension of the GCS and is based on the original WPTAS, but patients are tested in HOURLY
intervals instead of daily intervals. It was designed to prevent mild TBI patients remaining in hospital for
observation for unnecessary periods of time. Research from Shores and colleagues suggests that up to 4 hours
of observation of a person with mild TBI is sufficient to determine if discharge is safe. It is now mandatory in
NSW for all EDs to use to the A-WPTAS in suspected mild TBIs (NSW Ministry of Health, 2011). Research from
Liverpool Hospital, NSW (Level 1 Trauma centre) found that 94% of patients who were administered the A-
WPTAS were cleared of PTA within 4 hours of presentation and this reduced length of stay by 295 bed-days
(Watson et al., 2017). It is also essential to provide patients who have sustained a mild TBI with education, both
verbal and written, regarding discharge advice and how to assist with recovery. Refer to: Mild traumatic brain
Injury: Information for patients, families and carers.
The A-WPTAS encompasses the regular neurological observations of the GCS assessment, with the addition of
three pictures for the patient to learn and remember (testing memory recall). Only use the A-WPTAS for those
with a GCS between 13 and 15 (but the patient must obtain E4 & M6 on the GCS). The A-WPTAS is therefore not
suitable for those with a suboptimal motor score (i.e. score of less than 6) and reduced eye responses (i.e. score
of less than 4) on the corresponding sections of the GCS. It is also not suitable for those with a GCS verbal
component score of 2 or below. Such suboptimal scores would be suggestive of a more severe TBI, and A-WPTAS
is not indicated in these cases. If the patient obtains a score of less than 13, use the WPTAS upon admission to
a ward.
The patient is deemed ‘out of PTA’ when they obtain a score of 18/18 on the A-WTPAS. No additional or repeated
administrations are required after a perfect score (18/18) has been obtained. If the patient fails to score 18 on
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four testing occasions within 24 hours of the injury, they must be commenced on the standard WPTAS for more
detailed PTA evaluation
Testing considerations
The A-WPTAS and WPTAS are not the only screening measures of PTA, but are extensively validated and used
nationally and internationally. Both the WPTAS and A-WPTAS must be administered by appropriately trained
staff, such as occupational therapists, speech pathologists, neuropsychologists, nursing staff or medical
practitioners. Surgical intervention does not necessarily contraindicate the use of these PTA scales. PTA
screening can also be used in intoxicated individuals as long as they are cooperative and GCS requirements have
been met for each test. These measures can be used with an interpreter (Meares & Shores, 2017). Refer to
Monash Health EMR to view these tests: The WPTAS is a PowerForm in EMR, and the A-WPTAS is in the
Interactive View of EMR.
KEY STANDARDS, GUIDELINES OR LEGISLATION
REFERENCES
Arciniega, D.A., Frey, K.L., Newman, J., & Wortzel, H.S. (2010). Evaluation and management of posttraumatic cognitive
impairments. Psychiatry Annals, 40(11): 540-552.
Brain Injury Association of America (6th February 2011). BIAA Adopts new TBI definition.
Carroll, L.J., Cassidy, J.D., Holm, L., Kraus, J., & Coronado, V.G. (2004). Methodological issues and research
recommendations for mild traumatic brain injury: The WHO Collaborating Centre Task Force on mild traumatic brain injury.
Journal of Rehabilitation Medicine, Suppl. 43: p. 113-125.
Demery, J.A., Hanlon, R.E., & Bauer, R.M (2001). Profound amnesia and confabulation following traumatic brain injury.
Neurocase, 7(4): 295-302.
Fortune, N., & Wen, X. The definition, incidence and prevalence of acquired brain injury in Australia. (1999) Australian
Institute of Health and Welfare Canberra; Cat. No. DIS 15: 141.
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J.T., Collins, M.W. (eds.), Traumatic Brain Injury in Sports: An International Neuropsychological Perspective p. 45–70, Lisse:
Swets & Zeitlinger.
Gordner, RL., & Tuel, SM. (Ed.).(1998) Rehabilitation of persons with traumatic brain injury. Bethesda: National Library
of Medicine.
Guidelines for the NSW Compulsory Third Party Scheme and Lifetime Care and Support Scheme (2013). NSW
Government State Insurance Regulatory Authority.
Helps., Y., Henley, G., & Harrison, J. (2008). Hospital separations due to traumatic brain injury, Australia 2004-05.
Australian Institute of Health and Welfare Canberra; Cat. No. INJCAT 116: 128.
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Assessment and Management of Post-Traumatic Amnesia in Acute Procedure
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Traumatic Brain Injury (Adults)
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Monash Health wishes to acknowledge the use of protocols from Alfred Health, Austin Health, South West Local Health District, Westmead
Hospital, Queensland Health Royal Brisbane & Women’s Hospital, in addition to the authors of the A-WPTAS and WPTAS: Shores et al
(1986 & 2007) in the preparation of this procedure. We also acknowledge Professor Arthur Shores, Neuropsychologist (NSW) for ongoing
consultation and sharing of resources.
KEYWORDS
Post Traumatic Amnesia (PTA), Traumatic Brain Injury (TBI), Closed Head Injury, Concussion, Head Injury,
Westmead PTA Scale (WTPAS), Abbreviated Westmead PTA Scale (A-WPTAS), Glasgow Coma Scale (GCS).
Document Governance
Supporting Policy Evidence Based Clinical Care: Operational Policy
Executive Sponsor Stuart Cavill, Chief Allied Health Officer
Neuropsychology Unit, Acute Neuropsychology
Service Responsible
MMC Occupational Therapy, Neurosciences
Dr Niloufar Kirkwood, Senior Neuropsychologist
Document Author
Danielle Byrne, Neurosciences Occupational Therapist
Consumer Review Yes or No No
This Procedure has been
endorsed by an EMR Subject There are no Order Set or Quick Reference Guides linked
Matter Expert (SME)
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Assessment and Management of Post-Traumatic Amnesia in Acute Procedure
Traumatic Brain Injury (Adults)
A-WPTAS TARGET PICTURES:
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Assessment and Management of Post-Traumatic Amnesia in Acute Procedure
Traumatic Brain Injury (Adults)
A-WPTAS PICTURE RECOGNITION CHART
Only to be used if the patient says “I don’t know” or “I don’t remember.”
Do not use if incorrect response provided in the first instance when testing recall.
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