Westmead Post-traumatic Amnesia Scale Research Articles

Natural sequence of recovery from child post-traumatic amnesia: A retrospective cohort study

The aim of this study was to determine the sequence of skills recovery during post-traumatic amnesia (PTA) in children with moderate to severe traumatic brain injuries (TBIs). Setting: Fifty children aged 8 to 15 years consecutively admitted to a children’s hospital with TBI and PTA>24 were tested in a retrospective cohort study where the main measure was the Westmead PTA Scale (WPTAS). The group analyses show that orientation to time took longer to recover than orientation to person and place, but not memory, while the individual analyses revealed that when orientation to time was grouped with memory, 94% of children recovered orientation to person and place before orientation to time and memory (examiner and pictures). Correlation coefficients between age and the number of days taken to recover skills were not found to be significant. It was established that, in terms of the natural sequence of skills recovery in children aged 8 to 15 years following moderate to severe TBI, recovery of orientation to time is more closely aligned to memory than to orientation to person and place. It was also established that WPTAS items are developmentally appropriate for children aged 8 to 15 years who have sustained TBI. These findings are clinically important because monitoring recovery from PTA both impacts the rehabilitation offered to individuals during acute care and aids discharge planning.

Identifying Posttraumatic Amnesia in Individuals With a Glasgow Coma Scale of 15 After Mild Traumatic Brain Injury

ObjectiveTo examine the utility of the Abbreviated Westmead Post-traumatic Amnesia Scale, which includes the Glasgow Coma Scale (GCS) and 3 picture cards used to measure amnesia, in identifying the presence or absence of posttraumatic amnesia in individuals with mild traumatic brain injury (mTBI). DesignProspective study using data from the Abbreviated Westmead Post-traumatic Amnesia Scale. SettingTrauma hospital. ParticipantsIndividuals with possible mTBI who presented between April and September 2011 (N=252; age range, 18–65y; mean age, 37.4±13.9y; 77% men). InterventionAdministration of the Abbreviated Westmead Post-traumatic Amnesia Scale. Main Outcome MeasuresGCS and Abbreviated Westmead Post-traumatic Amnesia Scale pass/fail rates. ResultsOf the individuals, 169 (mean age, 35.1±13.6y; 77% men) received the scale. A pass/fail performance was achieved a median 121 minutes (interquartile range, 89–205min) after triage. Of the 45 who failed, 31 (69%) had a GCS score of 15. The likelihood of failing was associated with being older (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02–1.06; P<.05), having consumed alcohol (OR, 3.09; 95% CI, 1.42–6.74; P<.01), and the scale being administered closer to the time of the injury (OR, 0.99; 95% CI, 0.99–1.00; P<.05). Nineteen (42%) of those who failed had consumed alcohol, 11 had a GCS score of 15, and 8 had a GCS score of 14. ConclusionsA GCS score of 15 does not always signify return to normative cognitive function. Individuals with a GCS score of 15 who are acutely cognitively impaired are at risk of not being accurately identified. The addition of an amnesia score to the GCS in the Abbreviated Westmead Post-traumatic Amnesia Scale will assist in making a diagnosis of mTBI.

Abstracts of the 36th Brain Impairment Conference, May 2-4, 2013, Hobart

Background and Aim: Attention is implicated as the primary deficit of post-traumatic amnesia (PTA) by historical accounts and recent research. Paradoxically, attention is not directly assessed by the commonly used Westmead PTA Scale (WPTAS). Tentative validation was provided by Tate et al. (2006) who found few improvements in a limited subset of attention tasks by severely brain-injured patients between the first 12/12 score and the final of three consecutive 12/12 scores on the WPTAS. The aim of the current study was to examine the end stage of PTA as measured by the WPTAS against a broader array of executive attention tasks. Method: Fifteen participants (M:F 8:7, aged 34 ± 15 years [range: 18-63 years]) with predominately moderate-severe brain injury were assessed on information processing, verbal fluency, updating, inhibition/selective attention and switching tasks. Participants were assessed on the first 12/12 score on the WPTAS and the final of three consecutive 12/12 scores. Practice effects of testing were considered against 15 demographically matched controls assessed between equivalent intervals. Results: Repeated-measures ANOVA found only speed of processing to significantly improve as PTA resolved over and above the practice effect of a control group (between-within interaction F(1,28) = 5.78, p = 0.023). However, no significant improvement over a control group was noted for any other more complex measure of attention or executive functioning. Conclusion: The lack of a broader improvement in executive attention abilities suggests that patients have likely emerged from PTA by the first 12/12 score on the WPTAS.

Validation of the Abbreviated Westmead Post-traumatic Amnesia Scale: A brief measure to identify acute cognitive impairment in mild traumatic brain injury

Objective: To validate the use of the Abbreviated Westmead Post-traumatic Amnesia Scale (A-WPTAS) in the assessment of acute cognitive impairment in mild traumatic brain injury (mTBI).Methods: Data previously collected from 82 mTBI and 88 control participants using the Revised Westmead Post-traumatic Amnesia Scale (R-WPTAS) was converted to A-WPTAS scores and pass/fail classifications were calculated for both scales.Results: The proportion of failures on the R-WPTAS and the A-WPTAS did not differ and a similar number of mTBIs were classified on each. For mTBIs the relationship between the independent memory test and a pass/fail classification was the same for both scales. Bivariate logistic regressions revealed that mTBIs, relative to controls, were around 8 times more likely to fail the assessment (R-WPTAS: 95% CI: 3.70–18.87; A-WPTAS: 95% CI: 3.70–20.14). As verbal learning improved the likelihood of failure was reduced. Greater education was associated with a decreased likelihood of failure. The relationship between education and a fail performance was not sustained when education was adjusted for the effect of age, prior mTBI, blood alcohol level, injury status, verbal learning, and morphine administration.Conclusions: The A-WPTAS is a valid measure. The A-WPTAS may reduce the risk of failing to classify patients with mTBI by identifying and documenting acute cognitive impairment.

Introducing the Westmead post-traumatic amnesia scale: Our journey and lessons learnt

Introducing the Westmead post-traumatic amnesia scale: Our journey and lessons learnt

The Westmead Post-Traumatic Amnesia Scale for Children (WPTAS-C) Aged 4 and 5 Years Old

AbstractAssessment of posttraumatic amnesia (PTA) in young children remains problematic. This article details a version of the Westmead PTA Scale, which was adapted for use with children aged 4 and 5 years, and an evaluation of this scale with typically developing children. The Westmead PTA Scale for Children (WPTAS-C) comprises 2 orientation and 4 memory questions, including 2 items involving remembering pictures of familiar objects. Participants included 55 preschool and kindergarten children aged 4 and 5 years. The scale was administered for 4 consecutive days. Ninety-three per cent of the children achieved a score of 6 out 6 for the final 3 days of the 4-day test period. It is concluded that the WPTAS-C is an appropriate measure of orientation and continuous memory in 4- and 5-year-old typically developing children. Validation of the scale in clinical populations is recommended.

The diagnostic accuracy of the Revised Westmead PTA Scale as an adjunct to the Glasgow Coma Scale in the early identification of cognitive impairment in patients with mild traumatic brain injury

Background:Assessment of patients with mild traumatic brain injury (mTBI) is predominantly done using the Glasgow Coma Scale (GCS). While the GCS is universally accepted for assessment of severity of traumatic...

PTA testing, the westmead post traumatic amnesia scale and opiate analgesia: A cautionary note

Objective: To assess the validity of the Westmead PTA scale in patients treated with opiate analgesia.Method: Seventeen non-head injured, non-traumatic, electively hospitalized orthopaedic patients treated with opiate analgesia were tested on the Westmead PTA scale for a minimum of 2 consecutive days (n=17) to a maximum of 4 consecutive days (n=10).Results: Only 20% of participants tested over 4 days reached criteria of three consecutive 12/12 scores on the Westmead PTA scale. Daily failure rates on the 12 item scale ranged from 36–70%. All failures were on the ‘new learning’ items, orientation items were never failed.Conclusions: The low pass rate of non-head injured patients treated with opiate analgesics indicates that the Westmead PTA scale is non-specific to traumatic brain injury and is probably an invalid measure of post-traumatic amnesia in patients actively treated with opiates. Implications for the measurement and accurate classification of traumatic brain injury patients are discussed.

A multicentre, randomised trial examining the effect of test procedures measuring emergence from post-traumatic amnesia

Background: Post-traumatic amnesia (PTA) tests that record different PTA durations in the same patient, thereby raising measurement accuracy issues, have been reported previously. A major problem lies in determining the...

Protein S-100 and neuropsychological functioning following severe traumatic brain injury

Primary objective: To examine the relationship between serum concentrations of protein S-100β and neuropsychological functioning following severe traumatic brain injury.Design: Matched control group.Methods: Blood samples were taken within 12 hours of injury and then daily up to 7 days post-injury (n = 23). Within 2 weeks of emerging from post-traumatic amnesia (PTA), participants completed a battery of neuropsychological measures. These results were compared with a matched sample of healthy controls.Results: Early measurement of S-100 not only reflected overall brain injury severity, but also related to neuropsychological deficits, with higher serum concentrations associated with poorer performance across most cognitive domains. PTA duration, measured by the Westmead PTA Scale, was found to be the strongest predictor of S-100 concentration (R2 = 0.59, p < 0.001).Conclusions: These findings show that measurement of serum protein S-100 may further aid in the identification of individuals with severe TBI who are likely to experience cognitive difficulties.

Use of the Westmead PTA scale to monitor recovery of memory after mild head injury

Study objective: Duration of post-traumatic amnesia (PTA) is an important index of severity of head injury. Retrospective assessment of PTA duration is arguably unreliable. Existing objective measures of PTA duration are designed for use over a 24-hour timeframe and, therefore, are not useful for assessing PTA following mild head injury (MHI). A revised version of the Westmead PTA scale was developed for assessing patients with MHI in the Emergency Department (ED) at hourly intervals. The objective of this study was the field testing of this scale in EDs and assessment of validity and reliability of test items.Methods: The scale contained 12 items, assessing orientation, memory for a face and name in a photograph and three pictures of objects. This revised scale, administered by nursing staff, was completed at least four times at hourly intervals by 147 adults with MHI in the ED and again at follow-up 1 week later. It was also completed by 109 demographically similar controls. Results were compared with Glasgow Coma scores and retrospective estimates of PTA duration based on patient report and medical records.Results: Thirty-six per cent of MHI participants made errors on the scale in the ED, a significantly greater proportion than in MHI or controls at follow-up. Removal of the items 5 (day of week) and 9 (recall of name of face in photograph) improved the validity of the measure significantly. Scores correlated significantly with Glasgow Coma Scale scores and estimated duration of PTA.Conclusion: The Westmead Scale (minus items 5 and 9) is a valid measure of PTA duration in adult patients with MHI in ED. Its use will allow for more appropriate timing of discharge and accurate prognostic information.

Post-Traumatic Amnesia: Consistency-of-Recovery and Duration-to-Recovery Following Traumatic Brain Impairment

The aim of this research was to examine the nature and order of recovery of orientation and memory functioning during Post-Traumatic Amnesia (PTA) in relation to injury severity and PTA duration. The Westmead PTA Scale was used across consecutive testing days to assess the recovery of orientation and memory during PTA in 113 patients. Two new indices were examined: a Consistency-of-Recovery and a Duration-to-Recovery index. A predictable order of recovery was observed during PTA: orientation-to-person recovered sooner and more consistently than the following cluster; orientation-to-time, orientation-to-place, and the ability to remember a face and name. However, the type of memory functioning required for the recall face and name task recovered more consistently than that required for memorizing three pictures. An important overall finding was that the order-of-recovery of orientation and memory functioning was dependent upon both the elapsed days since injury, and the consistency of recovery. The newly developed indices were shown to be a valuable means of accounting for differences between groups in the elapsed days to recovery of orientation and memory. These indices also clearly increase the clinical utility of the Westmead PTA Scale and supply an objective means of charting (and potentially predicting) patients recovery on the different components of orientation and memory throughout their period of hospitalization.

Moderate head injury: A report on a prospective study

Seventy five per cent of the patients sustained multisystem trauma, generally of minor or moderate grade according to the Abbreviated Injury Scale (AIS). However, the death rate increased with the severity of the injury as measured by the Injury Severity Score (ISS). The initial CT scan was abnormal in 61% of patients and no patient with a normal scan developed a delayed intracranial haematoma (ICH) or neurological worsening. Those patients who developed a delayed ICH had a worse outcome. Sixteen patients underwent craniotomy for haematoma. The intracranial pressure (ICP) was measured selectively in 20 patients and exceeded 20mmHg in half, requiring treatment. Nine patients died as a result of head injury and all those had an intracranial haematoma. As a group those who died were older and had a higher ISS. Sixty per cent of patients had a hospital stay exceeding 7 days, over half (58%) had their head injury as the primary reason for their ongoing admission. Twenty patients required a period of ventilation in the ICU. Most patients achieved a good outcome (Glasgow Outcome Score). Twenty two per cent had some form of ongoing disability. Eighty patients underwent formal post traumatic amnesia (PTA) testing using the Westmead PTA scale. Seventy eight per cent of those patients had a period of PTA in excess of 24 hours and 51% of those patients in excess of 1 week, implying the likelihood of residual neuropsychological disability.

Further concurrent validity data on the Westmead PTA Scale

Further data supporting the concurrent validity of the Westmead PTA scale is presented. The initial concurrent validation data on the Westmead PTA Scale study was based on two separate groups of traumatic brain injury patients. In order to ensure that the results of that study were not due to sampling differences between the groups related to different degrees of recovery as a consequence of varying times since trauma, further investigation of the concurrent validity was undertaken using a group of patients as their own controls, tested once while in post-traumatic amnesia (PTA) and again shortly after emerging from PTA. Thirty patients with severe traumatic brain injuries, who were still experiencing PTA as defined by their Westmead PTA Scale performance, were assessed on an independent test of verbal learning ability. Once out of PTA, as defined by their performance on the Westmead PTA Scale they were retested on a parallel form of the test of verbal learning. Their performance on the two occasions differed significantly providing further concurrent validation of the Westmead PTA Scale.

Inter‐rater reliability of the Westmead Post‐traumatic Amnesia (PTA) scale

Clinically useful scales must be reliable. High inter‐rater reliability reduces errors of measurement. The purpose of this study was to assess the agreement between raters in scoring items of the Westmead post‐traumatic amnesia (PTA) scale. Two raters viewed 20 episodes of the Westmead PTA scale in clinical use. The inter‐rater reliability coefficients for the instrument overall and for a majority of the individual items were statistically convincing (r ≥ 0.72) and well within clinically acceptable ranges. The lowest correlation was for the item pertaining to recognition of the examiner's face. A procedure for improving the reliability of scoring this item is recommended.

The performance of hospitalized, non head-injured children on the Westmead PTA scale

Abstract The Westmead PTA Scale was designed to measure objectively the period of posttraumatic amnesia (PTA) in head-injured adults. This paper, the first of a series, reports on research aimed at adapting the Westmead PTA Scale for use with head-injured children. The first stage of this research involved gathering normative data from hospitalized, non head-injured children between the ages of 6 and 16 years. The performance of 90 children on the Westmead PTA Scale is described. Two findings emerged from the data. First, the performance of 6- and 7-year-olds on the scale was significantly different from that of older age groups. Second, 94% of the children over the age of 7 met the Westmead PTA Scale's criteria. The Westmead PTA Scale may, therefore, be considered suitable for investigation with head-injured children over the age of 7 years.