Background

Information on the development of the Westmead Post-Traumatic Amnesia (PTA) Scale and how this toolkit was developed to support its use in clinical practice.

This web-based toolkit is a revised version of The PTA Protocol – Guidelines for using the Westmead PTA Scale (1997). It includes updated language, clarity around standardised procedures and an expansion of frequently asked clinical questions. The integrity of the standardised protocol has been maintained with approval by the authors of the 1997 manual and related publications.

History of the Westmead PTA Scale

The work of W. Ritchie Russell (1903–1980) and colleagues forms the basis of all research about PTA. Their studies have shaped much of what is known about PTA today. They used subjective and retrospective estimates of PTA based on the careful questioning of patients (Shores 1990).

In 1943, Symonds and Russell warned of the risks of misinterpretation of results due to factors such as patients having “islands of memory” or presenting as orientated, despite ongoing amnesia (Shores 1990).

The Westmead PTA Scale was developed by a group of researchers at Westmead Hospital in NSW, Australia, in the 1980s with these warnings in mind. They expanded on previous work by the Oxford Group and Fortuny et al. 1980.

Since its first publication (Shores et al. 1986), the Westmead PTA Scale has been shown to be a powerful tool for predicting outcomes following traumatic brain injury (TBI) and has been used extensively in research and clinical practice. It has been successfully tested for reliability and validity across population groups since publication (Briggs et al. 2016; Briggs et al. 2023; Lah et al. 2017; Marosszeky et al. 1993; Meares et al. 2011; Shores 1995; Shores et al. 2008; Shores et al. 1986; Tate et al. 2006; Tesson et al. 2016; Walsh et al 2022).

The original manual for the administration of the Westmead PTA Scale was published in 1990 and updated in 1997. We acknowledge the authors of the 1997 manual:

• N.E.V. Marosszeky, B.A. (Hons), MAPS, Consulting Psychologist
• Lesley Ryan, B.App. Sc. (Occupational Therapy), Senior Occupational Therapist, Westmead Brain Injury Rehabilitation Service, Westmead Hospital
• E. Arthur Shores, B.A. (Hons), M.A. (Hons), Ph.D., Senior Lecturer, Psychology Department at Macquarie University and Senior Consultant Clinical Neuropsychologist at the Medical Centre, New Children's Hospital, Westmead
• Jennifer Batchelor, B.A. Sc. (Hons), MSc., Ph.D., Lecturer, Psychology Department at Macquarie University and Consultant Neuropsychologist
• J.E. Marosszeky, MB BS. DPRM, FACRM, FAFRM, Consultant in Rehabilitation Medicine, Department of Rehabilitation Medicine, Westmead Hospital

Developing this toolkit

This toolkit was developed in 2025 by a group of NSW Health clinicians skilled in the administration of the Westmead PTA Scale. This included clinicians from across acute and rehabilitation care settings, and from a range of medical, nursing and allied health disciplines.

Adjunct Professor E. Arthur Shores was a member of the working group and consulted with his colleagues to ensure no deviation from the accepted standardised protocols.

An updated literature review was completed to assess the accumulated evidence since 1998.

Email ACI-BrainInjuryRehab@health.nsw.gov.au for a copy of the full methodology and references.

Acknowledgements

Thank you to the following working group members and people who reviewed the updated toolkit:

• Associate Professor Jennifer Batchelor, Consultant Neuropsychologist, School of Psychological Sciences, Macquarie University
• Katherine Becker, Nurse Practitioner, Neurosurgery/Co-Director Neurosurgery Service, Royal North Shore Hospital
• Dr Stuart Browne, Clinical Director, Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation
• Emma Dwyer, Occupational Therapist, Wagga Wagga Acute Rehabilitation Team, Wagga Wagga Base Hospital
• Dr Joseph Gurka, Head of Department, Rehabilitation Medicine, Westmead Hospital
• Judy Lui, Senior Occupational Therapist, Inpatient Team, Liverpool Brain Injury Unit, Liverpool Hospital
• Dr Nicholas Marosszeky, Registered Psychologist
• Dr Kasey Metcalf, Senior Clinical Neuropsychologist, Community Team, Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital
• Jodie Nicholls, Senior Occupational Therapist, Brain Injury Rehabilitation Service, Westmead Hospital
• Lesley Ryan, Occupational Therapist
• Adjunct Professor E. Arthur Shores, School of Psychological Sciences, Macquarie University
• Erica Sullivan, Occupational Therapist, Acute Care, John Hunter Hospital

Related PTA assessment tools

The Abbreviated Westmead PTA Scale (A-WPTAS)

The A-WPTAS was developed to provide a consistent and efficient way to assess and monitor PTA in the first 24 hours following a suspected mild TBI. The A-WPTAS was introduced to help reduce hospital length of stay; avoid unnecessary admissions; and prevent inappropriate discharges.

In consultation with E.A. Shores, the tool was developed in 2007 by the ACI’s Institute of Trauma and Injury Management and the Emergency Care Institute. It was adopted by the Motor Accidents Authority NSW as an assessment for mild TBI in 2008.

In 2010, Liverpool Hospital piloted the A-WPTAS on the neurosurgery ward and later completed a 2-year retrospective study to examine the impact of completing the A-WPTAS on length of stay.

Studies have demonstrated the validity of the A-WPTAS (Meares et al. 2011) and the reliability in using it with children (Tesson et al. 2016).

Benefits of using the A-WPTAS include:

• assisting early clinical assessment of patients with mild TBI
• patient safety, as mild TBI may go undetected without direct questioning using a screening assessment
• identifying the need for appropriate management, education and follow-up
• the potential to minimise hospital admissions and length of stay.

More about the A-WPTAS

The Sydney Post-Traumatic Amnesia Scale (SYPTAS)

The SYPTAS was published in 2019 for use with children aged 4 years to 7 years 11 months. It has been shown to have good developmental, concurrent and predictive validity for this cohort (Lah et al. 2017).

The SYPTAS was developed through collaboration between the Brain Injury Rehabilitation Team at The Sydney Children's Hospital Randwick and the School of Psychology at the University of Sydney.

Download the SYPTAS Manual

Intellectual property, copyright and permissions

The Westmead PTA Scale is available free of charge for non-commercial clinical and research use. Appropriate attribution must be provided in all publications or reports; for example, by citing Westmead Hospital and the original Medical Journal of Australia paper or the PTA Protocol (technical manual) by the authors (e.g. Shores et al. 1986; Shores et al. 1990; Marosszeky et al. 1998).

Any modifications or alterations to the scale, such as item rephrasing, format adjustments, adaptations, or changes to the instructions, require prior written permission from the original authors.

References