When to use the Westmead PTA Scale

On this page

Use the correct tool and clinical flow for the assessment of post-traumatic amnesia, based on the severity of traumatic brain injury.

Clinicians use 2 key tools to assess and measure post-traumatic amnesia (PTA) following a traumatic brain injury (TBI).

The Westmead PTA Scale is a validated tool used in the assessment and measurement of disorientation and anterograde amnesia following moderate to severe TBI (Shores et al 1986; Shores 1995). It includes 7 orientation questions and 5 memory questions. It is unable to assess PTA durations of less than 24 hours.

The Abbreviated Westmead PTA Scale (A-WPTAS) is a screening tool for mild TBI and was developed after the Westmead PTA Scale (Shores et al, 2008; Tesson et al, 2016; Meares et al, 2011). It is often used in emergency departments to assess PTA in the first 24 hours after the injury. It incorporates the Glasgow Coma Scale (GCS) and a recall component, using the Westmead PTA Scale’s picture cards.

The A-WPTAS is generally started as soon as clinically appropriate within the 24-hour window post-injury and readministered hourly thereafter. Consider admitting the patient if they are unable to achieve a full score of 18 after 4 attempts, and transition the patient to the Westmead PTA Scale as soon as practicable.

Note: the A-WPTAS requires patients to remember the same 3 pictures – cup, keys, bird. When transitioning to the Westmead PTA Scale, the same 3 pictures are used as the first set of picture cards for the patient to remember. The pictures are changed only after the patient scores 12 (as per the standard protocol).

More about the A-WPTAS and its administration protocol.

The Westmead PTA Scale and the A-WPTAS are designed for different clinical scenarios and are not interchangeable. Use A-WPTAS for mild TBI. Use Westmead PTA Scale for moderate, severe and very severe TBI.

Suspected traumatic brain injury

Select:

Likely mild TBI

  1. Likely mild TBI (GCS >= 13)

  2. Administer A-WPTAS if patient is within 24 hours of brain injury

  3. If patient fails 4 attempts at the A-WPTAS within 24 hours of TBI, hospital admission should be strongly considered

    Transition to the Westmead PTA Scale as soon as practicable

Likely moderate, severe or very severe TBI

  1. Patient is conscious and able to respond to questions

  2. Patient communicates verbally

    Start testing with Westmead PTA Scale using standard protocol

    Patient communicates non-verbally

    Start testing with Westmead PTA Scale using relevant modifications (non-standard protocol)

  3. First assessment

    • Ask the 7 orientation questions
    • Record answers on scoresheet
    • Introduce the 5 memory questions for the next day

  4. Subsequent assessment

    On the following days:

    • Ask the 12 questions
    • Record answers on scoresheet
    • Tally the total score
    • Follow pathway based on score

  5. Westmead PTA Scale Score < 12

    Continue daily testing of all 12 questions until patient achieves score of 12

    Westmead PTA Scale Score = 12

    Change the 3 images the patient needs to remember for the following day

    Continue daily testing until patient scores 3 consecutive days of 12. Change the 3 images after each score of 12

Emergence from PTA: patient has emerged from PTA on the first day of 3 consecutive scores of 12.

Notes for score < 12

Patient unable to score 12 after 3 months: equates to extremely severe TBI with severe cognitive impairment. Seek advice of neuropsychologist or brain injury rehabilitation service regarding need for ongoing testing.

Ongoing testing can provide valuable clinical information about the patient's status, even if the patient doesn't score 12, e.g. deteriorating scores may indicate onset of delirium.

Notes for score = 12

Patient scores their first 12 more than 28 days post-TBI but is unable to achieve 3 consecutive days of 12: consult a neuropsychologist. Patient is deemed to have emerged from PTA on the day the first score of 12 was achieved. Daily testing may continue if deemed clinically useful.

Likely moderate, severe or very severe TBI

  1. Patient is unconscious

  2. Continue monitoring with GCS

  3. When patient regains consciousness and responds to questioning, start testing with Westmead PTA Scale

    PTA duration is measured from the day of injury and includes the period in coma

References

  • Meares S, Shores EA, Taylor AJ, Lammél A & Batchelor J (2011). Validation of the abbreviated Westmead Post-traumatic Amnesia Scale: a brief measure to identify acute cognitive impairment in mild traumatic brain injury. Brain Injury. 25(12): 1198-1205.
  • Shores EA (1990). The PTA protocol: a guide for the administration of the Westmead PTA Scale. Department of Rehabilitation Medicine, Westmead Hospital, Sydney. Available through the National Library of Australia (out of print).
  • Shores EA (1995). Further concurrent validity data on the Westmead PTA Scale. Applied Neuropsychology. 2: 167-169.
  • Shores EA, Marosszeky JE, Sandanam J & Batchelor J (1986). Preliminary validation of a clinical scale for measuring the duration of post-traumatic amnesia. Medical Journal of Australia. 144: 569-572.
  • Shores EA, Lammel A, Hullick C, Sheedy J, Flynn M, Levick W & Batchelor J (2008). 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. Journal of Neurology, Neurosurgery and Psychiatry. 79(10): 1100-1106.
  • Tesson SA, Nogajski RR, Macey J-A & Paget SP (2016). Reliability of the abbreviated Westmead Post-traumatic Amnesia Scale in children: impact of age on test results. Emergency Medicine Australasia. 28(1): 73-77.
Back to top