Frequently asked questions

No licences, fees or other permissions are needed for clinicians and researchers to use the Westmead PTA Scale. No acknowledgements are needed in medical records.

Yes; however, the score methodology cannot be changed. Clinicians may copy or recreate the scoresheet content onto their own service forms or electronic records, adding any prompts they feel will add to compliance and clinical usefulness, e.g. referral pathways based on results.

Allied health, nursing and medical clinicians can administer the Westmead PTA Scale. Most often, occupational therapists, nurses, speech pathologists and neuropsychologists will administer the test. Assessors need sufficient experience and clinical reasoning to identify when adaptations are necessary or recognise when confounding factors might be impacting administration and results.

There is no formal accreditation training to administer the Westmead PTA Scale. Achieving a valid result, however, relies on the skills of the assessor to comply with the standard procedure and apply clinical judgement to identify any adaptations that may be needed to accommodate patient attributes or comorbidities.

Assessors need to recognise when adaptations fall outside acceptable practice for a score to be valid.

Yes. There is no upper age limit for using the scale.

Ensure no pre-injury conditions or comorbidities (e.g. dementia) are present that could confound the results of PTA testing.

The Westmead PTA Scale is validated for children aged 8 years and older (Briggs et al 2016; Briggs et al, 2023; Marosszeky et al 1993).

The Sydney Post-Traumatic Amnesia Scale (SYPTAS) has been developed for children aged 4 to 7 years.

No adaptations are required to administer the test with children. Ensure parents understand the purpose of testing and do not prompt or coach the child. Establish with parents of younger children if the child was likely to have known the answers pre-injury.

Download the SYPTAS Manual

The Westmead PTA Scale was designed for patients with non-penetrating traumatic brain injury (TBI), especially when diffuse axonal injury is a pathological feature. While important clinical information may be obtained from using the scale in patients with penetrating TBI, interpret results with caution. The scale is not used for patients with non-traumatic acquired brain injury, such as stroke or hypoxia.

The Westmead PTA Scale does not measure retrograde amnesia, which refers to the inability of a person to recall information from before the injury, such as what they were doing or where they were in the hours/days leading up to the TBI.

The Westmead PTA Scale is used to measure the duration of PTA in people with suspected moderate to severe TBI. In isolation, it is not sufficient for diagnosis of a TBI. When used with a range of other clinical and/or radiological markers, the Westmead PTA Scale is considered a valid and reliable tool for identifying the severity of a TBI.

The Glasgow Coma Scale (GCS) and Westmead PTA Scale are both used to estimate TBI severity (Shores 1989). The duration of PTA is increasingly recognised as the most reliable predictor of functional outcome (Spitz et al. 2025). Level of consciousness, as measured by the GCS, shows moderate inverse correlation with the duration of PTA, as measured by the Westmead PTA Scale. Increasing severity of TBI is associated with lower scores on the GCS and longer durations of PTA on the Westmead PTA Scale. The table below defines commonly accepted severity classifications for different GCS and PTA ranges (Khan et al. 2003).

Patients with PTA are vulnerable. They may be disorientated and have significant new learning impairments. Most patients with PTA do not have capacity to make informed healthcare and other complex decisions, including being discharged against medical advice. Patients with acute PTA should be in hospital for medical assessment and care.

There may be circumstances when it’s appropriate for a patient to be supervised in a setting other than hospital. Use clinical judgement. Patient safety and close supervision by a responsible adult will be critical.

Patients who remain in a chronic amnesic state will need careful planning of their ongoing, post-hospital care by both family and the healthcare team.

The Westmead PTA Scale was not developed to determine a patient’s readiness for weekend leave.

Weekend leave may interrupt daily PTA assessment, which can compromise identifying when the patient has emerged from PTA.

While patients with PTA are generally best managed in hospital, there may be circumstances when it is appropriate for the patient to trial weekend leave. Use clinical judgement. Patient safety and close supervision by a responsible adult will be critical.

Children with PTA need to remain in hospital and are generally not approved for weekend leave.

A person with PTA usually lacks capacity to make complex decisions, due to problems with disorientation and new learning. However, people with PTA may be able to make decisions about other aspects of their day-to-day care. Decision-making capacity often improves substantially following emergence from PTA.

Yes. While patients may be disorientated and have difficulty learning new information, they can acquire new skills through procedural learning and repetition. Practising daily self-care routines and physical exercises can improve function. Clinicians can refer people for brain injury rehabilitation before they emerge from PTA, as long as they are medically stable.

Yes, if the standard procedure is followed.

More about how the tool was developed

No. An important marker of mild TBI is a PTA duration of less than 24 hours. The Westmead PTA Scale was developed to measure PTA durations greater than 24 hours, equating at least to moderate TBI severity. It is therefore not a reliable tool for mild TBI. Use the Abbreviated Westmead PTA Scale (A-WPTAS) for this purpose.

No. Other PTA screening tools include the Modified Oxford PTA Scale and the Galveston Orientation and Amnesia Test (GOAT), which is commonly used in North America (Spiteri et al. 2021).

The Westmead PTA Scale is widely used across NSW Health and more broadly in Australia.

Pre-injury orientation problems and day-to-day memory impairment may confound accurate assessment of PTA, because it will be unclear which cognitive deficits are due to the TBI.

If significant pre-injury cognitive impairment prevents the use of the Westmead PTA Scale, consult a clinical neuropsychologist and use other clinical and behavioural indicators to determine when the person has emerged from PTA.

No. The A-WPTAS was designed (and is validated) to screen for PTA only in the first 24 hours following injury. For patients with longer durations of PTA, use the Westmead PTA Scale.

Patients with a persistent A-WPTAS score of less than 18 after 4 separate hourly administrations should be considered for hospital admission. Continue PTA testing, but transition to using the full Westmead PTA Scale.

Start the Westmead PTA Scale protocol at the earliest, clinically appropriate opportunity. This usually occurs the day after the patient’s TBI, but may be less than 24 hours post-injury, depending on the time of day that the injury happened. The patient is initially asked the 7 orientation questions and their responses recorded on the scoresheet. The assessor then says his/her name to the patient and asks them to remember it for the following day (as per the standard protocol).

The A-WPTAS administration always asks patients to remember the same 3 pictures – cup, keys, bird. When transitioning to the Westmead PTA Scale, use the same 3 pictures as the first set of picture cards to remember. The pictures are changed only after the patient scores 12 (as per the standard protocol). Continue the Westmead PTA Scale until the patient is deemed to have emerged from PTA.

The validity of virtual testing has not been established. Assessors considering virtual testing should be mindful of the inherent difficulties in controlling prompts or accidental cues at the patient’s end.

The Westmead PTA Scale has not been validated under Hospital in the Home (HITH) conditions. Ideally, these patients should remain in hospital until testing is completed to minimise the risk that a serious TBI goes unrecognised. Prior to an early discharge to a HITH program, consult a brain injury specialist.

The time to administer the test varies from 5 to 20 minutes, depending on the need for adaptations. Additional time may be needed to reassure the patient and/or their family of the purpose of the test, as well as rehearse the responses for the following day.

Complete the test efficiently in a single session to reduce the impact of fatigue or triggering anxiety or agitation.

The ideal time to test a patient is when they are most alert and able to concentrate. This may vary across the day for patients, and clinicians are encouraged to identify suitable times.

If PTA testing is interrupted, it can be restarted at a later date. However, there are things to consider, depending on the circumstances.

More about interrupted testing

The 9 picture cards are designed to fit on an A4 page in a 3x3 layout. Each image is approximately 9 cm (h) by 7 cm (w) and can be presented as individual printed cards with these dimensions. Digital images with similar dimensions can be displayed on a tablet.

Photograph cards should be approximately 15 cm (h) by 10 cm (w) and can be presented in printed or digital form.

No. Validity is based on the set of 9 picture cards provided with the tool.

No; as long as the 2 additional staff photographs are similar in appearance to the usual assessor in terms of age, hair length/colour, skin tone and gender.

The target picture cards are only changed when the patient scores 12 out of 12.

A common mistake of those new to administering the scale is to change the picture cards when the patient correctly identifies the 3 images without correctly answering all the other items. The cards are only changed if the patient gets all questions correct, i.e. a score of 12.

The duration of PTA is measured from the day of injury to the day the patient emerges from PTA. This includes the period of coma, where relevant.

This criterion was established to avoid the common occurrence of an ‘island of memory’ in people with PTA, presenting as a single day of 12/12. The period of 3 days was chosen to ensure a reliable measure of PTA status.