Glasgow Coma Scale (GCS) and Abbreviated Westmead PTA Scale (A-WPTAS)

Administration and Scoring Presentation

Hello, my name is Arthur Shores. Welcome to this presentation on the administration of the Abbreviated-Westmead Post-Traumatic Amnesia Scale, (or the A-WPTAS, as we shall refer to it). The scale was developed to be helpful in the early identification of cognitive impairment following mild traumatic brain injury (mTBI).

Mild traumatic brain injury is an acute brain injury resulting from mechanical energy to the head from external forces. Reports suggest that in adults 70-90% of all hospital-treated traumatic brain-injuries are classified as mild.

Prompt identification of patients with cognitive problems is very important in the management of the acute stages of mTBI. The most common symptom of cognitive impairment is memory loss or amnesia. For patients presenting with a history of head injury, what we need to know is, do they have cognitive impairment? If so, this informs us as to the presence of possible brain damage.

The A-WPTAS was developed as a method of measuring the duration of post-traumatic amnesia (PTA) because this is a useful way of identifying the extent of brain damage. The abbreviated scale is based on the original Westmead PTA scale; however patients are tested in hourly intervals instead of daily intervals.

The scale is essentially an extended version of the Glasgow Coma Scale (GCS) and was developed so that a wide variety of health professionals can more accurately assess the duration of PTA in patients suspected of having suffered a mild TBI.

Andrea Lammél and I are responsible for the concept underlying the A-WPTAS, based on earlier work by Jennie Ponsford. Zoë Fitzgerald had a major contribution in the development of this presentation. I hope you find it of value in understanding how, when and why the A-WPTAS should be administered. Please remember that this is only a guide to the early diagnosis of a mild TBI. At the end of the day, it will be a combination of the developing research evidence, clinical acumen and most importantly, common sense, which must prevail when the diagnosis of mTBI is considered.

I would like to take this opportunity to extend my thanks to the NSW Motor Accident Authority for their support of this project.

References

Shores, E.A., Marosszeky, J.E., 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, E.A. (1989). Comparison of the Westmead PTA Scale and Glasgow Coma Scale as predictors of neuropsychological outcome following extremely severe blunt head injury. Journal of Neurology, Neurosurgery and Psychiatry, 52, 126-127.
Marosszeky, N.E.V., Batchelor, J., Shores, E.A., Marosszeky, J.E., Klein-Boonschate, M. & Fahey,P.P. (1993). The performance of hospitalized, non head-injured children on the Westmead PTA Scale. The Clinical Neuropsychologist, 7, 85-95.
Marosszeky, N. E. V., Ryan, L., Shores, E. A., Batchelor, J., & Marosszeky, J. E. (1998). The PTA Protocol: Guidelines for using the Westmead Post-Traumatic Amnesia (PTA) Scale. (www.psy.mq.edu.au/pta)
Ponsford, J., Cameron, P., Wilmott, C., Rothwell, A., Kelly, A-M, Nelms, R., & Ng, K. (2004). Use of the Westmead PTA scale to monitor recovery after mild head injury. Brain Injury, 18, 603-14.
Shores, E. A. (1995). Further concurrent validity on the Westmead PTA Scale. Applied Neuropsychology, 2, 167-169.
Shores, E. A., Lammél, 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, 1100-1106.

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Glasgow Coma Scale (GCS) and Abbreviated Westmead PTA Scale (A-WPTAS)