-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 1 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
TABLE OF CONTENTS
1. Definitions
Traumatic brain injury
Post-traumatic amnesia
Glasgow Coma Scale
Abbreviated Westmead PTA Scale
Westmead PTA Scale
Classification of traumatic brain injury
2. Precautions/Contraindications
3. Equipment
4. Standard Requirements
5. Procedure
Determining the appropriate PTA scale to use based on GCS
score
Monash Health Procedure for the assessment and management of PTA
in TBI and referral pathways
Screening using the AWPTAS (MILD TBI)
Guidelines to assist with decision-making in ED for admission of
TBI patients to the wards of Monash Health
Screening using the WPTAS (MODERATE TO SEVERE TBI)
Complicating factors when assessing PTA
Discharge planning
Decision-making-capacity
PTA documentation and communication
Supporting and managing symptoms of PTA
6. Related documentation
7. Background
8. Key standards, guidelines or legislation
9. References
10. Keywords
TARGET AUDIENCE and SETTING
This procedure applies to all staff working with adult patients
presenting to Monash Health with suspected or
confirmed traumatic brain injury (closed head injury) in the
acute setting.
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 2 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
PURPOSE
This document was created to provide evidence-based information
on the definition of PTA, and current clinical practice guidelines
for the standardised assessment and management of PTA in the
context of traumatic brain injury.
This procedure was created to ensure a consistent
interdisciplinary approach to the care of patients experiencing
PTA, in alignment with the National Safety and Quality Health
Services (NSQHS) Standard 5: Comprehensive Care. This procedure
does not cover the medical and surgical management of closed head
injury. Please follow the appropriate unit, hospital and state
processes for the primary management of traumatic brain injury.
DEFINITIONS
Traumatic brain injury (TBI): Brain injury caused by an external
mechanical force such as a blow to the head, concussive force,
acceleration-deceleration force or projectile missile.
Post-traumatic amnesia (PTA): Immediate stage of recovery after
a TBI when the person has emerged from loss of consciousness or
coma but remains confused.
Glasgow Coma Scale (GCS): A neurological scale that provides a
reliable and objective way of recording the conscious state of the
patient. The GCS is a 15-point scale
The Abbreviated Westmead Post Traumatic Amnesia Scale (A-WPTAS):
Screening tool used to examine PTA in people with mild TBI
The Westmead Post Traumatic Amnesia Scale (WPTAS): Screening
tool used to examine PTA in adults with moderate to severe TBI
Refer to BACKGROUND for full clinical definitions, descriptions
and the importance of assessment of PTA. CLASSIFICATION OF BRAIN
INJURY SEVERITY USING PTA The severity of TBI can be classified
based on the degree of disturbance to consciousness (coma) as
measured by the GCS, in addition to the duration of PTA. A commonly
identified classification system is as follow: TABLE 1:
CLASSIFICATION OF BRAIN INJURY SEVERITY
Source: Guidelines for the NSW Compulsory Third Party Scheme and
Lifetime Care and Support Scheme (2013) created by clinical working
party review. This has been based on the combination of numerous
classifications systems including the original index of severity
based on GCS score (Teasdale & Jennett, 1974) and PTA duration
index (Jennett & Teasdale, 1981 as referenced in Stein, 1996)
and combined criteria as seen in The Mayo Classification System
(Malec et al., 2007).
*Mild Traumatic Brain Injury Most mild TBIs do not result in
gross structural changes to the brain (Giza & Hovda, 2004).
Axons may be stretched or twisted, without being sheared or torn,
and therefore recover over time (Iverson, 2005). According to
consensus guidelines, it is rare (approximately 5-15%) for patients
who sustain a mild TBI to obtain an abnormality on CT scan or
require neurosurgical intervention (approximately 1-3%; New South
Wales Ministry
MILD * MODERATE SEVERE VERY SEVERE EXTREMELY
SEVERE
GCS 13-15 (Must obtain E4 & M6 on GCS)
GCS 9-12
GCS 3-8 GCS 3-8 GCS 3-8
PTA 4 weeks
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 3 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
of Health, 2011). Symptoms of a mild TBI must be separated from
other factors that can result in alterations in cognition and
mental state, such as substance use, medications and psychological
trauma. The majority of individuals who sustain a mild TBI make a
full recovery within days and weeks after the injury, and
persisting symptoms are referred to as ‘post concussive syndrome’
(McHugh et al, 2006; NSW Ministry of Health Guidelines, 2011;
Ontario Neurotrauma Foundation Guidelines, 2013). Excessive focus
on, or failing to validate, transient symptoms of mild TBI can lead
to delays and complications in recovery and adjustment processes in
this patient group. Complicated Mild Traumatic Brain Injury A
‘complicated mild TBI’, is an injury that meets the above criteria
for mild TBI, but also includes trauma related structural
abnormality, such as a contusion on the brain (as confirmed on CT
scan on the day of injury) that does not require surgery (Carroll
et al., 2004). Longer-term outcome and recovery trajectories differ
in mild complicated TBI as compared to typical mild TBI.
PRECAUTIONS/CONTRAINDICATIONS
Staff to maintain personal safety at all times. If the patient
is agitated and the safety of staff a concern at any time, consider
abandoning the clinical contact until a more appropriate time.
Refer to other relevant Monash Health procedures and
guidelines:
Code grey, aggressive, violent patient escalation:
Implementation tool
Delirium in hospital: Clinical guideline
Acute behavioural disturbance: Clinical guideline
Preventing falls and harm from falls
EQUIPMENT
Abbreviated Westmead Post-Traumatic Amnesia Scale (A-WPTAS) –
Interactive View on EMR o Set of 3 Picture Cards from the A-WPTAS
in printed/paper form o A-WPTAS picture card recognition chart
(option of 9 pictures) in printed/paper form o Pictures have been
displayed at the end of this document
Westmead Post-Traumatic Amnesia Scale (WPTAS) – PowerForm on EMR
o Set of 9 Picture Cards from the WPTAS in printed/paper form
o For weekend testing, nursing staff will require a set of 3
photos. One of the regular examiner plus photos of 2 other staff
members
STANDARD REQUIREMENTS
When undertaking any clinical interaction with a patient, staff
are expected to:
Perform routine hand hygiene. Refer to the Hand Hygiene
Procedure.
Introduce themselves to the Patient and Carer/ Family if in
attendance, as per standard clinical practice.
Check patient identification. Refer to the Patient
Identification Procedure.
Obtain consent for participation.
Document interaction in the electronic medical record or health
record using black pen; including date, time, signature and
designation.
It is expected that staff are familiar with the relevant
procedures and know when to undertake each step. Staff who are
expected to undertake this procedure regularly must ensure they
have completed all relevant training.
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 4 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
PROCEDURE
Refer to flow chart on page 5 (figure 2) for full procedure.
Indications to suspect a traumatic brain injury (TBI) include an
impact to the head resulting in confusion or
disorientation; alteration in GCS; anterograde or retrograde
amnesia; or a period of loss of consciousness.
Following arrival of a patient to the Emergency Department (ED)
with a suspected brain injury, or post-fall on
the ward, the GCS must be administered at the first
instance.
If the person’s initial GCS score (at the scene or at
presentation to ED) was less than 13, conduct the Westmead PTA
scale (WPTAS)* daily when the person is admitted to a ward. If the
person’s initial GCS (at the scene or at presentation to ED) was 13
or above (with optimal motor and eye opening scores), administer
the Abbreviated-Westmead PTA scale (A-WPTAS)* hourly. See figure 1
below.
Figure 1. Determining the appropriate PTA scale to use based on
GCS score
(Source: Adapted from Macquarie University, Sydney Australia,
Department of Psychology Education Module) *Please note that this
flowchart assists with determining the appropriate PTA scale to
utilise ONLY, it not guide other aspects of clinical management of
the patient.
* Testing considerations:
Review the patients file and liaise with treating team regarding
the patient’s behaviour and most
appropriate time of day for test administration
Where possible, ensure the testing environment is quiet and free
from distractions (i.e.
radios/televisions). Remove clocks and orientation boards prior
to commencement of the assessment
The A-WPTAS & WPTAS are screening measures only and not
diagnostic tools. Screening scores must
not be interpreted as an absolute, and clinical judgement is
always required
Drug and/or alcohol intoxication is not a preclusion for
assessment but ought to be factored into the
clinical assessment and decision making
The patient can provide answers via verbal responses, writing,
pointing to printed answers, indicating
“yes” or “no” when prompted, or via interpreter
Further information on testing considerations can be found in
the background section.
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 5 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
Figure 2. Procedure for the assessment and management of PTA in
TBI and referral pathways
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 6 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
1. SCREENING USING THE A-WPTAS (FOR MILD TBI ONLY)
Indications:
When the patient’s initial and current GCS is between 13 and15
(with points lost only for disorientation/
verbal component of the GCS)
Administered in ED or after acute injury, as soon as possible,
and when feasible with consideration of
the patient’s presentation and ability to co-operate (e.g.
agitation or combativeness)
Only to be used within the first 24 hours of sustaining a brain
injury*
Administration:
Refer to the ‘Interactive View’ on EMR for full administration
and scoring instructions. Questions are to be asked
in the order they appear on the test forms and then scored
accordingly
1.1. The A-WPTAS is initially scored out of 15 at time 1 (T1) as
the first administration is the GCS only. The three
pictures are presented at this administration point and recall
of the pictures is included in subsequent
administrations, i.e. time 2 (T2) and onwards.
1.2. All subsequent administrations are therefore scored out of
18 (GCS assessment + memory recall
component).
1.3. Administer the A-WPTAS hourly (or as close to hourly as
practical) until a perfect score of 18/18 is achieved,
whereby the test is considered to be ‘passed’. Do not exceed the
T5 administration time point.
1.4. A patient is deemed to be ‘out of PTA’ when first scoring
18/18. The A-WPTAS can subsequently be ceased
and no further cognitive testing is required.
1.5. If a patient does not pass the A-WPTAS (i.e. does not
achieve a score of 18/18) four times in succession, i.e.
at time 5 (T5), the patient remains in PTA and must be
investigated/monitored further as per standard TBI clinical
management guidelines.
1.6. Failure of the A-WPTAS: If the patient does not pass the
A-WPTAS in ED, they are to be admitted to the SSU
for a 24-hour period of monitoring (irrespective of normal CT
scan results). Referral is made to an ED care-
coordinator or occupational therapist for further cognitive
investigation and discharge planning.
During normal business hours the occupational therapist aligned
to the treating unit in ED can prioritise the
referral and undertake further assessment, as indicated. After
hours occupational therapy service in ED is not
available and weekend service is limited. Outside of normal
business hours referrals are made to an ED care-
coordinator.
1.7. Determining the presence of PTA at 24 hours post-injury:
The A-WPTAS can be re-administered prior to
discharge from the SSU to determine the presence of PTA, if this
cannot otherwise be ascertained by
multidisciplinary review, including occupational therapy input.
This re-administration must be conducted within
24-hours of the injury and using a new A-WPTAS entry in the
EMR.
If the patient is still demonstrating active PTA symptoms
24-hours after the sustained injury time point and has
not been clinically improving, the brain injury is no longer
considered to be mild in severity (refer to table 1 for
TBI classifications). Admission to an acute ward is now
indicated. Table 2 provides clinical guidelines to aid in
deciding on the admitting unit.
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 7 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
Table 2. Guidelines to assist with decision-making in ED for
admission of TBI patients to the wards of Monash Health.
NEUROLOGY GENERAL MEDICINE NEUROSURGERY OTHER
Neurological trauma not deemed to be major
Complex medical co-morbidities Older adult with history of
cognitive concerns No surgical intervention required
Haematoma, CSF leak or other findings that require surgical
intervention or neurosurgical management
Multi-trauma - consider transfer to Level 1 Trauma Centre
At the point of admission to a medical unit/ward, the
occupational therapist aligned to the unit must commence
the full Westmead PTA scale (WPTAS) as per standard
protocol.
1.8. Delayed hospital presentations: If a patient presents to ED
with a GCS ≥ 13 and greater than 24 hours after
the sustained injury, do not administer the A-WPTAS (the A-WPTAS
was designed only for use 5min)
Witnessed seizure
On serial assessment, considerations include:
Decrease in GCS
Persistent GCS < 15 at two hours post injury
Persistent abnormalities in alertness, behaviour, cognition
Persistent PTA (A-WPTAS
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 8 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
Post traumatic seizure Clinical judgement is also required in
instances where there has been any of the following:
A large scalp haematoma or laceration
Associated multi-systems injuries which may distract from subtle
neurological sings, and/or where analgesia, procedural sedation or
general anaesthesia has been used
A particularly dangerous mechanism to the injury (e.g.
pedestrian/cyclist vs vehicle; ejection from vehicle; fall >1m;
or focal blunt trauma to the head)
Pre-existing neurological/neurosurgical conditions making
clinical assessment difficult
Delayed hospital presentation or representation with persistence
of symptoms or new symptoms
No clinical decision rule is perfect and decisions for CT
scanning must always be made in conjunction with clinical
evaluation and would not override clinical judgment.
Consultation must occur with the neurosurgical service.
Also refer to the Monash Health clinical guideline on minor head
injury - patients on anticoagulant or antiplatelet
therapy.
2. SCREENING USING THE WPTAS (FOR MODERATE TO SEVERE TBI
ONLY)
Indications:
When initial GCS on presentation was less than 13
When the A-WPTAS was not-passed at the T5 administration time
point and PTA is ongoing and present 24 hours after the injury and
the person is admitted to a ward
When the patient has regained consciousness and can communicate
intelligibly Administration: Refer to the WPTAS PowerForm on EMR
for full administration and scoring instructions. Questions are to
be
asked in the order they appear on the form and then scored
accordingly
2.1. Administered once daily (every 24 hours) by the same
person, at the same time of day (where possible).
Typically conducted by the ward occupational therapist
2.2. The WPTAS is scored out of 7 on day 1 (first administration
time point), as questions relating to recall of the
name and face of the examiner and recall of the picture cards
can only occur after initial learning of this
information
2.3. The WPTAS is scored out of 12 on day 2 and subsequent
days
2.4. Continue the WPTAS assessment over weekends and public
holidays. If the occupational therapists are unavailable, an
alternate appropriately trained staff member would continue the
assessment of the WPTAS, i.e. nursing staff, ANUMs and/or trained
medical practitioners. 2.5. The period of PTA may be deemed over on
the first of 3 consecutive days of a score of 12/12. However,
this
must not be interpreted as an absolute rule. Use clinical
judgement to cease administration of the WPTAS prior
to 3 consecutive days of scoring 12/12 if the patient does not
display behavioural manifestations of PTA.
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 9 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
3. Complicating factors when assessing PTA
Complicating factors and confounders can be present in the
screening of PTA. Sub-optimal screening results may
be due to factors other than PTA. These include the
following:
Pre-existing acquired brain Injury or intellectual
disability
Non-English speaking background and cultural differences
Previous level of education
Drug &/or alcohol history: Recent usage, withdrawal or
detoxification
Medications affecting alertness (specially opioids or
psycho-active medication)
Speech and language deficits (pre-existing or new)
Participation factors: e.g. unwillingness to engage in
assessment, frustration, agitation, anxiety
Psychiatric conditions
Dementia and/or delirium
Physical condition of the patient (e.g. pain)
Vision and hearing difficulties (ensure aids are used)
In such instances the WPTAS or A-WPTAS may not be the most
appropriate tool to use, and alternative or
adjunctive screening measures is to be considered by
appropriately trained ward staff. Examples of alternative
measures include the Galveston Orientation and Amnesia Test
(GOAT) and/or the Orientation Log (O-Log).
Referral to neuropsychology can assist in these instances.
Determination of the presence of PTA must not be solely based on
a screening results alone and ought to be a
combination of screening and information regarding the patient’s
behavioural and psychological function as
witnessed by family and staff. If the patient’s PTA score is not
improving, consider referral to neuropsychology
prior to terminating PTA assessment. The neuropsychologist can
assist in identifying ‘non-PTA factors’ that may
be accounting for the patient’s clinical presentation.
Neuropsychology services are only available during business
hours and not on weekends.
4. Discharge planning
Accurate assessment and management of PTA requires an
interdisciplinary approach, and careful and higher-
level discharge planning. Interdisciplinary input includes:
Neuropsychology to establish the presence of PTA, if this has
been difficult to ascertain
Neuropsychology for formal cognitive assessment and management
of TBI symptoms, once PTA has resolved (this may occur as an
outpatient or via inpatient rehabilitation)
Occupational therapy for functional cognitive assessment and
management
Speech pathology if speech, language, cognitive-communication
and/or swallowing issues are present
Physiotherapy for rehabilitation of motor and sensory
impairments, spasticity management and support of respiratory
function as required
Social work to support patients and their families
Consultation-Liaison Psychiatry and Addiction Medicine services
for patients with co-morbid or pre-existing psychiatric conditions,
behaviour disturbance, and/or substance use history
Rehabilitation and Aged Care Liaison Services (RALS) for
consideration for inpatient rehabilitation/subacute admission, as
necessary
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 10 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
4.1. Appropriate discharge destination
Optimally, patients in active PTA are not discharged home, but
if so, they are discharged into the care of a responsible adult
with sufficient education for management
The treating medical team, in consultation with the allied
health team, have responsibility for determining the patients’
appropriateness for discharge
If the patient is still experiencing PTA, and once medically
stable, they can be transferred to subacute or a referral made to a
specialist inpatient ABI unit. A complete handover of the patient’s
PTA assessments to the subacute ward is required, in addition to
their management plan
If a patient in PTA absconds from hospital, the treating team
must contact the police and next of kin immediately
4.2. Discharge supports
If a patient who initially presented to ED with a GCS of ≥ 13,
passes the A-WPTAS within the first 24-
hours of the injury / admission, and is discharged home, ensure
they receive a diagnosis of mild TBI and
obtain adequate education regarding their condition (refer to
Mild traumatic brain Injury: Information
for patients, families and carers)
Refer these patients for outpatient neuropsychology for
follow-up by the ED medical team. The Monash
Health neuropsychology Unit will make contact with them in the
weeks following their hospital
presentation to ensure they are progressing well. If further
assessment and intervention is required, the
patient can attend neuropsychology outpatient for full
review
5. Decision-making capacity
Patients in PTA are typically NOT capable of making their own
decisions due to being in a confusional state. If a patient is in
PTA and wishes to self- discharge against medical advice, and
cannot be redirected, a Code Grey must be called and staff must
obtain security support to attempt to maintain the patient in a
safe environment with supervision
If there is doubt around the patient’s PTA status (e.g. end
stage PTA) the treating medical team is required to make a decision
as to whether the patient is able to competently self-discharge.
This decision usually involves consultation with key staff involved
in the patient’s care. Referral to neuropsychology can be made to
assess decision-making capacity formally, if this is not clear from
a medical perspective
In instances of more complex decision-making capacity or
consent, refer to Consent to Medical Treatment: Operational Policy
and also consult with the Office of Public Advocate and Monash
Health Legal Office (as needed). In some cases, consultation or
referral to Social Work and/or neuropsychology may be
necessary.
6. Third party interview and/or access to a patient experiencing
PTA within the hospital setting
All police, media and third-party requests to access a patient
and/or their personal health information are
required to go through the hospital Legal Office and/or Medical
Information Unit of Health Information Services.
Refer to Privacy Release of Information: Procedure
7. PTA documentation and communication
Document the overall PTA score after each administration time
point. Cross-reference PTA screening results in the inpatient
progress note entry, using standard hospital documentation
procedures: i.e. date, time, name of examiner, profession,
designation, signature and contact details
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 11 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
Include a summary of errors made and the patient’s presenting
behaviours during the assessment
Document implications of the PTA score and implications for
ED/ward management and discharge planning and update the treating
team regularly
Once you have appropriately assessed and documented PTA for
moderate to severe TBI patients (typically on the ward), provide
carers and families with written and verbal education regarding
PTA. Refer to: Post Traumatic Amnesia: Information for patients,
families and carers. Document in the progress note that you have
done so.
Once you have appropriately assessed and documented mild
traumatic brain injury (typically in ED) and/or after a fall or new
injury during a hospital admission, provide patients, carers and
families with written and verbal education regarding mild TBI.
Refer to: Mild traumatic brain Injury: Information for patients,
families and carers. Document in the progress notes and discharge
papers that you have done so.
8. Supporting and managing symptoms of PTA
The following are important considerations and management
strategies for patients in PTA and during acute
recovery from TBI. These will assist in maximising the patient’s
recovery, supporting their behaviour, and
reducing the potential of further risk to patient, staff and
visitors.
8.1. Physical environment:
Monitor sensory information, including noise and visual
stimulation, and the effect on the patient’s behaviour
Reduce lighting or minimise TV or radio if this is beneficial,
but also be aware if these are helpful in soothing the patient.
Carefully monitor for increases or decreases in agitation in
response to the environment and amend accordingly
Reduce clutter within the immediate environment
Consider placing the patient in a high visibility room and/or
consider a single room to minimise sensory overload
Minimise the number of room changes to prevent further
confusion/disorientation
Assess and manage the environment for patients at high risk of
falls
Assess and manage pressure injuries in restless and agitated
patients e.g. those with padded cot sides
Utilise staff who are trained in the management of PTA for
patients that require frequent re-direction or de-escalation
8.2. Communication strategies:
Use the patient’s preferred name
Use signs to label the patient’s environment and frequently
refer back to these
Implement simple, clear, and consistent instructions
Educate and involve family/carers of the patient’s presentation
and progress
8.3. Daily routine and structure:
Provide a structure for the day including rest periods
Ensure the person’s immediate needs are being met e.g. personal
care and eating at regular meal times at regular intervals
Minimise interruptions during meal times
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 12 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
Modify interventions and rehabilitation/therapy sessions that
rely heavily on memory and recall of information. Consider
implementing memory techniques such as procedural or errorless
learning to facilitate therapy sessions during active PTA (refer to
Trevena-Peters et al., 2017. Efficacy of Activities of Daily Living
Retraining During Posttraumatic Amnesia: A Randomized Controlled
Trial. Archives of physical medicine and rehabilitation).
8.4. Patient safety – As per National Safety and Quality Health
Service (NSQHS) standards:
Avoid indwelling catheters
Minimise falls risk (refer to Monash Health Falls Prevention
Procedure for full details: Preventing falls and harm from
falls
Identify and respond to triggers that may lead to increased
agitation, distress or confusion
Minimise mechanical and pharmacological restraints, where
possible
Consider utilising a patient attendant if the patient is at risk
of absconding
Consider using alert bracelets/arm bands for wandering patients
8.5. Family and visitor involvement:
Limit visitors (suggested maximum of two at a time) and ensure
short visiting periods, in the early stages of PTA and particularly
if increase noise and stimulation is agitating for the patient
Provide education to the patient’s family and significant others
to assist them in understanding what PTA is
Provide education and support as to how family/visitors can
assist the patient and team to support and manage PTA symptoms
Familiar faces can assist with reassuring a patient, provided
that the visitors are not overstimulating or distressing to the
patient
Completion of the Sunflower tool
8.6. Other behaviours of concern:
The treating team are responsible for developing a comprehensive
management plan for patients requiring repeated Code Greys and
demonstrating ongoing/severe behaviours of concern
Consider involvement from CL psychiatry, neuropsychology, RALS
and a team meeting to ensure that an adequate plan is put in place
to support behaviour
Referral to CL psychiatry and/or Addiction Medicine may be
necessary to provide medication
recommendations in support of severe behaviours of concern. It
ought to be noted, however, that the
Therapeutic Guidelines for the use of Psychotropic medication
(2008; Version 6) recommends
minimising sedation and antipsychotic medication use as these
can increase confusion and reduce
alertness during acute neurological states such as PTA. Also
refer the Delirium in hospital: Clinical
guideline.
RELATED DOCUMENTATION
Code grey, aggressive, violent patient escalation:
Implementation tool
Delirium in hospital: Clinical guideline
Acute behavioural disturbance: Clinical guideline
Falls prevention (adults): Procedure
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 13 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
BACKGROUND
Traumatic Brain Injury
Traumatic Brain Injury (TBI) can arise from an insult to the
brain from an external force or direct blow. Most
common causes to TBI include motor vehicle accidents, falls,
assaults or sporting injuries. The incidence of TBI
in Australia is between 107 to 149 per 100,000 people
(Australian Institute of Health and Welfare, 1999 & 2008).
The peak incidence of TBI occurs in males aged between 16 to 24
years of age (Marshman et al., 2013). The
majority (approximately 80%) of TBIs are mild in nature.
Moderate to severe TBIs usually require neurosurgical
intervention (Marshman et al., 2013).
Trauma to the brain can result in diminished or altered state of
consciousness and depending on the severity of
the injury can cause temporary or persisting impairments in
cognitive abilities and/or physical functions (Brain
Injury Association of America, 2011; Gordner & Tuel,
1998).
Stages of disturbance, and subsequent recovery, following a TBI
are characterised as follows;
(i) A period of coma with the absence of verbal and voluntary
motor responses and absence of spontaneous
eye opening
(ii) Emergence from coma and a state of altered consciousness
termed ‘post-traumatic amnesia’
(iii) Recovery and return to normal consciousness where
cognitive, physical/sensory-motor and behavioural
functions improve and may return to pre-morbid levels (depending
on injury severity)
(Katz, Zafonte & Zasler, 2006; Levin, 1979).
Recovery after a TBI is most rapid in the first 3-6 months
following the insult but depending on the severity of
the injury (and other complicating factors) this can continue
for several years. Numerous factors influence the
recovery process, including the aetiology of the injury,
neurophysiological and structural factors, and individual
characteristics of the person (Ponsford, Sloan & Snow,
2013).
Post-Traumatic Amnesia*
Post-Traumatic Amnesia (PTA) is the transitory state between
coma and return of full consciousness (Tate et al., 2006). PTA is
defined as the period of time following a TBI during which the
patient experiences the following:
Disorientation – confusion or loss of information related to a
person’s location in time and place and in relation to their
personal details
Anterograde amnesia – loss of the capacity to create and store
new information or memories occurring immediately after the brain
injury
Retrograde amnesia – loss of previously acquired information or
memory of events occurring prior to the brain injury
(Loring, 1999; Marshman et al., 2018; Schacter & Crovitz,
1977). *The amnesia of PTA arises due to neurological disruption
and is not due to any possible psychological trauma that may be
associated with the injury event. The duration of PTA is defined as
the time following the TBI (including coma period) until resumption
of normal and continuous day-to-day memory functions. The interval
of PTA can last from a few minutes to many weeks, or even months,
depending on the severity of the injury (Levin et al., 1979;
Schacter & Crovitz, 1977). The following lists the potential
behavioural manifestations or signs and symptoms of active PTA:
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 14 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
Confusion and disorientation: impaired attention and
concentration, impaired memory and reduced recall of information -
this can fluctuate over time
Irritability and agitation: Aggression, restlessness, altered
sleep patterns, non-compliance with treatment and care
Altered thought processes: Reduced insight and reduced
flexibility of thought
Odd beliefs: Beliefs that appear to be delusional/unreasonable,
inaccurate memories which may lead to confabulation and
fixation
Other behaviour changes: Wandering, inappropriate behaviour or
impulsivity. (Arciniegas et al., 2010; Demery, Hanlon & Bauer,
2001; Johnson, 2001; Weinstein & Lyerly, 1968) Notes: The
Monash Health procedure for assessment and management of TBI
symptoms focuses on the anterograde amnesia component of PTA. It
must be noted that this is one of the possible acute cognitive
disturbances arising from TBI, but not the only one. Certain
factors can complicate the assessment of PTA (refer to point 3
under the Procedure). Additionally, identifying the end point of
PTA can also be difficult and complex. In more severe cases of TBI,
the end point of PTA cannot readily be determined as symptoms
represent persisting, and possible permanent, cognitive deficits as
a consequence of the injury. Therefore, coordinated PTA assessment
and management is vital in ensuring optimal outcomes for this
patient group. A multidisciplinary team approach is key in
identifying and managing symptoms of PTA. THE IMPORTANCE OF
ASSESSMENT AND IDENTIFICATION OF PTA
Patient Care: Knowing whether a patient is experiencing active
PTA is important for guiding appropriate patient care,
supervision requirements, length of hospital stay, discharge
planning and rehabilitation needs, in addition to
ascertaining the likely functional outcomes upon discharge
including cognitive prognosis (Marshman et al., 2013)
Predictor of injury severity: Duration of PTA, when measured
using objective assessment scales, is a reliable and
sensitive predictor of severity of traumatic brain injury.
Conversely, subjective reports or a history taken
retrospectively, is a less reliable indicator of PTA
duration
Impact on rehabilitation outcomes: As patients in PTA have
difficulty retaining new information, rehabilitation that
relies on explicit memory recall and new learning is not
typically undertaken during the acute or active stages of PTA.
It is therefore essential to be aware of the presence of active
PTA to guide rehabilitation goals and progress
Longer-term impacts: Accurate assessment of PTA assists in
identifying whether a mild TBI/concussion has occurred.
Research indicates that TBI patients who receive information,
support and advice post-injury demonstrate
significantly less cognitive and psychological symptoms, and
social morbidity in the longer term (King, Crawford,
Wenden, Moss & Wade, 1997; Wade, King, Wenden, Crawford
& Caldwell, 1998)
ASSESSMENT SCALES THAT MONITOR FUNCTION AFTER TBI The Glasgow
Coma Scale (GCS) is a neurological scale that provides a reliable
and objective way of recording the conscious state of the patient.
The GCS is a 15-point scale. It estimates and categorises the
outcomes of injury to the brain based on a person’s ability to open
their eyes and provide motor and verbal responses. A lower GCS
score is typically correlated with a more severe neurological
injury, and poorer prognosis (Kahn, Zafonte & Zasler, 2003).
The GCS measurement alone, does not assess for memory impairment,
which is a pivotal
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 15 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
component of PTA (Meares & Shores, 2017). Therefore,
screening measures of PTA have been implemented in clinical
practice to address this gap, particularly relevant for mild TBI
when the GCS can be normal or return to normal quite quickly. The
Westmead Post Traumatic Amnesia Scale (WPTAS) is the most commonly
used adult PTA screening tool
within Australia and New Zealand (Marshman et al., 2013). The
WPTAS is a 12-item screening scale originally
created by Professor Arthur Shores, Neuropsychologist, and
colleagues in 1986, and adapted and used in clinical
practice in 2009. This is an objective assessment of PTA
examining the person’s orientation and ability to
consistently remember and retain information from one day to
another. The WPTAS, therefore, enables daily
prospective evaluation of PTA (Tate, Pfaff & Jurjevic,
2000). This assessment tool is suitable for use with a
moderate to severe TBI diagnostic group only, and has been
validated for closed head injury, and not penetrating
or open head injuries. PTA testing with this measure begins when
the patient has regained consciousness and
can communicate intelligibly and is conducted DAILY. The patient
may be able to communicate via speech,
writing, pointing to printed answers or by indicating “yes” or
“no” when prompted.
PTA may be deemed to be over on the first day of 3 consecutive
days of a score of 12/12 on the WPTAS. Obtaining
a ‘perfect’ score (12/12) on three consecutive days, ensures
that the person has consistently maintained
adequate memory function, rather than brief periods of sound
memory followed by further confusion or
amnesia. However, this criteria must not be used as a
hard-and-fast rule, and scores must not be interpreted as
an absolute, with clinical judgement required in every case.
The Abbreviated Westmead Post Traumatic Amnesia Scale (A-WPTAS)
was created by Shores and Lammel in
2007 as a way of measuring length of PTA during the acute stage
of a mild TBI within 24 hours of the initial injury.
The A-WPTAS is an extension of the GCS and is based on the
original WPTAS, but patients are tested in HOURLY
intervals instead of daily intervals. It was designed to prevent
mild TBI patients remaining in hospital for
observation for unnecessary periods of time. Research from
Shores and colleagues suggests that up to 4 hours
of observation of a person with mild TBI is sufficient to
determine if discharge is safe. It is now mandatory in
NSW for all EDs to use to the A-WPTAS in suspected mild TBIs
(NSW Ministry of Health, 2011). Research from
Liverpool Hospital, NSW (Level 1 Trauma centre) found that 94%
of patients who were administered the A-
WPTAS were cleared of PTA within 4 hours of presentation and
this reduced length of stay by 295 bed-days
(Watson et al., 2017). It is also essential to provide patients
who have sustained a mild TBI with education, both
verbal and written, regarding discharge advice and how to assist
with recovery. Refer to: Mild traumatic brain
Injury: Information for patients, families and carers.
The A-WPTAS encompasses the regular neurological observations of
the GCS assessment, with the addition of
three pictures for the patient to learn and remember (testing
memory recall). Only use the A-WPTAS for those
with a GCS between 13 and 15 (but the patient must obtain E4
& M6 on the GCS). The A-WPTAS is therefore not
suitable for those with a suboptimal motor score (i.e. score of
less than 6) and reduced eye responses (i.e. score
of less than 4) on the corresponding sections of the GCS. It is
also not suitable for those with a GCS verbal
component score of 2 or below. Such suboptimal scores would be
suggestive of a more severe TBI, and A-WPTAS
is not indicated in these cases. If the patient obtains a score
of less than 13, use the WPTAS upon admission to
a ward.
The patient is deemed ‘out of PTA’ when they obtain a score of
18/18 on the A-WTPAS. No additional or repeated
administrations are required after a perfect score (18/18) has
been obtained. If the patient fails to score 18 on
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 16 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
four testing occasions within 24 hours of the injury, they must
be commenced on the standard WPTAS for more
detailed PTA evaluation
Testing considerations
The A-WPTAS and WPTAS are not the only screening measures of
PTA, but are extensively validated and used nationally and
internationally. Both the WPTAS and A-WPTAS must be administered by
appropriately trained staff, such as occupational therapists,
speech pathologists, neuropsychologists, nursing staff or medical
practitioners. Surgical intervention does not necessarily
contraindicate the use of these PTA scales. PTA screening can also
be used in intoxicated individuals as long as they are cooperative
and GCS requirements have been met for each test. These measures
can be used with an interpreter (Meares & Shores, 2017). Refer
to Monash Health EMR to view these tests: The WPTAS is a PowerForm
in EMR, and the A-WPTAS is in the Interactive View of EMR.
KEY STANDARDS, GUIDELINES OR LEGISLATION
Key standards, guidelines and legislations to comply with:
Monash Health workplace safety, emergency and wellbeing
Monash Health occupational violence and aggression
Monash Health preventing falls and harm from falls
Monash Health clinical handover
Monash Health iCare
National Safety and Quality Health Services (NSQHS)
REFERENCES
Arciniega, D.A., Frey, K.L., Newman, J., & Wortzel, H.S.
(2010). Evaluation and management of posttraumatic cognitive
impairments. Psychiatry Annals, 40(11): 540-552.
Brain Injury Association of America (6th February 2011). BIAA
Adopts new TBI definition.
Carroll, L.J., Cassidy, J.D., Holm, L., Kraus, J., &
Coronado, V.G. (2004). Methodological issues and research
recommendations for mild traumatic brain injury: The WHO
Collaborating Centre Task Force on mild traumatic brain injury.
Journal of Rehabilitation Medicine, Suppl. 43: p. 113-125.
Demery, J.A., Hanlon, R.E., & Bauer, R.M (2001). Profound
amnesia and confabulation following traumatic brain injury.
Neurocase, 7(4): 295-302.
Fortune, N., & Wen, X. The definition, incidence and
prevalence of acquired brain injury in Australia. (1999)
Australian
Institute of Health and Welfare Canberra; Cat. No. DIS 15:
141.
Giza., C.C., & Hovda, D.A. (2004). The pathophysiology of
traumatic brain injury. In: Lovell, M.R., Echemendia, R.J.,
Barth,
J.T., Collins, M.W. (eds.), Traumatic Brain Injury in Sports: An
International Neuropsychological Perspective p. 45–70, Lisse:
Swets & Zeitlinger.
Gordner, RL., & Tuel, SM. (Ed.).(1998) Rehabilitation of
persons with traumatic brain injury. Bethesda: National Library
of Medicine.
Guidelines for the NSW Compulsory Third Party Scheme and
Lifetime Care and Support Scheme (2013). NSW
Government State Insurance Regulatory Authority.
Helps., Y., Henley, G., & Harrison, J. (2008). Hospital
separations due to traumatic brain injury, Australia 2004-05.
Australian Institute of Health and Welfare Canberra; Cat. No.
INJCAT 116: 128.
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 17 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
Jacobs, DG., Jacobs, DO., Kudsk, KA., Moore, FA., Oswanski, MF.,
Poole, GV., Sacks, G., Scherer, LR., & Sinclair, KE.
(2004).
Practice management guidelines for nutritional support of the
trauma patient. Journal of Trauma, 57: 660-679.
Johnson, M. (2001). Assessing confused patients. Journal of
Neurology, Neurosurgery and Psychiatry, 71(suppl. I): i7-
i12.
Katz, D. I., Zafonte, R. D., & Zasler, N. D. (2006). Brain
injury medicine: Principles and practice. Demos Medical
Publishing.
King, NS., Crawford, S., Wenden, FJ., Moss, NE., & Wade, DT.
(1997). Interventions and service needs following mild and
moderate head injury: the Oxford Head Injury Service. Clinical
Rehabilitation, 11(1): 13-27.
Khan, F., Baguley, I. J., & Cameron, I. D. (2003).
Rehabilitation after traumatic brain injury. Medical Journal of
Australia, 178(6), 290-297.
Levin, HS., O’Donnell, VM., & Grossman, RG. (1979). The
Galveston Orientation and Amnesia Test: a practical scale to
assess cognition after head injury. Journal of Nervous and
Mental Disorders, 167(11): 675-684.
Loring, D. (1999). INS Dictionary of Neuropsychology. Oxford
University Press.
Malec JF, Brown AW, Leibson CL, Flaada JT, Mandrekar JN, et al.
(2007) The Mayo Classification System for Traumatic
Brain Injury Severity. Journal of Neurotrauma, 9: 1417-1424.
Marshman, L.A.G., Jakabek, D., Hennessy, M., Quirk, F., &
Guazzo, E.P. (2013). Post-traumatic Amnesia. Journal of
Clinical Neuroscience, 20: 1475-1481.
Meares, S., & Shores, A. (2017). The abbreviated Westmead
post-traumatic amnesia scale: A procedure to identify post-
traumatic amnesia after mild traumatic brain injury. The
Neuropsychologist, 4: 33-40.
New South Wales Ministry of Health. (2011). Adult Trauma
Clinical Practice Guidelines: Initial Management of Closed
Head Injury in Adults. 2nd Edition.
McHugh T, Laforce R, Gallagher P, Quinn S, Diggle P, Buchanan L
(2006). Natural history of the long-term cognitive,
affective, and physical sequelae of a minor traumatic brain
injury. Brain and Cognition,60 (2): 209–11
Ontario Neurotrauma Foundation. (2013). Guidelines for
Concussion/Mild Traumatic Brain Injury & Persistent
Symptoms. 2nd Edition.
Ponsford, J., Sloan, S., & Snow, P. (2013). Traumatic brain
injury: Rehabilitation for everyday adaptive living. Psychology
Press.
Shores, E.A., Marossezeky, 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.
Schacter, D. L., & Crovitz, H. F. (1977). Memory function
after closed head injury: A review of the quantitative
research. Cortex, 13(2), 150-176.
Stein S (1996) Classification of head injury. In: Narayan R,
Povlishock J, Wilberger J (eds). Neurotrauma. McGraw-Hill.
Tate, RL., Perdices, M., Pfaff, A., & Jurjevic, L. (2001).
Predicting duration of posttraumatic amnesia (PTA) from early
PTA
measurements. Journal of Head Trauma Rehabilitation,16(6):
525-542.
Tate, RL., Pfaff, A., & Jurjevic, L. (2000). Resolution of
disorientation and amnesia during post-traumatic amnesia.
Journal
of Neurology, Neurosurgery and Psychiatry, 68: 178-185.
Tate, R.L., Pfaff, A., Baguley, I.J., Marosszeky, J.E., Gurka,
J.A., Hodgkinson, A.E., King, C., Lane-Brown, A.T., & Hanna,
J.
(2006). A multicentre, randomised trial examining the effect of
test procedures measuring emergence from post-traumatic
amnesia. Journal of Neurology, Neurosurgery, Psychiatry, 77:
841-849.
Teasdale, G., & Jennett, B (1974). Assessment of coma and
impaired consciousness. A practical scale. Lancet, 2: 81-84.
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 18 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
Wade, DT., King, NS., Wenden, FJ., Crawford, S., & Caldwell,
FE. (1998). Routine follow-up after head injury: a second
randomised controlled trial. Journal of Neurology, Neurosurgery
and Psychiatry, 65(2):177-83.
Watson, C.E., Clous, E.A., Jaeger, M., D’Amours, S.K. (2017).
Introduction of the abbreviated Westmead Post-traumatic
amnesia scale and impact on length of stay. Scandinavian Journey
of Surgery, 106 (4): 356-360.
Weir, N., Doig, EJ., Fleming, JM., Wiemers, A., & Zemljic,
C. (2006). Objective and behavioural assessment of the
emergence from post-traumatic amnesia (PTA). Brain Injury,
20(9): 927-935.
Weinstein, E.A, & Lyerly, O.G. (1968). Confabulation
following brain injury. Archives of General Psychiatry, 18(3):
348-
354.
Ylvisaker, M., Turkstra, L., Coehlo, C., Yorkston, K., Kennedy,
M., Sohlberg, MM., & Avery, J. (2007).Behavioural
interventions for children and adults with behaviour disorders
after TBI: a systematic review of the evidence. Brain Injury,
21(8):769-805.
Monash Health wishes to acknowledge the use of protocols from
Alfred Health, Austin Health, South West Local Health District,
Westmead Hospital, Queensland Health Royal Brisbane & Women’s
Hospital, in addition to the authors of the A-WPTAS and WPTAS:
Shores et al (1986 & 2007) in the preparation of this
procedure. We also acknowledge Professor Arthur Shores,
Neuropsychologist (NSW) for ongoing consultation and sharing of
resources.
KEYWORDS
Post Traumatic Amnesia (PTA), Traumatic Brain Injury (TBI),
Closed Head Injury, Concussion, Head Injury, Westmead PTA Scale
(WTPAS), Abbreviated Westmead PTA Scale (A-WPTAS), Glasgow Coma
Scale (GCS).
Document Governance
Supporting Policy Evidence Based Clinical Care: Operational
Policy
Executive Sponsor Stuart Cavill, Chief Allied Health Officer
Service Responsible Neuropsychology Unit, Acute
Neuropsychology
MMC Occupational Therapy, Neurosciences
Document Author Dr Niloufar Kirkwood, Senior
Neuropsychologist
Danielle Byrne, Neurosciences Occupational Therapist
Consumer Review Yes or No No
This Procedure has been endorsed by an EMR Subject Matter Expert
(SME)
There are no Order Set or Quick Reference Guides linked
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 19 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
A-WPTAS TARGET PICTURES:
-
Assessment and Management of Post-Traumatic Amnesia in Acute
Procedure Traumatic Brain Injury (Adults)
PROMPT Doc No: SNH0004137 v6.0
Date loaded on PROMPT: 13/01/2016 Page 20 of 20 Review By:
30/11/2022
Version Changed: 13/11/2020 Document uncontrolled when
downloaded.
Last Reviewed Date: 11/11/2020
A-WPTAS PICTURE RECOGNITION CHART Only to be used if the patient
says “I don’t know” or “I don’t remember.”
Do not use if incorrect response provided in the first instance
when testing recall.