ED Amnesia Testing After Head Injury: 8.2% Failed A-WPTAS
Key Takeaways
- Among adults with head injury tested at an Australian tertiary emergency department, 513 (8.2%) failed the abbreviated Westmead amnesia test.
- Reported loss of consciousness did not significantly distinguish A-WPTAS pass rates.
- A-WPTAS failure occurred more often with lower initial GCS scores, in male patients, after low falls, and among after-hours arrivals.
In a retrospective cohort, investigators conducted a single-center review of electronic records from The Alfred Hospital adult tertiary emergency department (ED) in Victoria, Australia, for January 1, 2019, through December 31, 2021. Eligible adults were at least 18 years old, had presented with head injury, and had a documented, sufficiently complete A-WPTAS assessment. Initial-only assessments and records missing the three-picture tasks were excluded. Hospital policy called for testing after head impact when a Glasgow Coma Scale (GCS) score of 13–15 accompanied confusion, disorientation, anterograde or retrograde amnesia, or brief LOC. Investigators compared passage and failure by reported LOC, initial GCS, age, and injury mechanism; they also reported sex and arrival time.
Of 6,259 analyzed adults, 5,746 passed the A-WPTAS (91.8%; 95% confidence interval [CI], 91.1%–92.5%). A passing result meant that the completed assessment did not detect post-traumatic amnesia.
Pass rates were 90.6% among adults with reported LOC and 92% among those without it (p=0.13), a difference that was not statistically significant. Failure occurred more often with lower initial GCS scores, in male patients, after low falls, and among after-hours arrivals. Because GCS contributes to A-WPTAS scoring, that association is not independent of the test itself. Age did not differ significantly between those who passed and failed; ED stays were longer among those who failed.
These observations come from adults with sufficiently complete testing at one Australian tertiary ED, rather than all adults presenting with head injury. LOC was self-reported and susceptible to recall bias. The inclusion of GCS in A-WPTAS scoring also limits what its association with failure can independently establish. No long-term follow-up occurred, so rates of persistent post-concussion symptoms in this cohort are unknown. A passing amnesia screen cannot establish the absence of other concussion symptoms or predict which adults will experience later symptoms.
For the investigators, amnesia detectable during an ED assessment represents one part of the clinical picture after concussion, not a measure of its full symptom burden.
Clinician Questions
How many adults who started A-WPTAS after head injury were excluded from the Australian ED analysis, and why?
At The Alfred Hospital ED in Victoria, Australia, 8,253 adults began A-WPTAS after head injury. Investigators excluded 47 whose GCS score was below 13 and 1,947 with incomplete data, including initial-only testing or incomplete assessment or documentation of the three-picture tasks.
Which concussion symptoms can A-WPTAS miss after adult head injury despite a passing amnesia screen?
After adult head injury, A-WPTAS focuses on post-traumatic amnesia and cognition. Essery and colleagues described possible concussion symptoms beyond overt amnesia, including emotional or behavioral change, cognitive fog or difficulty concentrating, headache or dizziness, sensory sensitivity, and sleep disruption.
Recommended Reading
- For more on falls in ED head injuries: Falls Lead Head, Face, and Neck Injury Cases in NEISS Analysis
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