Open Access Research article

Development and external validation of a new PTA assessment scale

Bram Jacobs1, Janneke van Ekert1, Lotje PL Vernooy1, Peter Dieperink1, Teuntje MJC Andriessen1, Marc PH Hendriks23, Arie B van Vugt4, Marjolein AA Emons4, George F Borm5 and Pieter E Vos1*

Author Affiliations

1 Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

2 Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands

3 Department of Behavioural Sciences, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands

4 Department of Emergency Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

5 Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

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BMC Neurology 2012, 12:69  doi:10.1186/1471-2377-12-69

Published: 8 August 2012



Post-traumatic amnesia (PTA) is a key symptom of traumatic brain injury (TBI). Accurate assessment of PTA is imperative in guiding clinical decision making. Our aim was to develop and externally validate a short, examiner independent and practical PTA scale, by selecting the most discriminative items from existing scales and using a three-word memory test.


Mild, moderate and severe TBI patients and control subjects were assessed in two separate cohorts, one for derivation and one for validation, using a questionnaire comprised of items from existing PTA scales. We tested which individual items best discriminated between TBI patients and controls, represented by sensitivity and specificity. We then created our PTA scale based on these results. This new scale was externally evaluated for its discriminative value using Receiver Operating Characteristic (ROC) analysis and compared to existing PTA scales.


The derivation cohort included 126 TBI patients and 31 control subjects; the validation cohort consisted of 132 patients and 30 controls. A set of seven items was eventually selected to comprise the new PTA scale: age, name of hospital, time, day of week, month, mode of transport and recall of three words. This scale demonstrated adequate discriminative values compared to existing PTA scales on three consecutive administrations in the validation cohort.


We introduce a valid, practical and examiner independent PTA scale, which is suitable for mild TBI patients at the emergency department and yet still valuable for the follow-up of more severely injured TBI patients.

Traumatic brain injury (TBI); Head injury; Post-traumatic amnesia (PTA); PTA assessment scale