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Shah Jahan Mohd Yussof Rossman Hawari

Abstract

INTRODUCTION


Mild traumatic brain injury (Mild-TBI) observation represents a large percentage of Emergency Department (ED) ward work in Malaysia. Despite numerous guidelines and protocols in-placed, the early assessment and identification of TBI induced cognitive impairments in ED's have been poorly described. Identification and duration of post-traumatic amnesia (PTA) provides prognostic information on the severity and outcome. Utilizing GCS alone is insufficient for such purposes.


DISCUSSION


Strategic PTA screening tools should be incorporated into the prospective assessment of TBI victims during ED presentation and observation. The A-WPTAS provides a rapid and comprehensive screening method for Mild-TBI induced cognitive impairments. Incorporating the screening assessment into "virgin" local practices may require certain amount of adaptation in order to achieve effective implementation. Aside from promoting awareness, it is essential that a clinical decision tree utilizing PTA assessment is created. The information gathered from A-WPTAS can greatly assist ED Doctors in providing effective clinical decision-making and disposition of patients. The authors believe that such interventions may be an effective risk-reduction modality in reducing premature discharge of patients with subtle cognitive impairments. In such instances, this can be debilitating both for the patient and family members. Un-diagnosed cognitive impairments as such, may gradually render the victim to socially deteriorate without having a "safety net" access back into the health care system.


SUMMARY


This guideline acts as a tool to assist Emergency Departments in Malaysia as well as other Countries with similar systems to develop effective internal protocols that incorporate PTA screening in clinical decision-making and disposition of mild-TBI victims.

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