Galveston Orientation Amnesia Test (GOAT)

Abstract

RESUMOO trauma crânio-encefálico contuso (TCEC) é freqüentemente seguido pela amnésia pós-traumática (APT), caracterizada como um estado transitório de confusão e desorientação. Sua duração tem sido utilizada para quantificar a gravidade do TCEC e prever distúrbios nas funções cognitivas, assim como para antever as alterações na capacidade funcional das vítimas pós-trauma. O Galveston Orientation Amnesia Test (GOAT) é o primeiro instrumento sistematizado criado e o mais amplamente utilizado para avaliar a APT. Este artigo apresenta esse instrumento, as bases conceituais para seu desenvolvimento e a adaptação e validação do GOAT para cultura brasileira. Além disso, descreve sua aplicação e comenta as restrições do seu uso. Resultados de pesquisas realizadas em nosso meio contribuíram para as evidências sobre a validade do GOAT. Também apontaram os indicadores do momento pós-trauma em que o GOAT deve ser aplicado e destacaram as dificuldades no uso desse instrumento. DESCRITORES ABSTRACTClosed head injury (CHI) is frequently followed by post-traumatic amnesia (PTA) and is characterized by a transitory state of confusion and disorientation. The PTA duration has been used to quantify the CHI severity and to predict disorders in cognitive functions, as well as to foresee any alteration in the functional capacity of posttrauma victims. The Galveston Orientation Amnesia Test (GOAT) is the first systematized instrument created, and the most broadly applied, to assess PTA. This article presents the GOAT, the conceptual basis for the development of the instrument, and its adaptation and validation to the Brazilian culture. In addition, the article describes the application of the instrument and makes comments on the restrictions of its use. Brazilian research results showed evidences of the GOAT's validity. They also point to the indicators of post-trauma conditions in which the GOAT must be applied, and highlight the difficulties in the application of the instrument. KEY WORDSAmnesia. Trauma Severity Indices. Head injuries, closed. Validation studies. RESUMENEl trauma cráneo-encefálico contuso (TCEC) es frecuentemente seguido por la amnesia pos-traumática (APT), caracterizada como un estado transitorio de confusión y desorientación. Su duración ha sido utilizada para cuantificar la severidad del TCEC y prever alteraciones en las funciones cognitivas, tanto como para antever las dificultades en la capacidad funcional de las vícti-mas pos-trauma. El Galveston Orientation Amnésia Test (GOAT) es la primera encuesta sistematizada que fue creada y el mas am-pliamente utilizada para evaluar la APT. Esta publicación presenta esta encuesta, las bases conceptuales para su desarrollo y la adaptación y validación del GOAT para la cultura brasileña. Además, describe su aplicación y limitaciones en el uso. Resultados de pesquisas brasileñas contribuyeron para las evidencias sobre la validad del GOAT. También apuntaron los indicadores del momento pos-trauma en que el GOAT debe ser aplicado y destacaron las dificultades en el uso de es...

Fatores associados à amnésia pós-traumática de longa duração

“…The final multivariate analysis model (Table 4), adjusted by the "intra/extra-axial area of injury" variable, showed that initial GCS stood out among the risk factors for long-term PTA, when <12 (OR=20.17). The result strengthened the association between PTA and GCS, in view of the MAIS/head results (OR=2.80), and it emphasized the most traditional definition of PTA, which is based on the assumption that this posttraumatic state is the initial stage of recovery, after an interval of decreased level of consciousness (2,6) . The observation that all victims with a GCS d" 8 and MAIS/head= 5 had long-term PTA, in addition to the remaining observations related to associations among these three parameters, could help to establish new directives in the assessment of PTA duration and also improve the role of these variables in the prediction of results.…”

“…Assessments were made until victims were discharged, transferred to another hospital or deceased, or when their PTA period ended, indicated by a minimum GOAT score of 75 for two consecutive days (2,6) . The application and calculation of total GOAT score followed the recommendations of the authors of this test (8) .…”

“…This syndrome is characterized by a temporary state of confusion, disorientation and anterograde amnesia, in addition to behavioral disorders, among which are insomnia, psychomotor agitation, fatigue, confabulation and, occasionally, severe affective and psychotic symptoms (1)(2)(3)(4)(5) . PTA is considered to be an indicator of CCET severity and an important aspect to predict functional results (1)(2)(6)(7) ; the longer the period of amnesia, the poorer the functional result expected.…”

“…PTA has been studied for more than 70 years; however, there are still many gaps in the study of this syndrome and in the relationships among cognitive functions (2) . It is believed that new studies identifying factors associated with long-term PTA can bring more information that clarifies the physiopathology involved in the post-traumatic cognitive recovery process, especially that of memory (6) .…”