Galveston Orientation and Amnesia Test

The Galveston Orientation and Amnesia test (GOAT) was intended to evaluate orientation to time, place and person and to provide an estimation of the intervals prior to and following a brain injury for which there is no recall (Levin et al. 1979). It is a brief and simple mental status examination developed for use by health professionals at the bedside or in the Emergency Department (Levin et al. 1979; van Baalen et al. 2003).

Assessment consists of 10 items regarding orientation to person (name, address, and birthdate), place (city/town and building they are in) and time (current time, date, month, year & date of hospital admission) as well as memory of events both after and prior to the injury (Bode et al. 2000). Oral questions are posed directly to the patient who may respond either orally or in writing (Jain et al. 2000; Levin et al. 1979). Error points are awarded for each incorrect response, summed and deducted from 100 to arrive at the total score. Both the scale and instructions for assigning error points are available in Levin et al. (1979).

The duration of post traumatic amnesia (PTA) is defined as the period following coma in which the GOAT score is <75 (Levin et al. 1979). PTA is considered to have ended if a score ≥75 is achieved on three consecutive administrations (Novack et al. 2000; Wade 1992; Zafonte et al. 1997). In the initial standardization study of Levin et al. (1979), using patients with mild head injury as a reference group, it was determined that a score of 75 represented a level achieved by 92% of the standardization group. No patients with mild head injury scored less than 65 on the GOAT. Scores between 66 and 75 are considered borderline-abnormal while scores above 75 fall into the range considered normal within the reference group (Levin et al. 1979; van Baalen et al. 2003). 

Table: Characteristics of the Galveston Orientation and Amnesia Test

Advantages. The GOAT provides an objective rating of early cognitive recovery eliminating the need for sometimes ambiguous terminology used to describe mental status, such as “confused” (Levin et al. 1979). Rasch analysis demonstrated that items on the GOAT represent a wide range of difficulty suggesting that the scale is useful for assessing patients with a wide range of cognitive impairments (Bode et al. 2000). 

Limitations. The standard GOAT response format makes administration difficult with nonverbal patients (Novack et al. 2000). The requirement for oral or written expression may result in penalizing patients who are experiencing deficits of expression but not in orientation or in the retrieval or consolidation of memory (Jain et al. 2000). An aphasia-specific version of the GOAT has been created, although it requires further evaluation. 

For items in which partial credit is used, Rasch analysis revealed step disorder (Bode et al. 2000). Collapsing these response categories to a simple dichotomy (right versus wrong) eliminated the disorder and allowed the construction of an equal interval measure from the GOAT (Bode et al. 2000). While the GOAT does contain items intended to provide an assessment of memory, it is primarily a measure of disorientation. Eight of the 10 GOAT items evaluate orientation while only two examine memory (Forrester et al. 1994). 

 

Summary-Galveston Orientation and Amnesia Test

Interpretability: The GOAT provides an objective assessment with a standardized cut-off for the presence of PTA. 

Acceptability: In its original form, the GOAT is not well suited to the assessment of patients with aphasia.

Feasibility: The GOAT may be too lengthy for a simple, repeated bedside assessment of mental status. However, it is freely available and can be used by any healthcare professional. 

 

Table: Galveston Orientation and Amnesia Test Evaluation Summary

Reliability

Validity

Responsiveness

Rigor

Results

Rigor

Results

Rigor

Results

Floor/ceiling

+

 

 

+++(IO)

++ (IC)

++

+++

N/A

N/A

N/A

NOTE: +++=Excellent; ++=Adequate; +=Poor; N/A=insufficient information; TR=Test re-test; IC=Internal Consistency; IO=Interobserver; Varied (re. floor/ceiling effects; mixed results).