Cross-Validation of a Classification System for Persons With Traumatic Brain Injury in the Posthospital Period

J Head Trauma Rehabil. 2017 Sep/Oct;32(5):E17-E25. doi: 10.1097/HTR.0000000000000290.

Abstract

Objective: To (1) identify groupings of persons with traumatic brain injury (TBI) in the posthospital period in a cohort recruited in Australia; (2) compare groupings from the Australian cohort to groupings previously developed for a US cohort.

Setting: Rehabilitation centers in the US and Australia.

Participants: A total of 170 persons with TBI from Australia and 504 persons with TBI from the United States. Participants were aged 18 to 64 years, greater than 6 months postinjury, had capacity to give consent, and had definitive contemporaneous medical evidence of TBI.

Design: Observational study.

Main measures: Cognitive tests-Wechsler Letter-Number Sequencing and Coding, Rey Auditory Verbal Learning Test, Trail Making Test, Verbal Fluency. Questionnaires-9 scales from the Traumatic Brain Injury Quality-of-Life system; Neurobehavioral Symptom Inventory; Economic Quality of Life, Family Assessment Device-General Functioning. Performance validity-Word Memory Test.

Results: Agreement in classification for the 2 samples was only moderate with 63.5% correctly classified and Cohen's κ = 0.53. A post hoc analysis placing all persons showing poor performance validity in the same group improved classification to 73% and Cohen's κ = 0.65 indicating substantial agreement.

Conclusion: Results provided support for the patient groups developed for the US sample and indicate that these groupings largely replicated in a new cohort.

Publication types

  • Multicenter Study
  • Observational Study
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Australia
  • Brain Injuries, Traumatic / classification*
  • Brain Injuries, Traumatic / diagnosis
  • Brain Injuries, Traumatic / rehabilitation*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Injury Severity Score
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Discharge
  • Quality of Life*
  • Rehabilitation Centers
  • Surveys and Questionnaires*
  • Time Factors
  • United States
  • Young Adult