Nelson Lindsay D, Furger Robyn E, Gikas Peter, Lerner E Brooke, Barr William B, Hammeke Thomas A, Randolph Christopher, Guskiewicz Kevin, McCrea Michael A
1Medical College of Wisconsin,Milwaukee,Wisconsin.
2New York University School of Medicine,New York,New York.
J Int Neuropsychol Soc. 2017 Apr;23(4):293-303. doi: 10.1017/S1355617717000157. Epub 2017 Mar 27.
The aim of this study was to evaluate the reliability and validity of three computerized neurocognitive assessment tools (CNTs; i.e., ANAM, DANA, and ImPACT) for assessing mild traumatic brain injury (mTBI) in patients recruited through a level I trauma center emergency department (ED).
mTBI (n=94) and matched trauma control (n=80) subjects recruited from a level I trauma center emergency department completed symptom and neurocognitive assessments within 72 hr of injury and at 15 and 45 days post-injury. Concussion symptoms were also assessed via phone at 8 days post-injury.
CNTs did not differentiate between groups at any time point (e.g., M 72-hr Cohen's d=-.16, .02, and .00 for ANAM, DANA, and ImPACT, respectively; negative values reflect greater impairment in the mTBI group). Roughly a quarter of stability coefficients were over .70 across measures and test-retest intervals in controls. In contrast, concussion symptom score differentiated mTBI vs. control groups acutely), with this effect size diminished over time (72-hr and day 8, 15, and 45 Cohen's d=-.78, -.60, -.49, and -.35, respectively).
The CNTs evaluated, developed and widely used to assess sport-related concussion, did not yield significant differences between patients with mTBI versus other injuries. Symptom scores better differentiated groups than CNTs, with effect sizes weaker than those reported in sport-related concussion studies. Nonspecific injury factors, and other characteristics common in ED settings, likely affect CNT performance across trauma patients as a whole and thereby diminish the validity of CNTs for assessing mTBI in this patient population. (JINS, 2017, 23, 293-303).
本研究旨在评估三种计算机化神经认知评估工具（CNTs，即ANAM、DANA和ImPACT）在通过一级创伤中心急诊科（ED）招募的患者中评估轻度创伤性脑损伤（mTBI）的可靠性和有效性。
从一级创伤中心急诊科招募的mTBI患者（n = 94）和匹配的创伤对照组（n = 80）在受伤后72小时内以及受伤后15天和45天完成症状和神经认知评估。还在受伤后8天通过电话评估脑震荡症状。
在任何时间点，CNTs均未在两组之间显示出差异（例如，伤后72小时时，ANAM、DANA和ImPACT的M值对应的Cohen's d分别为-.16、.02和.00；负值反映mTBI组损伤更严重）。在对照组中，大约四分之一的稳定性系数在各测量指标和重测间隔中超过0.70。相比之下，脑震荡症状评分在急性期能够区分mTBI组和对照组，且随着时间推移该效应量减小（伤后72小时、第8天、第15天和第45天的Cohen's d分别为-.78、-.60、-.49和-.35）。
所评估的CNTs是为评估与运动相关的脑震荡而开发并广泛使用的，但在mTBI患者与其他损伤患者之间未产生显著差异。症状评分比CNTs更能有效区分不同组，但其效应量比与运动相关的脑震荡研究中报告的要弱。非特异性损伤因素以及急诊环境中常见的其他特征可能会影响整个创伤患者群体中CNTs的表现，从而降低CNTs在该患者群体中评估mTBI的有效性。（《神经损伤与功能重建》，2017年，第23卷，第293 - 303页）
