Rowland Jared A, Martindale Sarah L, Shura Robert D, Miskey Holly M, Bateman James R, Epstein Erica L, Stern Mark J, Hurley Robin A, Taber Katherine H
Research and Academic Affairs, Salisbury VA Medical Center, Salisbury, North Carolina, USA.
Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, USA.
J Neurotrauma. 2020 Aug 15;37(16):1797-1805. doi: 10.1089/neu.2019.6972. Epub 2020 Apr 29.
With the increasing prevalence of traumatic brain injury (TBI), the need for reliable and valid methods to evaluate TBI has also increased. The purpose of this study was to establish the validity and reliability of a new comprehensive assessment of TBI, the Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC) Assessment of TBI (MMA-TBI). The participants in this study were post-deployment, combat exposed veterans. First, MMA-TBI outcomes were compared with those of independently conducted clinical TBI assessments. Next, MMA-TBI outcomes were compared with those of a different validated TBI measure (the Ohio State University TBI Identification method [OSU-TBI-ID]). Next, four TBI subject matter experts independently evaluated 64 potential TBI events based on both clinical judgment and Veterans Administration/Department of Defense (VA/DoD) Clinical Practice Guidelines. Results of the MMA-TBI algorithm (based on VA/DoD clinical guideline) were compared with those of the subject matter experts. Diagnostic correspondence with independently conducted expert clinical evaluation was 96% for lifetime TBI and 92% for deployment-acquired TBI. Consistency between the MMA-TBI and the OSU-TBI-ID was high (κ = 0.90; Kendall Tau = 0.94). Comparison of MMA-TBI algorithm results with those of subject matter experts was high (κ = 0.97-1.00). The MMA-TBI is the first TBI interview to be validated against an independently conducted clinical TBI assessment. Overall, results demonstrate the MMA-TBI is a highly valid and reliable instrument for determining TBI based on VA/DoD clinical guidelines. These results support the need for application of standardized TBI criteria across all diagnostic contexts.
随着创伤性脑损伤（TBI）患病率的不断上升，对评估TBI的可靠且有效的方法的需求也在增加。本研究的目的是确立一种新的TBI综合评估方法——大西洋中部精神疾病研究、教育与临床中心（MIRECC）TBI评估（MMA-TBI）的有效性和可靠性。本研究的参与者为部署后有过战斗经历的退伍军人。首先，将MMA-TBI的结果与独立进行的临床TBI评估结果进行比较。其次，将MMA-TBI的结果与另一种经过验证的TBI测量方法（俄亥俄州立大学TBI识别方法[OSU-TBI-ID]）的结果进行比较。接下来，四位TBI主题专家根据临床判断和退伍军人事务部/国防部（VA/DoD）临床实践指南，对64起潜在的TBI事件进行了独立评估。将MMA-TBI算法（基于VA/DoD临床指南）的结果与主题专家的结果进行比较。与独立进行的专家临床评估的诊断一致性在终身TBI方面为96%，在部署后获得的TBI方面为92%。MMA-TBI与OSU-TBI-ID之间的一致性很高（κ = 0.90；肯德尔tau系数 = 0.94）。MMA-TBI算法结果与主题专家结果的比较结果很高（κ = 0.97 - 1.00）。MMA-TBI是首个对照独立进行的临床TBI评估进行验证的TBI访谈工具。总体而言，结果表明MMA-TBI是一种基于VA/DoD临床指南确定TBI的高度有效且可靠的工具。这些结果支持在所有诊断环境中应用标准化TBI标准的必要性。
