Stenberg Jonas, Karr Justin E, Terry Douglas P, Saksvik Simen B, Vik Anne, Skandsen Toril, Silverberg Noah D, Iverson Grant L
Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Front Neurol. 2020 Jul 17;11:670. doi: 10.3389/fneur.2020.00670. eCollection 2020.
Measuring cognitive functioning is common in traumatic brain injury (TBI) research, but no universally accepted method for combining several neuropsychological test scores into composite, or summary, scores exists. This study examined several possible composite scores for the test battery used in the large-scale study Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Participants with mild traumatic brain injury (MTBI; = 140), orthopedic trauma ( = 72), and healthy community controls ( = 70) from the Trondheim MTBI follow-up study completed the CENTER-TBI test battery at 2 weeks after injury, which includes both traditional paper-and-pencil tests and tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Seven composite scores were calculated for the paper and pencil tests, the CANTAB tests, and all tests combined (i.e., 21 composites): the overall test battery mean (OTBM); global deficit score (GDS); neuropsychological deficit score-weighted (NDS-W); low score composite (LSC); and the number of scores ≤5th percentile, ≤16th percentile, or <50th percentile. The OTBM and the number of scores <50th percentile composites had distributional characteristics approaching a normal distribution. The other composites were in general highly skewed and zero-inflated. When the MTBI group, the trauma control group, and the community control group were compared, effect sizes were negligible to small for all composites. Subgroups with vs. without loss of consciousness at the time of injury did not differ on the composite scores and neither did subgroups with complicated vs. uncomplicated MTBIs. Intercorrelations were high the paper-and-pencil composites, the CANTAB composites, and the combined composites and lower the paper-and-pencil composites and the CANTAB composites. None of the composites revealed significant differences between participants with MTBI and the two control groups. Some of the composite scores were highly correlated and may be redundant. Additional research on patients with moderate to severe TBIs is needed to determine which scores are most appropriate for TBI clinical trials.
在创伤性脑损伤（TBI）研究中，测量认知功能很常见，但目前还没有一种被普遍接受的方法能将多个神经心理学测试分数合并为综合分数或总结分数。本研究考察了在大规模研究“欧洲创伤性脑损伤协作神经创伤有效性研究”（CENTER-TBI）中所使用测试组合的几种可能的综合分数。来自特隆赫姆轻度创伤性脑损伤随访研究的轻度创伤性脑损伤（MTBI；n = 140）患者、骨科创伤患者（n = 72）和健康社区对照组（n = 70）在受伤后2周完成了CENTER-TBI测试组合，该组合包括传统的纸笔测试和来自剑桥神经心理学测试自动成套系统（CANTAB）的测试。针对纸笔测试、CANTAB测试以及所有测试组合（即21种综合分数）计算了7种综合分数：整体测试组合均值（OTBM）；整体缺陷分数（GDS）；神经心理学缺陷分数加权（NDS-W）；低分综合分数（LSC）；以及分数≤第5百分位数、≤第16百分位数或<第50百分位数的数量。OTBM和分数<第50百分位数的综合分数具有接近正态分布的分布特征。其他综合分数总体上高度偏态且零膨胀。当比较MTBI组、创伤对照组和社区对照组时，所有综合分数的效应大小可忽略不计至较小。受伤时有意识丧失与无意识丧失的亚组在综合分数上没有差异，复杂与非复杂MTBI的亚组也是如此。纸笔综合分数、CANTAB综合分数以及组合综合分数之间的相互相关性较高，而纸笔综合分数和CANTAB综合分数之间的相关性较低。没有一种综合分数显示MTBI患者与两个对照组之间存在显著差异。一些综合分数高度相关，可能存在冗余。需要对中重度TBI患者进行更多研究，以确定哪些分数最适合TBI临床试验。
