Dept Psychology, Charles Darwin University, Darwin, Northern Territory 0810, Australia; Dept Psychology, James Cook University Singapore, Singapore 387380, Singapore.
Dept Neurosurgery, The Townsville Hospital, Douglas, Townsville, Queensland 4810, Australia; School of Medicine and Dentistry, James Cook University, Douglas, Townsville, Queensland 4810, Australia.
J Clin Neurosci. 2020 Nov;81:37-42. doi: 10.1016/j.jocn.2020.09.030. Epub 2020 Sep 25.
The duration of post-traumatic amnesia (PTA) following traumatic brain injury (TBI) is a key diagnostic and outcome indicator. However, concerningly, different PTA paradigms record different PTA durations: some over-estimate, others under-estimate, PTA. Thus, a compromise is implied. The potential effect of in-hospital confounders including opioids is unknown. Three clinical groups were prospectively recruited. Group-1: in-patients with moderate-severe-TBI (MS-TBI), considered likely 'in-PTA'. Group-2: patients rehabilitating after recent MS-TBI, considered 'out-of-PTA'. Group-3: orthopaedic in-patients without TBI undergoing elective surgery. Only Groups 1&3 were taking opioids. All were administered the Westmead Post-traumatic Amnesia Scale (WPTAS) and the Galveston Orientation and Amnesia Test (GOAT). Results were obtained in n = 56 (Group-1:n = 18, Group-2:n = 13 and Group-3:n = 25). On WPTAS, Groups 1&3 scored similarly, but significantly lower than, Group-2 (χ = 8.2, P = 0.017). Contrariwise, on GOAT, Group-1 scored significantly lower than Groups 2&3 (χ = 23.99, P < 0.001): however, no patient scored GOAT <75. WPTAS showed moderate sensitivity (72%) but poor specificity (40%) in distinguishing Group-1 from Groups 2&3. Contrariwise, GOAT showed 100% specificity but 0% sensitivity. WPTAS 'day of week' and 'pictures' combined with GOAT 'transport medium to hospital', 'anterograde amnesia' and 'retrograde amnesia' maximized sensitivity (100%), specificity (85-88%), PPV (77-83%) and NPV (100%) in distinguishing Group-1 from Groups 2&3. CONCLUSIONS: Confounders including opioids likely affected WPTAS overall, but not GOAT specificity. A merger, whereby WPTAS sensitivity augmented GOAT specificity, was therefore sought. Favourable items from WPTAS (4/12) and GOAT (3/10) together optimized, and yet simplified, PTA testing; despite prevalent clinical confounders. Less, not more, 'PTA' items would benefit both patients and staff alike.
创伤性脑损伤（TBI）后创伤后遗忘症（PTA）的持续时间是一个关键的诊断和预后指标。然而，令人担忧的是，不同的 PTA 范式记录的 PTA 持续时间不同：有些高估，有些低估。因此，需要妥协。医院内混杂因素（包括阿片类药物）的潜在影响尚不清楚。三个临床组前瞻性招募。第 1 组：中度至重度创伤性脑损伤（MS-TBI）住院患者，被认为可能处于“PTA 期”。第 2 组：近期 MS-TBI 后康复的患者，被认为处于“PTA 期外”。第 3 组：接受择期手术的无 TBI 骨科住院患者。只有第 1 组和第 3 组在服用阿片类药物。所有患者均接受了威斯特米德创伤后遗忘量表（WPTAS）和加尔维斯顿定向和遗忘测试（GOAT）。结果在 n = 56（第 1 组：n = 18，第 2 组：n = 13，第 3 组：n = 25）中获得。在 WPTAS 上，第 1 组和第 3 组的得分相似，但明显低于第 2 组（χ=8.2，P=0.017）。相反，在 GOAT 上，第 1 组的得分明显低于第 2 组和第 3 组（χ=23.99，P<0.001）：然而，没有患者的 GOAT 评分<75。WPTAS 在区分第 1 组和第 2 组和第 3 组方面具有中等敏感性（72%），但特异性（40%）较低。相反，GOAT 表现出 100%的特异性和 0%的敏感性。WPTAS 的“星期几”和“图片”与 GOAT 的“运输工具到医院”、“顺行性遗忘”和“逆行性遗忘”相结合，在区分第 1 组和第 2 组和第 3 组方面，将敏感性（100%）、特异性（85-88%）、阳性预测值（77-83%）和阴性预测值（100%）最大化。结论：包括阿片类药物在内的混杂因素可能影响了 WPTAS 的总体情况，但不影响 GOAT 的特异性。因此，寻求一种融合方法，即增加 WPTAS 的敏感性，增强 GOAT 的特异性。WPTAS（4/12）和 GOAT（3/10）中的有利项目一起优化了 PTA 测试，并且简化了测试；尽管存在普遍的临床混杂因素。对 PTA 项目的删减，而非增加，将使患者和工作人员都受益。
