TBI Network, Auckland University of Technology, Auckland, New Zealand.
School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
PLoS One. 2021 Feb 4;16(2):e0246512. doi: 10.1371/journal.pone.0246512. eCollection 2021.
Currently health care pathways (the combination and order of services that a patient receives to manage their injury) following a mild traumatic brain injury vary considerably. Some clinicians lack confidence in injury recognition, management and knowing when to refer. A clinical expert group developed the Brain Injury Screening Tool (BIST) to provide guidance on health care pathways based on clinical indicators of poor recovery. The tool aims to facilitate access to specialist services (if required) to improve longer term prognosis. The tool was developed using a three-step process including: 1) domain mapping; 2) item development and 3) item testing and review. An online retrospective survey of 114 adults (>16 years) who had experienced a mild brain injury in the past 10 years was used to determine the initial psychometric properties of the 15-item symptom scale of the BIST. Participants were randomised to complete the BIST and one of two existing symptom scales; the Rivermead Post-concussion Symptom Questionnaire (RPQ) or the Sports Concussion Assessment Test (SCAT-5) symptom scale to determine concurrent validity. Participant responses to the BIST symptom scale items were used to determine scale reliability using Cronbach's alpha. A principal components analysis explored the underlying factor structure. Spearman's correlation coefficients determined concurrent validity with the RPQ and SCAT-5 symptom scales. The 15 items were found to require a reading age of 6-8 years old using readability statistics. High concurrent validity was shown against the RPQ (r = 0.91) and SCAT-5 (r = 0.90). The BIST total symptom scale (α = 0.94) and the three factors identified demonstrated excellent internal consistency: physical/emotional (α = 0.90), cognitive (α = 0.92) and vestibular-ocular (α = 0.80). This study provides evidence to support the utility, internal consistency, factor structure and concurrent validity of the BIST. Further research is warranted to determine the utility of the BIST scoring criteria and responsiveness to change in patients.
目前，轻度创伤性脑损伤（TBI）患者的治疗路径（患者接受的服务组合和顺序）差异很大。一些临床医生对损伤识别、管理和何时转诊缺乏信心。一个临床专家组开发了脑损伤筛查工具（BIST），以基于不良恢复的临床指标为指导，提供治疗路径方面的建议。该工具旨在促进获得专科服务（如果需要），以改善长期预后。该工具的开发采用了一个包括三步的过程：1）领域映射；2）项目开发和 3）项目测试和审查。对 114 名在过去 10 年内经历过轻度脑损伤的成年人（>16 岁）进行了一项在线回顾性调查，以确定 BIST 15 项症状量表的初始心理测量特性。参与者被随机分配完成 BIST 和现有的两个症状量表之一；Rivermead 脑震荡后症状问卷（RPQ）或运动性脑震荡评估测试（SCAT-5）症状量表，以确定同时效度。使用 Cronbach 的 alpha 来确定量表的可靠性。对 BIST 症状量表项目的参与者反应进行了主成分分析，以探索潜在的因子结构。Spearman 相关系数确定了与 RPQ 和 SCAT-5 症状量表的同时效度。根据可读性统计数据，发现 15 项需要 6-8 岁的阅读年龄。与 RPQ（r = 0.91）和 SCAT-5（r = 0.90）的高度同时效度。BIST 总症状量表（α=0.94）和三个确定的因子表现出极好的内部一致性：身体/情绪（α=0.90）、认知（α=0.92）和前庭眼（α=0.80）。这项研究为 BIST 的实用性、内部一致性、因子结构和同时效度提供了证据支持。还需要进一步研究来确定 BIST 评分标准的实用性和对患者变化的反应性。
