Mind Research Network, Lovelace Biomedical Research Institute.
Department of Psychology, University of Calgary.
Neuropsychology. 2022 Sep;36(6):565-577. doi: 10.1037/neu0000803. Epub 2022 Apr 4.
This study assessed classification accuracy of paper-and-pencil and computerized cognitive batteries at subacute (SA; 1-11 days) and early chronic (EC; ∼4 months) phases of pediatric mild traumatic brain injury (pmTBI). Two statistical approaches focused on single-subject performance (individual task scores, total impairments) were used to maximize clinical utility.
Two hundred thirty-five pmTBI and 169 healthy controls (HC) participants aged 8-18 were enrolled, with a subset (190 pmTBI; 160 HC) returning for the EC visit. The paper-and-pencil battery included several neuropsychological tests selected from recommended common data elements, whereas computerized testing was performed with the Cogstate Brief Battery. Hierarchical logistic regressions (base model: Parental education and premorbid reading abilities; full model: Base model and cognitive testing variables) were used to examine sensitivity/specificity, with diagnosis as the dependent variable.
Number Sequencing and Cogstate One-Card Learning accuracy significantly predicted SA diagnosis (full model accuracy = 71.6%-71.7%, sensitivity = 80.6%-80.8%, specificity = 59.1%-59.6%), while only immediate recall was significant at EC visit (accuracy = 68.5%, sensitivity = 74.6%, specificity = 61.5%). Other measures (Letter Fluency, Cogstate Detection, and One-Card Learning accuracy) demonstrated higher proportions of impairment for pmTBI subacutely (pmTBI: 11.5%-19.8%; HC: 3.7%-6.1%) but did not improve classification accuracy. Evidence of multiple impairments across the entire testing battery significantly predicted diagnosis at both visits (full model accuracy = 66.2%-68.6%, sensitivity = 71.2%-78.9%, specificity = 54.3%-61.5%).
Current results suggest similar modest diagnostic accuracy for computerized and paper-and-pencil batteries across multiple pmTBI phases. Moreover, findings suggest the total number of impairments may be more clinically useful than any single test or cognitive domain in terms of diagnostic accuracy at both assessment points. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
本研究评估了纸笔认知测试和计算机化认知测试在儿科轻度创伤性脑损伤（pmTBI）亚急性期（SA；1-11 天）和早期慢性期（EC；约 4 个月）的分类准确性。两种专注于个体表现的统计方法（单项任务得分、总障碍）被用于实现临床效用最大化。
共纳入 235 名 pmTBI 患者和 169 名健康对照者（HC），年龄为 8-18 岁，其中亚组（190 名 pmTBI；160 名 HC）返回进行 EC 就诊。纸笔测试包含了从推荐的常见数据元素中选择的多项神经心理学测试，而计算机测试则采用了 Cogstate 简明测试。采用分层逻辑回归（基础模型：父母教育和发病前阅读能力；全模型：基础模型和认知测试变量）来检验诊断的敏感性/特异性，以诊断为因变量。
数字排序和 Cogstate 单次学习准确率显著预测了 SA 诊断（全模型准确率=71.6%-71.7%，敏感性=80.6%-80.8%，特异性=59.1%-59.6%），而只有即刻回忆在 EC 就诊时具有显著意义（准确率=68.5%，敏感性=74.6%，特异性=61.5%）。其他测试（字母流畅性、Cogstate 检测和单次学习准确率）在亚急性期（pmTBI：11.5%-19.8%；HC：3.7%-6.1%）表现出更高比例的障碍，但并未提高分类准确性。整个测试组合中存在多种障碍的证据在两次就诊时均显著预测了诊断（全模型准确率=66.2%-68.6%，敏感性=71.2%-78.9%，特异性=54.3%-61.5%）。
当前结果表明，在多个 pmTBI 阶段，计算机化和纸笔测试的诊断准确性相当。此外，研究结果表明，在两次评估中，与任何单一测试或认知域相比，总障碍数量可能在诊断准确性方面更具临床意义。（PsycInfo 数据库记录（c）2022 APA，保留所有权利）。
