Citation

McCauley SR, Wilde EA, Moretti P, Macleod MC, Pedroza C, Drever P, Fourwinds S, Frisby ML, Scott JN, Hunter JV, Traipe E, Valadka A, Clifton GL. J. Neurotrauma 2013; 30(17): 1506-1511.

Affiliation

Baylor College of Medicine, Physical Medicine and Rehabilitation, Houston, Texas, United States, Baylor College of Medicine, Neurology, Houston, Texas, United States, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States ; mccauley@bcm.edu.

Copyright

(Copyright © 2013, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2013.2925

PMID

23617608

Abstract

The Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) is a measure assessing neurological functioning in patients with TBI. We hypothesized the NOS-TBI would exhibit adequate concurrent and predictive validity and demonstrate more sensitivity to change compared to other well-established outcome measures. We analyzed data from the National Acute Brain Injury Study: Hypothermia-II clinical trial. Participants were ages 16-45 years with severe TBI assessed at 1, 3, 6, and 12 months postinjury. For analysis of criterion-related validity (concurrent and predictive), Spearman rank-order correlations were calculated between the NOS-TBI and the Glasgow Outcome Scale (GOS), GOS-Extended (GOS-E), Disability Rating Scale (DRS), and Neurobehavioral Rating Scale-Revised (NRS-R). Concurrent validity was demonstrated through significant correlations between the NOS-TBI and GOS, GOS-E, DRS, and NRS-R measured contemporaneously at 3, 6, and 12-months postinjury (all p < .0013). For prediction analyses, the multiplicity-adjusted p-value using the False Discovery Rate was < .015. The 1-month NOS-TBI score was a significant predictor of outcome in the GOS, GOS-E, and DRS at 3 and 6 months postinjury (all p < .015). The 3-month NOS-TBI significantly predicted GOS, GOS-E, DRS, and NRS-R outcomes at 6 and 12 months postinjury (all p < .0015). Sensitivity to change was analyzed using the Wilcoxon signed-rank sum test of subsamples demonstrating no change in the GOS or GOS-E between 3 and 6 months. The NOS-TBI demonstrated higher sensitivity to change compared to the GOS (p <.038) and GOS-E (p <.016). In summary, the NOS-TBI demonstrated adequate concurrent and predictive validity as well as sensitivity to change compared to 'gold standard' outcome measures. The NOS-TBI may enhance prediction of outcome in clinical practice and measurement of outcome in TBI research.

Language: en