Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools Part 2: Utility for Assessment of Mild Traumatic Brain Injury in Emergency Department Patients. (27th March 2017)

• Record Type: Journal Article
• Authors: Nelson, Lindsay D.; Furger, Robyn E.; Gikas, Peter; Lerner, E. Brooke; Barr, William B.; Hammeke, Thomas A.; Randolph, Christopher; Guskiewicz, Kevin; McCrea, Michael A.
• Is Part Of: Journal of the International Neuropsychological Society. Volume 23:Number 4(2017)
• Page Start: 293
• Page End: 303
• Publication Date: 2017-03-27
• Subjects: Mild traumatic brain injury, -- Concussion, -- Emergency department, -- Neurocognitive testing, -- Neuropsychological testing; Neuropsychology -- Periodicals; 616.8
• DOI: 10.1017/S1355617717000157
• Languages: English
• ISSNs: 1355-6177

Abstract

Abstract: Objectives: The aim of this study was to evaluate the reliability and validity of three computerized neurocognitive assessment tools (CNTs; i.e., ANAM, DANA, and ImPACT) for assessing mild traumatic brain injury (mTBI) in patients recruited through a level I trauma center emergency department (ED).Methods: mTBI ( n =94) and matched trauma control ( n =80) subjects recruited from a level I trauma center emergency department completed symptom and neurocognitive assessments within 72 hr of injury and at 15 and 45 days post-injury. Concussion symptoms were also assessed via phone at 8 days post-injury.Results: CNTs did not differentiate between groups at any time point (e.g., M 72-hr Cohen's d =−.16, .02, and .00 for ANAM, DANA, and ImPACT, respectively; negative values reflect greater impairment in the mTBI group). Roughly a quarter of stability coefficients were over .70 across measures and test–retest intervals in controls. In contrast, concussion symptom score differentiated mTBI vs . control groups acutely), with this effect size diminished over time (72-hr and day 8, 15, and 45 Cohen's d =−.78, −.60, −.49, and −.35, respectively).Conclusions: The CNTs evaluated, developed and widely used to assess sport-related concussion, did not yield significant differences between patients with mTBI versus other injuries. Symptom scores better differentiated groups than CNTs, with effect sizes weaker than those reported in sport-related concussion studies. Nonspecific injury factors, and other characteristics common in ED settings, likely affect CNT performance across trauma patients as a whole and thereby diminish the validity of CNTs for assessing mTBI in this patient population. ( JINS, 2017, 23, 293–303)