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Script concordance test (SCT) is a case based assessment format of clinical reasoning in which questions are nested into several cases. Recent results using Q4 format suggest that nested questions contribute more to reliability of measure than cases. The present study aims at documenting variance components associated with SCT cases and nested questions and to determine what are the optimal number and combinations of cases and nested questions. Data from SCT in three different fields are presented. G study and D study methodology are used to estimate variance component and to determine optimal number and combinations of cases and questions. Questions nested into cases contributed a large amount of score variance (more than 70%). D studies with varying samples show that, depending on the reliability of the test, an optimal number of 2-4 questions nested into 15-25 cases represents the best combination. Nested questions contribute to a significant portion of score variance, with the implication that formulation of up to 5 questions per case is an efficient way to optimize the reliability of SCT scores.

BackgroundMost patients who sustain mild traumatic brain injury (mTBI) have persistent symptoms at 1 week and 1 month after injury. This systematic review investigated the effectiveness of interventions initiated in acute settings for patients who experience mTBI.MethodsWe performed a systematic review of all randomized clinical trials evaluating any intervention initiated in an acute setting for patients experiencing acute mTBI. All possible outcomes were included. The primary sources of identification were MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central register of Controlled Trials, from 1980 to August 2012. Hand searching of proceedings from five meetings related to mTBI was also performed. Study selection was conducted by two co-authors, and data abstraction was completed by a research assistant specialized in conducting systematic reviews. Study quality was evaluated using Cochrane’s Risk of Bias assessment tool.ResultsFrom a potential 15,156 studies, 1,268 abstracts were evaluated and 120 articles were read completely. Of these, 15 studies fulfilled the inclusion/exclusion criteria. One study evaluated a pharmacological intervention, two evaluated activity restriction, one evaluated head computed tomography scan versus admission, four evaluated information interventions, and seven evaluated different follow-up interventions. Use of different outcome measures limited the possibilities for analysis. However, a meta-analysis of three studies evaluating various follow-up strategies versus routine follow-up or no follow-up failed to show any effect on three outcomes at 6 to 12 months post-trauma. In addition, a meta-analysis of two studies found no effect of an information intervention on headache at 3 months post-injury.ConclusionsThere is a paucity of well-designed clinical studies for patients who sustain mTBI. The large variability in outcomes measured in studies limits comparison between them.

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