Prediction of global outcome with acute neuropsychological testing following closed-head injury

Abstract

Delaying assessment until emergence from post-traumatic amnesia increases completion rates, but this practice causes variable time delays from the date of injury to testing, which can complicate the interpretation of research findings. In the current study, the performance of 105 head injury survivors on simple tests of language comprehension and attention was used to predict global outcome. It was hypothesized that 1 month performance on these measures would aid in the prediction of Disability Rating Scale (DRS) and Glasgow Outcome Scale (GOS) scores collected at 6 months post injury. Only raw scores on the modified Test of Complex Ideational Material accounted for a significant amount of the variance in DRS scores (4.4%) above that accounted for by age, education, Glasgow Coma Scale score, and pupil response. However, testability at 1 month post injury on all four tests consistently accounted for a larger portion of the variance in DRS scores (10.1-13.2%) and significantly improved prediction of GOS scores. Galveston Orientation and Amnesia Test scores collected at 1 month post injury accounted for substantially less variance in DRS scores (7.7-8.4%). Neuropsychological data, including the testability of patients, collected uniformly at 1 month following injury can contribute to the prediction of global outcome. (JINS, 2004, 10, 807-817.)

Speech pathologists’ current practice with cognitive-communication assessment during post-traumatic amnesia: A survey

“…Kalmar et al [29] found that testing was feasible early after moderate-to-severe TBI, regardless of PTA status. Pastorek et al [30] examined language and attention as part of neuropsychological testing during PTA and concluded that testability itself during PTA was indicative of outcome. These studies indicate that assessment of various cognitive functions may be feasible and productive during PTA.…”

“…This difficulty may be compounded by the absence of supporting speech pathology literature on the impact of PTA on communication or research on communication recovery early after TBI. Early prognostic factors relating to communication are still largely unknown, although recent research into the predictive value of neuropsychological testing during and shortly after PTA has indicated that there are aspects of clinically observable behaviour that may provide valuable information about outcome [26,30,35].…”

Functional outcome 10 years after traumatic brain injury: Its relationship with demographic, injury severity, and cognitive and emotional status

“…This variability has led to a focus on identifying factors predicting or indicating functional outcome. Studies conducted up to 3 years after injury have found that outcome may be influenced by injury severity, as measured by Glasgow Coma Scale (GCS) scores or duration of posttraumatic amnesia (PTA), demographic factors, including age, gender, and preinjury education and employment, as well as postinjury cognitive and social factors (Brown et al, 2005;Cattelani et al, 2002;Dikmen et al, 1995b;Fleming et al, 1999;Godfrey et al, 1993;Gollaher et al, 1998;Ip et al, 1995;Levin et al, 1990;Pastorek et al, 2004;Ponsford et al, 1995;Rothweiler et al, 1998;Van der Naalt et al, 1999;Van Zomeren & Van den Burg, 1985).…”

Early conversational discourse abilities following traumatic brain injury: An acute predictive study

“…The research literature includes several studies that have explored how factors such as demographic and pre-morbid characteristics of the individual (age, presence of prior neurological conditions, educational level, employment level or history of drug/alcohol abuse), severity of injury, type and location of lesions, early cognitive functioning or posttraumatic amnesia (PTA) influence cognitive outcome and functional and employment status in the first year post injury [18][19][20][21][22][23]. Less information is available, however, about the relationship between such variables and impairments in language and communication.…”