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

Nelson, Lindsay D.; Furger, Robyn E.; Gikas, Peter; Lerner, E. Brooke; Barr, William; Hammeke, Thomas A.; Randolph, Christopher; Guskiewicz, Kevin M.; McCrea, Michael

doi:10.1017/s1355617717000157

Cited by 30 publications

(25 citation statements)

References 39 publications

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“…This study calculated and evaluated seven candidate composite scores for the neuropsychological battery used in the CENTER-TBI. The MTBI sample, on average, performed in the broadly normal range on all of the individual cognitive test scores at 2 weeks post injury ( Table 2 ), which is generally consistent with studies examining neuropsychological outcome at 2 weeks after injury ( 13 – 16 ) and reflects the favorable cognitive outcome experienced by this sample. Further, there were no statistically significant differences in any of the composite scores, or in the individual tests, when comparing the MTBI, trauma control, and community control groups ( Tables 2 , 7 ).…”

Section: Discussionsupporting

confidence: 80%

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Developing Cognition Endpoints for the CENTER-TBI Neuropsychological Test Battery

et al. 2020

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Background: Measuring cognitive functioning is common in traumatic brain injury (TBI) research, but no universally accepted method for combining several neuropsychological test scores into composite, or summary, scores exists. This study examined several possible composite scores for the test battery used in the large-scale study Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Methods: Participants with mild traumatic brain injury (MTBI; n = 140), orthopedic trauma (n = 72), and healthy community controls (n = 70) from the Trondheim MTBI follow-up study completed the CENTER-TBI test battery at 2 weeks after injury, which includes both traditional paper-and-pencil tests and tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Seven composite scores were calculated for the paper and pencil tests, the CANTAB tests, and all tests combined (i.e., 21 composites): the overall test battery mean (OTBM); global deficit score (GDS); neuropsychological deficit score-weighted (NDS-W); low score composite (LSC); and the number of scores ≤5th percentile, ≤16th percentile, or <50th percentile. Results: The OTBM and the number of scores <50th percentile composites had distributional characteristics approaching a normal distribution. The other composites were in general highly skewed and zero-inflated. When the MTBI group, the trauma control group, and the community control group were compared, effect sizes were negligible to small for all composites. Subgroups with vs. without loss of consciousness at the time of injury did not differ on the composite scores and neither did subgroups with complicated vs. uncomplicated MTBIs. Intercorrelations were high within the paper-and-pencil composites, the CANTAB composites, and the combined composites and lower between the paper-and-pencil composites and the CANTAB composites. Conclusion: None of the composites revealed significant differences between participants with MTBI and the two control groups. Some of the composite scores Stenberg et al. Cognition Endpoints were highly correlated and may be redundant. Additional research on patients with moderate to severe TBIs is needed to determine which scores are most appropriate for TBI clinical trials.

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Section: Discussionsupporting

confidence: 80%

“…In this study, as well as in the CENTER-TBI study, patients with mild traumatic brain injury (MTBI) were assessed 2 weeks after the injury. The extent of cognitive deficits 2 weeks after MTBI is uncertain, and empirical studies report effect sizes ranging from very small to medium (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Developing Cognition Endpoints for the CENTER-TBI Neuropsychological Test Battery

et al. 2020

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“…There are few studies of cognition at 2 weeks after MTBI, and those identified have produced similar results. [22][23][24][25] Despite the general view that cognitive deficits in patients with MTBI tend to resolve rapidly after injury, subgroups of patients with MTBI may suffer from trauma-related cognitive impairments that might not be revealed by meta-analyses. 20,53 The current study evaluated three subgroups based on indices of injury severity: LOC, PTA, and positive neuroimaging.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12][13][14][15][16][17][18][19][20][21] The nature and extent of cognitive deficits during the subacute period, from 2 to 3 weeks following injury, are not well understood because the majority of studies examine other timepoints, such as during the first week or at 1, 3, 6, or 12 months following injury. Meta-analyses report small to medium effect sizes in the period 7 to 30 days post-injury, 10,21 and findings from individual empirical studies on cognitive functioning in patients 2 to 3 weeks post-MTBI commonly report very small to medium effect sizes that often do not reach statistical significance, [22][23][24][25] possibly due to insufficient statistical power.…”

Section: Introductionmentioning

confidence: 99%

Examining the Subacute Effects of Mild Traumatic Brain Injury Using a Traditional and Computerized Neuropsychological Test Battery

Karlsen

Saksvik

Stenberg

et al. 2021

Journal of Neurotrauma

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This study investigates subacute cognitive effects of mild traumatic brain injury (MTBI) in the Trondheim Mild TBI Study, as measured, in part, by the neuropsychological test battery of the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) program, including computerized tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) and traditional paper-and-pencil tests. We investigated whether cognitive function was associated with injury severity: intracranial traumatic lesions on neuroimaging, witnessed loss of consciousness (LOC), or post-traumatic amnesia (PTA) >1 h. Further, we explored which of the tests in the CENTER-TBI battery might be associated with the largest subacute effects of MTBI (i.e., at 2 weeks postinjury). We recruited 177 patients with MTBI (16-59 years of age) from a regional trauma center and an outpatient clinic,79 trauma control participants, and 81 community control participants. The MTBI group differed from community controls only on one traditional test of processing speed (coding; p = 0.009, Cliff's delta [D] = 0.20). Patients with intracranial abnormalities performed worse than those without on a traditional test (phonemic verbal fluency; p = 0.043, D = 0.27), and patients with LOC performed differently on the Attention Switching Task from the CANTAB (p = 0.020, D =-0.20). Patients with PTA >1 h performed worse than those with <1 h on 10 measures, from traditional tests and the CANTAB (D = 0.33-0.20), likely attributable, at least in part, to pre-existing differences in intellectual functioning between groups. In general, those with MTBI had good neuropsychological outcome 2 weeks after injury and no particular CENTER-TBI computerized or traditional tests seemed to be more sensitive to subtle cognitive deficits.

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“…Future work carried out in the ED can therefore utilise age‐scaled normative data collected for the CANTAB iPad application. A head‐to‐head study comparing performances of three different CNTs including ImPACT (Immediate Post‐Concussion and Cognitive Testing), ANAM and DANA (Automated Neuropsychological Assessment Metrics and Defence Automated Neurobehavioral Assessment) found that all three were unable to distinguish between mTBI and trauma patients within 72 h of injury recruited from a level 1 trauma centre . This supports the use of CANTAB neurocognitive battery and its early implementation within the ED given it could distinguish between the groups.…”

Section: Discussionmentioning

confidence: 77%

Neurocognitive testing in the emergency department: A potential assessment tool for mild traumatic brain injury

Lunter

Carroll

Housden

et al. 2018

Emerg Medicine Australasia

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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

Cited by 30 publications

References 39 publications

Developing Cognition Endpoints for the CENTER-TBI Neuropsychological Test Battery

Developing Cognition Endpoints for the CENTER-TBI Neuropsychological Test Battery

Examining the Subacute Effects of Mild Traumatic Brain Injury Using a Traditional and Computerized Neuropsychological Test Battery

Neurocognitive testing in the emergency department: A potential assessment tool for mild traumatic brain injury

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