The role of injury severity in neurobehavioral outcome 3 months after traumatic brain injury.
OBJECTIVE
To assess neurobehavioral outcome using the Neurobehavioral Rating Scale-Revised (NRS-R), an instrument with established specificity and validity in Traumatic Brain Injury (TBI) in a sample including the full spectrum of TBI severity 3 months after injury.


METHODS
A cohort group of 102 subjects with mild TBI, 41 with moderate TBI, and 139 with severe TBI, from multiple academic trauma centers, were assessed using the NRS-R and the Glasgow Outcome Scale.


RESULTS
Principal components analysis of the NRS-R resulted in a 3-factor model: (1) Cognitive, (2) Emotional, and (3) Hyperarousal. At 3 months, subjects with severe TBI show greater difficulties in cognitive and hyperarousal, but not emotional domains, than those with mild to moderate TBI. More than one third of subjects in all injury severity groups showed evidence of anxiety, depression, irritability, mental fatigability, and memory dysfunction. Scores on the NRS-R were related to outcome on the Glasgow Outcome Scale.


CONCLUSIONS
Three months after injury, subjects with severe TBI have more dysfunction in cognitive and behavioral (but not emotional) domains than those with mild-to-moderate TBI. The NRS-R is a useful tool for assessing the full spectrum of neurobehavioral dysfunction at all ranges of TBI severity.
Rapoport
Mark
M
Department of Psychiatry, Sunnybrook and Women's College Health Sciences Center, University of Toronto, Toronto, Ontario, Canada. mark.rapoport@swchsc.on.ca
McCauley
Stephen
S
Levin
Harvey
H
Song
James
J
Feinstein
Anthony
A
D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016896:Treatment Outcome