title: Neurological outcome scale for traumatic brain injury: III. Criterion-related validity and sensitivity to change in the NABIS hypothermia-II clinical trial.
abstract: The neurological outcome scale for traumatic brain injury (NOS-TBI) is a measure assessing neurological functioning in patients with TBI. We hypothesized that the NOS-TBI would exhibit adequate concurrent and predictive validity and demonstrate more sensitivity to change, compared with other well-established outcome measures. We analyzed data from the National Acute Brain Injury Study: Hypothermia-II clinical trial. Participants were 16-45 years of age with severe TBI assessed at 1, 3, 6, and 12 months postinjury. For analysis of criterion-related validity (concurrent and predictive), Spearman's rank-order correlations were calculated between the NOS-TBI and the glasgow outcome scale (GOS), GOS-extended (GOS-E), disability rating scale (DRS), and neurobehavioral rating scale-revised (NRS-R). Concurrent validity was demonstrated through significant correlations between the NOS-TBI and GOS, GOS-E, DRS, and NRS-R measured contemporaneously at 3, 6, and 12 months postinjury (all p<0.0013). For prediction analyses, the multiplicity-adjusted p value using the false discovery rate was <0.015. The 1-month NOS-TBI score was a significant predictor of outcome in the GOS, GOS-E, and DRS at 3 and 6 months postinjury (all p<0.015). The 3-month NOS-TBI significantly predicted GOS, GOS-E, DRS, and NRS-R outcomes at 6 and 12 months postinjury (all p<0.0015). Sensitivity to change was analyzed using Wilcoxon's signed rank-sum test of subsamples demonstrating no change in the GOS or GOS-E between 3 and 6 months. The NOS-TBI demonstrated higher sensitivity to change, compared with the GOS (p<0.038) and GOS-E (p<0.016). In summary, the NOS-TBI demonstrated adequate concurrent and predictive validity as well as sensitivity to change, compared with gold-standard outcome measures. The NOS-TBI may enhance prediction of outcome in clinical practice and measurement of outcome in TBI research.
authors.affiliation: Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas-Houston Medical School, Houston, Texas 77030, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: McCauley
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Wilde
authors.forename: Paolo
authors.initials: P
authors.lastname: Moretti
authors.forename: Marianne C
authors.initials: MC
authors.lastname: Macleod
authors.forename: Claudia
authors.initials: C
authors.lastname: Pedroza
authors.forename: Pamala
authors.initials: P
authors.lastname: Drever
authors.forename: Sierra
authors.initials: S
authors.lastname: Fourwinds
authors.forename: Melisa L
authors.initials: ML
authors.lastname: Frisby
authors.forename: Sue R
authors.initials: SR
authors.lastname: Beers
authors.forename: James N
authors.initials: JN
authors.lastname: Scott
authors.forename: Jill V
authors.initials: JV
authors.lastname: Hunter
authors.forename: Elfrides
authors.initials: E
authors.lastname: Traipe
authors.forename: Alex B
authors.initials: AB
authors.lastname: Valadka
authors.forename: David O
authors.initials: DO
authors.lastname: Okonkwo
authors.forename: David A
authors.initials: DA
authors.lastname: Zygun
authors.forename: Ava M
authors.initials: AM
authors.lastname: Puccio
authors.forename: Guy L
authors.initials: GL
authors.lastname: Clifton
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology* / Q000534:rehabilitation; D005260:Female; D023261:Glasgow Outcome Scale / Q000592:standards*; D006801:Humans; D007035:Hypothermia / Q000175:diagnosis* / Q000453:epidemiology* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult