title: Reliability and Validity of the Therapy Intensity Level Scale: Analysis of Clinimetric Properties of a Novel Approach to Assess Management of Intracranial Pressure in Traumatic Brain Injury.
abstract: We aimed to assess the reliability and validity of the Therapy Intensity Level scale (TIL) for intracranial pressure (ICP) management. We reviewed the medical records of 31 patients with traumatic brain injury (TBI) in two European intensive care units (ICUs). The ICP TIL was derived over a 4-day period for 4-h (TIL4) and 24-h epochs (TIL24). TIL scores were compared with historical schemes for TIL measurement, with each other, and with clinical variables. TIL24 scores in ICU patients with TBI were compared with two control groups: patients with extracranial trauma necessitating intensive care (Trauma_ICU; n = 20) and patients with TBI not needing ICU care (TBI_WARD; n = 19), to further determine the discriminative validity of the TIL for ICP-related ICU interventions. Interrater and intraobserver agreement were excellent for TIL4 and TIL24 (Cohen κ: 0.98-0.99; intraclass correlation coefficient: 0.99-1; p < 0.0005). The mean + standard deviation (SD) TIL24 in the ICU TBI cohort was significantly higher than the Trauma_ICU patients and the TBI_WARD patients (8.2 ± 3.2 vs. 2.2 ± 0.9 and 0.1 ± 0.1, respectively; p < 0.005 for both comparisons). Correlations between the TIL scale scores and historical TIL scores, between TIL24 and the Glasgow Coma Scale, and between a range of TIL metrics and summary measures of ICP over the 4-day period, were all highly significant (p < 0.01). The results were consistent with the expected direction. A linear mixed effect analysis, accounting for within-subjects repeated measures, showed strong correlation between TIL4 and 4-h ICP (p < 0.0000005). The TIL scale is a reliable measurement instrument with a high degree of validity for assessing the therapeutic intensity level of ICP management in patients with TBI.
authors: 1 Division of Anaesthesia, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom .|2 Department of Intensive Care Medicine, University Hospital Inselspital , Bern, Switzerland .
authors: Patrick
authors: P
authors: Zuercher
authors: 1 Division of Anaesthesia, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom .|3 Department of Neurosurgery, UMC Leiden , Leiden, the Netherlands .
authors: Justus L
authors: JL
authors: Groen
authors: 1 Division of Anaesthesia, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom .|4 Department of Critical Care, University of Groningen , UMC Groningen, Groningen, the Netherlands .
authors: Marcel J H
authors: MJ
authors: Aries
authors: 5 Center for Medical Decision Sciences , Department of PH, Erasmus MC, Rotterdam, the Netherlands .
authors: Ewout W
authors: EW
authors: Steyerberg
authors: 6 Department of Neurosurgery, University Hospital Antwerp - University of Antwerp , Edegem, Belgium .
authors: Andrew I R
authors: AI
authors: Maas
authors: 1 Division of Anaesthesia, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom .
authors: Ari
authors: A
authors: Ercole
authors: 1 Division of Anaesthesia, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom .
authors: David K
authors: DK
authors: Menon
keywords: ICP; TBI; TIL scale; clinimetrics