title: Preliminary evaluation of a measure for reliable assessment of need for constant visual observation in adults with traumatic brain injury.
abstract: To develop and provide initial validation of a measure for accurately determining the need for Constant Visual Observation (CVO) in patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation.
  
  
  
  Rating scale development and evaluation through Rasch analysis and assessment of concurrent validity.
  
  
  
  One hundred and thirty-four individuals with moderate-severe TBI were studied in seven inpatient brain rehabilitation units associated with the National Institute for Disability, Independent Living and Rehabilitation Research (NIDILRR) TBI Model System. Participants were rated on the preliminary version of the CVO Needs Assessment scale (CVONA) and, by independent raters, on the Levels of Risk (LoR) and Supervision Rating Scale (SRS) at four time points during inpatient rehabilitation: admission, Days 2-3, Days 5-6 and Days 8-9.
  
  
  
  After pruning misfitting items, the CVONA showed satisfactory internal consistency (Person Reliability = 0.85-0.88) across time points. With reference to the LoR and SRS, low false negative rates (sensitivity > 90%) were associated with moderate-to-high false positive rates (29-56%).
  
  
  
  The CVONA may be a useful objective metric to complement clinical judgement regarding the need for CVO; however, further prospective study is desirable to further assess its utility in identifying at-risk patients, reducing adverse events and decreasing CVO costs.
authors.affiliation: a Mayo Clinic Department of Physical Medicine & Rehabilitation , Rochester , MN , USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Moessner
authors.affiliation: b Physical Medicine and Rehabilitation , Indiana University School of Medicine and Rehabilitation Hospital of Indiana , Indianapolis , IN , USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Malec
authors.affiliation: c UPMC Mercy Hospital Rehabilitation Institute , Pittsburgh , PA , USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Beveridge
authors.affiliation: c UPMC Mercy Hospital Rehabilitation Institute , Pittsburgh , PA , USA.
authors.forename: Cara Camiolo
authors.initials: CC
authors.lastname: Reddy
authors.affiliation: d The Ohio State University Wexner Medical Center , Columbus , OH , USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Huffman
authors.affiliation: e Department of Rehabilitation , Baylor Institute for Rehabilitation-Dallas Campus , Dallas , TX , USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Marton
authors.affiliation: f NYP/Cornell-Weill Medical Center , New York , NY , USA.
authors.forename: Audrey J
authors.initials: AJ
authors.lastname: Schmerzler
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States; D055815:Young Adult
keywords: Behavior Rating Scale; Brain injury; patient safety; rehabilitation; safety management