Abstract
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 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.
Highlights
The European Commission has funded a large-scale, multinational longitudinal observational study called the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-traumatic brain injury (TBI)) [1,2,3,4]
Tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) [5], a battery of computerized cognitive tests that has been used in research on a variety of neurological disorders, including TBI [6,7,8,9,10,11,12], were included in the CENTER-TBI battery
Adult patients were included if they were between ages 18 and 59 years and sustained a mild traumatic brain injury (MTBI) per the criteria described by the WHO Collaborating Center Task Force on MTBI: (a) mechanical energy to the head from external physical forces; (b) Glasgow Coma Scale (GCS) score of 13–15 at presentation to the emergency department; and (c) either witnessed loss of consciousness (LOC)
Summary
The European Commission has funded a large-scale, multinational longitudinal observational study called the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) [1,2,3,4]. CENTER-TBI aspires to identify best practices, develop precision medicine, and improve outcomes for people with TBIs via comparativeeffectiveness studies. The present study evaluates candidate cognitive endpoints, or composite scores, for the CENTER-TBI neuropsychological battery using data from the Trondheim MTBI follow-up study. As well as in the CENTER-TBI study, patients with mild traumatic brain injury (MTBI) were assessed 2 weeks after the injury. 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)
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