Abstract
Currently health care pathways (the combination and order of services that a patient receives to manage their injury) following a mild traumatic brain injury vary considerably. Some clinicians lack confidence in injury recognition, management and knowing when to refer. A clinical expert group developed the Brain Injury Screening Tool (BIST) to provide guidance on health care pathways based on clinical indicators of poor recovery. The tool aims to facilitate access to specialist services (if required) to improve longer term prognosis. The tool was developed using a three-step process including: 1) domain mapping; 2) item development and 3) item testing and review. An online retrospective survey of 114 adults (>16 years) who had experienced a mild brain injury in the past 10 years was used to determine the initial psychometric properties of the 15-item symptom scale of the BIST. Participants were randomised to complete the BIST and one of two existing symptom scales; the Rivermead Post-concussion Symptom Questionnaire (RPQ) or the Sports Concussion Assessment Test (SCAT-5) symptom scale to determine concurrent validity. Participant responses to the BIST symptom scale items were used to determine scale reliability using Cronbach’s alpha. A principal components analysis explored the underlying factor structure. Spearman’s correlation coefficients determined concurrent validity with the RPQ and SCAT-5 symptom scales. The 15 items were found to require a reading age of 6–8 years old using readability statistics. High concurrent validity was shown against the RPQ (r = 0.91) and SCAT-5 (r = 0.90). The BIST total symptom scale (α = 0.94) and the three factors identified demonstrated excellent internal consistency: physical/emotional (α = 0.90), cognitive (α = 0.92) and vestibular-ocular (α = 0.80). This study provides evidence to support the utility, internal consistency, factor structure and concurrent validity of the BIST. Further research is warranted to determine the utility of the BIST scoring criteria and responsiveness to change in patients.
Highlights
Traumatic brain injury occurs where there is an external force causing an alteration in brain function [1]
Based on the identified constraints the clinical expert group (CEG) determined the need for development of a new symptom measure called the Brain Injury Screening Tool (BIST)
The findings of this study provide initial support for readability, scale reliability and use of the BIST as a total symptom scale and subscales
Summary
Traumatic brain injury occurs where there is an external force causing an alteration in brain function [1]. One of the critical acute decisions clinicians need to make, is to determine the risk of bleeding and swelling in the brain following injury. This includes establishing if any of a range of clinical indicators for further diagnostic imaging are present. Research has shown that risk factors for poor recovery outcome include a history of (previous) TBI, a pre-existing mental health condition, delayed medical attention (including patient delays in seeking treatment), older age, maladaptive coping, and increased severity of acute symptoms [6, 7]. The current pathway can create significant barriers or delays in treatment
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