Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-26T13:10:16.841Z Has data issue: false hasContentIssue false
  • English
  • Français

Prediction of global outcome with acute neuropsychological testing following closed-head injury

Published online by Cambridge University Press:  01 October 2004

NICHOLAS J. PASTOREK ,
H. JULIA HANNAY  and
CHARLES S. CONTANT
NICHOLAS J. PASTOREK
Affiliation:
Department of Psychology, University of Houston, Houston, Texas
H. JULIA HANNAY
Affiliation:
Department of Psychology, University of Houston, Houston, Texas Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
CHARLES S. CONTANT
Affiliation:
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
Get access Rights & Permissions [Opens in a new window]

Abstract

Delaying assessment until emergence from post-traumatic amnesia increases completion rates, but this practice causes variable time delays from the date of injury to testing, which can complicate the interpretation of research findings. In the current study, the performance of 105 head injury survivors on simple tests of language comprehension and attention was used to predict global outcome. It was hypothesized that 1 month performance on these measures would aid in the prediction of Disability Rating Scale (DRS) and Glasgow Outcome Scale (GOS) scores collected at 6 months post injury. Only raw scores on the modified Test of Complex Ideational Material accounted for a significant amount of the variance in DRS scores (4.4%) above that accounted for by age, education, Glasgow Coma Scale score, and pupil response. However, testability at 1 month post injury on all four tests consistently accounted for a larger portion of the variance in DRS scores (10.1–13.2%) and significantly improved prediction of GOS scores. Galveston Orientation and Amnesia Test scores collected at 1 month post injury accounted for substantially less variance in DRS scores (7.7–8.4%). Neuropsychological data, including the testability of patients, collected uniformly at 1 month following injury can contribute to the prediction of global outcome. (JINS, 2004, 10, 807–817.)

Keywords

Closed-head injuryAssessmentOutcome
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 10 , Issue 6 , October 2004 , pp. 807 - 817
Copyright
© 2004 The International Neuropsychological Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Binder, L.M., Rohling, M.L., & Larrabee, J. (1997). A review of mild head trauma. Part I: Meta-analytic review of neuropsychological studies. Journal of Clinical and Experimental Neuropsychology, 19, 421–431.Google Scholar
Boake, C., Millis, S.R., High, W.M., Jr., Delmonico, R.L., Kreutzer, J.S., Rosenthal, M., Sherer, M., & Ivanhoe, C.B. (2001). Using early neuropsychologic testing to predict long-term productivity outcome from traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 82, 761–768.CrossRefGoogle Scholar
Borenstein, M. & Cohen, J. (1988). Statistical power analysis: A computer program. Hillsdale, NJ: L. Erlbaum.
Chan, R.C. (2000). Attentional deficits in patients with closed head injury: A further study to the discriminative validity of the test of everyday attention. Brain Injury, 14, 227–236.CrossRefGoogle Scholar
Cifu, D.X., Keyser-Marcus, L., Lopez, E., Wehman, P., Kreutzer, J.S., Englander, J., & High, W. (1997). Acute predictors of successful return to work 1 year after traumatic brain injury: A multicenter analysis. Archives of Physical Medicine and Rehabilitation, 78, 125–131.CrossRefGoogle Scholar
Clifton, G.L., Miller, E.R., Choi, S.C., Levin, H.S., McCauley, S., Smith, K.R., Muizelaar, P., Wagner, F.C., Jr., Marion, D.W., Luerssen, T.G., Chesnut, R.M., & Schwartz, M. (2001). Lack of effect of induction of hypothermia after acute brain injury. New England Journal of Medicine, 344, 556–563.CrossRefGoogle Scholar
De Renzi, E. & Vignolo, L.A. (1962). The Token Test: A sensitive test to detect receptive disturbances in aphasics. Brain, 85, 665–678.CrossRefGoogle Scholar
Dikmen, S., Reitan, R.M., & Temkin, N.R. (1983). Neuropsychological recovery in head injury. Archives of Neurology, 40, 333–338.CrossRefGoogle Scholar
Dikmen, S.S., Temkin, N.R., Machamer, J.E., Holubkov, A.L., Fraser, R.T., & Winn, H.R. (1994). Employment following traumatic head injuries. Archives of Neurology, 51, 177–186.CrossRefGoogle Scholar
Ellenberg, J.H., Levin, H.S., & Saydjari, C. (1996). Posttraumatic amnesia as a predictor of outcome after severe closed head injury: Prospective assessment. Archives of Neurology, 53, 782–791.CrossRefGoogle Scholar
Ewert, J., Levin, H.S., Watson, M.G., & Kalisky, Z. (1989). Procedural memory during posttraumatic amnesia in survivors of severe closed head injury. Implications for rehabilitation. Archives of Neurology, 46, 911–916.Google Scholar
Fearnside, M.R., Cook, R.J., McDougall, P., & McNeil, R.J. (1993). The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables. British Journal of Neurosurgery, 7, 267–279.Google Scholar
Fodor, I.E. (1972). Impairment of memory functions after acute head injury. Journal of Neurology, Neurosurgery, and Psychiatry, 35, 818–824.CrossRefGoogle Scholar
Gomez, P.A., Lobato, R.D., Boto, G.R., De la Lama, A., Gonzalez, P.J., & de la Cruz, J. (2000). Age and outcome after severe head injury. Acta Neurochirurgica, 142, 373–380.CrossRefGoogle Scholar
Goodglass, H. & Kaplan, E. (1983). Assessment of aphasia and other related disorders (2nd ed.). Philadelphia: Lea and Febiger.
Goodman, J.C., Robertson, D.P., Gopinath, S.P., Narayan, R.K., Grossman, R.G., Simpson, R.K., Jr., & Robertson, C.S. (1995). Measurements of lactic acid and amino acids in the cerebral cortex of head-injured patients using microdialysis. In T. Tsubokawa, A. Marmarou, C. Robertson, & G. Teasdale (Eds.), Neurochemical monitoring in the intensive care unit (pp. 78–83). Tokyo: Springer.
Groher, M. (1977). Language and memory disorders following closed head trauma. Journal of Speech Hearing Research, 20, 212–223.CrossRefGoogle Scholar
Hannay, H.J., Struchen, M.A., Contant, C.F., Stallings, G.A., & Roberston, C.S. (1994, February). Assessment of severely head injured patients and the prediction of outcome. Paper presented at the 22nd Annual INS Meeting, Cincinnati, Ohio.
Hannay, H.J. & Sherer, M. (1996). Assessment of outcomes from head injury. In R.K. Narayan, J.E. Wilberger, & J.T. Povlishock (Eds.), Neurotrauma: A complete textbook on head and spinal injury (pp. 723–747). New York: McGraw Hill.
Heilman, K.M., Safran, A., & Geschwind, N. (1971). Closed head trauma and aphasia. Journal of Neurology, Neurosurgery, and Psychiatry, 34, 265–269.CrossRefGoogle Scholar
Hinchliffe, F.J., Murdoch, B.E., & Chenery, H.J. (1998). Towards a conceptualization of language and cognitive impairment in closed-head injury: Use of clinical measures. Brain Injury, 12, 109–132.CrossRefGoogle Scholar
Jennett, B. & Bond, M. (1975). Assessment of outcome after severe brain damage. Lancet, 1, 480–484.CrossRefGoogle Scholar
Katz, D.I. & Alexander, M.P. (1994). Traumatic brain injury: Predicting course of recovery and outcome for patients admitted to rehabilitation. Archives of Neurology, 51, 661–670.CrossRefGoogle Scholar
Koura, S.S., Doppenberg, E.M.R., Marmarou, A., Choi, S., Young, H.F., & Bullock, R. (1988). Relationship between excitatory amino acid release and outcome after severe human head injury. Acta Neurochirurgica, 71, 244–246.Google Scholar
Levin, H.S., Gary, H.E., Jr., Eisenberg, H.M., Ruff, R.M., Barth, J.T., Kreutzer, J., High, W.M., Jr., Portman, S., Foulkes, M.A., Jane, J.A., Marmarou, A., & Marshall, L.F. (1990). Neurobehavioral outcome 1 year after severe head injury. Experience of the Traumatic Coma Data Bank. Journal of Neurosurgery, 73, 699–709.CrossRefGoogle Scholar
Levin, H.S., Grossman, R.G., & Kelly, P.J. (1976). Aphasic disorder in patients with closed head injury. Journal of Neurology, Neurosurgery, and Psychiatry, 39, 1062–1070.CrossRefGoogle Scholar
Levin, H.S., Grossman, R.G., Rose, J.E., & Teasdale, G. (1979a). Long-term neuropsychological outcome of closed head injury. Journal of Neurosurgery, 50, 412–422.Google Scholar
Levin, H.S., Hannay, H.J., Martin, A., & Kreutzer, J. (1988a). Acute battery tests for the Army Penetrating Head Injury Project. Unpublished manuscript.
Levin, H.S., High, W.M., Jr., & Eisenberg, H.M. (1988b). Learning and forgetting during posttraumatic amnesia in head injured patients. Journal of Neurology, Neurosurgery, and Psychiatry, 51, 14–20.Google Scholar
Levin, H.S., O'Donnell, V.M., & Grossman, R.G. (1979b). The Galveston Orientation and Amnesia Test: A practical scale to assess cognition after head injury. Journal of Nervous and Mental Disease, 167, 675–684.Google Scholar
Mamelak, A.N., Pitts, L.H., & Damron, S. (1996). Predicting survival from head trauma 24 hours after injury: A practical method with therapeutic implications. Journal of Trauma, 41, 91–99.CrossRefGoogle Scholar
Maxwell, S.E. & Delaney, H.D. (2000). Designing experiments and analyzing data: A model comparison perspective. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
McCauley, S.R., Hannay, H.J., & Swank, P.R. (2001). Use of the Disability Rating Scale recovery curve as a predictor of psychosocial outcome following closed-head injury. Journal of the International Neuropsychological Society, 7, 457–467.CrossRefGoogle Scholar
Meyers, C.A. & Levin, H.S. (1992). Temporal perception following closed head injury: Relationship of orientation and attention span. Neuropsychiatry, Neuropsychology and Behavioral Neurology, 39, 1001–1007.Google Scholar
Rao, N. & Kilgore, K.M. (1992). Predicting return to work in traumatic brain injury using assessment scales. Archives of Physical Medicine and Rehabilitation, 73, 911–916.Google Scholar
Rappaport, M., Hall, K., Hopkins, K., Belleza, T., & Cope, D.N. (1982). Disability Rating Scale for severe head trauma: Coma to community. Archives of Physical Medicine and Rehabilitation, 63, 118–123.Google Scholar
Ruesch, J. & Moore, B.E. (1943). Measurement of intellectual function in the acute stage of head injury. Archives of Neurology and Psychiatry, 50, 165–170.CrossRefGoogle Scholar
Sarno, M.T. (1980). The nature of verbal impairment after closed head injury. Journal of Nervous and Mental Disease, 168, 685–692.CrossRefGoogle Scholar
Sarno, M.T. (1984). Verbal impairment after closed head injury. Report of a replication study. Journal of Nervous and Mental Disease, 172, 475–479.Google Scholar
Sarno, M.T., Buonaguro, A., & Levita, E. (1986). Characteristics of verbal impairment in closed head injured patients. Archives of Physical Medicine and Rehabilitation, 67, 400–405.Google Scholar
Scheibel, R.S., Levin, H.S., & Clifton, G.L. (1998). Completion rates and feasibility of outcome measures: Experience in a multicenter clinical trial of systemic hypothermia for severe head injury. Journal of Neurotrauma, 15, 685–692.CrossRefGoogle Scholar
Signorini, D.F., Andrews, P.J., Jones, P.A., Wardlaw, J.M., & Miller, J.D. (1999). Predicting survival using simple clinical variables: A case study in traumatic brain injury. Journal of Neurology, Neurosurgery, and Psychiatry, 66, 20–25.CrossRefGoogle Scholar
SPSS for Windows (Rel. 10.0.1) [computer software]. (1999). Chicago: SPSS, Inc.
Stuss, D.T. & Buckle, L. (1992). Truamatic brain injury: Neuropsychological deficits and evaluation at different stages of recovery and in different pathologic subtypes. Journal of Head Trauma Rehabilitation, 7, 40–49.CrossRefGoogle Scholar
Stuss, D.T., Ely, P., Hugenholtz, H., Richard, M.T., LaRochelle, S., Poirier, C.A., & Bell, I. (1985). Subtle neuropsychological deficits in patients with good recovery after closed head injury. Neurosurgery, 17, 41–47.CrossRefGoogle Scholar
Tabachnick, B.G. & Fidell, L.S. (2001). Using Multivariate Statistics (4th ed.). Boston: Allyn & Bacon.
Teasdale, G. & Jennett, B. (1974). Assessment of coma and impaired consciousness. Lancet, ii, 81–84.CrossRefGoogle Scholar
Thomsen, I.V. (1975). Evaluation and outcome of aphasia in patients with severe closed head trauma. Journal of Neurology, Neurosurgery, and Psychiatry, 38, 713–718.CrossRefGoogle Scholar
Zafonte, R.D., Mann, N.R., Millis, S.R., Black, K.L., Wood, D.L., & Hammond, F. (1997). Posttraumatic amnesia: Its relation to functional outcome. Archives of Physical Medicine and Rehabilitation, 78, 1103–1106.CrossRefGoogle Scholar