Preliminary Validation of an Abbreviated Acute Concussion Symptom Checklist Using Item Response Theory.
Preliminary Validation of an Abbreviated Acute Concussion Symptom Checklist Using Item Response Theory.
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DOI：
10.1177/0363546520953440
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Nelson LD
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文献类型：
--
作者：
Wilmoth K;Magnus BE;McCrea MA;Nelson LD
症状评估是脑震荡诊断和管理的关键组成部分，项目选择主要由临床判断或专家共识驱动。我们最近证明，由运动脑震荡评估工具（SCAT）评估的脑震荡症状基本上是单维度的，这意味着用相对较少的问题就可以准确估计总体症状严重程度。更简短、基于证据的症状评估表格将为临床医生提供灵活性。
利用项目反应理论（IRT）分析，我们开发并验证了一种对一般脑震荡症状严重程度的简化评估方法。
前瞻性纵向队列研究
265名受伤运动员和235名匹配的队友对照在脑震荡后24 - 48小时以及8天、15天和45天完成了广泛的临床评估（SCAT3/5、脑震荡后即时认知测试、平衡错误评分系统和简明症状量表 - 18全球严重程度指数）。使用IRT项目信息曲线选择症状检查表简表（3 - 14项，源自最初的22项）。对各表格进行了内部一致性信度（克朗巴赫α系数）、与同时评估的标准测量值的相关性（即急性神经认知表现、平衡和情绪症状）、预测效度（与症状持续时间的相关性）以及脑震荡组和对照组之间的差异（科恩d值）的检验。使用从对照组得出的可靠变化指数估计并比较了各表格的敏感度和假阳性率。
在3 - 22项的表格中，内部一致性良好（克朗巴赫α系数为0.90 - 0.94）。所有简表的临床相关性均显著（P ≤ 0.017）且程度相似。在24 - 48小时（科恩d值为1.27 - 1.51）和8天随访（科恩d值为0.31 - 0.44）时，各表格的组间差异置信区间有重叠。各简表的敏感度相似，对照组的假阳性率较低。
我们的研究结果表明，即使是超短（3项）的量表也能在受伤后24 - 48小时对总体脑震荡症状严重程度提供足够可靠和有效的估计。SCAT的未来修订版可以删除低效项目，不过在更大样本中进行重复验证以及扩展到其他伤后时间点是有必要的。
简表可以在需要快速评估和分诊的环境（例如运动赛场边）中快速筛查总体脑震荡症状严重程度。不过，它并不旨在替代随访期间的全面临床评估。
Symptom assessment is a critical component of concussion diagnosis and management, with item selection primarily driven by clinical judgment or expert consensus. We recently demonstrated that concussion symptoms assessed by the Sport Concussion Assessment Tool (SCAT) are essentially unidimensional, implying that overall symptom severity may be accurately estimated with relatively few questions. Briefer, evidence-based forms for symptom assessment would provide clinicians flexibility. Using item response theory (IRT) analyses, we developed and validated an abbreviated assessment of general concussion symptom severity. Prospective, longitudinal cohort study Broad clinical assessments (SCAT3/5, Immediate Post-Concussion and Cognitive Testing, Balance Error Scoring System, and Brief Symptom Inventory-18 Global Severity Index) were completed by 265 injured athletes and 235 matched teammate controls at 24–48 hours and 8, 15, and 45 days post-concussion. Symptom checklist short forms (3–14 items, from the original 22) were selected using IRT item information curves. Internal consistency reliability (Cronbach’s alpha), correlation with criterion measures assessed concurrently (i.e., acute neurocognitive performance, balance, and emotional symptoms), predictive validity (correlations with symptom duration), and differences between concussed and control groups (Cohen’s d) were examined across forms. Sensitivity and false positive rates of the forms were estimated and compared using reliable change indices derived from controls. Across the 3- to 22-item forms, internal consistency was excellent (Cronbach’s alphas were .90–.94). Clinical correlations were significant (P ≤ .017) and to similar degrees for all short forms. Group difference confidence intervals overlapped across forms at 24–48-hour (Cohen’s ds 1.27–1.51) and 8-day follow-up (Cohen’s ds 0.31–0.44). Sensitivity remained similar across short forms, with a low false positive rate in controls. Our findings suggest that even an ultra-short (3-item) inventory provides sufficiently reliable and valid estimates of overall concussion symptom severity 24–48 hours post-injury. Future revisions of the SCAT could eliminate inefficient items, though replication in larger samples and extension to other post-injury time points is warranted. Short forms can quickly screen global concussion symptom severity in settings requiring rapid evaluation and triage (e.g., sport sideline). Although, it not intended to replace comprehensive clinical evaluation during follow-up.
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DOI：
10.1017/s1355617712000872
发表时间：
2013-01-01
影响因子：
2.6
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DOI：
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发表时间：
2018-09-01
影响因子：
2.6
作者：
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通讯作者：
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影响因子：
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