Criterion validity of the brief test of adult cognition by telephone (BTACT) for mild traumatic brain injury

There is a growing demand for remote assessment options for measuring cognition after mild traumatic brain injury (mTBI). The current study evaluated the criterion validity of the Brief Test of Adult Cognition by Telephone (BTACT) in distinguishing between adults with mTBI and trauma controls (TC) who sustained injuries not involving the head or neck. The BTACT was administered to the mTBI (n = 46) and TC (n = 35) groups at 1–2 weeks post-injury. Participants also completed the Rivermead Post Concussion Symptoms Questionnaire. The BTACT global composite score did not significantly differ between the groups (t(79) = −1.04, p = 0.30); the effect size was small (d = 0.23). In receiver operating characteristic curve analyses, the BTACT demonstrated poor accuracy in differentiating between the groups (AUC = 0.567, SE = 0.065, 95% CI [0.44, 0.69]). The BTACT’s ability to discriminate between mTBI and TCs did not improve after excluding mTBI participants (n = 15) who denied ongoing cognitive symptoms (AUC = 0.567, SE = 0.072, 95% CI [0.43, 0.71]). The BTACT may lack sensitivity to subacute cognitive impairment attributable to mTBI (i.e., not explained by bodily pain, post-traumatic stress, and other nonspecific effects of injury).

当前，轻度创伤性脑损伤（mild traumatic brain injury, mTBI）后认知功能评估的远程评估方案需求日益增长。本研究评估了电话版成人简易认知测试（Brief Test of Adult Cognition by Telephone, BTACT）区分轻度创伤性脑损伤患者与未累及头颈部的创伤对照组（trauma controls, TC）成人受试者的效标效度。研究于损伤后1~2周对轻度创伤性脑损伤组（n=46）与创伤对照组（n=35）施测该测试，所有受试者同时完成了Rivermead脑震荡后症状问卷（Rivermead Post Concussion Symptoms Questionnaire）。两组的电话版成人简易认知测试总分无显著差异（t(79) = -1.04, p = 0.30），效应量较小（d = 0.23）。受试者工作特征曲线（receiver operating characteristic curve, ROC）分析结果显示，该测试区分两组的准确性较差（AUC = 0.567, SE = 0.065, 95%置信区间CI = [0.44, 0.69]）。在剔除15名自述无持续性认知症状的轻度创伤性脑损伤受试者后，电话版成人简易认知测试区分两组的能力未得到提升（AUC = 0.567, SE = 0.072, 95%CI = [0.43, 0.71]）。该测试或许无法有效检测轻度创伤性脑损伤所致的亚急性认知损伤，即无法通过躯体疼痛、创伤后应激及其他损伤非特异性效应解释的认知损伤。