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Towards a Better Measure of Brain Injury Outcome: New Measures or a New Metric?

  • Jacob Kean
    Affiliations
    Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN

    Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN

    Regenstrief Institute, Indianapolis, IN
    Search for articles by this author
  • James F. Malec
    Correspondence
    Corresponding author James F. Malec, PhD, ABPP-Cn, Rp, Professor and Research Director, Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, 4141 Shore Dr, Indianapolis, IN 46254.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN

    Rehabilitation Hospital of Indiana, Indianapolis, IN
    Search for articles by this author
Published:April 11, 2014DOI:https://doi.org/10.1016/j.apmr.2014.03.023
      An audio podcast accompanies this article.
      The Glasgow Outcome Scale (GOS), its successor the Glasgow Outcome Scale-Extended (GOSE),
      • Wilson J.L.
      • Pettigrew L.E.
      • Teasdale G.M.
      Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use.
      and the Disability Rating Scale (DRS)
      • Rappaport M.
      • Hall K.
      • Hopkins K.
      • Belleza T.
      • Cope D.
      Disability Rating Scale for severe head trauma: coma to community.
      represent a desire for a single outcome score that can be used to track the progression of a patient with brain injury (BI) from coma to community. Although the GOS/GOSE and DRS have been rightly criticized for their psychometric and other limitations,
      • Hall K.
      • Cope D.
      • Rappaport M.
      Glasgow Outcome Scale and Disability Rating Scale: comparative usefulness in following recovery in traumatic head injury.
      • Hall K.M.
      • Bushnik T.
      • Lakisic-Kazazic B.
      • Wright J.
      • Cantagallo A.
      Assessing traumatic brain injury outcome measures for long-term follow-up of community-based individuals.
      • Hall K.M.
      • Hamilton B.B.
      • Gordon W.A.
      • Zasler N.D.
      Characteristics and comparisons of functional assessment indices: Disability Rating Scale, Functional Independence Measure, and Functional Assessment Measure.
      these scales span the major domains of the International Classification of Functioning, Disability and Health—that is, bodily functions, activities, and participation.
      World Health Organization
      International Classification of Functioning, Disability and Health: ICF.
      These early outcomes scales also map directly onto the conceptual domains identified as representing outcome in 2010 by the Common Data Elements (CDE) Task Force (fig 1). Two of the areas targeted by the CDE Task Force but not explicitly mentioned by the GOSE and DRS—behavioral function and neuropsychological impairment—may be considered more detailed and objective measurements of cognitive limitations that are clearly targeted as outcome indicators by both the GOSE and DRS. The additional domains identified by the CDE Task Force (health economic measures, patient-reported outcomes) represent, in the former case, an outcome indicator that does not reside within the person with BI, and in the latter case, a domain that overlaps with other domains.
      Figure thumbnail gr1
      Fig 1Brain injury outcome domains and recommended measures. Abbreviations: CHART-SF, The Craig Handicap Assessment and Reporting Technique–Short Form; PART, Participation Assessment with Recombined Tools; TBI, traumatic brain injury.

      List of abbreviations:

      BI (brain injury), CDE (Common Data Elements), DRS (Disability Rating Scale), GOS (Glasgow Outcome Scale), GOSE (Glasgow Outcome Scale–Extended), SES (socioeconomic status), TBIMS (Traumatic Brain Injury Model Systems)
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