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Abstract
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In their wide ranging and impressive Commission of traumatic brain injury (TBI), Andrew Maas and colleagues recommend the development and validation of multidimensional outcome constructs that quantify overall burden of disability from TBI. Their observation that there are already nearly 1000 assessment instruments to consider is one of many challenges that need to be overcome to achieve this aim.
Outcome assessment after TBI is complicated by factors previous to the injury, as well as injury factors and the patient's response to the environment—whether psychological, social, or physical—at various stages of recovery. Hence, many measures (eg, cognition or quality of life) that might be included in a clinical assessment tool to improve sensitivity are, by their nature, strongly affected by sociodemographic and psychological factors, and fundamentally lack specificity in detecting consequences of the initial brain injury. For any such tool to have utility, practical considerations that include time, cost, and completeness of follow-up are vital in both clinical and research contexts. Hence, a balance has to found between attempting to build a picture of the complex and variable array of factors responsible for an individual's current presentation and using an overall index of survival and social handicap to characterise, classify, and compare patient groups. The option of selecting from a range of validated tools to answer questions specific to the clinical or research focus, in addition to assessing a global outcome, should not be overlooked. New approaches being investigated include formative measures composed of indicators that together determine the construct of outcome after head injury...
Language: en |