Central Curation of Glasgow Outcome Scale-Extended Data: Lessons Learned from TRACK-TBI. J Neurotrauma 2021 Sep 01;38(17):2419-2434
Date
04/10/2021Pubmed ID
33832330Pubmed Central ID
PMC8390785DOI
10.1089/neu.2020.7528Scopus ID
2-s2.0-85114327884 (requires institutional sign-in at Scopus site) 6 CitationsAbstract
The Glasgow Outcome Scale (GOS) in its original or extended (GOSE) form is the most widely used assessment of global disability in traumatic brain injury (TBI) research. Several publications have reported concerns about assessor scoring inconsistencies, but without documentation of contributing factors. We reviewed 6801 GOSE assessments collected longitudinally, across 18 sites in the 5-year, observational Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. We recorded error rates (i.e., corrections to a section or an overall rating) based on site assessor documentation and categorized scoring issues, which then informed further training. In cohort 1 (n = 1261; February 2014 to May 2016), 24% of GOSEs had errors identified by central review. In cohort 2 (n = 1130; June 2016 to July 2018), acquired after curation of cohort 1 data, feedback, and further training of site assessors, the error rate was reduced to 10%. GOSE sections associated with the most frequent interpretation and scoring difficulties included whether current functioning represented a change from pre-injury (466 corrected ratings in cohort 1; 62 in cohort 2), defining dependency in the home and community (163 corrections in cohort 1; three in cohort 2) and return to work/school (72 corrections in cohort 1; 35 in cohort 2). These results highlight the importance of central review in improving consistency across sites and over time. Establishing clear scoring criteria, coupled with ongoing guidance and feedback to data collectors, is essential to avoid scoring errors and resultant misclassification, which carry potential to result in "failure" of clinical trials that rely on the GOSE as their primary outcome measure.
Author List
Boase K, Machamer J, Temkin NR, Dikmen S, Wilson L, Nelson LD, Barber J, Bodien YG, Giacino JT, Markowitz AJ, McCrea MA, Satris G, Stein MB, Taylor SR, Manley GT, TRACK-TBI InvestigatorsAuthors
Michael McCrea PhD Professor in the Neurosurgery department at Medical College of WisconsinLindsay D. Nelson PhD Associate Professor in the Neurosurgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultBrain Injuries, Traumatic
Disability Evaluation
Female
Glasgow Outcome Scale
Humans
Longitudinal Studies
Male
Middle Aged
Recovery of Function
Reproducibility of Results
United States
Young Adult