Concordance of patient and family report of neurobehavioral symptoms at 1 year after traumatic brain injury

Objective: To determine concordance between patient and family report of neurobehavioral symptoms and problems across 6 domains of function and 3 levels of injury severity at 1 year after traumatic brain injury (TBI). Design: Prospective longitudinal design with follow-up between 10 and 14 months postinjury. Setting: Seventeen Traumatic Brain Injury Model Systems centers. Participants: A total of 267 adults with primarily moderate and severe TBI who had completed self-ratings and whose neurobehavioral symptoms had also been rated by their significant others. Interventions: Not applicable. Main Outcome Measures: Neurobehavioral Functioning Inventory-Revised, a 70-item scale with subscales assessing frequency of symptoms in motor, somatic, memory and attention, depression, communication, and aggression domains. Results: Twenty-three items showed significant differences or trends between the self- and other ratings; 18 of these were in the direction of the injured individual reporting less frequent problems. Differences were most pronounced on the depression, aggression, and memory and attention subscales. On the latter 2 subscales, patient-family concordance was higher for those with less severe injuries. However, severity effects were not clear cut. Analyses of selected rating patterns indicating clinically significant "underreporting" of symptoms revealed that these affected the depression, aggression, and memory and attention subscales more than the motor or somatic subscales. Conclusions: At 1 year post-TBI, concordance between self- and other report of neurobehavioral symptoms was moderately high overall, but varied by symptom domain. For per- sons with moderate and severe TBI, reports from significant others may be needed for a full picture of the range, severity, and clinical importance of the patient's emotional, behavioral, and cognitive difficulties.