Preliminary evaluation of a measure for reliable assessment of need for constant visual observation in adults with traumatic brain injury

Abstract

Primary objective: To develop and provide initial validation of a measure for accurately determining the need for Constant Visual Observation (CVO) in patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation.

Research design: Rating scale development and evaluation through Rasch analysis and assessment of concurrent validity.

Methods and procedures: One hundred and thirty-four individuals with moderate–severe TBI were studied in seven inpatient brain rehabilitation units associated with the National Institute for Disability, Independent Living and Rehabilitation Research (NIDILRR) TBI Model System. Participants were rated on the preliminary version of the CVO Needs Assessment scale (CVONA) and, by independent raters, on the Levels of Risk (LoR) and Supervision Rating Scale (SRS) at four time points during inpatient rehabilitation: admission, Days 2–3, Days 5–6 and Days 8–9.

Outcomes and results: After pruning misfitting items, the CVONA showed satisfactory internal consistency (Person Reliability = 0.85–0.88) across time points. With reference to the LoR and SRS, low false negative rates (sensitivity > 90%) were associated with moderate-to-high false positive rates (29–56%).

Conclusions: The CVONA may be a useful objective metric to complement clinical judgement regarding the need for CVO; however, further prospective study is desirable to further assess its utility in identifying at-risk patients, reducing adverse events and decreasing CVO costs.

Keywords:

• Brain injury
• rehabilitation
• patient safety
• safety management
• Behavior Rating Scale

Acknowledgement

The authors are grateful to the following individuals for their assistance in study recruitment and implementation at the various study sites: Mary Ferraro, PhD, OTR/L, Lisa Pinder, RN, BSN, CRRN, Rachelle Rigous, RN, BSN, CRRN (Drucker Brain Injury Center, MossRehab); Mary Gordon, RN, BSN, CRRN, Leanne Scroggins, MSN, CRRN (Mayo Clinic, Department of Nursing); Batya Geft, PT, Jason van de Ven, OTR/L BOT, Debra Zeitlin, MS CCC/SLP CBIS (Mount Sinai Hospital, Department of Rehabilitation Medicine); Lynne M. Genter, MS,RN,CRRN, Michele Rinkes, RN, CRRN (Ohio State University, Wexner Medical Center); Mark Williams, RN (Rehabilitation Hospital of Indiana, Department of Neuropsychology).

Declaration of interest

The authors report no conflicts of interest. The contents of this report were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) for the Baylor Institute for Rehabilitation (Dallas, TX); Mayo Clinic (Rochester, MN); MossRehab (Philadelphia, PA); Mount Sinai Rehabilitation Center (New York, NY); University of Pittsburgh Medical Center (Pittsburgh, PA); Indiana University/Rehabilitation Hospital of Indiana TBI Model System (USDE-90DP0036-01-00); and the Ohio Regional TBI Model System at Ohio State University (Columbus, OH) (USDE-90DP0040-01-00). NIDILRR is a Centre within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this report do not necessarily represent the policy of NIDILRR, ACL, HHS and endorsement by the Federal Government should not be assumed. At the time this study was conducted, Ms. Schmerzler was employed by The Mount Sinai Hospital Department of Rehabilitation Medicine.