Abstract:
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 post traumatic brain injury (TBI).

Design: Prospective longitudinal design with follow-up between 10 and 14 months post injury.

Setting: 17 TBI Model System centers.

Patients: 267 adults with primarily moderate and severe TBI who had completed self-ratings and also had significant other ratings of neurobehavioral symptoms.

Main Outcome Measures: Neurobehavioral Functioning Inventory, Revised (NFI-R), a 70-item scale with subscales assessing frequency of symptoms in Motor, Somatic, Memory/ Attention, Depression, Communication and Aggression domains.

Results: 23 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/ Attention subscales. On the latter two scales, 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 under-reporting of symptoms revealed that these affected the Depression, Aggression, and Memory/ Attention subscales more than the Motor or Somatic scales.

Conclusions: At 1 year post TBI, concordance between self- and other-report of neurobehavioral symptoms is moderately high overall, but varies by symptom domain. For persons with moderate and severe TBI, reports of significant others may be needed for a full picture of the range, severity and clinical importance of emotional, behavioral and cognitive difficulties.