Normative and Psychometric Characteristics of the Health and Behavior Inventory Among Children With Mild Orthopedic Injury Presenting to the Emergency Department: Implications for Assessing Postconcussive Symptoms Using the Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5)

Abstract

Objective: The study sought to present normative and psychometric data and reliable change formulas for the Health and Behavior Inventory (HBI), a postconcussive symptom rating scale embedded in the Child Sport Concussion Assessment Tool 5th edition (Child SCAT5). Design: Prospective cohort study with longitudinal follow-up. Setting: Pediatric emergency departments (EDs). Participants: As part of 3 studies conducted in the United States and Canada between 2001 and 2019, 450 children aged 8 to 16 years with mild orthopedic injuries were recruited during ED visits and assessed postacutely (M = 9.38 days, SD = 3.31) and 1 month and 3 months postinjury. Independent variables were rater (child vs parent), sex, and age at injury. Main Outcome Measure: HBI ratings. Methods: Children and parents rated children's symptoms at each time point; parents also rated children's preinjury symptoms retrospectively. Normative data (mean, SD, skewness, kurtosis, and percentiles) were computed for child and parent ratings. Internal consistency was assessed using Cronbach alpha (α), and test–retest reliability and interrater agreement were assessed with intraclass correlations (ICCs). Reliable change formulas were computed using linear regression and mixed models. Results: HBI ratings were positively skewed. Mean ratings and percentiles were stable over time. Child and parent ratings demonstrated good-to-excellent internal consistency (α 0.76-0.94) and moderate-to-good test–retest reliability (ICC 0.51-0.76 between adjacent assessments). However, parent–child agreement was poor to moderate (ICC 0.31-0.69). Conclusions: The HBI demonstrates acceptable normative and psychometric characteristics. Modest parent–child agreement highlights the importance of multiple informants when assessing postconcussive symptoms. The results will facilitate the use of the HBI in research and clinical practice.

Longitudinal white matter microstructural changes in pediatric mild traumatic brain injury: An A‐CAP study

“…Total premorbid (pre‐injury) symptoms were rated by parents during the post‐acute visit, and total post‐injury symptoms were rated by both parents and children weekly and also at each follow‐up assessment (Ayr et al, 2009). A reliable change index ( z ‐score) score comparing total 1‐month post‐injury symptom scores to premorbid scores was calculated using the following formulas based on regression analyses using data from the OI group for child ratings (O'Brien et al, 2021): and parent ratings: Results were used to classify children with mTBI into two groups using a critical z ‐score >1.65 (one‐tailed p <.05): (i) children with mTBI and persistent symptoms (significant increase at 1‐month post‐injury relative to premorbid) and (ii) without persistent symptoms (no significant increase at 1‐month post‐injury relative to premorbid) (Ledoux et al, 2019; Mayer et al, 2020).…”

“…The Health and Behavior Inventory was used to assess cognitive and somatic symptoms. This measure has good internal consistency and test–retest reliability, and has been adopted as a core measure in the common data elements for pediatric TBI (Adelson et al, 2012 ; McCauley et al, 2012 ; O'Brien et al, 2021 ). Total premorbid (pre‐injury) symptoms were rated by parents during the post‐acute visit, and total post‐injury symptoms were rated by both parents and children weekly and also at each follow‐up assessment (Ayr et al, 2009 ).…”

“…A reliable change index (z-score) score comparing total 1-month postinjury symptom scores to premorbid scores was calculated using the following formulas based on regression analyses using data from the OI group for child ratings (O'Brien et al, 2021):…”

Cerebral Hemodynamics and Microvasculature Changes in Relation to White Matter Microstructure After Pediatric Mild Traumatic Brain Injury: An A-CAP Pilot Study

“…Assessments were completed ∼36 days post-injury ( M = 35.73, SD = 5.02). At this time point, the Health and Behavior Inventory 20 was completed by the child, and somatic (OI = 3.25 ± 3.77; mTBI = 3.71 ± 5.35) and cognitive (OI = 4.75 ± 8.22; mTBI = 7.86 ± 9.28) scores were computed (shown as mean and standard deviation).…”

Can quantitative susceptibility mapping help diagnose and predict recovery of concussion in children? An A-CAP study

“…Additionally, parents and children provided weekly ratings on the HBI for the first 3 months, and then biweekly from 3 to 6 months, using a mobile phone application or web-based survey. Two standard subscale scores were calculated, representing cognitive and somatic symptoms 21…”