Diagnostic Accuracy, Sensitivity, and Specificity of Executive Function Tests in Moderate Traumatic Brain Injury in Ghana

Abstract

The sociocultural differences between Western and sub-Saharan African countries make it imperative to standardize neuropsychological tests in the latter. However, Western-normed tests are frequently administered in sub-Saharan Africa because of challenges hampering standardization efforts. Yet a salient topical issue in the cross-cultural neuropsychology literature relates to the utility of Western-normed neuropsychological tests in minority groups, non-Caucasians, and by extension Ghanaians. Consequently, this study investigates the diagnostic accuracy, sensitivity, and specificity of executive function (EF) tests (The Stroop Test, Trail Making Test, and Controlled Oral Word Association Test), and a Revised Quick Cognitive Screening Test (RQCST) in a sample of 50 patients diagnosed with moderate traumatic brain injury and 50 healthy controls in Ghana. The EF test scores showed good diagnostic accuracy, with area under the curve (AUC) values of the Trail Making Test scores ranging from .746 to .902. With respect to the Stroop Test scores, the AUC values ranged from .793 to .898, while Controlled Oral Word Association Test had AUC value of .787. The RQCST scores discriminated between the groups, with AUC values ranging from .674 to .912. The AUC values of composite EF score and a neuropsychological score created from EF and RQCST scores were .936 and. 942, respectively. Additionally, the Stroop Test, Trail Making Test, EF composite score, and RQCST scores showed good to excellent sensitivities and specificities. In general, this study has shown that commonly used EF tests in Western countries have diagnostic accuracy, sensitivity, and specificity when administered in Ghanaian samples. The findings and implications of the study are discussed.

On the utility of the trail making test in migraine with and without aura: a meta-analysis

“…The TMT has reasonably high sensitivity, specificity and test-retest reliability from a clinical viewpoint [39,40]; cf. [41].…”

Factorial and convergent validity of the Youth Psychopathic Traits Inventory‐Short Version in Ghana

“…It follows that developing culture‐specific psychopathy assessment measures in Ghana is desirable. However, efforts to undertake this very important exercise have been hindered by resource and logistic constraints (Adjorlolo, ), thus necessitating the use of measures constructed in different cultural settings. Even though this could contribute to cross‐cultural discussions on psychopathy, the previous commentaries and studies (e.g., Adjorlolo, 2016) suggest the need to elucidate their appropriateness in new settings.…”

Oculomotor Behavior as a Biomarker for Differentiating Pediatric Patients With Mild Traumatic Brain Injury and Age Matched Controls

“…Significant area under the curve (AUC) with 95% confidence intervals (p < 0.05) was used to indicate the ability of each variable to differentiate concussed participants from non-concussed. We set our criteria for a satisfactorily accurate area under the curve (AUC) to the standard of least of 0.7 (Adjorlolo, 2018). We calculated cut-off points, sensitivity, specificity, and positive and negative predictive value (PPV and NPV, respectively) for each significant AUC.…”

“…Furthermore, clinicians do not usually use imagining for pediatric mTBI cases (Oakes, 2018). Therefore, The Graded Symptoms Checklist (GSC) in the Standardized Assessment of Concussion (SAC) was also used as a secondary clinical tool for measurement of mTBI as recommended by the Journal of the American Medical Association Pediatrics clinical guidelines (Adjorlolo, 2018;Lumba-Brown et al, 2018a,b). Though numerous, current methods of concussion detection are often subjective or lacking in their oculomotor components (Ventura et al, 2015).…”