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Assessing Aggression Following Traumatic Brain Injury: A Systematic Review of Validated Aggression Scales

Cusimano, Michael D. MD, PhD, FRCSC, FACS; Holmes, Scott A. MSc; Sawicki, Carolyn BSc; Topolovec-Vranic, Jane PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: March/April 2014 - Volume 29 - Issue 2 - p 172–184
doi: 10.1097/HTR.0b013e31827c7d15
Original Articles

Background: Every year, millions of people worldwide suffer traumatic brain injuries (TBIs). Aggressive behavior, a known psychological symptom following TBI, has been regarded as an obstacle toward rehabilitation. Having measures that accurately assess aggression during rehabilitation is critical toward proper evaluation.

Objective: To undertake a systematic review of the validated scales used to assess aggression in the postacute stage (≥3 months) after sustaining a TBI in the adult population. A comprehensive search was performed and studies meeting the inclusion criteria were reviewed in full. Quality and validity of supporting articles were assessed via the Downs and Black and QUADAS checklists along with their supporting statistics.

Results: A total of 1329 articles were reviewed from the literature. Thirty-two were reviewed in detail and 6 studies eventually passed the exclusion criteria. Of these, 6 neuropsychological scales were represented pertaining to the measurement of aggressive behavior; however, only 1 directly addressed the validity of their scale's aggression component.

Conclusions: Further research is required to establish the validity of scales that specifically address aggression for use in the adult TBI population which could be used to support rehabilitation and social reintegration strategies.

Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre, Division of Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (Dr Cusimano); Department of Neurology and Neurosurgery, McGill University; Montreal, Quebec, Canada (Mr Holmes); University of Western Ontario; London, Ontario, Canada (Ms Sawicki); and Li Ka Shing Knowledge Institute, Trauma and Neurosurgery Program and Keenan Research Centre, St Michael's Hospital, Toronto, Ontario (Dr Topolovec-Vranic), Canada.

Corresponding Author: Michael D. Cusimano, MD, PhD, FRCSC, FACS, Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre, Division of Neurosurgery, St Michael's Hospital, University of Toronto, 30 Bond St, Toronto, ON, Canada, M5B 1W8 (injuryprevention@smh.toronto.on.ca).

The authors represent the Canadian Brain Injury and Violence Research Team. This research was supported by the Canadian Institutes of Health Research Strategic Team Grant in Applied Injury Research #TIR-103946 and funding from the Ontario Neurotrauma Foundation and St Michael's Hospital Foundation.

The authors decalre no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins