The neurobehavioural rating scale-revised: Sensitivity and validity in closed head injury assessment

S. R. McCauley, H. S. Levin, M. Vanier, J. M. Mazaux, C. Boake, P. R. Goldfader, D. Rockers, M. Butters, D. A. Kareken, J. Lambert, G. L. Clifton

Research output: Contribution to journalArticle

55 Scopus citations


Objectives - To investigate the factor structure and psychometric properties of the neurobehavioural rating scale-revised (NRS-R) and to determine its usefulness in clinical trials. Methods - A consecutive series of patients sustaining severe closed head injury were evacuated to one of 11 large regional North American trauma centres and entered into a randomised, phase III, multicentre clinical trial investigating the therapeutic use of moderate hypothermia. Acute care personnel were blinded to outcome and outcome personnel were blinded to treatment condition. The Glasgow outcome scale (GAS) was the primary outcome measure. Secondary outcome measures included the disability rating scale (DRS) and the NRS-R. Results - Exploratory factor analysis of NRS-R data collected at 6 months after injury (n=210) resulted in a five factor model including: (1) executive/cognition, (2) positive symptoms, (3) negative symptoms, (4) mood/affect, and (5) oral/motor. These factors showed acceptable internal consistency (0.62 to 0.88), low to moderate interfactor correlations (0.19 to 0.61), and discriminated well between Gas defined groups. Factor validity was demonstrated by significant correlations with specific neuropsychological domains. Significant change was measured from 3 to 6 months after injury for the total score (sum of all 29 item ratings) and all factor scores except mood/affect and positive symptoms. The total score and all factor scores correlated significantly with concurrent Gas and DRS scores. Conclusions - The NRS-R is well suited as a secondary outcome measure for clinical trials as its completion rate exceeds that of neuropsychological assessment and it provides important neurobehavioural information complementary to that provided by global outcome and neuropsychological measures.

Original languageEnglish (US)
Pages (from-to)643-651
Number of pages9
JournalJournal of Neurology Neurosurgery and Psychiatry
Issue number5
StatePublished - Nov 1 2001


  • Head injury
  • Neurobehavioural sequelae
  • Outcome measures
  • Randomised clinical trials

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Neuroscience(all)
  • Psychiatry and Mental health

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    McCauley, S. R., Levin, H. S., Vanier, M., Mazaux, J. M., Boake, C., Goldfader, P. R., Rockers, D., Butters, M., Kareken, D. A., Lambert, J., & Clifton, G. L. (2001). The neurobehavioural rating scale-revised: Sensitivity and validity in closed head injury assessment. Journal of Neurology Neurosurgery and Psychiatry, 71(5), 643-651.