INS NYC 2024 Program

Poster	Poster Session 03 Program Schedule 02/15/2024 09:30 am - 10:40 am Room: Majestic Complex (Posters 61-120) Poster Session 03: Neurotrauma \| Neurovascular Final Abstract #68 Factors Associated with Performance on the Medical Symptom Validity Test (MSVT) in a Diverse Sample of Pediatric TBI Patients Zachary Wood, Dell Medical School, University of Texas at Austin, Austin, United States Laura Winstone-Weide, Dell Medical School, University of Texas at Austin, Austin, United States Allison Shields, Dell Medical School, University of Texas at Austin, Austin, United States Kelly Gettig, Dell Medical School, University of Texas at Austin, Austin, United States Kimberly Mooney, Dell Medical School, University of Texas at Austin, Austin, United States Cynthia Austin, Dell Medical School, University of Texas at Austin, Austin, United States Category: Concussion/Mild TBI (Child) Keyword 1: concussion/ mild traumatic brain injury Keyword 2: performance validity Keyword 3: pediatric neuropsychology Objective: The use of Performance Validity Tests (PVT) in assessment following pediatric concussion/TBI has gained growing attention due to findings suggesting high rates of suboptimal effort within this population (approximately 20%). This study sought to better understand factors associated with PVT performance by examining group level differences between those who passed and those who failed the Medical Symptom Validity Test (MSVT; a commonly used measure of performance validity in pediatric populations). We were particularly interested in differences across domain-specific concussion symptoms (e.g., cognitive, emotional, physical, and fatigue) and cultural/demographic factors. We hypothesized that patient reported cognitive symptom severity would be elevated in the MSVT failure group. Participants and Methods: Participants included 149 individuals (55% female) ages 12-19 years (M = 15.48, SD = 1.34) who visited an outpatient concussion/TBI clinic at a children’s hospital in the southwest United States. Those with pre-existing neurological conditions or intellectual disability were excluded. A majority identified as Non-Hispanic White (52%) and approximately 40% identified as Hispanic. Participants completed English versions of the MSVT and Post-Concussion Symptom Inventory. Overall failure rate of the MSVT was approximately 21%, which is consistent with adult and pediatric concussion/mTBI literature. Results: Results indicated participants who failed the MSVT endorsed more concussion symptoms on average, t(51) = -2.95, p=0.002. More specifically, those who failed the MSVT reported higher cognitive, t(147)=-2.76, p=.003, and fatigue symptoms, t(147)=-2.45, p=.008, but not physical or emotional symptoms. While several variables were significantly associated with MSVT failure in this group (e.g., sex, time since injury, loss to follow up, cognitive symptoms, fatigue symptoms), logistic regression analysis suggested only female sex, β = -1.177, p = .026, and time since injury, β = -0.018, p < .001, were significantly associated with the likelihood of MSVT failure. This model explained more variance (29%) than one comprised only of cognitive and fatigue symptoms (8%). No statistically significant group level differences in pre-injury history of anxiety/depression, baseline symptoms, age, or ethnicity were observed. Conclusions: This study replicated and built upon previous research that found prolonged concussion symptoms and certain demographic variables were associated with MSVT failure. Female sex and longer time since injury were the most robust predictors of MSVT failure. Though individuals who failed the MSVT reported significantly higher cognitive and fatigue symptoms, higher symptom severity was not associated with an increased likelihood of MSVT failure after accounting for demographic risk factors. These results reinforce that cognitive complaints are common in those with prolonged concussion symptoms, but may not predict performance. We found similar MSVT performance across ethnic groups, which is reassuring when utilizing the MSVT in a diverse clinic setting. Overall, additional research exploring factors associated with MSVT failure in pediatric TBI/concussion populations is needed.

Poster

02/15/2024
09:30 am - 10:40 am
Room: Majestic Complex (Posters 61-120)

Poster Session 03: Neurotrauma | Neurovascular

Final Abstract #68

Factors Associated with Performance on the Medical Symptom Validity Test (MSVT) in a Diverse Sample of Pediatric TBI Patients

Zachary Wood, Dell Medical School, University of Texas at Austin, Austin, United States
Laura Winstone-Weide, Dell Medical School, University of Texas at Austin, Austin, United States
Allison Shields, Dell Medical School, University of Texas at Austin, Austin, United States
Kelly Gettig, Dell Medical School, University of Texas at Austin, Austin, United States
Kimberly Mooney, Dell Medical School, University of Texas at Austin, Austin, United States
Cynthia Austin, Dell Medical School, University of Texas at Austin, Austin, United States

Category: Concussion/Mild TBI (Child)

Keyword 1: concussion/ mild traumatic brain injury
Keyword 2: performance validity
Keyword 3: pediatric neuropsychology

Objective:

The use of Performance Validity Tests (PVT) in assessment following pediatric concussion/TBI has gained growing attention due to findings suggesting high rates of suboptimal effort within this population (approximately 20%). This study sought to better understand factors associated with PVT performance by examining group level differences between those who passed and those who failed the Medical Symptom Validity Test (MSVT; a commonly used measure of performance validity in pediatric populations). We were particularly interested in differences across domain-specific concussion symptoms (e.g., cognitive, emotional, physical, and fatigue) and cultural/demographic factors. We hypothesized that patient reported cognitive symptom severity would be elevated in the MSVT failure group.

Participants and Methods:

Participants included 149 individuals (55% female) ages 12-19 years (M = 15.48, SD = 1.34) who visited an outpatient concussion/TBI clinic at a children’s hospital in the southwest United States. Those with pre-existing neurological conditions or intellectual disability were excluded. A majority identified as Non-Hispanic White (52%) and approximately 40% identified as Hispanic. Participants completed English versions of the MSVT and Post-Concussion Symptom Inventory. Overall failure rate of the MSVT was approximately 21%, which is consistent with adult and pediatric concussion/mTBI literature.

Results:

Results indicated participants who failed the MSVT endorsed more concussion symptoms on average, t(51) = -2.95, p=0.002. More specifically, those who failed the MSVT reported higher cognitive, t(147)=-2.76, p=.003, and fatigue symptoms, t(147)=-2.45, p=.008, but not physical or emotional symptoms. While several variables were significantly associated with MSVT failure in this group (e.g., sex, time since injury, loss to follow up, cognitive symptoms, fatigue symptoms), logistic regression analysis suggested only female sex, β = -1.177, p = .026, and time since injury, β = -0.018, p < .001, were significantly associated with the likelihood of MSVT failure. This model explained more variance (29%) than one comprised only of cognitive and fatigue symptoms (8%). No statistically significant group level differences in pre-injury history of anxiety/depression, baseline symptoms, age, or ethnicity were observed.

Conclusions:

This study replicated and built upon previous research that found prolonged concussion symptoms and certain demographic variables were associated with MSVT failure. Female sex and longer time since injury were the most robust predictors of MSVT failure. Though individuals who failed the MSVT reported significantly higher cognitive and fatigue symptoms, higher symptom severity was not associated with an increased likelihood of MSVT failure after accounting for demographic risk factors. These results reinforce that cognitive complaints are common in those with prolonged concussion symptoms, but may not predict performance. We found similar MSVT performance across ethnic groups, which is reassuring when utilizing the MSVT in a diverse clinic setting. Overall, additional research exploring factors associated with MSVT failure in pediatric TBI/concussion populations is needed.