Validity of the Brief Test of Adult Cognition by Telephone in Level 1 Trauma Center Patients Six Months Post-Traumatic Brain Injury: A TRACK-TBI Study

J Neurotrauma. 2021 Apr 15;38(8):1048-1059. doi: 10.1089/neu.2020.7295. Epub 2020 Dec 14.


Our objective was to examine the construct validity of the Brief Test of Adult Cognition by Telephone (BTACT) and its relationship to traumatic brain injury (TBI) of differing severities. Data were analyzed on 1422 patients with TBI and 170 orthopedic trauma controls (OTC) from the multi-center Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Participants were assessed at 6 months post-injury with the BTACT and an in-person neuropsychological battery. We examined the BTACT's factor structure, factorial group invariance, convergent and discriminant validity, and relationship to TBI and TBI severity. Confirmatory factor analysis supported both a 1-factor model and a 2-factor model comprising correlated Episodic Memory and Executive Function (EF) factors. Both models demonstrated strict invariance across TBI severity and OTC groups. Correlations between BTACT and criterion measures suggested that the BTACT memory indices predominantly reflect verbal episodic memory, whereas the BTACT EF factor correlated with a diverse range of cognitive tests. Although the EF factor and other BTACT indices showed significant relationships with TBI and TBI severity, some group effect sizes were larger for more comprehensive in-person cognitive tests than the BTACT. The BTACT is a promising, brief, phone-based cognitive screening tool for patients with TBI. Although the BTACT's memory items appear to index verbal Episodic Memory, items that purport to assess EFs may reflect a broader array of cognitive domains. The sensitivity of the BTACT to TBI severity is lower than domain-specific neuropsychological measures, suggesting it should not be used as a substitute for comprehensive, in-person cognitive testing at 6 months post-TBI.

Keywords: BTACT; Brief Test of Adult Cognition by Telephone; phone-based cognitive assessment; telemedicine; traumatic brain injury.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Brain Injuries, Traumatic / diagnosis*
  • Brain Injuries, Traumatic / psychology*
  • Brain Injuries, Traumatic / therapy
  • Cognition / physiology
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / psychology*
  • Cognition Disorders / therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mental Recall / physiology
  • Middle Aged
  • Neuropsychological Tests / standards*
  • Prospective Studies
  • Reproducibility of Results
  • Telephone / standards
  • Time Factors
  • Trauma Centers / standards*