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E-ISSN : 2733-4538
본 연구는 외상성 뇌손상 심도에 따른 시계 그리기 검사(Clock Drawing Test: CDT)와 Hutt식 벤다형태검사(Hutt Adaptation of the Bender Gestalt Test: HABGT)의 변별 효율성을 알아보고자 하였다. 두부외상을 경험한 환자 90명을 의식소실 기간과 뇌 영상 검사결과에 따라 뇌손상 없음, 경도에서 중등도의 뇌손상, 고도의 뇌손상 집단으로 분류하고, 연령과 교육수준을 균등화시켰다. 각 집단간에 CDT 및 HABGT의 채점 체계인 정신병리 척도, 접근-기피 척도, 형태적 분석법, Lacks 방식의 평균을 비교하였고, 각 도구의 절단점, 효율성, 민감도, 특이도, +LR 및 -LR을 산출하였으며, ROC 곡선 비교를 통해 이 도구들의 상대적인 진단적 효율성을 알아보았다. 그 결과, 뇌손상이 없는 집단과 고도의 뇌손상 집단은 CDT와 HABGT의 네 가지 채점 체계 모두에서 유의한 차이를 보였으나 뇌손상이 없는 집단과 경도에서 중등도의 뇌손상 집단간에는 유의한 차이가 없었다. CDT와 HABGT의 네 가지 채점 체계 모두 뇌손상이 없는 집단과 고도의 뇌손상 집단을 효율적으로 변별하였고, 그 중 가장 효율성이 높은 것은 CDT와 정신병리척도, Lacks 방식이었으나 다른 집단들에서는 효율성이 떨어졌다. 끝으로 본 연구의 시사점, 제한점 및 향후 연구방향을 논의하였다.
The purpose of this study was to examine the differential efficiencies of the Clock Drawing Test (CDT) and the Hutt Adaptation of the Bender Gestalt Test (HABGT) depending on the severity of traumatic brain injury (TBI). Ninety patients with traumatic head injury, matched age and education level, were classified into the three groups on the length of the loss of consciousness and the result of brain imaging test: non-brain injured, mild to moderate brain injured, and severe brain injured group. For three groups, the Means of CDT and the four scoring systems of HABGT (the psychopathology scale, the adience-abience scale, the configurational approach, and the Lacks adaptation of the Hutt-Briskin scoring system) were compared. Additionally, the cut-off scores, efficiencies, sensitivities, specificities, positive likelihood ratio, and negative likelihood ratio of each method were estimated for three groups as well as being compared the relative diagnostic efficiencies with Receiver Operating Characteristic (ROC) Curve. As a result, there were significant differences between the non-brain injured group and the severe brain injured group for the scores of the CDT and the four scoring systems of HABGT, but not the mild to moderate brain injured group and the non-brain injured group. All methods significantly differentiated the severe brain injured group from the non-brain injured group, but those differential efficiencies were lowered between other two groups. The most efficient methods for detecting the severity of TBI were the CDT, the psychopathology scale, and Lacks adaptation of the Hutt-Briskin scoring system. Finally, the suggestions, limitations and further issues for future study were discussed.
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