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




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.


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.


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.


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.





Human Services and Justice Coordinating Committee