378
T. Ownsworth et al.
Table I. Receiver operating characteristic (ROC) curve data for SADI Total Scores (State Variable) and Awareness Questionnaire
Discrepancy scores for Individuals with TBI (bold font represents the optimal balance between sensitivity and specificity)
SADI ≥ 2 (60%)
AUC: 0.82
(CI: 0.72–0.91)
SADI ≥ 3 (45%)
AUC: 0.88
(CI: 0.80–0.96)
SADI ≥ 4 (26%)
AUC: 0.87
(CI: 0.79–0.96)
SADI ≥ 5 (13%)
AUC: 0.88
(CI: 0.79–0.96)
SADI ≥ 6 (10%)
AUC: 0.88
(CI: 0.78–0.98)
AQ Discrepancy (% with ISA ) Sensitivity Specificity Sensitivity Specificity Sensitivity Specificity Sensitivity Specificity Sensitivity Specificity
≥ 2 (59)
≥ 3 (56)
≥ 4 (48)
≥ 5 (46)
≥ 6 (43)
≥ 7 (41)
≥ 8 (39)
≥ 9 (34)
≥ 10 (31)
≥ 11 (29)
≥ 12 (26)
≥ 13 (21)
0.72
0.78
0.84
0.84
0.91
0.91
0.91
0.97
0.97
0.97
0.97
0.97
0.89
0.89
0.81
0.78
0.75
0.75
0.72
0.67
0.61
0.58
0.53
0.42
0.66
0.70
0.80
0.80
0.84
0.86
0.89
0.93
0.93
0.95
0.95
0.95
0.95
0.95
0.95
0.95
0.91
0.91
0.86
0.81
0.76
0.71
0.67
0.52
0.54
0.58
0.70
0.71
0.75
0.76
0.78
0.83
0.85
0.86
0.82
0.89
1.0
1.0
1.0
1.0
0.90
0.90
0.90
0.90
0.90
0.90
0.90
0.60
0.47
0.50
0.60
0.62
0.64
0.66
0.69
0.74
0.77
0.80
0.83
0.84
1.0
1.0
1.0
1.0
0.88
0.88
0.88
0.88
0.88
0.88
0.88
0.63
0.46
0.49
0.58
0.60
0.62
0.64
0.67
0.72
0.75
0.78
0.81
0.89
AQ: Awareness Questionnaire; AUC: area under the curve; CI: 95 th lower and upper confidence intervals; ISA: impaired self-awareness; Self-Awareness of
Deficits Interview; TBI: traumatic brain injury.
Table II. Consistency of Classification of Impaired Self-Awareness between the Self-Awareness of Deficits Interview and Awareness
Questionnaire at Optimal Levels of Sensitivity and Specificity (bold font indicates consistent classification)
SADI score (% with ISA)
AQ discrepancy score
AUC (95 th CI)
Sensitivity
Specificity
0.79
0.79
0.69
0.67
0.65
0.63
0.58
0.54
0.46
0.42
0.33
0.25
Classification, n (%)
≥ 2 (60%)
AQ ≥ 2 (59%)
≥ 3 (45%)
AQ ≥ 4 (48%)
≥ 4 (26%)
AQ ≥ 9 (34%)
≥ 5 (13%)
AQ ≥ 12 (26%)
0.82 (0.72–0.91) 0.88 (0.80–0.96) 0.87 (0.79–0.96) 0.88 (0.79–0.96)
0.79
0.78 0.81
0.80 0.81
0.83 0.90
0.83
ISA
AQ ISA
38 (79.2)
AQ Good SA
10 (20.8)
Overall classification consistency, n (%) 76.3
Good SA
ISA
9 (28.1) 29 (80.6)
23 (71.9) 7 (19.4)
80
Good SA
ISA
9 (20.5) 17 (81.0)
35 (79.5) 4 (19.0)
83
Good SA ISA Good SA
10 (16.9)
49 (83.1) 9 (90)
1 (10)
84 12 (17.1)
58 (82.9)
AQ: Awareness Questionnaire; AUC: area under the curve; ISA: impaired self-awareness; SA: self-awareness.
DISCUSSION
Fig. 1. Receiver operating characteristic (ROC) curve indicating optimal
sensitivity and specificity of the Awareness Questionnaire discrepancy
score ≥ 4 relative to the Self-Awareness of Deficits Interview score ≥ 3.
www.medicaljournals.se/jrm
Good concordance between the AQ and SADI indica-
ted that the tools yield consistent information regarding
the presence of ISA in community-based individuals.
A 4-point AQ discrepancy corresponded to the SADI
score (≥ 3) that previously distinguished between good
and poor self-awareness groups and community outco-
mes (6). Classification consistency was also high when
adopting more conservative scores for ISA; namely,
SADI ≥ 4~AQ ≥ 9 or SADI ≥ 5~AQ ≥ 12.
These AQ discrepancies are smaller than ISA cut-offs
(> 20) in an inpatient sample (7). Given that self-awa-
reness typically improves following hospital discharge
(1, 8), smaller AQ discrepancies may be more sensi-
tive to detect persisting ISA in a community sample.
Accurate identification of ISA is imperative to guide
appropriate management and use of clinical resources.
Due to its brevity, the AQ is more feasible for routine
administration to detect ISA and determine the need for
metacognitive interventions. The SADI could be used
as a more comprehensive assessment to determine the
nature of awareness deficits (i.e. specific to a particular
functional domain or generalized across multiple do-
mains) and the extent to which individuals understand