[BMJ Open] New predictive model for microsurgical outcome of intracranial arteriovenous malformations: study protocol [颅内动静脉畸形显微外科手术疗效预测新模型：研究方案]

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Authors
Minxue Shen, Ming Hu, Zhenqiu Sun

Abstract
Objectives To develop and validate brief scales to measure common emotional and behavioural problems among adolescents in the examination-oriented education system and collectivistic culture of China.

Setting Middle schools in Hunan province.

Participants 5442 middle school students aged 11–19 years were sampled. 4727 valid questionnaires were collected and used for validation of the scales. The final sample included 2408 boys and 2319 girls.

Primary and secondary outcome measures The tools were assessed by the item response theory, classical test theory (reliability and construct validity) and differential item functioning.

Results Four scales to measure anxiety, depression, study problem and sociality problem were established. Exploratory factor analysis showed that each scale had two solutions. Confirmatory factor analysis showed acceptable to good model fit for each scale. Internal consistency and test–retest reliability of all scales were above 0.7. Item response theory showed that all items had acceptable discrimination parameters and most items had appropriate difficulty parameters. 10 items demonstrated differential item functioning with respect to gender.

Conclusions Four brief scales were developed and validated among adolescents in middle schools of China. The scales have good psychometric properties with minor differential item functioning. They can be used in middle school settings, and will help school officials to assess the students’ emotional/behavioural problems.