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Predictive Value of a New Brief Cognitive Test for Long-term Functional Outcome in Acute Traumatic Brain Injury

Published:March 17, 2022DOI:https://doi.org/10.1016/j.apmr.2022.02.015

      Highlights

      • Acute neuropsychological assessment using a new brief test to predict functional outcome in traumatic brain injury.
      • Administration of new brief test during the acute phase of traumatic brain injury to predict long-term functional outcome.

      Abstract

      Objective

      To determine how results on the EXAmen Cognitif abrégé en Traumatologie (EXACT), a new test specifically designed to briefly assess global cognitive functioning during the acute phase of traumatic brain injury (TBI), can predict long-term functional outcome compared with length of posttraumatic amnesia (PTA), a well-established predictor.

      Design

      Inception cohort.

      Settings

      Level 1 trauma center.

      Participants

      A total of 90 patients (N=90) hospitalized for a moderate or severe TBI.

      Interventions

      Not applicable.

      Main Outcome Measures

      Performance on the EXACT in the first 3 months after injury and results on the Disability Rating Scale (DRS) at follow-up 1-2 years later.

      Results

      EXACT scores were all correlated with length of PTA and DRS result. Compared with length of PTA, the EXACT added significantly to the regression and improved prediction of functional outcome. More specifically, a total score ≤80 on the EXACT was associated with a higher rate of long-term disability because of more severe TBI consequences. Behavioral regulation and executive functions were the cognitive domains that showed the most impairment, followed by attention and working memory as well as episodic memory. Except for length of PTA and hospital stay, the DRS score was not correlated with other demographic (age, education) or clinical variables (Glasgow Coma Scale and maximum score on the Therapy Intensity Level Scale).

      Conclusions

      The EXACT can be administered to most patients early in the acute phase of TBI, and results could be used, along with other predictors such as PTA, to estimate their long-term functional sequelae. The EXACT may be a promising brief cognitive instrument for future studies investigating recovery after TBI.

      Keywords

      List of abbreviations:

      ANOVA (analysis of variance), DRS (Disability Rating Scale), ED (emergency department), EXACT (EXAmen Cognitif abrégé en Traumalogie (Brief Cognitive Examination in Traumatology)), GCS (Glasgow Coma Scale), ICU (intensive care unit), PTA (posttraumatic amnesia), TBI (traumatic brain injury), TIL (Therapy Intensity Level)
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