Executive functioning as outcome in patients after traumatic brain injury.

The present study was designed to determine how traumatic brain injury affect executive functioning, to know whether different treatments in the acute phase improve this functioning, and to check whether the severity of the neurocognitive impairment is detected by the Glasgow Outcome Scale (GOS). Ability for problem solving and executive functioning within 2 years after Traumatic Brain Injury (TBI) was examined in 35 conscious survivors. Two groups were formed. One group consisted of 13 patients who needed neurosurgery. The other group was made up of 22 patients without neurosurgical treatment. All were treated in the Neurosurgical Intensive Care Unit and in the Rehabilitation Service. The following variables were registered: Secondary Lesions, Glasgow Coma Scale (GCS), CT, subacute CT, and Glasgow Outcome Scale. Neuropsychological tests administered were Wisconsin Card Sorting Test (WCST) and the Tower of Hanoi/Sevilla. Comparing both groups' test performance (man Whitney U) we found that a severe traumatic brain injury, whatever the treatment applied in the acute phase, impairs the executive functioning of the patients; this impairment is related to acute pathophysiological events. The neurosurgical intervention does not improve the executive functioning. The Glasgow Outcome Scale does not detect more than 25% of the patients with severe impairment. It is suggested that the Tower of Hanoi/Sevilla could be a good tool to evaluate the executive functioning routinely in TBI patients as outcome. It also suggested that mild TBI patients must be referred for a complete neuropsychological examination.