Cognitive screening in mild traumatic brain injuries: analysis of the neurobehavioral cognitive status examination when utilized during initial trauma hospitalization.

Abstract

Cognitive screening following mild traumatic brain injury (MTBI) remains variable with method of diagnosis, indications for testing, and utilization of results differing between institutions. The Neurobehavioral Cognitive Status Examination (NCSE) was originally developed for use in organic brain dysfunction and central nervous system (CNS) lesions. When attention is given to both the objective cognitive area scores and the "process features" component of the exam, it is an effective tool for identifying cognitive deficits associated with MTBI. One hundred seven MTBI patients underwent cognitive screening in the acute care setting. Memory was the function most frequently affected in patients with positive cognitive screens. Several of the NCSE deficits also correlated significantly with each other but not with memory. Age, length of stay, injury severity score (ISS), and cranial computed tomography scan were not associated with cognitive screen results. An admission Glasgow Coma Scale (GCS) of 13 or 14 was significantly associated with a positive cognitive screen, but a GCS of 15 did not predict a negative cognitive screen. All patients with MTBI require cognitive screening to identify deficits, ensure patient and family education, and when necessary facilitate treatment.