title: Executive function after severe childhood traumatic brain injury - Age-at-injury vulnerability periods: The TGE prospective longitudinal study.
abstract: BACKGROUND
  Executive function (EF) impairment is a major predictor of overall outcome after traumatic brain injury (TBI). TBI severity is a factor of poor outcome, but most studies include a majority of children with mild and moderate TBI. The aims of this study were to estimate EF impairment after severe childhood TBI and to explore factors predicting EF outcome. The secondary aim was to compare recovery trajectories by age-at-injury groups.
  
  
  METHODS
  This was a prospective longitudinal study of children with severe TBI who were tested for EFs by performance-based tests and questionnaires at 3, 12 and 24 months.
  
  
  RESULTS
  Children with TBI (n=65) showed significant impairment in working memory, inhibition, attention and global EF, with little or no recovery at 24 months. For flexibility and performance-based EF score, children were impaired at 3 months only and showed normal scores by 12 months. No impairment was found in planning. At 3 and 24 months, Glasgow Coma Scale score and parental education predicted global EF. Coma length was not a significant predictor of outcome. Age at injury predicted progress in EF, but the relationship was not linear; children 10-12 years old at injury showed better outcome than older and younger children.
  
  
  CONCLUSIONS
  EFs are impaired after severe TBI in childhood. The relationship between age at injury and outcome is not linear. Relying on only performance-based EF tests can underestimate EF impairment.
authors: Outreach Department for Patients With Acquired Brain Injury, University Rehabilitation Institute Clemenceau Strasbourg, France; Pediatric Orthopedics Department, Hautepierre Hospital, Strasbourg University Hospitals, Strasbourg, France; Sorbonne Universités, UPMC Université Paris 06, Inserm, CNRS, LIB, 7013 Paris, France; Groupe de Recherche Clinique Handicap Cognitif et Réadaptation - UPMC Paris 6, France. Electronic address: agatakrasny@yahoo.com.
authors: Agata
authors: A
authors: Krasny-Pacini
authors: Sorbonne Universités, UPMC Université Paris 06, Inserm, CNRS, LIB, 7013 Paris, France; Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France; Groupe de Recherche Clinique Handicap Cognitif et Réadaptation - UPMC Paris 6, France.
authors: Mathilde
authors: M
authors: Chevignard
authors: Département de la recherche clinique et du développement (DRCC) Assistance Publique Hopitaux de Paris, France.
authors: Sabine
authors: S
authors: Lancien
authors: INSERM UMR 1181: Biostatistiques, Biomathématique, Pharmaco-Epidémiologie et Maladies Infectieuses, Equipe Biostatistique et Pharmacoépidémiologie, Villejuif, France.
authors: Sylvie
authors: S
authors: Escolano
authors: Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France; Outreach team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France.
authors: Anne
authors: A
authors: Laurent-Vannier
authors: INSERM UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Developmental Origins of Health and Disease (ORCHAD) Team, Villejuif 94807, France.
authors: Maria
authors: M
authors: De Agostini
authors: Université Descartes Paris5, Hôpital Universitaire Necker, Anesthesiology Department, Pediatric Neuro Critical Care Unit, 75015 Paris, France.
authors: Philippe
authors: P
authors: Meyer
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000070642:Brain Injuries, Traumatic / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D056344:Executive Function; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D013997:Time Factors
keywords: Child; Cohort; Executive functions; Follow-up; Longitudinal prospective study; Outcome; Traumatic brain injury; Vulnerability periods