Examining the validity of the Delis–Kaplan Executive Function System (D‐KEFS) in traumatic brain injury

Abstract This study examines the validity of the Delis–Kaplan Executive Function System (D‐KEFS) in a traumatic brain injury (TBI) population compared to participants with orthopaedic injuries and normative controls. The utility of the D‐KEFS was examined using a between groups design. One hundred patients with mild uncomplicated to severe TBI were recruited from a consecutive cohort of patients admitted as inpatients to a UK Major Trauma Centre and compared to 823 participants from the D‐KEFS normative sample and 26 participants with orthopaedic injuries. Data were filtered for performance validity. Sample discrimination was calculated from D‐KEFS subtest scores and derived index scores. Sensitivity to TBI severity was established. The TBI participants performed significantly lower on the D‐KEFS Trail Making Test, Colour Word Interference, Colour Word Switching, Letter Fluency and Verbal Fluency Category Switching Total Words Correct. The D‐KEFS index scores discriminated between TBI, orthopaedic and normative participants with large and moderate effect sizes, respectively. The D‐KEFS demonstrated a dose–response relationship with TBI severity. These effects were robust to differences in premorbid intellectual functioning; however, D‐KEFS performance was sensitive to performance on tests of mental processing speed. The use of a D‐KEFS index score provides a robust and reliable discrimination of TBI patients from healthy control participants. This discrimination is not accounted for by premorbid intellect or the non‐specific effects of trauma. The clinical and conceptual implications of these findings are considered.