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. 2021 Sep 15;38(18):2590-2599.
doi: 10.1089/neu.2020.7513. Epub 2021 Jun 18.

Cognitive Outcomes in Children with Mild Traumatic Brain Injury: An Examination Using the National Institutes of Health Toolbox Cognition Battery

Leah Chadwick  1 , Elizabeth Roth  2 , Nori M Minich  2 , H Gerry Taylor  3   4 , Erin D Bigler  5 , Daniel M Cohen  3   4 , Ann Bacevice  2   6 , Leslie K Mihalov  3   4 , Barbara A Bangert  7 , Nicholas A Zumberge  4 , Keith Owen Yeates  1   8
Affiliations

Cognitive Outcomes in Children with Mild Traumatic Brain Injury: An Examination Using the National Institutes of Health Toolbox Cognition Battery

Leah Chadwick et al. J Neurotrauma. .

Abstract

This study is the first to examine cognitive outcomes after pediatric mild TBI using the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB), a computerized cognitive test battery. The NIHTB-CB includes two complex measures of attention and executive function that allow differentiation of accuracy and response speed. We compared performance on the NIHTB-CB among children 8-16 years of age with mild TBI (n = 143) versus children with orthopedic injuries (OIs; n = 74) recruited in emergency departments and followed for 6 months post-injury. Mixed-model analyses showed that the mild TBI group showed significantly lower Fluid Cognition composite scores than the OI group at 10 days (group intercept, p = 0.018); the magnitude of group differences declined modestly over time (group × time interaction, p = 0.055). Effect sizes were d = 0.34 at 10 days post-injury, d = 0.27 at 3 months, and d = 0.10 at 6 months. No significant effects of group or time were found for the Crystallized Cognition composite. Analyses of Fluid Cognition subtests indicated that children with mild TBI displayed deficits for as long as 3 months on measures of attention and executive function (e.g., cognitive flexibility, inhibitory control), but not on measures of explicit memory, working memory, or processing speed. The poorer performance of the mild TBI group on measures of attention and executive function was attributable largely to slowed reaction time, not decreased accuracy. The findings suggest that children with mild TBI demonstrate persistent deficits in fluid cognition that are most apparent on tasks that combine demands for both speed and executive function.

Keywords: cognitive assessment; crystalized cognition; fluid cognition; pediatric; traumatic brain injury.

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Conflict of interest statement

Erin D. Bigler reports forensic consultation.

Figures

FIG. 1.
FIG. 1.
Model estimates (M, 95% CI) of performance on the NIH Toolbox Cognitive Battery fluid cognition composite for children with mild TBI and OI over time. CI, confidence interval; M, mean; mTBI, mild traumatic brain injury; OI, orthopedic injuries.
FIG. 2.
FIG. 2.
Model estimates (M, 95% CI) of performance on the NIH Toolbox Cognitive Battery crystalized cognition composite for children with mild TBI and OI over time. CI, confidence interval; mTBI, mild traumatic brain injury; OI, orthopedic injuries.
See this image and copyright information in PMC

References

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