CoChat
Sign Up
Cited by 1Traumatic Brain Injury ResearchTraumatic Brain Injury and Neurovascular DisturbancesCognitive Functions and Memory

Evaluating cognitive performance using the National Institutes of Health Toolbox Cognitive Battery in children with traumatic brain injury

Open access
Petersen, Bailey, Vo, Ngoc-Thanh N., Anton, Nivinthiga, Yeates, Keith Owen, Treble-Barna, Amery·2025·Journal of the International Neuropsychological Society
DOI 10.1017/s135561772510146xPMC PMC12990185
Open this paper in CoChat — free accountOpen PDF

Abstract

Objective: We examined cognitive performance in children with complicated mild-severe traumatic brain injury (TBI) versus orthopedic injury (OI) using the National Institutes of Health Toolbox Cognitive Battery (NIH TB-CB). Method: We recruited children ages 3–18, hospitalized with complicated mild-severe TBI ( n = 231) or orthopedic injury (OI, n = 146). Cognition was assessed using the NIH TB-CB at six and twelve months post-injury. We used linear mixed models to assess associations of injury group (TBI versus OI), timepoint (six versus twelve months), and the interaction of injury group and timepoint with NIH TB-CB Total Cognition, Fluid Cognition, and Crystallized Cognition composites, adjusted for sex and socioeconomic status (SES), with Bonferroni correction. We evaluated differences in cognition stratified by injury severity (complicated mild–moderate TBI vs severe TBI) using ANCOVA, adjusting for sex and SES. Results: Neither injury group nor the interaction of group and timepoint were associated with Total (group: p = 0.50; timepoint*group: p = 0.185), Fluid (group: p = 0.297; timepoint*group: p = 0.842), or Crystallized Cognition (group: p = 0.039; timepoint*group: p = 0.017). However, children with severe TBI performed significantly worse on Fluid and Total Cognition than children with complicated mild–moderate TBI at six months (Fluid: p = 0.004, partial η 2 = 0.06, moderate effect, Total: p = 0.012 partial η 2 = 0.03, small–moderate effect) and twelve months post-injury (Fluid: p < 0.001, partial η 2 = 0.11, moderate–large effect, Total: p = 0.002, partial η 2 = 0.06, moderate effect). Conclusions: The NIH TB-CB detects worse cognitive functioning in children with severe TBI six-twelve months post-injury, largely driven by differences in Fluid Cognition. Our findings suggest the NIH TB-CB may be suitable for monitoring cognition in children with TBI.

AI snapshot

Written from the paper’s full text.

TL;DR

In children with complicated mild–severe TBI versus orthopedic injury, the NIH Toolbox Cognitive Battery did not show overall injury-group differences at 6 or 12 months post-injury. However, children with severe TBI performed worse than children with complicated mild–moderate TBI on Total and Fluid Cognition at both timepoints, largely driven by Fluid Cognition.

Key findings

  • No significant injury-group or group×timepoint effects were found for Total Cognition (group: p = 0.50; interaction: p = 0.185), Fluid Cognition (group: p = 0.297; interaction: p = 0.842), or Crystallized Cognition (group: p = 0.039; interaction: p = 0.017) after Bonferroni correction (α = 0.017).
  • Children with severe TBI performed significantly worse than children with complicated mild–moderate TBI on Fluid Cognition at 6 months (p = 0.004, partial η² = 0.06) and 12 months (p < 0.001, partial η² = 0.11), and on Total Cognition at 6 months (p = 0.012, partial η² = 0.03) and 12 months (p = 0.002, partial η² = 0.06). Crystallized Cognition did not differ by severity.
  • Lowest post-resuscitation GCS score was positively correlated with Fluid Cognition at 6 months (ρ = 0.27, p = 0.022) and 12 months (ρ = 0.37, p = 0.005), and with Total Cognition at 6 months (ρ = 0.23, p = 0.018) and 12 months (ρ = 0.37, p = 0.001).
  • Timepoint was associated with increased Fluid Cognition from 6 to 12 months (F₁,₁₃₇ = 8.28, p = 0.005, d = 0.19), and SES was positively associated with all composite scores (p < 0.001 for all models).

Methods

  • Observational, prospective, longitudinal concurrent cohort study (EETR) at UPMC Children’s Hospital of Pittsburgh; children ages 3–18 hospitalized overnight for complicated mild–severe non-penetrating TBI or orthopedic injury (OI). The analytic sample included 120 children with TBI (86 complicated mild–moderate, 34 severe) and 60 with OI who completed the NIH TB-CB version 2 at 6 and/or 12 months post-injury.
  • Cognition was measured with NIH TB-CB Total, Fluid, and Crystallized Cognition composites (ages 7+; Early Cognition Composite for ages 3–6 combined with Total Cognition). Linear mixed models assessed injury group, timepoint, and their interaction, adjusted for sex and SES z-score, with Bonferroni correction (α = 0.05/3 = 0.017).
  • Exploratory severity analyses used ANCOVA comparing complicated mild–moderate TBI versus severe TBI, adjusted for sex and SES, with partial η² effect sizes; Spearman correlations examined GCS score with composite scores.

Limitations

  • The paper states high attrition from enrollment to 6- and 12-month follow-up due to COVID-19, travel distance/catchment area, a switch to NIH TB version 3 on June 6, 2024, and hesitancy to provide blood biospecimens; however, included and excluded children did not differ significantly in demographics or TBI severity.
  • The paper states that the small moderate TBI sample required combining complicated mild and moderate TBI, acute assessments were very limited due to hospital time constraints and lack of suitable testing space, TBI severity was classified by GCS alone, and the wide age range included 3-year-olds even though 3-year-olds may struggle with the Early Cognition battery; two 3-year-old children with severe TBI could not complete testing and were excluded.
  • The paper notes that the lack of overall TBI versus OI differences may reflect the larger proportion of complicated mild TBI relative to severe TBI in the sample; the severity analyses were exploratory with smaller samples and kept alpha at 0.05.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1017/s135561772510146x

Cites

54 of 54 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

10 of 36 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    Lowest post-resuscitation GCS score was moderately positively correlated with Total Cognition at twelve months post-injury (ρ = 0.37, p = 0.001).

    “Additionally, we found moderate positive correlations of GCS score with Total Cognition at six months post-injury (ρ = 0.23, p = 0.018) and at twelve months post-injury (ρ = 0.37, p = 0.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    Among children with complicated mild-moderate TBI, 14.8% at six months and 12.5% at twelve months performed more than one standard deviation below the mean on Fluid Cognition.

    “Among children with cmmTBI, only 14.8% at six months and 12.5% at twelve months performed more than one standard deviation below the mean on Fluid Cognition.”
    Quote in the paperSubstantial claim
  • Findingown data

    On the seven individual NIH TB-CB tests, there were no significant associations of injury group or injury group by timepoint interaction after Bonferroni correction (p > 0.007).

    “On the individual tests, there were no significant associations of injury group or interaction of injury group*timepoint (p > 0.007 after Bonferroni correction) for any test (Supplemental Data).”
    Quote in the paperSubstantial claim
  • Findingown data

    Timepoint was significantly associated with Fluid Cognition, reflecting an increase in Fluid Cognition from six months to twelve months post-injury (F1,137 = 8.28, p = 0.005, d = 0.19, small effect).

    “Timepoint was significantly associated with Fluid Cognition, reflecting an increase in Fluid Cognition from six months to twelve months post-injury (F1,137 = 8.28, p = 0.005, d = 0.19, small effect).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Lowest post-resuscitation GCS score was significantly moderately positively correlated with Fluid Cognition at twelve months post-injury (ρ = 0.37, p = 0.005).

    “Lowest post-resuscitation GCS score was significantly moderately positively correlated with Fluid Cognition at six months post-injury (ρ = 0.27, p = 0.022) and at twelve months post-injury (ρ = 0.37, p = 0.005, Figure 4).”
    Quote in the paperSubstantial claim
  • May combine two claims. 19
  • Classified as probably not a substantial claim. 17
  • The quote only partly states this claim. 2

  • May combine two claims.

    Premisecitation

    Traditional neuropsychological tests show that Fluid Cognition is worse after TBI, while Crystallized Cognition is often spared.

    “These findings are consistent with the vast literature using traditional neuropsychological tests demonstrating that Fluid Cognition is worse after TBI, while Crystallized Cognition is often spared (Tulsky, Carlozzi et al., 2017).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Tulsky, Carlozzi et al., 2017 source

  • May combine two claims.

    Study design and conductcitation

    Children with orthopedic injury were selected as a comparison group to control for the experience of being hospitalized with a traumatic injury and to adjust for pre-morbid risk factors such as lower socioeconomic status associated with increased risk for sustaining a traumatic injury.

    “We selected children with OI as a comparison group to control for the experience of being hospitalized with a traumatic injury and to adjust for pre-morbid risk factors such as lower socioeconomic status (SES) that are associated with an increased risk for sustaining a traumatic injury (Asarnow et al., 1995; Yeates, 2010).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Asarnow et al., 1995

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Yeates, 2010 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Previous studies show that children with mild TBI and complicated mild TBI generally demonstrate few deficits in cognitive performance after three months post-injury, while children with severe TBI demonstrate consistently poorer cognitive performance compared to children with orthopedic injury.

    “Previous studies show that children with mild TBI and complicated mild TBI generally demonstrate few deficits in cognitive performance after three months post-injury, while children with sTBI demonstrate consistently poorer cognitive performance compared to children with OI (Babikian & Asarnow, 2009; Chadwick et al., 2021; Keenan et al., 2018).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites Babikian & Asarnow, 2009 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites Chadwick et al., 2021 source
    • cites Keenan et al., 2018 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The NINDS TBI Classification and Nomenclature Workshop yielded recommendations to expand TBI classification to include additional clinical assessments, neuroimaging, blood-based biomarkers and psychological and environmental modifiers.

    “The workshop yielded recommendations to expand TBI classification to include additional clinical assessments, neuroimaging, blood-based biomarkers and psychological and environmental modifiers (Bazarian et al., 2025; Bragge et al., 2025; Corrigan et al., 2025; Mac Donald et al., 2025; Manley et al., 2025; Menon et al., 2025; Nelson et al., 2025).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites Bazarian et al., 2025 source

      The Abstract and Overview of Literature and Current State describe recommendations to incorporate blood-based biomarkers into a revised TBI classification system, alongside neuroimaging. This paper reports the blood-based biomarker working group’s recommendations; the passages do not support the sentence’s additional claim about psychological and environmental modifiers. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Bragge et al., 2025 source
    • cites Corrigan et al., 2025 source

      The Introduction says the workshop produced classification recommendations, and the Discussion recommends recording clinical, biomarker, imaging, and relevant modifier information for acute TBI characterization. But this paper does not specify psychological and environmental modifiers, and it cautions that blood-based biomarkers cannot yet be used to detect or characterize past TBI. Its recommendations therefore support only part of the broader workshop claim. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent evidence suggests that the interaction between SES and biological variables (e.g. side of hemispheric injury, genomics, neural imaging) may contribute to the relationship between SES and cognition.

    “While the association of SES with cognition has been well studied, recent evidence suggests that the interaction between SES and biological variables (e.g. side of hemispheric injury, genomics, neural imaging) may contribute to this relationship (Cohen-Zimerman et al., 2019; Noble et al., 2012; Raizada et al., 2008; Schneider et al., 2024; Shi et al., 2024).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Cohen-Zimerman et al., 2019 source
    • cites Noble et al., 2012 source

      The Abstract and Discussion report SES-related differences in brain regions that support cognitive skills, consistent with a possible neural pathway linking SES and cognition. But the study did not test whether an interaction between SES and a biological variable contributes to the SES–cognition relationship; the Discussion says that assessing brain structure and specific cognitive skills together is future work. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites Raizada et al., 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Studies evaluating reference ranges of biomarkers and neuroimaging in pediatric TBI are ongoing.

    “While these recommendations were predominantly geared towards adults, studies evaluating reference ranges of biomarkers and neuroimaging in pediatric TBI are ongoing (Marzano et al., 2022; Mondello et al., 2016; Munoz Pareja et al., 2022; Reisner et al., 2024).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites Marzano et al., 2022

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Mondello et al., 2016 source

      The Results (no page provided) report biomarker concentrations in children with TBI and controls, including age-related differences among controls; the Methods describe using head CT to assess intracranial injury. This supports ongoing work on pediatric biomarker levels and their relationship to imaging, but the paper does not evaluate neuroimaging reference ranges. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites Munoz Pareja et al., 2022 source

      The Results and Discussion (Brain-Specific Biomarkers; page not provided) identifies studies of pediatric biomarker levels and says a few studies have examined GFAP reference ranges, leaving a research gap. The paper does not establish that studies of pediatric neuroimaging reference ranges are ongoing, so that part of the attributed claim is unsupported. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    When stratified by TBI severity, there were differences between children with severe TBI and children with complicated mild-moderate TBI in Total Cognition and Fluid Cognition, but not Crystallized Cognition, at both six and twelve months post-injury.

    “When stratified by severity, we found differences between TBI groups in Total Cognition and Fluid Cognition, but not Crystallized Cognition, at both timepoints (Figure 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among children with severe TBI, 55% performed more than one standard deviation below the mean at six months and 45% performed more than one standard deviation below the mean at twelve months on Fluid Cognition.

    “Among children with sTBI, 55% performed more than one standard deviation below the mean at six months and 45% performed more than one standard deviation below the mean at twelve months on Fluid Cognition.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Mean Fluid Cognition scores for children with severe TBI were in the Low Average range at six and twelve months, whereas mean scores for children with complicated mild-moderate TBI were in the Average range at six and twelve months post-injury.

    “Mean scores for Fluid Cognition among children with sTBI were in the Low Average range at six and twelve months, whereas mean scores for children with cmmTBI were in the Average range at six and twelve months post-injury.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The interaction of injury group and timepoint was not significantly associated with the NIH TB-CB Crystallized Cognition composite after Bonferroni correction (p = 0.017).

    “timepoint*group: F1,135 = 5.95, p = 0.017”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Injury group was not significantly associated with the NIH TB-CB Crystallized Cognition composite after Bonferroni correction (p = 0.039).

    “Crystallized Cognition (group: p = 0.039; timepoint*group: p = 0.017)”
    • Also stated in: § Cognition by injury group · plain
      “Crystallized Cognition (F1,135 = 4.34, p = 0.039, d = 0.35; timepoint*group: F1,135 = 5.95, p = 0.017”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Mean Total Cognition scores for children with severe TBI were in the Average range at six and twelve months, whereas mean scores for children with complicated mild-moderate TBI were in the Average range at six months and the High Average range at twelve months post-injury.

    “Mean scores for Total Cognition among children with sTBI were in the Average range at six and twelve months, whereas mean scores for children with cmmTBI were in the Average range at six months and the High Average range at twelve months post-injury.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    SES was significantly positively associated with all NIH TB-CB composite scores, indicating that higher SES relative to the sample mean was associated with better cognition (p < 0.001 for all models).

    “SES was significantly positively associated with all composite scores, indicating that higher SES (relative to our sample mean) was associated with better cognition (p < 0.001 for all models).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The NIH TB-CB detects lower cognitive performance in children with sTBI at six and twelve months post-injury, but not children with cmmTBI.

    “Here we provide evidence that the NIH TB-CB detects lower cognitive performance in children with sTBI at six and twelve months post-injury, but not children with cmmTBI, consistent with previous research on cognitive outcomes of pediatric TBI.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    All 3-year-old children who completed the test scored within the Low Average to Extremely High performance ranges and were not outliers in the dataset (> 1.5*IQR of Total Cognition composite scores).

    “All the 3-year-old children who completed the test scored within the Low Average to Extremely High performance ranges and were not outliers in our dataset (> 1.5*IQR of Total Cognition composite scores).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In children with mild TBI, the NIH TB-CB showed poorer Fluid Cognition relative to children with orthopedic injury in the ten days following injury, but the groups were comparable at three and six months post-injury.

    “Another study of children with mild TBI reported poorer Fluid Cognition on the NIH TB-CB relative to children with OI in the ten days following injury, but that the groups were comparable at three and six months post-injury (Chadwick et al., 2021).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Chadwick et al., 2021 source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Random effects for participant were included to allow inclusion of participants with missing data at one timepoint.

    “We included random effects for participant to allow for inclusion of participants with missing data at one timepoint.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The severity-stratified ANCOVA was adjusted for sex and SES.

    “we also evaluated differences in cognitive performance stratified by injury severity (cmmTBI vs sTBI) using an ANCOVA, adjusting for sex and SES.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a small heterogeneous sample of children with acquired brain injury, the NIH TB-CB was feasible to administer in inpatient rehabilitation settings and day treatment rehabilitation facilities, with 95% of children tested able to complete the test.

    “In a small heterogeneous sample of children with acquired brain injury, the NIH TB-CB was shown to be feasible to administer in inpatient rehabilitation settings and day treatment rehabilitation facilities (95% of children tested were able to complete the test);”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Watson et al., 2020 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a small heterogeneous sample of children with acquired brain injury, children with acquired brain injury had poorer performance on fluid cognition than crystallized cognition on the NIH TB-CB.

    “while the study was underpowered to determine statistical differences in cognition, children with ABI had poorer performance on fluid cognition than crystallized cognition (Watson et al., 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Watson et al., 2020 source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    A Bonferroni correction for multiple comparisons was used for primary outcomes, with a significance level of α = 0.05/3 = 0.017.

    “We used a significance level of α = 0.05/3 = 0.017 after Bonferroni correction for multiple comparisons for primary outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The NIH TB-CB detects worse cognitive functioning in children with severe TBI six to twelve months post-injury, largely driven by differences in Fluid Cognition.

    “The NIH TB-CB detects worse cognitive functioning in children with severe TBI six-twelve months post-injury, largely driven by differences in Fluid Cognition.”
    • Also stated in: § Statement of Research Significance · plain
      “The Toolbox Cognitive Battery detects lower cognitive performance in children with severe traumatic brain injury at six and twelve months post-injury, but not children with complicated mild–moderate traumatic brain injury. These differences occur largely in Fluid Cognition and are most pronounced in children with severe traumatic brain injury.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Age-corrected standardized scores were used in accordance with guidance from the American Board of Clinical Neuropsychology and American Academy of Clinical Neuropsychology, which supports eliminating race as a demographic adjustment in neuropsychological assessments.

    “For this study, we used age-corrected standardized scores in accordance with guidance from the American Board of Clinical Neuropsychology and American Academy of Clinical Neuropsychology, which supports eliminating race as a demographic adjustment in neuropsychological assessments (Bodin et al., 2023).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Bodin et al., 2023 source

  • May combine two claims.

    Study design and conductown data

    There were no differences in age or sex either across injury groups or within the TBI group stratified by severity (complicated mild-moderate TBI vs severe TBI).

    “There were no differences in age or sex either across injury groups (Table 2) or within the TBI group stratified by severity (cmmTBI vs. sTBI).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Assumptions of homogeneity of regression slopes and normality of residuals were assessed using a regression analysis and Shapiro Wilks test, respectively.

    “We assessed assumptions of homogeneity of regression slopes and normality of residuals using a regression analysis and Shapiro Wilks test, respectively.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The statistical models were adjusted for sex and SES z-score.

    “Models were adjusted for sex and SES z-score.”
    • Also stated in: § Statistical methods · plain
      “All models were adjusted for sex and SES composite z-score.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    A Bonferroni correction for multiple comparisons was used for the seven individual test scores, with a significance level of α = 0.05/7 = 0.007.

    “We used a significance level of α = 0.05/7 = 0.007 after Bonferroni correction for multiple comparisons.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    DSM-5 delineates neuropsychological performance 1 to 2 standard deviations below the mean as a modest cognitive impairment, suggesting the clinical importance of scores one standard deviation below the mean.

    “Additionally, the DSM-5TM delineates neuropsychological performance 1 – 2 standard deviations below the mean as a modest cognitive impairment, suggesting the clinical importance of scores one standard deviation below the mean (Diagnostic and Statistical Manual of Mental Disorders, 2013).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Diagnostic and Statistical Manual of Mental Disorders, 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The findings here support the critical importance of continuing to include SES as a covariate in models of cognition after TBI.

    “The findings here also support the critical importance of continuing to include SES as a covariate in models of cognition after TBI.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The findings largely reflect differences in Fluid Cognition, which are more pronounced in children with sTBI.

    “The findings largely reflect differences in Fluid Cognition, which are more pronounced in children with sTBI.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Classifying TBI severity by GCS score alone has limitations.

    “We also acknowledge the limitations of classifying TBI severity by GCS score alone, as noted by the recent National Institute of Neurological Disorders and Stroke TBI Classification and Nomenclature Workshop.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Recent studies have reported that 3-year-olds may struggle to perform three of the four tests on the Early Cognition version of the NIH TB-CB.

    “Recent studies have reported that 3-year-olds may struggle to perform three of the four tests on the Early Cognition version of the NIH TB-CB (Becker et al., 2023).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Becker et al., 2023

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    In settings with inadequate time, resources, or personnel to complete comprehensive neuropsychological testing, the NIH TB-CB may be a suitable option for longitudinal monitoring of cognition in children with TBI in research and clinical contexts.

    “In settings with inadequate time, resources, or personnel to complete comprehensive neuropsychological testing, our findings suggest the NIH TB-CB may be a suitable option for longitudinal monitoring of cognition in children with TBI in research and clinical contexts.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The NIH TB-CB is a brief cognitive assessment that does not need to be administered by neuropsychologists or neuropsychological technicians.

  • May combine two claims.

    Study design and conductown data

    Because of the low number of patients with moderate TBI, children with complicated mild to moderate TBI were combined for analysis (n = 86), consistent with current approaches to analyzing cognitive recovery after TBI in children and adults.

    “Because of the low number of patients with moderate TBI, we combined children with complicated mild to moderate TBI (cmmTBI) for analysis (n = 86), consistent with current approaches to analyzing cognitive recovery after TBI in both children (Keenan et al., 2018; Keenan et al., 2019; Levin et al., 2008) and adults (Tulsky et al., 2017).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Keenan et al., 2018 source
    • cites Keenan et al., 2019 source
    • cites Levin et al., 2008 source
34 of 34

  • The paper relies on this without support.

    Many standard neuropsychological tests take a long time to administer in research and clinical settings and require administration by a trained neuropsychologist or neuropsychological technician.

    “However, many of these tests take a long time to administer in both research and clinical settings and require administration by a trained neuropsychologist or neuropsychological technician.”

  • The paper relies on this without support.

    The NIH TB-CB is a brief cognitive assessment that does not need to be administered by neuropsychologists or neuropsychological technicians.

    “The NIH TB-CB was designed to be a brief cognitive assessment that does not need to be administered by neuropsychologists or neuropsychological technicians and may provide a unique opportunity to broadly track cognitive recovery in children with TBI in these settings.”

  • The paper relies on this without support.

    Children with cmmTBI demonstrate recovery of Fluid Cognition relatively quickly compared to the sustained lower long-term Total and Fluid Cognition seen after sTBI.

    “Taken together, these findings are consistent with prior studies showing that children with cmmTBI demonstrate recovery of Fluid Cognition relatively quickly compared to the sustained lower long-term Total and Fluid Cognition seen after sTBI.”

  • The paper relies on this without support.

    The NINDS TBI Classification and Nomenclature Workshop recommendations were predominantly geared towards adults.

    “While these recommendations were predominantly geared towards adults, studies evaluating reference ranges of biomarkers and neuroimaging in pediatric TBI are ongoing (Marzano et al., 2022; Mondello et al., 2016; Munoz Pareja et al., 2022; Reisner et al., 2024).”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Figure 3 applies a stricter significance threshold than the reported result meets

    Major

    The six-month Total Cognition difference is reported as significant at p = 0.012, but the Figure 3 caption describes that difference as significant while specifying p < 0.008 for significance.

  • Figure 4 reverses the stated significance inequality

    Minor

    The Figure 4 caption defines significant associations as having p > 0.05, although the reported significant correlations have p-values below 0.05.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. 10.1089/neu.2016.4476 · DOI
  2. Asarnow, 1995, Traumatic head injury in children, 117

Cited by

Still being checked.

Related

Authors
Petersen, B., Vo, N.-T. N., Anton, N., Yeates, K. O., & Treble-Barna, A.
Affiliations
  • University of Pittsburgh (US)
  • University of Calgary (CA)
  • University of Pittsburgh School of Medicine
ORCID
Venue
Journal of the International Neuropsychological Society
Publisher
Cambridge University Press (CUP)
Published
2025-06
Volume
31
Issue
5-6
Pages
396-405
ISSN
  • 1355-6177 (ISSN-L)
  • 1469-7661
DOI
10.1017/s135561772510146x
PMC
PMC12990185
OpenAlex
W4415496046
Semantic Scholar
70c3281b619d6bc97d4ea826d8f939f00917f1b8
Cited by
1
References
54
Citations by year
2026: 1
FWCI
0.70
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the International Neuropsychological Society (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
Funders
  • National Institutes of Health
  • National Institute of Neurological Disorders and Stroke (R01NS135492)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (K01 HD097030)
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
Keywords
traumatic brain injury, pediatric traumatic brain injury, cognitive performance, fluid cognition, orthopedic trauma, injury severity, severe traumatic brain injury, cognitive recovery, cognitive monitoring
MeSH terms
Brain Injuries, Traumatic, Adolescent, Brain Concussion, Child, Child, Preschool, Female, Humans, Male, National Institutes of Health (U.S.), Neuropsychological Tests, United States, Cognitive Dysfunction

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review