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Assessment of speed of processing after paediatric head trauma: need for better norms
A Kizilbash1, S Warschausky, J Donders
1Psychology Service, Mary Free Bed Hospital, Grand Rapids, MI 49503, USA.
Insights
Age significantly impacts neuropsychological test performance in children with traumatic head injury (THI). However, current age-based norms for tests like the Trail Making Test (TMT) and Finger Tapping Test (FTT) may not adequately capture these effects for injury classification.
Area of Science:
- Neuropsychology
- Pediatric Neurology
- Traumatic Brain Injury Research
Background:
- Traumatic head injury (THI) in children can lead to lasting cognitive deficits.
- Assessing the impact of THI requires understanding factors influencing neuropsychological test performance.
- Age and injury severity are critical variables in pediatric TBI assessment.
Purpose of the Study:
- To evaluate the influence of injury severity and age on neuropsychological test performance in children with THI.
- To determine if current age-based norms improve the classification of injury severity.
- To identify needs for improved normative data in pediatric TBI assessment.
Main Methods:
- Neuropsychological test scores of 47 children (aged 9-14 years) with THI were analyzed.
- Stepwise regression identified the contribution of age and injury severity (coma length) to test performance.
- Logistic regression assessed the utility of age-based norms for injury classification.
Main Results:
- Age significantly predicted performance on the Trail Making Test (TMT) and Finger Tapping Test (FTT), independent of injury severity.
- Existing age-based norms did not enhance the classification accuracy of mild-moderate versus severe injuries compared to raw scores.
- The findings highlight limitations in current age-referenced norms for pediatric TBI.
Conclusions:
- Age is a crucial factor in the neuropsychological assessment of children with THI.
- Current age-based norms for common pediatric tests may lack the necessary stratification to fully account for age-related performance variations.
- Development of more robust, larger, and better-stratified age-referenced norms is recommended for improved TBI assessment in children.
Abstract:
The neuropsychological test scores of 47 children with traumatic head injury (THI), aged 9-14 years, were evaluated to determine the relative contributions of severity of injury (length of coma) and age on performance. Stepwise regression analyses revealed that age consistently explained a statistically significant proportion of the variance on the Trail Making Test (TMT) and Finger Tapping Test (FTT), even after accounting for injury severity. However, logistic regression analyses indicated that currently available age-based norms for these tests did not improve classification of mild-moderate vs. severe injuries, as compared to a system based exclusively on raw scores. It is concluded that, whereas age is an important consideration when assessing children with THI, available age-based norms for some common paediatric neuropsychological tests do not appear to be sufficiently stratified or robust to fully capture these age effects. It is suggested that more comprehensive age-referenced norms, based on larger and more adequately stratified samples, are needed. In addition, some practical implications of these findings are discussed.