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Incorporating a Computerized Cognitive Battery Into the Emergency Department Care of Pediatric Mild Traumatic Brain Injuries—Is It Feasible?

Khetani, Aneesh M., BSc*; Brooks, Brian L., PhD; Mikrogianakis, Angelo, MD; Barlow, Karen M., MB, ChB, MRCPCH (UK)§∥

doi: 10.1097/PEC.0000000000000959
Original Articles

Objectives The use of computers to test cognitive function acutely after a concussion is becoming increasingly popular, especially after sport-related concussion. Although commonly performed in the community, it is not yet performed routinely in the emergency department (ED), where most injured children present. The challenges of performing computerized cognitive testing (CCT) in a busy ED are considerable. The aim of this study was to evaluate the feasibility of CCT in the pediatric ED after concussion.

Methods Children, aged 8 to 18 years with mild traumatic brain injury, presenting to the ED were eligible for this prospective study. Exclusion criteria included the use of drugs, alcohol, and/or physical injury, which could affect CCT performance. A 30- or 15-minute CCT battery was performed. Feasibility measures included environmental factors (space, noise, waiting time), testing factors (time, equipment reliability, personnel), and patient factors (age, injury characteristics).

Results Forty-nine children (28 boys; mean age, 12.6; SD, ± 2.5) participated in the study. All children completed CCT. Mean testing times for the 30- and 15-minute battery were 29.7 and 15.2 minutes, respectively. Noise-cancelling headphones were well tolerated. A shorter CCT was more acceptable to families and was associated with fewer noise disturbances. There was sufficient time to perform testing after triage and before physician assessment in over 90% of children.

Conclusions Computerized cognitive testing is feasible in the ED. We highlight the unique challenges that should be considered before its implementation, including environmental and testing considerations, as well as personnel training.

From the *Cumming School of Medicine,

Neurosciences (Brain Injury and Rehabilitation Program), Alberta Children’s Hospital Departments of Paediatrics and Clinical Neurosciences,

Section of Emergency Medicine, Alberta Children’s Hospital Department of Paediatrics, Cumming School of Medicine,

§Departments of Neurosciences and Paediatrics, Alberta Children's Hospital Research Institute for Child & Maternal Health, and

Traumatic Brain Injury Rehabilitation Program, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada.

Disclosure: The authors declare no conflict of interest.

Reprints: Karen M. Barlow MB, ChB, MRCPCH, (UK), Alberta Children's Hospital, C4-335, 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8 (e-mail:

Funding was provided by Alberta Children’s Hospital Research Institute and the McCarthy Tetrault Award. B.L.B. receives funding from a test publisher (Psychological Assessment Resources, Inc.), book royalties from Oxford University Press, and in-kind test credits for research from the computerized test publisher (CNS Vital Signs).

Prior Presentations: Preliminary versions of this work have been presented at the following conferences as poster or PowerPoint presentations:

(1) University of Calgary Undergraduate Research Symposium, Calgary, Alberta, Canada, on November 29, 2012.

(2) Alberta Children’s Hospital Behavior and Developing Brain Symposium, Calgary, Alberta, Canada, on August 16, 2013.

(3) Tenth World Congress on Brain Injury, San Francisco, California, USA, on March 19, 2014.

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