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Neurocognitive testing in the emergency department: A potential assessment tool for mild traumatic brain injury.

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Lunter, Catherine M 
Carroll, Ellen L 
Housden, Charlotte 
Outtrim, Joanne 
Forsyth, Faye 


OBJECTIVE: Despite mild traumatic brain injury (mTBI) accounting for 80% of head injury diagnoses, recognition of individuals at risk of cognitive dysfunction remains a challenge in the acute setting. The objective of this study was to evaluate the feasibility and potential role for computerised cognitive testing as part of a complete ED head injury assessment. METHODS: mTBI patients (n = 36) who incurred a head injury within 24 h of presentation to the ED were compared to trauma controls (n = 20) and healthy controls (n = 20) on tests assessing reaction time, speed and attention, episodic memory, working memory and executive functioning. Testing occurred during their visit to the ED at a mean of 12 h post-injury for mTBI and 9.4 h for trauma controls. These tasks were part of the Cambridge Neuropsychological Test Automated Battery iPad application. Healthy controls were tested in both a quiet environment and the ED to investigate the potential effects of noise and distraction on neurocognitive function. RESULTS: Reaction time was significantly slower in the mTBI group compared to trauma patients (P = 0.015) and healthy controls (P = 0.011), and deficits were also seen in working memory compared to healthy controls (P ≤ 0.001) and in executive functioning (P = 0.021 and P < 0.001) compared to trauma and healthy controls. Performances in the control group did not differ between testing environments. CONCLUSION: Computerised neurocognitive testing in the ED is feasible and can be utilised to detect deficits in cognitive performance in the mTBI population as part of a routine head injury assessment.



concussion, mild traumatic brain injury, neurocognitive testing, Adolescent, Adult, Aged, Brain Concussion, Emergency Service, Hospital, Female, Glasgow Coma Scale, Humans, Male, Mental Status and Dementia Tests, Middle Aged, Neurologic Examination, Prospective Studies, Statistics, Nonparametric, Surveys and Questionnaires

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Emerg Med Australas

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Academy of Medical Sciences (unknown)
European Commission (270259)
This work was supported by the European Commission under the 7th Framework Programme (FP7-270259-TBICare,, the Neurosciences Theme of the Cambridge NIHR Biomedical Research Centre, and the Technology Platform funding provided by the UK Department of Health. The NIHR/Wellcome Trust Cambridge Clinical Research Facility provided nursing support to aid in the data collection within the Emergency Department. Cambridge Cognition supplied the iPad research application. BJS receives funding from the Neurodegeneration Theme and MentalHealthTheme of the Cambridge NIHR Biomedical Research Centre, and the NIHR Brain Injury MedTech Co-operative. DKM was supported by the National Institute for Health Research (NIHR,UK) through the NIHR Cambridge Biomedical Centre grant and a Senior Investigator Award. VFJN was supported by The Health Foundation/Academy of Medical Sciences Clinician Scientist Fellowship. The funders had no role in study design, data collection and analyses, decision to publish, or preparation of the manuscript.