Test or Rest? Computerized Cognitive Testing in the Emergency Department after Pediatric Mild Traumatic Brain Injury Does Not Delay Symptom Recovery

Rest is commonly prescribed following a mild traumatic brain injury (mTBI). There is concern that cognitive exertion by an acutely or sub-acutely injured brain may negatively alter outcome. The objective of this study was to determine if computerized cognitive testing in the emergency department alters symptom outcome from mTBI. Participants included 77 youth with mTBI who underwent computerized cognitive testing (mean age, 13.6; 95% confidence interval [CI] = 13.0-14.2) and were matched to 77 youth with mTBI who did not participate in cognitive testing (mean age, 13.5; 95% CI = 12.9-14.0). Participants who underwent cognitive testing did not differ from those who did not undergo acute cognitive testing on mean symptom ratings or the proportion who were not recovered at 7-10 days, 1 month, 2 months, or 3 months. There also was no difference in symptom outcome for those who underwent a shortened (four subtests, mean time = 16 min) or full-length (seven subtests, mean time = 28 min) version of the computerized test. Brief cognitive exertion using a computerized cognitive assessment after mTBI in youth does not result in worse symptoms at these follow-up periods, does not prolong symptom recovery, should not be considered contraindicated to recovery, and could be considered as another tool to aid in the management of these injuries. Further research with different samples is warranted.