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Better Brainstorming

• Hal Gregersen

Great innovators have long known that the secret to unlocking a better answer is to ask a better question. Applying that insight to brainstorming exercises can vastly improve the search for new ideas—especially when a team is feeling stuck. Brainstorming for questions, rather than answers, helps you avoid group dynamics that often stifle voices, and it lets you reframe problems in ways that spur breakthrough thinking.

After testing this approach with hundreds of organizations, MIT’s Hal Gregersen has developed it into a methodology: Start by selecting a problem that matters. Invite a small group to help you consider it, and in just two minutes describe it at a high level so that you don’t constrain the group’s thinking. Make it clear that people can contribute only questions and that no preambles or justifications are allowed. Then, set the clock for four minutes, and generate as many questions as you can in that time, aiming to produce at least 15. Afterward, study the questions generated, looking for those that challenge your assumptions and provide new angles on your problem. If you commit to actively pursuing at least one of these, chances are, you’ll break open a new pathway to unexpected solutions.

Focus on questions, not answers, for breakthrough insights.

The Problem

Great innovators have always known that the key to unlocking a better answer is to ask a better question—one that challenges deeply held assumptions. Yet most people don’t do that, even when brainstorming, because it doesn’t come naturally. As a result, they tend to feel stuck in their search for fresh ideas.

The Solution

By brainstorming for questions instead of answers, you can create a safe space for deeper exploration and more-powerful problem solving. This brief exercise in reframing—which helps you avoid destructive group dynamics and biases that can thwart breakthrough thinking—often reveals promising new angles and unexpected insights.

About 20 years ago I was leading a brainstorming session in one of my MBA classes, and it was like wading through oatmeal. We were talking about something that many organizations struggle with: how to build a culture of equality in a male-dominated environment. Though it was an issue the students cared about, they clearly felt uninspired by the ideas they were generating. After a lot of discussion, the energy level in the room was approaching nil. Glancing at the clock, I resolved to at least give us a starting point for the next session.

• Hal Gregersen is a Senior Lecturer in Leadership and Innovation at the MIT Sloan School of Management , a globally recognized expert in navigating rapid change, and a Thinkers50 ranked management thinker. He is the author of Questions Are the Answer: A Breakthrough Approach to Your Most Vexing Problems at Work and in Life and the coauthor of The Innovator’s DNA: Mastering the Five Skills of Disruptive Innovators .

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• Corpus ID: 18400175

A Review of Brainstorming Research: Six Critical Issues for Inquiry

• Published 1998
• Education, Psychology

Tables from this paper

104 Citations

Creative reflections on brainstorming., ideation in the digital age: literature review and integrative model for electronic brainstorming, traverse the landscape of the mind by walking: an exploration of a new brainstorming practice, creative thinking of engineering undergraduates through brainstorming during mathematical problem solving, brainstorming beyond the laboratory: idea generation practices in software development firms, brainstorming under constraints: why software developers brainstorm in groups.

• Highly Influenced

Crossing the group-individual divide; brainsketching in design education

Course of action development – brainstorm or brickstorm, designing olms for reflection about group brainstorming at interactive tabletops, open learner models to support reflection on brainstorming at interactive tabletops, 154 references, implications for problem‐solving groups of empirical research on ‘brainstorming’: a critical review of the literature, perceptions of brainstorming in groups: the quality over quantity hypothesis, cultivating imagination: factors that enhance and inhibit creativity in brainstorming groups, effects of "brainstorming" instructions on creative problem solving by trained and untrained subjects., does group participation when using brainstorming facilitate or inhibit creative thinking.

• Highly Influential

Acceptance of Ideas Generated Through Individual and Group Brainstorming

Facilitating group creativity: experience with a group decision support system, performance and perceptions of brainstormers in an organizational setting, unblocking brainstorms., productivity loss in brainstorming groups: toward the solution of a riddle., related papers.

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Overview of Brainstorming and Searching for Articles

This nearly four minute video on database searching takes you through the steps this guide presents. 

1.a. Brainstorm Your Topic

What do you want to research? If you need help brainstorming, think about what you are interested in and why? Search the internet for current events, encyclopedia entries, etc. about your interests.

1.b. Breakdown Your Topic

What are the main concepts and themes in your topic? Breakdown your topic to three to five themes/concepts. 

1.c. Brainstorm Search Terms

Brainstorm search terms for each concept and theme. How else can you describe the concepts and themes? Consult a thesaurus or search engine to find synonyms. Also think broader (e.g., TikTok is a social media platform) and more focused (anxiety is one aspect of mental health).

1.d. Brainstorm Disciplines

Brainstorm the disciplines that study these concepts. Who on campus studies the concepts?

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10 Best Brainstorming Tools for Better Collaboration & Ideation

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• Best for flowchart-like visualization: Lucidchart
• Best for complex workflows: Miro
• Best for versatility: ClickUp
• Best for software development teams: Creately
• Best for students and small teams: Bubbl.us
• Best for ease of use: Coggle
• Best for extensive color and styling options: MindMeister
• Best free brainstorming software: WiseMapping
• Best for intelligent note taking: Scapple
• Best for digital whiteboard and augmented intelligence: Stormboard

The human mind is a complex system with billions of neurons that allow it to perform many functions, one of which is to think and generate ideas. Experts estimate that the mind thinks between 60,000 to 80,000 thoughts a day; this practically means that your mind can conceive thousands of ideas per day, but without a proper way to document these ideas, they would be lost to oblivion. That is where brainstorming software comes in.

Brainstorming software, also known as mind mapping tools, is used to develop creative ideas. It lets you document and organize your thoughts, add visuals or notes to them and create connections between them.

We have carefully curated a list of the best brainstorming software for teams of all sizes across various industries with different needs. We analyzed each tool’s features, pricing and their pros and cons to help you determine the best option for your organization.

Top brainstorming tools: Comparison chart

Here is a comparison feature summary of the best brainstorming software.

Lucidchart: Best for flowchart-like visualization

LucidChart is an easy-to-use and intuitive web-based brainstorming app that enables individuals, small teams and large enterprises to visualize and structure their ideas. It provides a vast library of shapes to simply drag and drop onto your mind map, allowing you to create complex diagrams, flowcharts and organizational charts with ease. To start your idea boards, you can begin building your diagrams by choosing from a template from the library or importing outlined ideas from a spreadsheet.

• Free: Available at no cost for up to 3 editable Lucidchart documents, 60 shapes per Lucidchart document and 100 templates.
• Individual: . This plan costs$7.95It includes up to 1 GB of storage.
• Team: It costs $9 per user.
• Enterprise: Custom quote.

Lucid allows you to bundle its Lucidchart and Lucidsparks products offerings as one package.

• Free: You can assess Lucidchart and Lucidspark’s basic features for free.
• Individual bundle: This plan costs $11.93.
• Team Bundle: It costs $13.50 per user.
• Enterprise bundle: Quote available upon request.
• Support collaborative diagramming with team members.
• Drag-and-drop interface.
• Extensive shape libraries.
• Integration with third-party services like Microsoft Teams, Salesforce, Slack, Trello and Visio.
• Generous free plan.
• Real time collaboration.
• Offers over 500 mind map templates.
• New users may experience steep learning curves, as the capabilities may take some time to master.
• Some users reported that the tool is somewhat pricey for small businesses.

See how Lucidchart compares to other mind-mapping software for project management.

Miro: Best for complex workflows

Miro is an online workspace that enables distributed teams to brainstorm ideas and create mind maps and roadmaps on a single, infinite canvas. It provides a digital canvas where users can add sticky notes, drawings, images and various other visual elements to organize and share ideas.

Miro offers over 400 templates across various categories, including:

• Meetings and workshops.
• Brainstorming and ideation.
• Research and design.
• Strategy and planning.
• Agile workflow.
• Mapping and diagramming.

• Free: Best for individuals and teams exploring Miro. Limited to three editable boards and up to five talktracks.
• Starter: Best for teams. It costs $8 per member per month, billed annually or $10 per member per month, billed monthly.
• Business: Best for advanced collaborations. It costs $16 per member per month, billed annually or $20 per member per month, billed monthly.
• Enterprise: Custom quotes. This plan is ideal for enterprises with complex collaboration workflows. It requires a minimum of 30 members.
• Offers 2000+ advanced diagramming shapes from BPMN, UML, AWS, Google, Azure and Cisco.
• Interactive presentation mode.
• Allow you to recover saved board history automatically.
• Versatile export options.
• Whiteboarding capabilities.
• Offers an extensive library of templates.
• Integrates with 100+ third-party applications, including Zoom, Slack, Google Drive and Sketch.
• Offers a free forever education plan for staff and students of educational institutions.
• Miro’s advanced features may take time to learn.
• Board owners cannot provide editing access.

ClickUp: Best for versatility

ClickUp is an all-in-one productivity software that allows teams of all sizes to manage projects and tasks and collaborate on ideas. Though ClickUp is primarily a project management tool, its advanced mind map and whiteboard features earned it a spot on our list of the best brainstorming software.

After creating your vision on the ClickUp mind map or whiteboards, you can select and convert the shapes to tasks and assign them to team members. This seamless integration between mind mapping and task management makes ClickUp a powerful tool for brainstorming and idea implementation.

• Free Forever: Available for unlimited team members.
• Unlimited: $7 per user per month when billed annually or $10 per user per month when billed monthly.
• Business: $12 per user per month when billed annually or $19 per user per month when billed monthly.
• There are over 16 ways to visualize your work, including mind map, Gantt, calendar, list, timeline view and whiteboards.
• Offers two mind map options, including node-based and task-based mind maps.
• Drag-and-drop to connect dependencies.
• You can create, edit or delete tasks directly from your Mind Map.
• Offers over 50 native integrations.
• Native time tracking.
• It is not primarily designed for brainstorming.
• ClickUp free and unlimited plans mind map capability have a use limit of 60 and 100, respectively.

For more information, read our full ClickUp review .

Creately: Best for software development teams

Creately is a visual collaboration platform that allows you to create, collaborate and share diagrams, draw flowcharts, UML, mind maps, UI mockups, network diagrams and wireframes. It offers a variety of pre-designed templates and a simple drag-and-drop interface to create professional-looking visuals. Creately can be used by individuals, teams and organizations across different industries for brainstorming, planning, problem-solving and communication purposes.

• Free Forever: Support up to three canvases, one folder, basic Integrations and basic collaboration.
• Personal: This plan costs $5 per month, billed annually or $8 per month, billed monthly.
• Team: This plan costs $10 per month, billed annually or $16 per month, billed monthly.
• Business: This plan costs $89 per month, billed annually or $149 per month, billed monthly.
• Enterprise: Quote available upon request.
• Advanced diagramming and whiteboarding.
• Real-time collaboration.
• Support timelines, grids and kanban boards.
• Project management capability.
• Image export – 4K, high resolution.
• Ready-to-use templates.
• Infinite canvas.
• OKR and KPI mapping.
• Mind maps, concept maps and decision trees.
• Creately mobile app can be improved.
• Some users experience occasional lag.

Bubbl.us: Best for students and small teams

If you are on a budget and are looking for a cheap brainstorming tool, Bubbl.us is your go-to solution. The platform simplifies the process of mind mapping and brainstorming, allowing you to organize your thoughts and ideas easily. Its affordable pricing plans will enable you to access all the essential features without breaking the bank. Whether you’re a student working on a project or a professional seeking simple and beginner-friendly solutions, Bubbl.us will do the trick.

• Basic: Free for up to three mind maps.
• Premium: $4.91 per month, billed annually or $6 per month, billed monthly.
• Team: Minimum of 3 users.$59 per year per user, $177 billed annually or $18 per month, billed monthly.
• Allow you to export your work as JPG, PNG and text.
• You can create and edit mind maps on any device.
• Ability to customize color and font as you wish.
• It is affordable.
• Offers students, teachers and employees of nonprofit organizations up to 50% discount.
• The premium plan storage capacity is limited to 5 GB.
• It’s less feature-rich than other tools on our list.

Coggle: Best for ease of use

With Coggle, you can take notes, brainstorm ideas, plan and collaborate with others. It is a simple yet dependable brainstorming platform and its user-friendly interface and intuitive design make it easy for beginners to navigate and use the platform without fuss.

• Free Forever: No cost for up to 3 private diagrams.
• Awesome: $5 per month.
• Organization: $8 per month.
• Coggle for Enterprise: Custom quote.
• PDF and Image download.
• Export and import as .mm and text.
• Unlimited image uploads.
•  Color customization.
• Offers revision history capability.
• Integration with third-party apps like Asana, Dropbox, GitHub, Google Drive, Jira, MeisterTask, Microsoft Teams, Trello and Typeform.
• Not suitable for planning complex projects.
• The free and awesome plans lack branded diagrams capability.

MindMeister: Best for extensive color and styling options

MindMeister is an online mind mapping software that allows users to organize and present ideas visually. It provides a collaborative platform for brainstorming, planning, meeting management and note-taking. Users can create and edit mind maps using various templates, colors and styles. MindMeister is accessible on web browsers and offers mobile applications for iOS and Android devices.

• Basic: Free forever per user.
• Personal: $3.50 per user per month, billable yearly or $4.50 per user per month, billable 6-monthly.
• Pro: $5.50 per user per month, billable yearly or $6.50 per user per month, billable 6-monthly.
• Business: $8.50 per user per month, billable yearly or $10.50 per user per month, billable 6-monthly.
• File and image attachments.
• Team collaboration capability.
• Custom product branding.
• Export to PDF, image, Freemind, XMind, MindManager, text, MindMeister, Microsoft Word and PowerPoint.
• Import from text, Freemind, XMind, MindMeister and MindManager.
• Multiple export and import options.
• Extensive styling options.
• Versions history.
• Doesn’t offer a month-to-month plan.
• Limited integrations

WiseMapping: Best free brainstorming software

Budget-conscious individuals and businesses looking for free brainstorming software should consider WiseMapping. This mind mapping tool is based on an open source project and it helps individuals and teams visualize their ideas and create structured diagrams at no cost. It offers various features, such as different layouts and styles, collaboration options, attachable notes and the ability to export and share the created maps.

WiseMapping is a free, open source tool.

• Export your maps to SVG, PNG, JPG and FreeMind.
• Personal workspace.
• Collaborative workspace.
• Drag-and-drop function.
• Excellent for educational use.
• Limited functions.
• Lacks real-time collaborative editing.

Scapple: Best for intelligent note taking

Do you like documenting your thoughts and ideas for future reference? Literature & Latte’s brainstorming software, Scapple, can help you organize your thoughts, ideas and information. It provides a flexible and freeform interface where you can connect and arrange elements such as text and notes non-linearly. Scapple is commonly used for brainstorming, outlining storyboarding and project planning.

Scapple offers a 30-day free trial.

• Standard license : $20.99.
• Educational license: $16.79. Only available to students & academics. Requires institutional affiliation.
• Stack notes in columns of related ideas.
• Customize the appearance of notes.
• You can create background shapes to group notes.
• Allow you to connect notes using drag and drop.
• You can drag notes from Scapple into Scrivener.
• No mobile app.
• No free forever plan.

Stormboard: Best for digital whiteboard and augmented intelligence

Commonly used for brainstorming sessions, project planning, agile retrospectives and virtual meetings, Stormboard allows teams to remotely collaborate and organize ideas visually and interactively. It provides a virtual whiteboard where users can create sticky notes, add images, drawings and documents and move them around to develop and structure ideas.

• Personal: Free for up to five users per storm.
• Business: $8.33 per user per month, billed annually or $10 per user per month billed monthly.
• Digital sticky notes.
• CSV, JSON, XML and OPML raw data exports.
• Word cloud, votes and tasks exports.
• Visually appealing.
• Intuitive interface and user-friendly.
• Task tracking for project management.
• Limited functionality.
• Limited storage capacity.

Key features of brainstorming tools

Here are some key features to look out for when shopping for the best brainstorming software for your company.

Building a mind map from scratch can be overwhelming, especially for those new to brainstorming software. A tool that offers predefined templates for different types of brainstorming sessions (e.g., SWOT analysis, mind mapping, or affinity diagrams) can easily guide you through the process and help structure your ideas.

Integration with third-party applications

Before selecting a brainstorming tool, take inventory of the applications you currently use within your organization. Choose a brainstorming software that integrates with all or most of your apps to ensure seamless workflow and data sharing across platforms. Integration with project management software or task trackers is essential, as it allows for a seamless transition from brainstorming to execution by directly converting ideas into actionable tasks or projects.

Data visualization

The visualization capability provides you with visual representations of complex data and information. Selecting a brainstorming software with data visualization capability allows you to better understand and analyze the ideas generated during a brainstorming session. The tools we explored in this guild enable you to create charts, diagrams, mind maps or other visual representations to connect ideas and identify patterns or trends.

Voting and ranking

Not all brainstorming software providers offer this capability, but it is an essential component of brainstorming software. Voting and ranking features allow team members to vote or rank ideas. This helps identify the most popular or promising ideas, fostering consensus and prioritization.

How do I choose the best brainstorming tool for my business?

The right brainstorming software for you depends on your team size, needs and preferences. If you prioritize affordability, consider Bubbl.us, WiseMapping or Coggle. If you value features and functionalities over money, ClickUp, Miro or Creately are excellent choices. MindMeister allows you to customize and style your mind map tool to suit your needs.

At the same time, Stormboard and Scapple’s note-taking capabilities make them desirable for more free-flowing brainstorming sessions, while Lucidchart’s visualization features make it a good option for creating flowcharts and diagrams during brainstorming sessions.

Methodology

To write this review, we analyzed 25+ brainstorming software. We selected the top 10 that ranked high based on our evaluation of their features, costs, ease of use, interaction with third-party services and customer service and support.

We collected each product’s information from their websites and signed up for a free plan/trial where possible to gain first-hand experience with the tool’s capabilities. We also looked at user reviews to learn about real-world users’ experiences with the brainstorming software. This information was then used to analyze the tool’s strengths and weaknesses.

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Table of contents

What is brainstorming?

Definition of brainstorming.

Brainstorming is a creative thinking technique for coming up with new ideas and solving problems. Teams use this ideation method to encourage new ways of thinking and collectively generate solutions. Brainstorming encourages free thinking and allows for all ideas to be voiced without judgment, fostering an open and innovative environment. This process typically involves a group of people, although it can be done individually as well.

This guide will help you get the most out of every creative session. When you're ready to start your next free thinking exercise, jump into Miro’s brainstorming tool to generate ideas and turn them into action.

What is the main purpose of brainstorming?

The primary purpose of a brainstorming session is to generate and document many ideas, no matter how “out there” they might seem. Through this lateral thinking process, inventive ideas are suggested, which sparks creative solutions. By encouraging everyone to think more freely and not be afraid to share their ideas, teams can build on each other’s thoughts to find the best possible solution to a problem. Brainstorming usually takes place in a group setting where people get together to creatively solve problems and come up with ideas. However, it’s also useful for individuals who need to explore novel solutions to a problem. Sitting down by yourself and writing down solutions to potential problems is a great way to brainstorm individually. Focusing your mind on a defined problem allows you to think of many creative ways to get to an answer. While brainstorming normally allows for free-form methods of thinking and doesn’t require many rules, the best results usually stem from controlled sessions. Posing questions and role-playing different scenarios during the brainstorming session is a smart way to pull out unusual ideas and never-before-thought-of solutions.

Benefits of brainstorming

Why is brainstorming such a popular approach to solving problems and generating ideas? Here are some of its many advantages:

Encourages creativity

Brainstorming sessions are meant to be free of judgment. Everyone involved is meant to feel safe and confident enough to speak their minds. There will be some good and some bad ideas, but this doesn’t matter as long as the final outcome is one that can solve the problem. This kind of free-thinking environment, along with a few essential brainstorming rules, encourage creativity in the workplace.

Fosters collaboration and team building

Brainstorming is not only good for problem-solving. It also allows employees and team members to understand how the people around them think. It helps the team get to know each other’s strengths and weaknesses and helps build a more inclusive and close-knit workforce.

Generates innovative, revolutionary ideas

Brainstorming is the perfect mix between a free-thinking, creative environment and one that is governed by rules. Being faced with a defined problem or asking questions like “What do we do in X scenario?” forces everyone in the room to come up with ideas and solutions. No two people think alike. So, combining the good parts of everyone’s answers will result in holistic and revolutionary solutions.

Establishes different perspectives

One of the major benefits of brainstorming is that it allows and encourages all members of the session to freely propose ideas. This type of environment fosters courage in people who may not usually offer their perspective on a problem. Garnering a range of different perspectives can lead to a never-before-thought-of solution.

Introduces many ideas quickly

The beauty of brainstorming is that it encourages teams to come up with many ideas in a relatively short period of time. Ideas are thrown around, and every train of thought is documented. Different perspectives give different answers, and sifting through a few good answers in quick succession may lead to the perfect solution in no time.

Types of brainstorming techniques

There are plenty of creative brainstorming techniques to choose from. Here are some of the most popular ones:

Reverse brainstorming

In a typical brainstorming session, the group is asked to consider solutions to a problem. This means that they will spend time thinking about the outcome — the end goal — rather than the root of the problem — the starting point. Reverse brainstorming is simply the opposite: teams are asked to ideate on the problem instead of the solution. This type of brainstorming is done before the start of an important project, as it helps teams anticipate any future obstacles that might arise. To help frame this way of thinking, use a Reverse Brainstorming Template to get the team started.

Random word brainstorming

One of the main goals of a brainstorming session is to come up with new ideas. One of the best ways to do this is to say the first words that come to mind when a specific topic or subject is mentioned. Random word brainstorming allows for exactly that. The team is given a problem, and they need to shout out the first words that they think of, regardless of what they are. These words are then written down and later put into interesting combinations to see if they will lead to a usable solution. This brainstorming method is extremely fast and usually very efficient at solving a defined problem. The Random Words Brainstorming Template can help get you started.

The 5 Whys Method

Like the reverse brainstorming method, the 5 Whys method aims to look at the root causes of a problem to stop that same issue from arising again. This method attempts to curb the problem before it can reoccur by asking the question “why?” over and over until it can no longer be answered. Once you reach this stage, you have arrived at the root cause of the issue.

SCAMPER model

Developed by Bob Earle, an author of creativity books for kids, the SCAMPER model was originally a game aimed at imagination development in adolescents. It has, however, become popular in the corporate world as a means of improving and encouraging creativity in team members when dealing with complex, defined problems. Using this model, your team will view a problem through 7 filters: substitute, combine, adapt, modify, put to another use, eliminate, and reverse.

Rapid ideation

Rapid ideation brainstorming is almost the exact same thinking model as random word brainstorming. In this method, however, everyone writes down the solutions they are thinking of instead of shouting them out. This gives participants a bit more privacy with their immediate thoughts — possibly leading to even more creative and revolutionary outcomes.

Starbursting

Once again, brainstorming can change based on the team’s perspective and each session’s expected outcome. Starburst brainstorming focuses on getting the team to ask questions instead of coming up with answers.

How to hold a brainstorming workshop

Ready to harness the power of a well-run brainstorming session? Here’s a step-by-step guide on how to organize a successful brainstorming workshop:

1. Assign a facilitator

When done as a group, a brainstorming session needs to have boundaries. You need to choose someone who will facilitate the session and provide guidelines for the thinking exercises that the group will partake in. This is so the session doesn’t get too scattered and stays on the right track. The facilitator should pose questions and guide the group from start to finish.

2. Establish context and ensure group understanding

A brainstorming session cannot be properly carried out without context. The group must understand why they are meeting and what the end goal of the session is. Everyone should also understand the meaning of brainstorming and what to expect from the brainstorming process. The brainstorming method that will be used should also be established (see point 5) and explained at the outset.

3. Define an objective

While brainstorming is often looked at as a form of free-thinking creativity, it is best to try to stay within certain rules. It’s essential that you define a clear objective and use the session to reach your predetermined goal.

4. Set a time limit

Setting a defined time limit before the session starts is important to the success of your brainstorming session. No doubt your team could come up with countless ideas, but there has to be a limit on how long the session can run. Knowing that you need to solve a problem within one hour, for instance, will help the team focus on the job at hand and come up with ideas faster. It will also keep everyone thinking about the same problem.

5. Decide on the brainstorming technique

The brainstorming technique that will be used must be decided on before the session begins. The best way to do this is to look at the problem at hand. If you’re looking to prevent obstacles from arising in the future, try the “5 Whys” technique. If you’re looking to come up with new marketing ideas or get creative with workplace conflicts, try the rapid ideation technique.

6. Set some ground rules

As stated above, the best and most productive brainstorming sessions are those that allow for free thinking and creativity within preset boundaries. Brainstorming ground rules are essential to to the success of the session, as they keep everyone focused on the topic at hand and ensure that no one goes off track.

7. Capture all ideas

The entire point of a brainstorming session is to come up with as many ideas as possible, regardless of whether the standalone suggestion will lead to success. This means that you need to use the right tools to document the ideas being suggested. Miro has a host of idea-capturing tools, including a simple-to-use visual platform for remote brainstorming sessions and digital sticky notes .

8. Discuss and vote on ideas

After all the ideas have been captured, it’s time to discuss them. The team needs to be productive in choosing a creative idea that suits the problem, or they can try combining a few ideas to come up with a holistic solution. To make decisions as a group and come to an agreement, teams can use the dot voting method . This technique reveals group priorities and helps everyone reach a consensus on the direction to take.

9. Turn ideas into action

Once the final idea has been chosen, it’s time to create a plan of action and a deadline for the idea to be put in place. Transform your ideas into detailed, tangible steps with the Action Plan Template . This will help with coordination between team members and ensures that nothing is missed.

Tips for your brainstorming activities

While all brainstorming sessions look a little different, here are some best practices to get the most out of yours:

Record all ideas

If you want to have a successful and productive brainstorming session, it’s important that you capture every idea suggested, good and bad. An idea might seem silly when first brought up, but it might become an invaluable idea as the session moves on. Capture everything, and right at the end, work out which ideas best suit the problem.

Ensure that everyone’s ideas are heard

When brainstorming is done as a group activity, everyone needs to feel comfortable and confident to propose ideas. The best way to make sure the environment fosters these feelings is to make the session feel like a conversation, not a presentation. Create a safe and open environment that gives everyone equal opportunity to voice their opinions and ideas.

Focus on quantity

People often like to say, "Focus on quality, not quantity," but it’s the opposite when brainstorming. In a brainstorming session, you should focus on getting as many ideas on the board as possible, even if they're only one-word ideas. These can all be used to come to a holistic solution at the end of the session. Each suggestion could be invaluable if you're coming up with a combined idea.

Brainstorming should be a fun and creative endeavor. You shouldn’t be too rigid — though some ground rules are important. If your team has weekly brainstorming sessions, try new brainstorming techniques and activities each time you meet. This will keep your team members on their toes and help make them excited about the next meeting. It will also encourage out-of-the-box thinking, which is essential to any successful brainstorming session.

Avoid criticism

We’ll say it again: there are no bad ideas in a brainstorming session. This is the attitude that all team members must adopt when entering the session. No one should be criticized for the ideas that they propose. The best way to foster an environment that is devoid of criticism and encourages creativity is to maintain a relaxed approach. This will make everyone feel comfortable and happy to contribute their ideas.

Discover more

Guide to collaborative brainstorming, when to use brainstorming (and which techniques are best), what is brainwriting, what is reverse brainstorming, how to conduct a brainstorming session, get on board in seconds, plans and pricing.

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Blog Beginner Guides 15 Best Brainstorming Tools To Supercharge Your Ideas

15 Best Brainstorming Tools To Supercharge Your Ideas

Written by: Krystle Wong Sep 07, 2023

Whether you’re striving to ignite the next big project, unlock a novel concept or simply find fresh solutions to everyday challenges, having the right brainstorming tools at your fingertips can be a game-changer for you and your team.

That said, I’ve carefully picked 15 of my favorite brainstorming tools that have redefined the way I generate and refine ideas. From virtual whiteboards and mind mapping software to collaborative platforms and AI-driven aids, these tools are your ticket to a world of unlimited creativity and innovation. 

To save time, you can always turn to Venngage’s professionally designed brainstorming templates . Venngage offers a variety of mind mapping templates that can significantly aid brainstorming sessions by providing structure, visual appeal and enhanced organization. 

Click to jump ahead:

15 Must-have brainstorming tools to ignite your creative spark

What are the key features to look for in a brainstorming tool, online brainstorming tools v.s. traditional brainstorming methods, 7 essential tips for effective brainstorming, best brainstorming tools faqs, enhance your team’s brainstorming sessions, 1. venngage.

Venngage is a powerhouse when it comes to transforming ideas into engaging visuals. Its main forte lies in infographic creation, making it an ideal choice for marketers, data analysts and educators. Here’s what sets Venngage apart:

User-friendly interface

Venngage boasts an intuitive, user-friendly interface that allows both beginners and experienced professionals to dive right in. You don’t need to be a design guru to create stunning visuals and infographics to represent your ideas effectively.

Wide array of brainstorming templates

With Venngage, you have access to a vast library of professionally designed brainstorming templates . This extensive collection ensures that you can find the perfect template for your brainstorming needs.

Customization at your fingertips

Flexibility is key when it comes to brainstorming and Venngage understands that. You can customize every aspect of your brainstorming project – colors, fonts, icons and more – to match your unique style and brand and make your brainstorming idea presentation-ready with our brainstorm presentation templates .

Data visualization made easy

Sometimes, brainstorming involves data analysis. Venngage’s charts and graphs feature allows you to present complex data in a visually appealing and easy-to-understand manner, making it an invaluable tool for strategic planning and decision-making.

Real-time collaboration features

Brainstorming is often a team effort and Venngage makes collaboration a breeze. Invite team members or classmates to collaborate in real-time, offering feedback and ideas directly on your projects.

Main features

Infographic creation, templates, data visualization.

Who’s it for

Marketers, data analysts, educators.

Create your first 5 designs with Venngage for free and upgrade to a premium or business plan for $10 USD/month per user and $24 USD/month per user to enjoy premium features. For larger teams who need extra support, controls and security, the enterprise plan starts from $499 USD/month for 10+ seats.

Additionally, there are also plans available for classrooms priced at $99 USD/year for up to 35 students per instructor. Non profit organizations can also apply for a nonprofit discount to any Venngage plan.

Scapple offers a refreshing approach to brainstorming with its freeform mind mapping capabilities. It provides a digital canvas where users can freely jot down ideas, concepts and connections. 

Simplicity and intuitiveness are the hallmarks of Scapple. The brainstorming software is an ideal tool for users who prefer a clean slate for their thoughts, making it especially popular among writers, researchers and creative thinkers. 

While Scapple’s strength lies in its simplicity, this also means it lacks some of the advanced features found in more specialized brainstorming tools. Users seeking features like advanced collaboration or complex diagramming may find Scapple less suitable.

Main features: Freeform mind mapping, drag-and-drop interface.

Pros: Simple and intuitive, versatile brainstorming.

Cons: Lack of advanced features.

Who’s it for: Writers, researchers, creative thinkers.

Pricing: Scapple offers a 30-day free trial while the standard license is available for a one time purchase of$20.99. For students and academics, the educational license is available at $16.79 with institutional affiliation required. 

3. IdeaBoardz

IdeaBoardz is all about straightforward, collaborative brainstorming. With its virtual sticky notes and real-time collaboration features, it’s a no-fuss tool favored by small teams, educators and remote collaborators. 

While its simplicity is a strength, the free brainstorming tool may be considered basic in terms of interface and features. Users who need more advanced functionality or advanced organization capabilities may find it lacking.

Main features: Virtual sticky notes, real-time collaboration.

Pros: Easy to use, collaborative, no login required.

Cons: Basic interface.

Who’s it for: Small teams, educators, remote collaboration.

Pricing: Ideaboardz is a free product. 

Coggle shines in collaborative mind mapping, offering real-time updates and an intuitive interface. This makes it a top pick for project managers, educators and creative teams. 

The online brainstorming tool strikes a balance between simplicity and functionality. It’s visually appealing and offers teamwork features that facilitate collaborative brainstorming. Users appreciate its intuitive approach and the ability to create aesthetically pleasing diagrams.

While Coggle provides a free version, it has limitations and users with more demanding needs may consider upgrading to a paid plan to access advanced features. The free version may also have restrictions on the number of diagrams you can create.

Main features: Collaborative mind mapping, real-time updates.

Pros: User-friendly, visually appealing, teamwork features.

Cons: Limited free version.

Who’s it for: Project managers, educators, creative teams.

Pricing: Users can create 3 private diagrams and unlimited public diagrams for free with Coggle. Additionally, the personal plan with unlimited private diagrams is available for $5 per month while the organization plan is priced at $8 per month/user with more advanced features. 

5. TheBrain

TheBrain takes mind mapping to the next level, offering dynamic mind maps and advanced organization capabilities. It’s the tool of choice for users dealing with complex projects, intricate research and detailed planning. 

TheBrain is available both as an online application and as an offline software application for both Mac and Windows users to download and install on their computers or devices. Users can access and work on their brainstorming projects from anywhere with an internet connection, while also having the option to work offline when connectivity is limited or when they prefer not to rely on the internet.

It excels in rich visualization and advanced organization, making it ideal for handling multifaceted projects and extensive research. However, due to its advanced features, TheBrain may have a learning curve. Users seeking a quick and straightforward brainstorming solution may find it overwhelming.

Main features: Dynamic mind mapping, advanced organization.

Pros: Rich visualization, extensive features, hierarchical structuring.

Cons: Learning curve.

Who’s it for: Complex projects, researchers, strategists.

Pricing: A 30-day free trial is available for all users. One-time purchase of the offline software is priced at $219 while the online version is available at $15 per month when billed annually. Alternatively, for access to both offline licenses and cloud services, users would have to pay a fee of $299 per year/seat. 

Miro offers a comprehensive range of products for businesses and teams with different needs from product roadmap workflows to wireframing, visual project management and more. 

For teams looking for a collaborative brainstorming tool, Miro’s digital whiteboard offers a versatile canvas for teams to brainstorm, design and ideate together. It’s a favorite among design teams and those involved in agile projects. The collaborative tool is tailored for design teams seeking a digital canvas for brainstorming and remote collaboration. 

While Miro is intuitive for basic use, its advanced features may require a learning curve. Some users might find these features challenging to master.

Main features: Digital whiteboard, real-time collaboration.

Pros: Versatile, teamwork features, integrations.

Cons: Learning curve for advanced features.

Who’s it For: Design teams, agile projects, remote collaboration.

Pricing: While there is a free version available for all users, the starter pack with unlimited private boards and essential features is priced at $8 per month when billed annually and $10 when billed monthly. For businesses that require advanced collaboration, the business pack is priced at $20 per month or $16 per month when billed annually. Alternatively, enterprises can reach out to the Miro sales team for more scaled up packages. 

7. MindMeister

MindMeister is an online mind mapping tool designed for collaboration. It offers an intuitive platform for creating, sharing and collaborating using mind maps . 

One of the most significant advantages of the MindMeister mobile app that is available on both Android and iOS devices is its accessibility. You can brainstorm ideas and create mind maps from your smartphone or tablet, whether you’re commuting, waiting in line or simply away from your computer. 

While a free version is available, the brainstorming app comes with limitations, which may prompt users with more extensive needs to consider upgrading.

Main features: Online mind mapping, collaboration.

Pros: User-friendly, collaborative, integration options.

Who’s it for: Educators, project managers, creative teams.

Pricing: Users can create up to 3 mind maps for free and subscribe to the personal plan for $6 per month/user. For teams looking for more advanced collaboration features, the Pro Plan is priced at $10 per month/user while the business plan costs $15 per month/user. 

8. Bubbl.us

Bubbl.us is all about straightforward online mind mapping and real-time collaboration. It’s designed to simplify brainstorming and idea visualization.

Being one of the many virtual brainstorming tools, Bubbl.us shines in ease of use and quick setup. The collaborative brainstorming tool is an ideal choice for students seeking a straightforward tool for project planning, small teams involved in rapid brainstorming sessions and educators facilitating collaborative learning activities.

However, being an innovative web-based tool, Bubbl.us would require a stable internet connection to function. Users in areas with unreliable or slow internet access may experience interruptions or difficulties in accessing their mind maps.

Main features: Simple online mind mapping, real-time collaboration.

Pros: Easy to use, quick setup, sharing options.

Cons: Dependency on internet connectivity. 

Who’s it for: Students, small teams, educators.

Pricing: Create up to 3 mind maps for free and subscribe to the Premium version for $4.91 per month or $59 per year. For teams, the team plan starts at $59/year per user for a minimum of 3 users. 

9. WiseMapping

WiseMapping is one of the free brainstorming tools that makes brainstorming, idea visualization and thought organization a breeze. Plus, it’s open-source, which means no fancy licenses or restrictions. 

The beauty of WiseMapping lies in its simplicity. The user-friendly interface ensures that you spend less time learning the tool and more time brainstorming creatively. Invite team members, classmates or colleagues to join your mind map in real time and watch as ideas merge and evolve together on the virtual canvas. 

If you value simplicity, open-source software and ease of use for basic mind mapping tasks, WiseMapping can be a valuable tool. However, it may not be the ideal choice for handling complex projects or extensive data analysis.

Main features: Online mind mapping, open-source.

Pros: Free and open-source, collaborative.

Cons: Less polished interface, less suitable for complex projects. 

Who’s it for: Educators, open-source enthusiasts, small teams.

Pricing: WiseMapping is a free tool with no restrictions of any type. 

When it comes to brainstorming tools, Trello stands out as a powerful and versatile option that can turn your creative ideas into actionable plans. This user-friendly platform is widely known for its Kanban-style task management , but it’s also a formidable tool for brainstorming sessions.

At its core, Trello is a visual project management tool that uses boards, lists and cards to help teams organize tasks and projects. However, it’s this visual and flexible nature that makes it a valuable asset for brainstorming and idea generation.

That said, Trello’s brainstorming features, while robust, may not offer the same level of advanced capabilities as dedicated brainstorming tools. It can also be challenging to keep track of a large number of cards and lists for extensive projects with numerous tasks and ideas. 

Main features: Kanban-style task management, collaboration.

Pros: Highly customizable, visual organization, integration options.

Cons: Can become complex for extensive projects.

Who’s it for: Project managers, agile teams, task-driven projects.

Pricing: The free plan includes up to 10 boards per workspace or you can upgrade to the standard plan for $5 per month/user when billed annually for unlimited boards, advanced checklists and more. For larger teams that require more advanced features, the premium plan is priced at $10 per month/user (billed annually) while the enterprise plan starts at $17.50 per month/user (billed annually) starting with 50 users. 

Slack, primarily known as a team communication platform, offers valuable features for brainstorming. Its real-time communication capabilities facilitate instant idea sharing and feedback.

Additionally, the platform’s diverse integrations with various apps and tools allow users to seamlessly incorporate brainstorming sessions into their existing workflows. 

However, Slack can sometimes feel overwhelming, as it’s not exclusively focused on brainstorming. Nonetheless, the tool is ideal for remote teams, collaborative workspaces and businesses looking to enhance their communication and integrate brainstorming into their daily operations.

Main features: Team communication, file sharing, integrations.

Pros: Real-time communication, diverse integrations.

Cons: Can be overwhelming, not focused solely on brainstorming.

Who’s it for: Remote teams, collaborative workspaces, businesses.

Pricing: There is a free version available for Slack with only up to 90 days of access to message and file history. For paid plans, the Pro version is priced at $7.25 per month/user when billed annually while the Business+ plan would cost $12.50 per month/user. Alternatively, enterprises with more advanced needs may contact their sales representatives for a price estimate. 

12. Conceptboard

Conceptboard is a versatile virtual whiteboard designed for visual collaboration. Its standout feature is the ability to create visual representations of ideas in real-time, making it an excellent choice for designers and creative teams. 

While some advanced features may require a paid plan, the platform’s ease of use and real-time editing capabilities more than compensate. The visual collaboration platform is tailored for creative professionals, remote collaboration and anyone seeking a visually engaging brainstorming experience.

Main features: Virtual whiteboard, visual collaboration.

Pros: Versatile for visual collaboration, real-time editing.

Cons: May require paid plans for advanced features.

Who’s it for: Designers, creative teams, remote collaboration.

Pricing: For individuals who are just getting started with visual collaboration, Conceptboard offers a free plan and a 30 day free trial for all of its paid plans. For small and medium teams, the premium plan is priced at $6 per month/user when billed annually while larger teams can opt for the business plan for $9.50 per month/user with annual billing. Alternatively, enterprises, those in the public sector and a data center edition is also available upon request. 

Mural stands out as a digital workspace that excels in visual collaboration. With a rich set of collaborative features, including templates and integrations, it’s perfect for design thinking teams and innovation workshops. 

However, there might be a learning curve for new users as they explore the extensive features. Nevertheless, Mural shines in fostering creativity and collaboration among remote teams engaged in visual brainstorming sessions.

Main features: Digital workspace, visual collaboration.

Pros: Rich collaborative features, templates, integrations.

Cons: Learning curve for new users.

Who’s it for: Design thinking teams, innovation workshops, remote collaboration.

Pricing: Get started with 3 free murals with their free plan and subscribe to the Team+ plan $9.99 per month/user with annual billing. For larger teams, the Business plan is available at $17.99 per month/user when billed annually while enterprises can reach out to their sales team for a customized quote. 

14. Stormboard

Stormboard offers a unique approach to brainstorming with its digital sticky notes and real-time collaboration features. 

Its user-friendly interface allows for interactive brainstorming without requiring users to create accounts, which is particularly beneficial for small teams and educators. 

While the free version is limited, Stormboard remains an accessible option for remote workshops and collaborative idea generation.

Main features: Digital sticky notes, real-time collaboration.

Pros: User-friendly, interactive, no account needed.

Who’s it for: Small teams, educators, remote workshops. 

Pricing: Get started for individuals or teams of 5 or less with their free plan or upgrade to the business plan for $8.33 per month/user when billed annually. For larger organizations looking for added security, scalability and support, you can reach out to their sales team for custom pricing. 

15. Microsoft Teams

When it comes to brainstorming and collaborative work, Microsoft Teams has emerged as a powerful contender. 

As a part of the Microsoft 365 suite, it offers a robust platform that seamlessly integrates messaging, document sharing, video conferencing and more, making it a versatile tool for unleashing creativity within teams.

However, it’s essential to recognize that Teams may come with a learning curve and the potential risk of over-integration, which could impact the efficiency of brainstorming sessions. Nevertheless, with the right approach, training, and certification using resources like  AZ-900 Dumps , Microsoft Teams can be a dynamic ally in your quest for creative brilliance.

Main Features: Real-time chat, document collaboration, video conferencing, file sharing, cross-platform access, Microsoft 365 integration and organization tools.

Pros: Versatile collaboration, cross-platform compatibility, secure file sharing and robust organization features.

Cons: Not solely dedicated to brainstorming, a learning curve for new users, potential for distractions due to extensive integration.

Who’s It for: Business professionals, writers and students seeking versatile collaboration, organization and communication tools.

Pricing: Subscribe to Microsoft Teams Essentials for $4 per month/user or get the Microsoft 365 Business Basic plan for only $6 per month/user that comes with the web and mobile versions of Microsoft 365 apps. The Microsoft 365 Business Standard plan on the other hand is priced at $12.50 per month/user. 

The key to harnessing the full potential of brainstorming in this digital age lies in finding the perfect brainstorming tool. From ease of use and collaboration capabilities to the versatility of idea capture and robust security, let’s explore the essential features you should keep in mind when evaluating your options:

Ease of use

A user-friendly interface can make or break your brainstorming sessions. Look for a tool that boasts an intuitive design, allowing team members to dive in without the need for extensive training. The smoother the learning curve, the more your team can focus on generating creative ideas.

Collaboration capabilities

Seek tools with real-time collaboration features that enable team members, regardless of their location, to work together seamlessly. The ability to contribute, edit and comment on ideas in real-time fosters a sense of teamwork and collective creativity.

Venngage enables real-time collaboration, making it easy for teams to work together on brainstorming projects, no matter where team members are located. Team members can provide feedback and comments directly on the visuals, fostering a collaborative environment where ideas can be refined and developed collectively.

Versatile idea capture

Ideas come in various forms – from text descriptions to visual sketches, images and multimedia. A versatile brainstorming tool should accommodate multiple media types, ensuring that every idea, regardless of its format, can be captured and explored.

Organization and structure

As ideas flow, it’s essential to organize and structure them coherently. A good tool should offer features for categorizing, grouping and visually arranging ideas.

Export and integration

The ability to export or share your brainstormed content in different formats, such as PDF or CSV, is crucial. Additionally, integration with other software your team uses, such as project management tools or document storage platforms, streamlines the transition from brainstorming to implementation.

Venngage offers various export options, such as PDFs, PNGs and more with a Premium or Business account. This versatility ensures that you can share your brainstorming outputs in the format that best suits your needs.

Customization

Every team has its unique preferences and needs. Customizable tools allow you to tailor the interface, layouts and templates to match your team’s specific brainstorming processes and branding.

With Venngage’s user-friendly drag-and-drop interface, you have the creative freedom to design visuals that best represent your ideas. You can experiment with different layouts and design elements to create truly unique and engaging content.

Customization in Venngage extends to adapting your visuals for various purposes, whether it’s for a presentation, report or social media post. This adaptability makes it a versatile tool for brainstorming across different contexts.

Privacy and security

For teams handling sensitive information or proprietary ideas, robust security features are non-negotiable. Ensure your chosen tool offers strong data protection measures and gives you control over who can access and edit your brainstorming content.

Compatibility

Effective collaboration relies on accessibility. Consider whether the tool is available on the platforms and devices your team uses. Cross-platform compatibility ensures that everyone can participate, regardless of their choice of device or operating system.

Search and retrieval

Ideas generated in past sessions can be a goldmine of inspiration. An effective search function helps you quickly find and retrieve these past ideas and notes, making it easier to reference and build on previous brainstorming sessions.

Cross-platform compatibility

In today’s diverse tech landscape, teams often use a variety of devices and operating systems. A tool with cross-platform compatibility ensures that everyone on your team can participate in brainstorming, no matter their device or OS.

Templates and frameworks

Structured brainstorming sessions benefit from predefined templates and frameworks. Some tools offer these resources, making it simpler to get started with organized and productive brainstorming sessions.

Venngage offers an extensive collection of professionally designed brainstorming templates across numerous categories. These templates serve as a starting point, helping you structure your brainstorming sessions effectively. Looking for more ideas? This article on brainstorming examples might help.

For those seeking a visual tool to clarify, organize and communicate complex ideas or relationships — concept map is for you. To help kickstart your brainstorming session, here are some concept map examples that you could use. 

Brainstorming, the creative engine that drives innovation and problem-solving, comes in various forms, each with its own set of advantages and drawbacks. In the digital age, online brainstorming tools and traditional brainstorming methods stand as two formidable contenders. Let’s break down the good, the bad and the in-between:

Online brainstorming tools

The positives:.

Accessibility: Allow for remote collaboration, enabling team members to participate in real-time brainstorming sessions even if you’re not in the same room.

Versatility: Many online tools offer a wide range of features, such as mind mapping, brainstorming board and multimedia integration, making them adaptable to various brainstorming styles.

Organization: Online tools often provide features for categorizing and structuring ideas, which can help streamline your online brainstorming sessions and effectively generate ideas.

Documentation: Ideas and discussions are digitally recorded, making it easier to review and reference them later.

Integration: They can often integrate with other digital tools and software, facilitating seamless transitions from brainstorming to project planning and execution.

The drawbacks:

Learning curve: Some team members may find it challenging to adapt to new online tools, potentially slowing down the brainstorming process.

Dependency on technology: Online tools rely on internet connectivity and may be vulnerable to technical issues or outages.

Privacy and security: Ensuring the security of sensitive information can be a concern when using online tools.

Traditional brainstorming methods

Simplicity: Traditional methods, like whiteboard sessions or in-person meetings, are straightforward and require little to no technology.

Face-to-face interaction: In-person brainstorming can foster better communication and immediate feedback among team members.

Tangible: Ideas written on sticky notes or a physical whiteboard are tangible, making it easy to rearrange and visualize the brainstormed content.

No Tech Barriers: Traditional methods don’t require team members to be tech-savvy or have access to specific software or devices.

Geographical constraints: In-person brainstorming limits participation to those who can physically attend meetings, excluding remote team members.

Documentation challenges: Traditional methods often rely on manual note-taking, which may be less organized and harder to share and store.

Limited versatility: Traditional methods may be less versatile in terms of capturing and organizing ideas, especially for complex or multifaceted projects.

Time and resource intensive: Setting up physical meetings and arranging materials can be time-consuming, especially for distributed teams.

At the end of the day, you should always consider your project’s nature, your team’s preferences and the tech resources you have on hand. Sometimes, mixing and matching both styles can cook up the perfect brainstorming concoction.

When it comes to brainstorming, success hinges on the approach you take. Here are seven vital tips to ensure your brainstorming session hits the mark:

1. Choose the right tool

Your brainstorming tool can make or break the session. Select one that aligns with your team’s needs and preferences. Ensure it offers the features and capabilities that will support your brainstorming process. 

2. Create a welcoming environment

The brainstorming environment matters. Foster an open and non-judgmental atmosphere where team members feel comfortable sharing their ideas. Encourage diversity of thought; sometimes, the most unconventional ideas spark innovation.

3. Set clear objectives

To make sure that everyone on the team is on the same page, clearly define the problem or goal you’re addressing in the brainstorming session. Having a specific focus helps guide the discussion and leads to more targeted and actionable ideas.

4. No idea is a bad idea

In brainstorming, there’s no room for idea discrimination. Encourage participants to share even the wildest or seemingly unconventional ideas. Sometimes, the best ideas come from these out-of-the-box concepts.

5. Use visual aids and templates

Many brainstorming tools offer visual aids, such as mind maps and templates. Take advantage of these features to organize and structure all the good ideas effectively. Visual aids can clarify complex concepts and enhance creativity.

6. Build upon ideas

Brainstorming is a collaborative effort. Collect ideas and encourage participants to build upon each other’s ideas and iterate. Online tools make it easy to refine and expand upon concepts as the session progresses. 

7. Time management

Productive brainstorming is also about efficiency. Set time limits for each phase of the ideation session within the tool. This keeps the discussion focused and ensures the session doesn’t drag on endlessly. 

Remember, effective brainstorming is not just about generating ideas; it’s about fostering an environment for creative thinking. With these tips and the right tool in hand, your brainstorming sessions can become a wellspring of innovation and problem-solving.

Mind maps are perfect for visually organizing ideas, fostering creativity and clarity during brainstorming sessions. Explore these guides for more mind map examples and top mind-mapping software that can allow you and your team to explore connections, identify patterns and generate new insights

How do virtual whiteboards function as brainstorming tools?

Virtual whiteboards function as brainstorming tools by providing a digital canvas where teams can ideate, collaborate and organize ideas. Participants can use drawing tools, add text, images and diagrams to visually represent ideas in real-time, fostering creativity and group interaction.

What is mind mapping and how is it related to brainstorming tools?

Mind mapping is a brainstorming technique and a visual representation of ideas, concepts and information. It’s related to brainstorming tools because many of these tools include mind mapping features. Users can create interconnected diagrams to explore and expand upon ideas, making mind mapping an integral part of brainstorming processes.

How can I integrate brainstorming tools into project management workflows?

You can integrate brainstorming tools into project management workflows by exporting or linking brainstormed ideas and plans to project management software like Trello, Asana or Jira. This integration ensures a seamless transition from brainstorming to project execution, making it easier to track and implement creative solutions.

What are some common brainstorming techniques?

Common brainstorming techniques include traditional brainstorming sessions, brainwriting, mind mapping, SWOT analysis and the Delphi method, among others. These techniques offer structured approaches to idea generation and problem-solving, often enhanced by using brainstorming tools.

Are there any mobile apps for brainstorming on the go?

Yes, there are mobile apps designed for brainstorming on the go. Apps like MindMeister, SimpleMind and Brainstormer allow users to brainstorm and capture ideas using their mobile devices, ensuring flexibility and accessibility.

What are the advantages of using cloud-based brainstorming tools over desktop applications?

Cloud-based brainstorming tools offer advantages like real-time collaboration, automatic syncing across devices and accessibility from anywhere with an internet connection. Desktop applications may lack these features and can be less flexible for team collaboration.

Can I use brainstorming tools for personal projects and goal setting or are they primarily for business use?

Brainstorming tools can be used for both personal projects and business purposes. Many tools cater to a wide range of users, allowing individuals to brainstorm ideas, set personal goals and organize their thoughts effectively.

Are there any specific brainstorming tools designed for creative writing?

While there are brainstorming tools suitable for creative writing, they might not be exclusive to this purpose. Tools like Scrivener and Ulysses are commonly used by writers for brainstorming, organizing plot ideas and drafting content.

Can you recommend some user-friendly brainstorming tools suitable for students?

Some of the user-friendly brainstorming tools that are suitable for students include MindMeister, Bubbl.us and Coggle. These tools offer intuitive interfaces and collaborative features, making them ideal for educational settings.

Are there free brainstorming tools available or do I need to pay for them?

Yes, there are free brainstorming tools available. Some options include MindMup, Bubbl.us and Stormboard, which offer basic features at no cost. However, premium versions often provide more advanced capabilities to fuel your brainstorm session.

How can I measure the effectiveness of brainstorming sessions conducted with these tools?

Measuring the effectiveness of brainstorming sessions conducted with these tools can involve assessing the quantity and quality of new ideas, tracking the implementation of ideas into projects and soliciting feedback from participants through surveys or retrospectives. The effectiveness may also be judged by the impact of generated ideas on project outcomes or problem-solving success.

In conclusion, the world of brainstorming tools is filled with options that can genuinely turbocharge your idea-generation process. With the 15 stellar tools I’ve walked you through, you now have a versatile toolkit at your disposal, each offering its own unique features to cater to various team dynamics and creative demands.

However, it’s important to remember that the tool is just one part of the equation. The success of your brainstorming sessions also hinges on cultivating a collaborative and open-minded atmosphere, setting clear objectives and executing well-defined action plans.

So, whether you opt for virtual whiteboards, concept maps, mind mapping or keep it simple with the traditional pen and paper, the key is finding the right tool that complements your team’s strengths and aligns with your specific goals.

In a world where innovation is the engine driving success, these brainstorming tools can fuel your creative thinking, leading you to groundbreaking ideas and creative solutions. Armed with the right tools and a team that’s ready to collaborate, the sky’s the limit for what you can achieve. 

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Brainstorming

What is brainstorming.

Brainstorming is a method design teams use to generate ideas to solve clearly defined design problems. In controlled conditions and a free-thinking environment, teams approach a problem by such means as “How Might We” questions. They produce a vast array of ideas and draw links between them to find potential solutions.

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How To Use Brainstorming Best

Brainstorming is part of design thinking . You use it in the ideation phase. It’s extremely popular for design teams because they can expand in all directions. Although teams have rules and a facilitator to keep them on track, they are free to use out-of-the-box and lateral thinking to seek the most effective solutions to any design problem. By brainstorming, they can take a vast number of approaches—the more, the better—instead of just exploring conventional means and running into the associated obstacles. When teams work in a judgment-free atmosphere to find the real dimensions of a problem, they’re more likely to produce rough answers which they’ll refine into possible solutions later. Marketing CEO Alex Osborn, brainstorming’s “inventor”, captured the refined elements of creative problem-solving in his 1953 book, Applied Imagination . In brainstorming, we aim squarely at a design problem and produce an arsenal of potential solutions. By not only harvesting our own ideas but also considering and building on colleagues’, we cover the problem from every angle imaginable.

“It is easier to tone down a wild idea than to think up a new one.” — Alex Osborn

Everyone in a design team should have a clear definition of the target problem. They typically gather for a brainstorming session in a room with a large board/wall for pictures/Post-Its. A good mix of participants will expand the experience pool and therefore broaden the idea space.

Brainstorming may seem to lack constraints, but everyone must observe eight house rules and have someone acting as facilitator.

Set a time limit – Depending on the problem’s complexity, 15–60 minutes is normal.

Begin with a target problem/brief – Members should approach this sharply defined question, plan or goal and stay on topic.

Refrain from judgment/criticism – No-one should be negative (including via body language) about any idea.

Encourage weird and wacky ideas – Further to the ban on killer phrases like “too expensive”, keep the floodgates open so everyone feels free to blurt out ideas (provided they’re on topic).

Aim for quantity – Remember, “quantity breeds quality”. The sifting-and-sorting process comes later.

Build on others’ ideas – It’s a process of association where members expand on others’ notions and reach new insights, allowing these ideas to trigger their own. Say “and”—rather than discourage with “but”—to get ideas closer to the problem.

Stay visual – Diagrams and Post-Its help bring ideas to life and help others see things in different ways.

Allow one conversation at a time – To arrive at concrete results, it’s essential to keep on track this way and show respect for everyone’s ideas.

To capture everyone’s ideas in a brainstorming session, someone must play “scribe” and mark every idea on the board. Alternatively, write down your own ideas as they come, and share these with the group. Often, design problems demand mixed tactics: brainstorming and its sibling approaches – braindumping (for individuals), and brainwriting and brainwalking (for group-and-individual mixes).

Take Care with Brainstorming

Brainstorming involves harnessing synergy – we leverage our collective thinking towards a variety of potential solutions. However, it’s challenging to have boundless freedom. In groups, introverts may stay quiet while extroverts dominate. Whoever’s leading the session must “police” the team to ensure a healthy, solution-focused atmosphere where even the shiest participants will speak up. A warm-up activity can cure brainstorming “constipation” – e.g., ask participants to list ways the world would be different if metal were like rubber.

Another risk is to let the team stray off topic and/or address other problems. As we may use brainstorming in any part of our design process—including areas related to a project’s main scope—it’s vital that participants stick to the problem relevant to that part (what Osborn called the “Point of View”). Similarly, by framing problems with “How Might We” questions, we remember brainstorming is organic and free of boundaries. Overall, your team should stay fluid in the search for ways you might resolve an issue – not chase a “holy grail” solution someone has developed elsewhere. The idea is to mine idea “ore” and refine “golden” solutions from it later.

How to Supercharge Brainstorming with AI

Learn more about brainstorming.

The Interaction Design Foundation’s course on Design Thinking discusses Brainstorming in depth.

This blog offers incisive insights into Brainstorming workshops .

Jonathan Courtney’s article for Smashing Magazine shows Brainstorming’s versatility .

Literature on Brainstorming

Here’s the entire UX literature on Brainstorming by the Interaction Design Foundation, collated in one place:

Learn more about Brainstorming

Take a deep dive into Brainstorming with our course Design Thinking: The Ultimate Guide .

Some of the world’s leading brands, such as Apple, Google, Samsung, and General Electric, have rapidly adopted the design thinking approach, and design thinking is being taught at leading universities around the world, including Stanford d.school, Harvard, and MIT. What is design thinking, and why is it so popular and effective?

Design Thinking is not exclusive to designers —all great innovators in literature, art, music, science, engineering and business have practiced it. So, why call it Design Thinking? Well, that’s because design work processes help us systematically extract, teach, learn and apply human-centered techniques to solve problems in a creative and innovative way—in our designs, businesses, countries and lives. And that’s what makes it so special.

The overall goal of this design thinking course is to help you design better products, services, processes, strategies, spaces, architecture, and experiences. Design thinking helps you and your team develop practical and innovative solutions for your problems. It is a human-focused , prototype-driven , innovative design process . Through this course, you will develop a solid understanding of the fundamental phases and methods in design thinking, and you will learn how to implement your newfound knowledge in your professional work life. We will give you lots of examples; we will go into case studies, videos, and other useful material, all of which will help you dive further into design thinking. In fact, this course also includes exclusive video content that we've produced in partnership with design leaders like Alan Dix, William Hudson and Frank Spillers!

This course contains a series of practical exercises that build on one another to create a complete design thinking project. The exercises are optional, but you’ll get invaluable hands-on experience with the methods you encounter in this course if you complete them, because they will teach you to take your first steps as a design thinking practitioner. What’s equally important is you can use your work as a case study for your portfolio to showcase your abilities to future employers! A portfolio is essential if you want to step into or move ahead in a career in the world of human-centered design.

Design thinking methods and strategies belong at every level of the design process . However, design thinking is not an exclusive property of designers—all great innovators in literature, art, music, science, engineering, and business have practiced it. What’s special about design thinking is that designers and designers’ work processes can help us systematically extract, teach, learn, and apply these human-centered techniques in solving problems in a creative and innovative way—in our designs, in our businesses, in our countries, and in our lives.

That means that design thinking is not only for designers but also for creative employees , freelancers , and business leaders . It’s for anyone who seeks to infuse an approach to innovation that is powerful, effective and broadly accessible, one that can be integrated into every level of an organization, product, or service so as to drive new alternatives for businesses and society.

You earn a verifiable and industry-trusted Course Certificate once you complete the course. You can highlight them on your resume, CV, LinkedIn profile or your website .

All open-source articles on Brainstorming

Stage 3 in the design thinking process: ideate.

• 1.2k shares
• 4 years ago

14 UX Deliverables: What will I be making as a UX designer?

Introduction to the Essential Ideation Techniques which are the Heart of Design Thinking

• 1.1k shares

Learn How to Use the Best Ideation Methods: Brainstorming, Braindumping, Brainwriting, and Brainwalking

Three Ideation Methods to Enhance Your Innovative Thinking

Ideation for Design - Preparing for the Design Race

Transform Your Creative Process with Design Thinking

Revolutionize UX Design with VR Experiences

• 3 weeks ago

Start Your UX Journey: Essential Insights for Success

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Literature Review Tips & Tools

• Tips & Examples

Organizational Tools

Tools for systematic reviews.

• Bubbl.us Free online brainstorming/mindmapping tool that also has a free iPad app.
• Coggle Another free online mindmapping tool.
• Organization & Structure tips from Purdue University Online Writing Lab
• Literature Reviews from The Writing Center at University of North Carolina at Chapel Hill Gives several suggestions and descriptions of ways to organize your lit review.
• Cochrane Handbook for Systematic Reviews of Interventions "The Cochrane Handbook for Systematic Reviews of Interventions is the official guide that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions. "
• Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) website "PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. PRISMA focuses on the reporting of reviews evaluating randomized trials, but can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions."
• PRISMA Flow Diagram Generator Free tool that will generate a PRISMA flow diagram from a CSV file (sample CSV template provided) more... less... Please cite as: Haddaway, N. R., Page, M. J., Pritchard, C. C., & McGuinness, L. A. (2022). PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis Campbell Systematic Reviews, 18, e1230. https://doi.org/10.1002/cl2.1230
• Rayyan "Rayyan is a 100% FREE web application to help systematic review authors perform their job in a quick, easy and enjoyable fashion. Authors create systematic reviews, collaborate on them, maintain them over time and get suggestions for article inclusion."
• Covidence Covidence is a tool to help manage systematic reviews (and create PRISMA flow diagrams). **UMass Amherst doesn't subscribe, but Covidence offers a free trial for 1 review of no more than 500 records. It is also set up for researchers to pay for each review.
• PROSPERO - Systematic Review Protocol Registry "PROSPERO accepts registrations for systematic reviews, rapid reviews and umbrella reviews. PROSPERO does not accept scoping reviews or literature scans. Sibling PROSPERO sites registers systematic reviews of human studies and systematic reviews of animal studies."
• Critical Appraisal Tools from JBI Joanna Briggs Institute at the University of Adelaide provides these checklists to help evaluate different types of publications that could be included in a review.
• Systematic Review Toolbox "The Systematic Review Toolbox is a community-driven, searchable, web-based catalogue of tools that support the systematic review process across multiple domains. The resource aims to help reviewers find appropriate tools based on how they provide support for the systematic review process. Users can perform a simple keyword search (i.e. Quick Search) to locate tools, a more detailed search (i.e. Advanced Search) allowing users to select various criteria to find specific types of tools and submit new tools to the database. Although the focus of the Toolbox is on identifying software tools to support systematic reviews, other tools or support mechanisms (such as checklists, guidelines and reporting standards) can also be found."
• Abstrackr Free, open-source tool that "helps you upload and organize the results of a literature search for a systematic review. It also makes it possible for your team to screen, organize, and manipulate all of your abstracts in one place." -From Center for Evidence Synthesis in Health
• SRDR Plus (Systematic Review Data Repository: Plus) An open-source tool for extracting, managing,, and archiving data developed by the Center for Evidence Synthesis in Health at Brown University
• RoB 2 Tool (Risk of Bias for Randomized Trials) A revised Cochrane risk of bias tool for randomized trials
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13 Best Brainstorming Tools & Apps to Bring Your Ideas to Life

Haillie Parker

February 13, 2024

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In fast-paced meetings, it’s easy to forget promising ideas that simply pass through the discussion.

Taking effective meeting notes definitely helps, but not as much as powerful brainstorming software to take your ideas from concept through creation.

These tools are excellent for broadening your approach to brainstorming, encouraging creativity, and revealing new project planning methods that may just change the way you work altogether.

This blog will highlight our 13 favorite brainstorming software including their pros, cons, best features, pricing, and reviews. 💪🏼

3. Lucidchart

4. infinity, 5. mindmeister, 6. wisemapping, 10. stormboard, 11. conceptboard, 12. mindnode.

What Are the Benefits of Brainstorming Tools?

While brainstorming software may seem like a niche investment, its benefits actually span several use cases.

Coming up with new ideas is never a bad thing, in fact, it is encouraged!

Whether you’re looking to change the way to tackle a project, a different snack to spice-up your day, or a more functional layout for your beloved home office—we live for the thrill of discovering something new.

And TBH, the old-fashioned pen and paper simply aren’t enough to develop those new ideas anymore.

Brainstorming software is designed to help you express your ideas by capturing them digitally using proven brainstorming techniques .

One of the best and most productive brainstorming strategies is mind mapping.

Like a highly visual string of thoughts, mind maps are an excellent tool for fleshing out details, multi-step processes, and project plans. Think of it almost like a family tree where one task connects to the next, branching out from one clear starting point or goal.

Mind mapping software allows you to gain insights, brainstorm, and bring your ideas to life on an endless canvas—but not all mind mapping software is equally flexible or feature-rich.

Plus, you can create in multiple ways! Even on a digital whiteboard . 🎨

Pretty neat, huh? 🙂

But the big question still remains— who uses brainstorming software?

The short answer: everyone .

Brainstorming software and project management software often share some similar features. Collaboration, creativity, structure, and productivity are key—but that doesn’t mean you have to be a project manager to reap the benefits of brainstorming software.

Writers, students, teachers, marketers, and designers all depend on the brainstorming process in their fields. And while those processes may look different when it comes to the details, the tools and techniques they use are almost identical.

So, let’s get into it—what are the best brainstorming tools on the market ATM?

13 Best Brainstorming Software for Any Use Case

Before investing in any new software, it’s important to first understand your own needs.

Here are 13 of our favorite brainstorming software, plus, their key features, benefits, limitations, pricing, and reviews, to help you make the best possible choice for your unique situation.

ClickUp is the go-to, all-in-one productivity platform for teams of any size to centralize their work and collaborate on new ideas. Its ever-growing list of highly functional features includes ClickUp’s highly visual Mind Maps and ClickUp Whiteboards —perfect for quickly developing new ideas into detailed roadmaps, and acting on those plans instantly.

Start your new Mind Map from scratch in Blank Mode, choose from a pre-built template , or draw it by hand on your Whiteboard canvas , the possibilities are truly endless.

And we haven’t even told you the best part yet.

You can convert any shape on your Mind Map and Whiteboard directly into a ClickUp task, making it easier than ever to start managing your ideas in the same place that they happened.

Plus, ClickUp integrates with over 1,000 other work tools including G Suite, Dropbox, and GitHub, making your Mind Maps that much more valuable to your team from the get-go.

Key Features

• Dynamic ClickUp Docs for creating sharable guides, blogs, and wikis
• Share updates, links, action items, and more with ClickUp’s an-app chat and threaded comments
• Over 15 unique ways to visualize your work including Gantt, Calendar, List, Timeline view, and more
• Manage projects from any device or window with ClickUp’s mobile app and Chrome Extension
• Take your Mind Map further by linking tasks, drawing task relationships, and sharing options
• Advanced diagramming features with Blank Mode, ClickUp Whiteboards, and its many templates
• Quick to set up and easy to learn its drag-and-drop interface
• Feature-rich Free Forever Plan
• Tons of collaboration tools to align the entire team
• Fully customizable features adapt to any work style and scale as you grow
• Over 1,000 integrations to streamline your workflow
• Not all views are available on the mobile app (yet!)
• There can be a bit of a learning curve adjusting to so many powerful features
• Free Forever:  Whiteboards, Mind Maps, unlimited tasks and members, 100MB of storage, and more
• Unlimited ($7 per member, per month):  Unlimited storage, unlimited integrations, unlimited Dashboards
• Business ($12 per member, per month):  Unlimited teams, custom exporting, advanced public sharing
• Business Plus ($19 per member, per month):  Custom role creation, custom permissions, increased automations
• Enterprise ( contact sales for pricing ) : Enterprise API, guided onboarding, dedicated success manager

ClickUp Ratings

• G2: 4.7/5 (4,510+ reviews)
• Capterra: 4.7/5 (2,270+ reviews)

Miro is a collaborative digital whiteboard software for remote teams to create mind maps, org charts, and roadmaps on a single, infinite canvas. It is helpful for product developers, remote teams, and even UX researchers who may work asynchronously on large projects.

Miro integrates with over 70 applications to broaden its capabilities with tools to create surveys, track tasks on your board, embed documents, and increase file storage.

• Hundreds of pre-made templates for flowcharts, mind maps, and more
• Built-in video and chat features
• Zoom into specific areas on your whiteboard in Miro’s present mode
• Video call with the team from your board
• Folder organization to keep track of whiteboards
• Highly visual and easy to use
• Multiple collaboration tools directly from your board
• Easily integrates with other services
• Board owners are unable to give editing access
• Limited features in the free plan and pricey paid plan options
• It can be a bit overwhelming if you’re new to digital whiteboards
• Free  
• Team: $8 per member, per month
• Business: $16 per member, per month
• Enterprise: Contact for pricing

Miro Ratings

• G2: 4.8/5 (3,670+ reviews)
• Capterra: 4.7/5 (710+ reviews)

Lucidchart is a digital diagramming tool for businesses looking to brainstorm and visualize complex systems or structures. As with other popular whiteboarding tools, users can create detailed mind maps in Lucidchart using its many shapes, templates, and drag-and-drop functionality.

• Automated layout for quickly creating data-driven diagrams
• Over 500 mind map templates
• A vast library of shapes to simply drag and drop onto your mind map
• A wide variety of templates
• It generates entries that can be seamlessly integrated
• Import data from popular apps including Zapier, Excel, and Salesforce
• Limited offline functionality
• Outdated-looking interface
• Limited free version
• Individual : Starting as low as $7.95
• Team : Starting as low as $9 per user
• Enterprise : Contact for pricing

Lucidchart Ratings

• G2: 4.5/5 (670+ reviews)
• Capterra: 4.5/5 (1,200+ reviews)

Check out these Lucidchart Alternatives !

Infinity is a project management software with multiple customizable views to develop ideas. The collaboration features built into Infinity help teams take new concepts beyond the brainstorming phase with calendars, tables, Gantt charts, lists, and columns to manage data together.

• Multiple project views to help your ideas take shape
• Custom attributions to add context to your ideas
• Workspace can organize and store data easily
• The hierarchy system helps break down projects into a mind map-like structure
• Multiple options to easily share your projects
• Several pre-made templates
• No free plan
• Limited features to make the most of Infinity’s many project views
• Limited integrations
• Limited permissions and personal settings
• Duo (two members) : Basic starting at $99, can upgrade to Pro for $149
• Team (five members) : Basic starting at $199, can upgrade to Pro for $299
• Startup (10 members) : Basic starting at $299, can upgrade to Pro for $399
• Business (25 members) : Basic starting at $499, can upgrade to Pro for $699
• Company (50 members) : Basic starting at $999, can upgrade to Pro for $1,299
• Unlimited (unlimited members) : Basic starting at $1,999, can upgrade to Pro for $2,499
• Enterprise : Custom pricing

Infinity Ratings

• G2: 4.6/5 (10+ reviews)
• Capterra: 4.8/5 (10+ reviews)

MindMeister is a mind mapping tool to organize your ideas and boost your creativity in brainstorming sessions. The software automatically aligns nodes, making creating mind maps quick and easy. It allows creative thinking while helping users to collaborate in real-time, take notes, brainstorm ideas, and plan projects.

• Multiple themes with styles, colors, and formatting options
• Full-screen presentation mode
• Comments feature for team collaboration
• Diagramming tools
• Customizable mind map themes
• Multiple exporting options
• Simple to learn
• Limited features on the free plan
• No tracking features to follow through on your ideas
• Basic   plan : Free
• Personal   plan : Starting at $4.99 per month
• Pro   plan : Starting at $8.25 per month
• Business   plan : Starting at $12.49 per month

MindMeister Ratings

• G2: 4.4/5 (20+ reviews)
• Capterra: 4.7/5 (220+ reviews)

Check out these MindMeister Alternatives!

WiseMapping is a free brainstorming software that centers on mind mapping in public and private workspaces. It is a web-based software that allows users to create complex mind maps.

• Text style and formatting
• Multiple sharing and exporting options
• Several features specific to educators and classroom use
• Drag and drop function ality
• The option of either a collaborative or personal workspace
• Free for personal use
• Heavy emphasis on educational use cases
• Focused on idea development through mind maps
• Brainstorming features are limited to mind maps
• Lacks real-time collaborative editing
• Designed for classrooms rather than project or product managers

WiseMapping is free for personal and commercial use.

WiseMapping Ratings

• G2: 4.3/5 (8 reviews)
• Capterra: N/A

Mindly allows you to create unique digital mind maps to capture ideas, brainstorm, plan projects, or prepare for meetings.

• Passcode protection to access your mind maps
• Custom color schemes and map elements
• Visual clipboard for reorganizing ideas and styling options
• Multiple export options
• Accessible on multiple devices
• Great for creating a visual hierarchy of ideas
• Limited features in the free version
• No task or management features

Mindly offers a free option, but pricing for its full version varies based on your device.

Mindly Ratings

Coggle is an intuitive digital mind mapping and flowcharting software for planning processes and breaking down ideas. For mind map beginners, it is easy to get the hang of, but the software may be limiting for more seasoned users looking to plan complex projects.

• Collaborative drawing and real-time editing
• Annotate your mind map with floating text, media, and images
• Saved edit history of all changes
• Auto-arranging branches
• Convenient sharing via URL
• Intuitive interface with branches that auto-arrange for fast drafting
• Multiple ways to link related topics together on one map
• Mind maps on Coggle’s free version are automatically public
• Few other brainstorming tools besides mind maps
• No mobile app
• Free Forever
• Awesome : Starting at $5 per month
• Organization : Starting at $8 per member, per month

Coggle Ratings

• G2: 4.4/5 (5+ reviews)
• Capterra: 4.6/5 (30+ reviews)

Scapple is a brainstorming software that provides users with a digital canvas to write their ideas and get back to them later. Think of it as a virtual notebook for jotting down quick ideas, sentences, and notes for when you’re on the go. Ideal for creatives like songwriters, writers, and literary professionals, Scapple is most often used for making to-do lists and creating simple mind maps with arrows, text bubbles, and shapes.

• Connect notes on Scapple with its drag and drop interface
• Group notes based on shapes and backgrounds
• Organize notes of related ideas in a word cloud-style way
• Data import and export features
• Easy to use and quick to learn
• Simple and clean interface
• No free trial and paid plans are pricey
• No support for mobile use
• It May be too simple for complex ideas and projects
• Scapple offers a 30-day free trial
• Standard Licence: For macOS and Windows, $18
• Educational Licence: For macOS and Windows, $14.40

Scapple Ratings

• G2: 4.5/5 (2+ reviews)
• Capterra: 4.7/5 (150+ reviews)

Stormboard is a digital whiteboard solution for remote teams to collaborate, conduct meetings, and monitor projects. Like a bulletin board accessible on virtually any device, Stormboard has several visual elements like sticky notes , images, links, and presentation features to jog your creativity during brainstorming sessions.

• Idea management features like folders and task priorities
• Navigation panel to hone in on specific areas of your board
• Project tracking and backlog management
• Highly visual and interactive
• Tons of templates
• Mobile and desktop access
• Limited free plan, especially for mid-sized teams
• Tons of features can take a while to learn
• Personal : Free
• Startup: $5 per user, per month
• Business: $10 per user, per month
• Enterprise: $16.67 per user, per month

Stormboard Ratings

• G2: 4.3/5 (20+ reviews)
• Capterra: 4.5/5 (30+ reviews)

Conceptboard is a digital whiteboard tool for teams to brainstorm and develop new ideas together, with clients, groups, and external partners as if they are in the same room.

Add style to your board with shapes, sticky notes, drawings, and media, then present your ideas with collaboration features like live pointers, video conferencing, and screen sharing.

• Various visual styling options
• Customizable pre-made templates
• Share your board with a password-protected link
• Clean and intuitive interface
• V ideo and audio calling and screen sharing
• Few features to manage ideas beyond the brainstorming phase
• Limited text editing tools
• Premium: $6 per user, per month
• Business: $9.50 per user, per month
• Enterprise: Contact for pricing, minimum 250 licenses

Conceptboard Ratings

• G2:4.5/5 (40+ reviews)

Mindnode is a digital brainstorming app for organizing, capturing, and sharing new ideas in the form of a mind map. Mindnode makes it easy for users to express their thoughts visually and establish connections between different ideas.

• Choose to capture your ideas as text or as an image
• Share documents publicly through the MyMindNode service
• Clean interface
• Easy to use
• Limited templates and icons to choose from
• Only allows basic editing in Mindnode’s free version
• Not ideal for complex projects or ideas

Mindnode offers free basic editing. To access Mindnode on your iPad, iPhone, or Mac, you’ll need the paid plan which starts at $2.49 per month per user.

Mindnode Ratings

• G2: 4.2/5 (30+ reviews)
• Capterra: 4.7/5 (10+ reviews)

Ayoa is a mind mapping software with productivity tools like kanban boards, whiteboards, instant messaging, and task management. It is suitable for users who want a visual way to stay on top of tasks. The platform allows you to invite collaborators to work in real time and allows users to communicate easily with their team members.

• Collaborative whiteboards
• Real-time collaboration and chat tools
• Public mind map sharing
• It is easy to use
• Tasks can be viewed in different ways
• The interface can look a bit busy
• Free trial : Seven days
• Mind Map : Starting at $10 per user, per month
• Task : Starting at $10 per user, per month
• Ultimate : Starting at $13 per user, per month

Ayoa Ratings

• G2: 4.4/5 (50+ reviews)
• Capterra: 4.5/5(200+ reviews)

Use Brainstorming Software for Your Next Brainstorming Session

Brainstorming software should help you think big, get creative, and put your ideas in motion. While there are tons of tools that benefit a limited set of use cases, you should look for the platform that will help you push beyond your current situation.

AKA, look for ClickUp. 🤓

Number one on this list and in our hearts, ClickUp is the only software with built-in Whiteboards and Mind Maps that can turn your ideas into actionable tasks.

Sign up for ClickUp for free, forever, and uplevel your brainstorming processes to new heights. 🏔

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Emergency pediatric patients and use of the pediatric assessment triangle tool (PAT): a scoping review

• Tore A. G. Tørisen 1 ,
• Julie M. Glanville 2 ,
• Andres F. Loaiza 3 , 4 &
• Julia Bidonde 5  

BMC Emergency Medicine volume  24 , Article number:  158 ( 2024 ) Cite this article

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We conducted a scoping review of the evidence for the use of the Pediatric Assessment Triangle (PAT) tool in emergency pediatric patients, in hospital and prehospital settings. We focused on the psychometric properties of the PAT, the reported impact, the setting and circumstances for tool implementation in clinical practice, and the evidence on teaching the PAT.

We followed the Joanna Briggs Institute methodology for scoping reviews and registered the review protocol. We searched MEDLINE, PubMed Central, the Cochrane Library, Epistemonikos, Scopus, CINAHL, Grey literature report, Lens.org, and the web pages of selected emergency pediatrics organizations in August 2022. Two reviewers independently screened and extracted data from eligible articles.

Fifty-five publications were included. The evidence suggests that the PAT is a valid tool for prioritizing emergency pediatric patients, guiding the selection of interventions to be undertaken, and determining the level of care needed for the patient in both hospital and prehospital settings. The PAT is reported to be fast, practical, and useful potentially impacting overcrowded and understaff emergency services. Results highlighted the importance of instruction prior using the tool. The PAT is included in several curricula and textbooks about emergency pediatric care.

Conclusions

This scoping review suggests there is a growing volume of evidence on the use of the PAT to assess pediatric emergency patients, some of which might be amenable to a systematic review. Our review identified research gaps that may guide the planning of future research projects. Further research is warranted on the psychometric properties of the PAT to provide evidence on the tool’s quality and usefulness. The simplicity and accuracy of the tool should be considered in addressing the current healthcare shortages and overcrowding in emergency services.

Review registration: Open Science Framework; 2022. https://osf.io/vkd5h/

Peer Review reports

Emergency medical services (EMS) are crucial to emergency care systems providing effective emergency medical care to people in need [ 1 ]. The World Health Organization (WHO) Emergency Care System Framework [ 2 ] (see Additional file 1) notes that effective emergency care involves a coordinated and integrated system of care, including the provision of prehospital care, transportation, and emergency department (ED) services. The WHO framework emphasizes the importance of early recognition of health issues and the timely provision of appropriate interventions to reduce morbidity and decrease the incidence of death and illness. Pediatric emergencies, particularly acute injuries and illnesses, generate considerable numbers of ambulance calls and ED visits in developed countries [ 3 , 4 ].

There is a general understanding that lack of pediatric emergency flow (or crowding) may lead to adverse outcomes for the child. However, the prevalence of pediatric emergencies poses significant challenges to emergency healthcare providers [ 5 , 6 ]. In the UK, pediatric emergencies represent 5–10% of all emergencies [ 7 ] and in the USA, children represent 20% of ED patients [ 8 ]. Injuries are the leading cause of morbidity and mortality among children and adolescents [ 9 , 10 ].

Caring for critically ill or injured pediatric patients can be challenging for emergency healthcare workers (EHWs) [ 11 ]. Patients’ histories may be difficult to obtain if the patient cannot provide verbal information or has been found alone without a caregiver [ 12 ]. Taking vital signs can be difficult and may not provide accurate information due to normal age-based variations [ 12 ]. Furthermore, some EHWs may have not received training in pediatric emergencies, which can be stressful [ 13 ].

Despite these challenges, EHWs need to conduct a rapid and accurate assessment of the pediatric patient to deliver timely effective emergency treatment. EHWs also need to reassure patients and caregivers and bring order to potentially chaotic situations. EHWs who lack specialized training in pediatric emergencies may unintentionally exacerbate stressful situations [ 13 ]. Emergency pediatric training for healthcare professionals inside and outside of the hospital is essential to ensure the best outcomes for critically ill or injured pediatric patients [ 14 , 15 ].

Emergency triage involves quickly identifying patients who require medical attention to prioritize treatment efficiently for those in greatest need [ 14 ]. Triage tools such as the Manchester Triage System and the Emergency Severity Index are helpful [ 16 ]. The Paediatric Canadian Triage and Acuity Scale (PaedCTAS) was developed specifically for pediatric patients [ 17 ], using the Pediatric Assessment Triage (PAT) tool as the first step in assessing emergency patients. It includes the “general impression” stage using the PAT, primary assessment with the airway, breathing, circulation, disability, and exposure (ABCDE) approach [ 18 ], secondary assessment, diagnostic assessment, and reassessment.

The Pediatric Assessment Triangle (PAT)

The PAT is used to quickly identify critically ill or injured children needing immediate medical attention. It focuses on three presenting components (“arms”): appearance, work of breathing, and circulation (Fig. 1 ). It can be used in prehospital or hospital settings for efficient rapid assessment of the patient's level of consciousness, breathing, and circulation, without requiring hands-on assessment or equipment [ 5 , 19 ]. It can help identify key pathophysiological problems and whether urgent transport or resources are needed. The PAT assessment takes 30–60 s [ 5 , 19 ] and it can be performed remotely (a “through the room” assessment).

The Pediatric Assessment Triangle components (arms). Figure adapted from Fuchs S and McEvoy M [ 20 ]]

Scoping review aim and design

Give the current shortage of healthcare personnel worldwide, and overcrowding of emergency departments, gathering of the PAT’s evidence is essential. This review aimed to identify the available scientific evidence about the PAT and its use by EMS. Our objective was to complete a scoping review within the pre-and-hospital care to synthesize:

What are the psychometric properties of the PAT (e.g., validity, reliability, applicability)?

What are the reported impact(s) of the PAT? (e.g., improved triage, cost, better clinical outcomes)

What are the requirements or circumstances for PAT implementation in clinical practice?

What is the evidence on the value of teaching EMS workers about PAT?

We followed the Joanna Briggs Institute framework for scoping reviews [ 21 ]. The review protocol was registered [ 22 ]. The review is reported according to the PRISMA extension for scoping reviews [ 23 ] (Additional file 2).

Eligibility criteria

Eligible publications (Table  1 ) reported the use of the PAT with pediatric populations in prehospital, hospital or training settings. Eligible outcomes matched our specific aims as follows: 1) psychometric performance, 2) impact(s), 3) implementation of PAT utilization, and 4) evidence on teaching the PAT.

We searched MEDLINE (PubMed), PubMed Central (via LitSense), the Cochrane Library, Epistemonikos, Scopus and CINAHL, from 1995 to July 2022, to include publications before the introduction of the PAT in the curricula of Pediatric Education for Prehospital Professionals (PEPP) and Advanced Pediatric Life Support (APLS) in 2000 [ 24 ]. The database searches were conducted from 24 to 28 July 2022. Fourteen websites of organizations involved in policy making in emergency pediatrics were searched between 6 and 10 August 2022. We searched for unpublished (grey) literature using Grey Literature Report ( http://www.greylit.org/ ) and Lens.org ( https://www.lens.org/ ). Full searches are presented in additional file 3.

Study selection process

We deduplicated records in EndNote and conducted double independent screening (TT, AFL-B) in Covidence (Veritas) against the eligibility criteria (Table  1 ). Conflicts were resolved by consensus or arbitrated by a third reviewer (JB). Additional file 4 lists records excluded at full text with reasons. Records reporting the same study were grouped and we cite the earliest publication while presenting relevant data from any of the related publications.

Data collection process

Data were extracted from eligible studies into a Microsoft 365 Excel form which was piloted on a random sample of five included studies, and modified as required based on feedback from the team [ 22 ]. One reviewer (TT) completed data extraction and a second reviewer (AFL-B) verified the extracted data. Disagreements were resolved by consensus or arbitrated by a third reviewer (JB). Risk of bias was not assessed [ 21 ].

Knowledge user (KU)/patient engagement and methodological appraisal

We defined KU/ patient engagement as individuals who may be affected by the research findings. Since this review was time sensitive, we did not recruit knowledge users or patients.

We did not appraise methodological quality or risk of bias of the included articles, which is consistent with guidance on scoping review conduct.

The synthesis included quantitative (e.g. psychometric properties) and qualitative analyses (e.g. content analysis) of the components of the impact, implementation and teaching. A word cloud was drawn for the impact of the PAT using the online program WordClouds. The team members identified, coded, and charted relevant units of text from the articles using a framework established a priori as a guide. The framework was developed through team discussions upon reviewing the preliminary results. Data were grouped by question and overviews are provided using charts and tables generated using Microsoft 365 Excel.

Search results and publication characteristics

The searches identified 548 records (Fig. 2 ). Fifty-five publications were included (full citations listed in Additional file 5) of which three were books. Sixteen publications were in non-English languages, but with English abstracts, and of these we retrieved 14 full text publications (Spanish ( n  = 9), German ( n  = 2), French ( n  = 1), Turkish ( n  = 1), and assumed Taiwanese Mandarin ( n  = 1)). Of these, there were seven papers that described the psychometric properties of the PAT, 18 were about the PAT’s impact, 38 described implementation pros and cons, and 30 provided references to the PAT used in educational/training environments. The publication dates ranged from 1999 to 2022, representing 18 countries with the majority classified as "high income" (World Bank classification) [ 25 ] (see Additional file 6). Study designs were diverse: primary research ( n  = 27, 49.1%), secondary research ( n  = 4, 7.3%), and "other" ( n  = 24, 43.6%). We identified no randomized controlled trials, systematic reviews, or scoping reviews.

PRISMA flow chart

Psychometric properties

The seven papers reporting psychometric properties were as follows. Four studies (Table 2 ) reported sensitivity and specificity, measuring test accuracy [ 26 , 27 , 28 , 29 ], of which one study reported an area under the receiver operating characteristic curve (AUROCC) [ 29 ] and four studies reported likelihood ratios (LR) [ 26 , 27 , 28 , 30 ].

PAT sensitivity (Fig. 3 ) ranged from 77.4% to 97.3% (four studies) suggesting it can accurately identify a large proportion of patients with the targeted condition [ 26 , 27 , 28 , 29 ]. Specificity, measuring a test's ability to correctly identify patients without the condition, ranged from 22.9% to 99.15% (four studies) [ 26 , 27 , 28 , 29 ].

PAT sensitivity and specificity

One study evaluated the PAT’s validity and reliability [ 31 ] by collecting data for 157 patients triaged by a single trained observer and an “enfermera clasificadora” (classifying nurse). This single pair showed high inter-observer agreement in applying the PAT and no errors associated with polypnea, pre-existing pallor, or irritability.

Likelihood ratios (LR) measure a test’s diagnostic accuracy which are less likely to change with the prevalence of a disorder. A positive LR (LR +) indicates a positive test result is more likely in people with the condition and a negative LR (LR-) indicates that a negative test result is more likely in people without the condition of interest. One study reported LR + of 5.2 (95% CI 5–7.8) [ 26 ] with a statistically significant high odds ratio (OR 111, 95% CI 73–168.6; p  < 0.001), indicating the PAT has a high ability to correctly identify and classify initial severity of disease during triage. A second study reported a LR + of 7.7 (95% CI 5.9–9.1) [ 27 ]. A third study triaged 1002 children using the PAT, reporting a LR + of 0.12 (95% CI 0.06–0.25) for children deemed stable by the PAT ( n  = 200) [ 28 ]. This study’s results for categories of pathophysiology (respiratory distress, respiratory failure, shock, central nervous system/metabolic disorder, and cardiopulmonary failure) highlighted the need to consider the clinical scenario when interpreting the PAT in EMS. However, the moderate LR- value (0.22, 95% CI 0.18–0.26) indicated that the test is less able to correctly identify children who do not need urgent care. The study reported a LR- of 0.12 (95% CI 0.06–0.25) for children found to be stable by the PAT ( n  = 802) [ 28 ]. The LR- values for children with the five specified categories of pathophysiology suggest the PAT has relatively low LR for identifying respiratory distress and shock, indicating it is better at ruling out those conditions. However, the relatively high LR- for respiratory failure and cardiopulmonary failure suggests the PAT is less effective at ruling out those conditions.

One study (2017) found that abnormal PAT results were associated with an increased risk of admission to the hospital (OR 5.14, 95% CI 4.98–5.32; p  < 0.01) [ 30 ]. Abnormal appearance (OR 3.99, 95% CI 3.63–4.38) or having one or more components of the PAT (OR 14.99, 95% CI 11.99–18.74) were significantly associated with hospital admission [ 30 ]. The study identified adjusted age (OR 4.44, 95% CI 3.77–5.24; p  < 0.001) and triage (OR 1.78, 95% CI 1.72–1.84; p  < 0.001) as independent risk factors for intensive care unit admission and longer stays in the pediatric ED [ 30 ]. One study reported the PAT performed similarly to the Pediatric Early Warning Score (PEWS) (AUROCC 0.963 (PAT) and 0.966 (PEWS); x 2  = 0.10; p  = 0.74) [ 29 ].

Four studies reported high levels of reliability in PAT results [ 27 , 28 , 29 , 32 ]. One study reported 93.6% reliability (Kappa index 0.7, 95% CI 0.5–0.8) [ 29 ]. A second study found paramedics used the PAT highly consistently across its three arms (Kappa 0.93, 95% CI 0.91–0.95) [ 32 ] and the paramedics’ impression, completed using PAT on first contact with the patient, showed substantial agreement with the investigators’ retrospective chart review on diagnosis and disposition (Kappa 0.62, 95% CI 0.57–0.66) and categorization of stable versus unstable (Kappa 0.66, 95% CI 0.62–0.71). A third study reported substantial inter-rater reliability agreement on PAT scores ( n  = 1002, two pediatric emergency physicians and a pediatric nurse practitioner) (Fleiss' κ 0.7, p  < 0.001) [ 28 ]. A fourth study reported an agreement rate of 93.24% between the PAT and the condition of sick children [ 29 ].

Reported impacts of the PAT

Eighteen publications reported on impacts after PAT implementation; the word cloud of impact names is display in Fig.  4 . Terms most used were “triage –communication -vocabulary and care”.

The PAT reported impact

Impact reported were on mortality, safety, effectiveness of care, timeliness of care, triage, and communication [ 27 , 28 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Three studies showed the ability of the PAT to correctly assess critical cases (e.g. higher risk of mortality in patients with sepsis with an altered or unstable PAT) [ 33 , 34 , 36 ]. Two studies found that PAT helped to avoid unnecessary interventions or potential harm to patients [ 27 , 35 ]. One study reported that a normal PAT result did not exclude severe infections, and a proper examination was still necessary to diagnose emergency pediatric patients [ 33 ]. One study reported that the PAT was timely and rapid to apply (mean 32.4 s) [ 31 ] and two studies reported that the PAT was equally effective, but faster and easier to use, than the PEWS in predicting critical illness in pediatric patients [ 29 , 38 ].

Communication and documentation were another way the PAT’s impact were reported. The PAT’s “general impression” aided in care communication and helped prioritize management options. The specific vocabulary to describe a patient’s vital signs and physical findings allowed for easy documentation and transfer/flow of information between EHWs [ 27 , 28 , 37 ]. Two studies highlighted the power of a common vocabulary in EMS replacing subjective comments with specific assessments [ 27 , 28 ].

Studies offered insights into achieving optimal triage outcomes using the PAT. One study demonstrated the PAT’s usefulness when classifying non-urgent patients [ 40 ] and a second noted the importance of setting severity and prioritization criteria (1 to 5 depending on severity) and using the PAT to ensure proper attention [ 45 ].

Abnormal PAT findings helped to identify patients with a higher risk of hospitalization [ 30 ] and enabled earlier interventions for high-risk patients [ 42 ]. One study used the PAT for children experiencing secondary complications to hematopoietic cell transplantation [ 44 ] and reported that an unstable PAT, along with other factors, accurately predicted the need for admission (relative risk 3.4, 95% CI 2.6–4.6; p  < 0.001). A study investigated features of 17,243 cases referred from in-hospital areas to the pediatric ED (median age 42 months (range: 0–120)); 65% of transferred patients were PAT-assessed as stable [ 41 ]. One study assessed the PAT as a discriminator in the triage classification system and assessed the correlation between pathophysiological diagnosis and triage classification [ 31 ]. Four studies suggested the PAT was considered practical and helpful in identifying emergency pediatric patients in need of intervention and identifying the probable underlying cause of illness [ 26 , 28 , 38 , 46 ]. Treatment priorities were met in children with fever, and to a lesser extent for pain, respiratory distress, and oxygen needs.

One study concluded that an abnormal PAT and a more severe triage level (I-III) were independent factors in identifying asthmatic children requiring hospitalization and longer stays [ 43 ]. One study suggested that the PAT did not perform well for patients with anaphylaxis and as a result patients did not receive timely interventions [ 39 ].

We found no data for impacts on pediatric readmission, patient/caregiver experience, or provider burnout.

Setting and circumstances for PAT implementation

Ten studies evaluated pre-hospital triage using the PAT [ 6 , 20 , 27 , 30 , 38 , 47 , 48 , 49 , 50 ] and 28 evaluated hospital triage [ 24 , 26 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. No studies reported PAT use in emergency call centers or telemedicine services. One study noted that the PAT may be implemented by midwives working in hospitals or prehospital settings [ 37 ]. A study of 391 admissions reported PAT was considered a useful triage tool in resource-poor hospitals [ 52 ].

Four studies recommended formal training on using the PAT as necessary for effective use [ 27 , 28 , 45 , 47 ]. One study ( n  = not reported) found that a low utilization rate for the PAT (patient report forms collected over a three-month period) following its introduction increased significantly following training in PAT use (12% vs 63.3%) [ 47 ]. After implementation, one study reported that the 30 emergency nurses involved preferred using the PAT over the PEWS when assessing emergency pediatric patients [ 29 ]. In a study of the Advanced Pediatric Life Support (APLS) course, attendees considered the systematic assessment approach incorporating the PAT crucial to their clinical practice, highlighting the importance of training prior implementation [ 54 ]. Studies acknowledged that applying the PAT with young infants (7–89 days old) was challenging [ 33 ], implementing the PAT requires skills, on-site senior emergency pediatric care providers, and a pediatric-friendly environment [ 59 ] and that the feasibility of the PAT is promising, but further research for “clinical validation” (not further defined) was needed [ 30 ].

We found no information about the implementation of PAT in clinical guidelines, requirements for recertification after PAT implementation, cost of implementation, or sustainability.

Teaching the PAT

Thirty studies presented data on teaching PAT to EHWs as follows: an early report suggested that the PAT was ideal for pediatric life support courses in all settings, based on its simplicity and reproducibility for both teachers and clinicians [ 60 ]. The PAT is included in one textbook of general emergency pediatrics [ 61 ] and two textbooks for emergency pediatric care in the prehospital environment [ 20 , 62 ]. Courses for EHWs on pediatric life support have incorporated the PAT for the “first impression” assessment, as well as training on the use of the PAT tool itself [ 29 , 30 , 63 ].

Methods for teaching the PAT tool included classroom-based, use of simulation, use of virtual reality and video for case training [ 54 , 64 , 65 ]. The PAT has been recommended as a teaching tool for the goal-directed management of shock in children [ 66 ].

The number of people who have received PAT training is unknown, but more than 170,000 EHWs had received formal training up to 2010 (worldwide) [ 63 ]. The numbers of EHWs trained in the studies ranged from 30 to 1520 [ 29 , 54 ].

Eighteen studies reported the care of emergency pediatric patients and provide insights into best practices for care which can, in turn, inform educational programs or be used to develop evidence-based protocols [ 30 , 37 , 48 , 49 , 50 , 56 , 57 , 59 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ]. Four publications describe how emergency care providers use the PAT to assess emergency pediatric patients generally or with specific medical problems [ 30 , 49 , 59 , 67 ].

We identified 55 documents reporting the use of the PAT in hospital and pre-hospital emergency pediatric care. Research indicates that the PAT is a valid and reliable tool for evaluating emergency pediatric patients, prioritizing interventions, and determining the appropriate level of care. EHWs found the PAT is fast and practical, akin to the intuitive ‘gut feeling’ of experienced clinicians., but they should complete formal training before implementing the PAT. Several emergency pediatric care course curricula and key textbooks include the PAT.

We found only seven publications on the PAT’s psychometric properties, which suggest that the PAT has good sensitivity and some variability in specificity. The low research volume may reflect ethical challenges around research involving children, the unique and unpredictable nature of emergency situations, the impossibility of controlling all variables and difficulties in obtaining funding [ 77 ]. Research on psychometric properties can be expensive and funding for pediatric-focused psychometric research may not be a priority for research funders. The PAT’s ease of use may have contributed to its rapid adoption in practice before adequate psychometric testing was conducted and published. Implementing the PAT may still be challenging in terms of training or resistance to change [ 47 ]. Despite the challenges of research in the emergency setting, a third of the included studies reported positive impacts when using the PAT, suggesting its potential for triaging and improving patient outcomes in clinical settings which merits further investigation in an era of emergency department overcrowding and shortages of healthcare personnel.

Other tools are also used for emergency pediatric assessment (e.g., the Pediatric Glasgow Coma Scale, the PEWS, and the Pediatric Vital Sign Score) and each has its strengths and limitations. Choosing a tool depends on the specific circumstances and the healthcare provider's expertise. Based on the included comparative studies, the PAT is often favored for its simplicity, rapidity, and ease of use in remote or face-to-face emergency settings, since it does not require hands-on assessment or the use of specialized equipment. The available research and comparative studies merit further investigation.

Evidence was identified on training EHWs to use the PAT to assess accurately a child's appearance, work of breathing, and circulation. Proficiency is needed in using the tool and there is a need to use it regularly, to maintain their knowledge. While the PAT can provide a quick snapshot of a child's overall condition, it is only one part of a comprehensive assessment, and EHWs should use additional tools and techniques to assess a child's condition. Online courses, in-person workshops, and continuing education courses offered by professional organizations as well as guides or manuals with step-by-step instructions on how to use the PAT are all available. Healthcare providers who are considering preparing or updating their PAT training, perhaps using simulation-based approaches, should review these sources of evidence-based training [ 78 ].

The main challenges to PAT instruction noted to date are the limited provision of hands-on experience (i.e. real-life emergency situations), limited feedback on site to the EHW on their performance (to enable them to identify and correct areas of weakness in their assessment skills) and lack of standardization in the training programs. Skill decay is problematic as EHWs may forget the PAT steps without regular use. Re-certification requirements depend on the EHW’s professional organization and any employer’s certification requirements.

Although research evidence seems to show that the PAT is considered a valuable tool for rapid assessment of the status of a distressed patient, and its simplicity makes it easy to implement across a range of settings, we identified limited evidence on using the PAT in low-income settings [ 52 , 79 ]. Resource-limited settings may lack coordinated emergency systems including at the scene aid, a system of triage, emergency medical care and critical care [ 80 ]. In these situations, different approaches to pediatric assessments may be adopted, limited data may be recorded on the frequency and quality of PAT assessments [ 81 ] and access to PAT training may be limited. Workforce shortages can impact the availability of trained EHWs to provide PAT instruction. Despite the limited evidence, we anticipate that the PAT is still a feasible tool for EHWs with limited resources [ 52 ]. The PAT’s simplicity can be helpful in rural areas, remote communities, and resource-limited clinics. Based on evidence from this review, the PAT provides a practical and effective way for EHWs to assess children in emergency situations and make informed decisions about their care.

Limitations

This scoping review has limitations. Firstly, we focused on English language articles and there may be additional full text publications in non-English languages that might have provided information on low- and middle-income countries’ experiences of the PAT, its impact, or its psychometric properties. This scoping review was pragmatic, but a follow up review may identify additional studies in languages other than English. Secondly, the search for grey literature was conducted on 14 websites, was hampered by the varying quality (and sometimes absence) of website search engines and the list of websites was prepared by one author (TT). A full systematic review would ideally search a larger number of websites and other sources of grey literature to potentially identify further research, particularly for LMICs. and might have been enhanced by suggestions from experts in the field.

Options for a future systematic review and other areas of research

A full systematic review would likely focus on those research questions for which there are most data following the scoping review and would also include detailed data extraction as well as the grouping of studies by outcomes of interest to provide summaries of the evidence for each outcome. Scoping reviews typically do not conduct risk of bias assessments or evaluate publication bias. A future systematic review could include these steps to assess the strength and quality of the evidence for the use of the PAT.

Other areas for research identified are how the PAT affects pediatric readmissions, patient/caregiver experience, and provider burnout. This scoping review did not find evidence of implementation, that is requirements of recertification and costs or data on utilization for example use of the PAT by emergency call centers, assessments by videoconference or other telemedicine services. Evidence on the utilization of the PAT specific to different emergency transport services such as air medical services, disaster response, etc. was not found.

In summary, this scoping review shows that the PAT has been used in clinical settings for over 20 years. There is some evidence of its validity and reliability, impacts and that the tool is broadly accepted by EHWs. Although the PAT condenses years of experience into a practical and useful assessment suitable for use by less experienced personnel, the need for prior training and certification was highlighted. Although there are gaps in the literature, the evidence has increase in recent years. Scoping reviews are used to inform research agendas and identify implications for policy or practice. As such, psychometric tool data are imperative. Further research on impact and implementation is warranted, and in particular, there is a need to standardize the teaching of PAT teaching and its certification. The simplicity, friendliness and low resources requirement of the tool should be considered in addressing the current healthcare shortages and overcrowding in emergency services.

Availability of data and materials

All data generated or analysed during this study are included in this published article [and its additional information files].

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Acknowledgements

This work was submitted as a thesis requirement for the Master in Pre-Hospital Critical Care, University of Stavanger, Norway in December 2022. We thank the Norwegian Institute of Public Health for supporting this publication open access fees.

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Additional file 1: appendix b. prisma-scr, additional file 2. appendix c. search strategy, additional file 3. appendix d. excluded studies with reasons for exclusion, additional file 4. appendix e. included studies, additional file 5. tables, additional file 6. appendix a – who emergency care system framework, rights and permissions.

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Tørisen, T.A.G., Glanville, J.M., Loaiza, A.F. et al. Emergency pediatric patients and use of the pediatric assessment triangle tool (PAT): a scoping review. BMC Emerg Med 24 , 158 (2024). https://doi.org/10.1186/s12873-024-01068-w

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Speaker 1: The first thing you've got to do when you start a literature review is come up with a structure. You've got to start with the end in mind. Now when you're first starting you're not quite sure what that is, so the first thing I would do is head over to ChatGPT and ask it for a structure. So for example here I've put, I want to write a literature review about organic photovoltaic device and can you help me come up with a structure for this review? And ChatGPT will kick out a preliminary structure for you. That doesn't mean you can add to it later, but this is going to be the first step in sort of like organizing our ideas and if we come up with more themes later we can slot them in. Alright then, so here we can see it's got the title, it's got an abstract which we'll save to later. We've got an introduction, background, advances in materials and technology, performance and efficiency. So all of these are going to be sort of like the key parts that we use to structure our literature review. So I would take this and copy and paste it over to something like Word or to Google Docs and then the next step is to go find literature. And this actually is one of the most exciting, maybe even fun parts of a literature review. So the second step of organizing your literature review is trying to fill out the words and finding literature that supports the different sections of your literature review. Now the first thing I want to do is have a look at the structure ChatGPT has come up with and this one, explain the basic principles and components of organic photovoltaic devices is very important. So I would literally go to an AI tool called illicit and that is illicit.com and I've typed in explain the basic principles and components. So exactly what ChatGPT spit out and what you can see here, it's given us a summary of the top four papers but importantly I'm organizing it by most recent. I want to have a look at the most recent stuff because that is going to now allow me to have a look at derivative works and also it's going to be the most up-to-date information obviously. So here I'm scanning through and I'm seeing well this one really doesn't answer my question but this one, overview of high efficiency organic photovoltaic materials and devices, that could be perfect as a seed paper and you'll see what I mean in a minute. So I'm going to have a look at that one which is here and you can see that it sort of like does give us the sort of higher level view of what we want. So then I take that seed paper, I copy the DOI and I take it over to a service that allows us to see what has referenced this paper and what is referencing this paper. There are two services that I really like to use. The first one is Litmaps and this is this paper here. So you can see that I put in this as a seed paper. So here is the future of organic photovoltaics and we can also discover more related articles but initially this is what it gives us. It gives us this kind of like map of where the actual paper is, this is our seed. If we go this way, this is where all later works are. If we go this way, this is what is all previous works and if they're up here it means that they're highly cited and if they're down here it means they're not cited very much. So it's really this quadrant that I'm looking for and this one is pretty interesting to me. Now what I need to do is collect all of these references and put them somewhere. Now I've not really found a really great place that not only collects the papers but allows you to reference them. So this is where I would do two things. The first thing is I would collect all of these references and I'd put them in a reference manager like Mendeley. I really like Mendeley, I've been using it for years and it can also watch a folder so that when you upload PDFs to a certain folder it will capture it and put it in your reference manager. Now it's really important that we actually keep the PDF separately in like a folder on our computer and you'll see why in a minute. But essentially this is what I would do to look for research works. I would also go to discover more related articles which is here and this is something that they've recently included which is brilliant and you can see that I want recent only and it will also have a look for any sort of like related works that I should know about and this is an exploratory phase. I'm going out, I'm finding things, I'm collecting them, I'm putting them in a folder and I'm also putting them in Mendeley. Those are two really important things and it's always working with PDFs. If you can't find a PDF and you can't get access to it, you definitely shouldn't use something like SciHub. You definitely shouldn't use this because this is really bad and it is completely sort of like ruining academia because it's giving you stuff for free and if you can't access it elsewhere you definitely shouldn't go to SciHub and type in the DOI here and push open because what you'll end up doing is finding the full paper and then you can download it as a PDF but yeah, this is terrible so definitely don't do that. Once we've got our seed map, you can see that we've got loads of other stuff that we can sort of like get in to our reference manager Mendeley. Now you have to be selective, you have to kind of like read the abstracts. This is a really long process and it's not about just sort of like slotting in stuff wherever. You really do have to be quite sort of like targeted. For this one, we're after high level information because we're filling out the explain the background principles and components of organic photovoltaic devices and so this is what we need to find. Some of these aren't going to be useful. You can see all of the different titles of the papers here and some of them are going to be good, some of them not, some of them are going to be useful for later sections but really here we're looking for the high sort of level information, the review papers. That's what I'm really looking for and for each section that you're filling out, you've got to kind of do the same. Another tool I really like is Connected Papers and this is because it gives you, once you've got your seed map and you put in the DOI, you can look at prior and derivative works. Now that's really important to me. I like derivative works because you can see it's more recent papers and it means that you can kind of get an idea of where we're up to at the moment because look, this one is from 2017, recent advances in wide band gap semiconducting polymers. That is a nice big review paper that I definitely want in this section. I'm going through, I'm saving PDFs, I'm putting them in a file, I'm getting them automatically added to Mendeley which is our reference manager and that is what I do. For each section, I probably want to find 20 to 30 different papers. That's just my field, your field may be different but I'm looking for a good chunk of information and that will take a long time. It's a really big process to go through each of these sections that ChatGPT has recommended and find appropriate references but that is exactly what a literature review is about. So that is the second stage, finding different papers that we can discuss in our literature review. Then, it gets even more interesting. As you're reading the papers, you should definitely be taking notes in your Word document underneath the section that you're working on. So if I saw something interesting, I'd put it in, I'd reference it with my reference manager. In this case, I'm using Mendeley but there is a way to chat to all of the documents in a section at once and this is an AI tool that I think is super powerful and completely underrated and not mentioned by a load of academic YouTube channels and that is DocAnalyzer.ai. This AI tool is really fantastic because it won't just spill out information and hallucinate and you'll see what I mean in a minute. So here we have DocAnalyzer. The most important thing is that you add documents. So here are some documents that I've uploaded and it's a really inexpensive tool to use. I think it costs US$8 a month for this pro plan but you only need it for your literature review and you can cancel it if you don't use it through large portions of your PhD but I think you'll see that the power is well worth the money. This isn't a sponsored segment by the way. I just love this tool and so here we are. We've uploaded our documents and then the important thing is we go to labels and you create different labels. So here I've got my literature review. I've got all of my documents in there and then you click on chat with these documents. You could set up a new label for each different section of your literature review if you need to. If you've got loads and loads of documents, you know, challenges and future directions, applications and market potential, these are all different labels that you could put into here but I've just put them all as literature review at the moment and then I literally say chat with these documents. Now chatting with this AI tool is quite frustrating sometimes but in a good way and I'll show you what because, you know, I wanted, what are the most important parts of these documents? That's what I asked it and it said to identify the important parts of the documents, I would need more specific keywords. Now this is really good. Initially I was frustrated but listen, it's good because it's not just like hallucinating and making stuff up. It wants to give you important information but it needs more from you to make sure it's giving you valuable information and this is so good. It's not just going to make stuff up to appease you like some other AI tools will. So here we've got, actually I'd like a summary of the key findings and it's like, no, could you please specify which document or page you're referring to? So I'm like, okay, maybe I need to be super specific and then what is the effect of a calcium electrode? Ooh, capital A, naughty me, bad chemist. Okay, so the effect of a calcium cathode and then it gives me the information. And then here, this is the exact thing that I want to talk about. Okay, do you remember from the very beginning I've got here, explain the basic principles and components of photovoltaic devices? Well, once you've got all the literature you think will answer that question, bundle it all together, upload it to this tool and you'll see that you can then just get an answer that then you can use to frame your own response in your literature review. So here it says, explain the basic principles and components of an organic photovoltaic device. I took that directly from the chat GPT prompt, the structure we've been working on and here it says, the basic principles, blah, blah, blah, are discussed in the documents. And then from here, it's essentially just a really nice answer with references and it says where it's finding it, page one, page one, page two, page two. This is fantastic. This tells you exactly where it's getting the information from and then all I would do is copy and paste this into my draft literature review and then I would replace these red bits with the actual citation using my citation manager, in this case, Mendeley. And it's as easy as that. So another bit, I want to know about efficiency. So down here, it says, performance and efficiency, discuss how the efficiency is measured and present data on the current efficiency levels. I was like, I wonder if it can do that looking across all of the papers I've uploaded. So I just said, present data on the key efficiency levels and once again, it's like, well, you know, I could do that but what do you actually want? And once again, initially, I was like, oh, I'm so frustrated but no, this is good because what I really wanted was the power conversion efficiency and it said, okay, I can provide the blah, blah, blah but this isn't explicitly available in the content provided. Brilliant, this tells me I need to upload more information if I want to get this out of the document. So it helps you write a really robust literature review. And here I said, explore factors that impact the power conversion efficiency from the documents that I have provided, oh, typing. But it says, from the documents provided, several factors impact the power conversion efficiency. It's got all of the different things that I've uploaded and overall, I think it's just like a great way to question a load of different papers and it does it so well. It does it actually better than any other tool that I've tried at the moment. Go give it a go because it really is, I think, super useful for a literature review when you need to get loads of data into one spot and ask it questions, brilliant. And then you do all of that again for the next bit. So if I wanted here to look at applications and market potential, I look here and it says, discuss how organic photovoltaics are being used and future. So I can just type that into illicit and the process starts all over again for the next section. So here we can see if I sort by most recent, then we've got future of organic photovoltaics, brilliant, 2015, that's what I want to know about. So I'm clicking on that and I'm using this as a seed paper for litmaps and I'm starting to collect that next load of information, brilliant. Easy as that. Takes a while. Read all of the literature that you're actually citing. You can't always rely on this but it's making it so much easier. So there we have it. That's how you write your literature review using AI tools. If you love this video, remember to go check out this one where I talk about three unbelievable technologies to actually automate the literature review process. It is cheating a little bit. You can't rely on automation but go check it out because I think there's some tools in there you'll love. So there we have it. That's how you write your literature review with AI. Let me know in the comments what you would add and also remember there are more ways you can engage with me. The first way is to sign up to my newsletter. Head over to andrewstapeton.com.au forward slash newsletter. The link is in the description. When you sign up, you'll get five emails over about two weeks, everything from the tools I've used, the podcast I've been on, How to Write a Perfect Abstract and more. It's exclusive content available for free so go sign up now and also remember to go check out academiainsider.com. That's my project where I've got e-books, I've got resource packs, I've got courses coming soon, I've got loads of blogs, I've got a forum and everything is over there to make sure that academia works for you. Alright then, I'll see you in the next video. Bye. Transcribed by https://otter.ai

Bilateral thigh compartment syndrome following intraoperative pelvic binder reduction of open pelvic fracture: a case report and review of literature

• Up-to date Review and Case Report
• Open access
• Published: 06 September 2024

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• Phillip Chung 1 ,
• Ian G. Hasegawa 2 ,
• Andrew M. Duong 1 ,
• Soroush Shabani 1 &
• Joseph T. Patterson   ORCID: orcid.org/0000-0002-7494-7366 1  

A 22-year-old man with a type IIIA open AO/OTA 61C2.2b pelvis fracture and hypotension received exploratory laparotomy, temporary open ligation of the bilateral internal iliac arteries, and retroperitoneal packing. After prompt fracture debridement, a pelvic binder was positioned over the thighs as a reduction aid and maintained for six hours during pelvis open reduction internal fixation. Bilateral anterior thigh compartment syndrome was diagnosed three hours after packing and binder removal.

Prolonged application of a pelvic binder to the thighs as an intraoperative reduction tool, shortly after temporary internal iliac artery ligation, may be associated with reperfusion injury and thigh compartment syndrome.

Avoid common mistakes on your manuscript.

Introduction

Pelvic fractures resulting from high-energy trauma increased in incidence from 27 to 34 per 100,000 capita between 1990 and 2007 [ 1 ]. Open pelvic fractures, with a 14% mortality rate and a 50% complication rate, are particularly devastating injuries [ 2 ]. While mortality from high-energy pelvic fractures has decreased over time to 5%, massive noncompressible hemorrhage remains the leading cause of death among patients presenting with hypotension and pelvic fracture [ 3 , 4 ].

Early aggressive resuscitation with application of a pelvic circumferential compression device (PCCD) such as a pelvic binder or sheet and clamps reduces mortality by mitigating the hemorrhage associated with volume-expanding pelvic ring injuries [ 5 ]. Typically used in conjunction with resuscitation, PCCDs serve as an adjunct to angiographic embolization and/or pelvic packing [ 6 ]. By applying an internal rotation torque to each hemipelvis, a PCCD is also a useful reduction aid for percutaneous and open management of “open book” pelvic ring disruptions [ 6 ]. However, prolonged application of a PCCD carries potential complications including soft tissue necrosis, nerve palsy, and bladder incarceration [ 7 , 8 , 9 , 10 ].

Acute compartment syndrome (ACS) is defined as increased pressure within a closed osteofascial compartment impairing local circulation [ 11 ]. ACS of the thigh (ACST) is rare because of the increased compliance of the thigh myofascial compartments, which also can make clinical diagnosis of ACST difficult [ 12 , 13 ]. Invasive thigh compartment pressure measurements 30 mm Hg greater than diastolic blood pressure are concerning for ACST if corroborated by clinical signs and symptoms [ 11 ]. Complications can include muscle necrosis, rhabdomyolysis, nerve damage, infection, renal dysfunction, and multiorgan failure with a mortality rate as high as 47% [ 13 ]. Treatment of ACST includes immediate fasciotomy of the affected compartments, possible debridement, meticulous hemostasis, and delayed secondary closure of skin or skin grafting [ 11 , 12 , 13 ].

To our knowledge, ACST associated with intraoperative use of a PCCD as a reduction tool has not previously been reported.

Case report

A 22-year-old man arrived at our Level 1 trauma center with a Glasgow coma scale of 12, significant facial trauma, active hemorrhage from a right inguinal laceration with open pelvic fracture, and class III hemorrhagic shock after being struck by a vehicle while operating a motorcycle. Circumferential pelvic compression was applied with a pelvic sheet. Radiographs and CT scan of the pelvis demonstrated a type IIIA open AO/OTA 61C2.2b pelvic ring disruption with complete disruption of the right sacroiliac joint, partial injury to the left sacroiliac joint, and bilateral pubic root and ischiopubic segment fractures involving the anterior wall of the acetabulum (Fig.  1 ). On physical examination, there was a right perineal laceration posterior to the scrotum spanning to the right inferior pubic ramus fracture and a right inguinal puncture wound with resulting right thigh hematoma.

A Initial AP pelvis radiograph per ATLS protocol without circumferential pelvic compression. B 3D surface reconstruction and C axial, D coronal, E sagittal representative images of pelvic CT scan after application of circumferential pelvic compression

Approximately two hours after arrival, an emergent exploratory laparotomy was performed with temporary vessel loop ligation of the bilateral internal iliac arteries and retroperitoneal packing for persistent hypotension. The patient sustained 50 cubic centimeters of blood loss during this operation in addition to one liter of blood loss in the emergency room. He received two units of packed red blood cells (pRBC) in the emergency department and required four units pRBC, one liter of crystalloid, and two units of fresh frozen plasma during the operation. In a hybrid vascular operative suite two and a half hours later, the left internal iliac artery demonstrated extravasation under fluoroscopy, suggesting active hemorrhage and necessitating GelFoam embolization. The right internal iliac artery was spared and temporary ligatures were removed three hours after initial applications. The laparotomy was later re-explored without closure of the abdomen.

Twenty-two hours after arrival, the patient underwent debridement and irrigation of the open pelvic fracture. A pelvic binder was then applied to the thighs with routine compressive force as a reduction aid via internal rotation and adduction of the thighs (Fig.  2 ). As shown in the fluoroscopic inlet image in Fig.  2 B, closed reduction did not provide a satisfactory reduction of the right posterior sacroiliac joint despite iterative application of the pelvic binder and internal rotation of the lower extremities. After reviewing an intraoperative arterial blood gas and confirming with the anesthesia team that the patient was appropriately resuscitated and sufficiently stable for an open surgical approach, a multidisciplinary team decision was made to proceed with early appropriate care. A definitive open reduction of the right sacroiliac joint complete posterior pelvic ring injury was performed through Pfannenstiel and lateral windows using a screw-based clamp with bilateral S1 sacroiliac screws, S2 transsacral transiliac screw, bilateral antegrade anterior column screws, and symphyseal plating. The laparotomy was explored, packing removed, and the abdomen closed with no new violation of the peritoneum identified. The pelvic binder was removed six hours after application.

A Clinical photograph of pelvic binder placement prior to skin prep for skeletal stabilization of the pelvic ring injury B - E intraoperative fluoroscopy following percutaneous bilateral internal fixation of the anterior column fractures, open reduction internal fixation of the pubic symphysis and right sacroiliac joint, and percutaneous internal fixation of the bilateral posterior pelvis

Three hours after binder removal, bilateral thigh swelling concerning for compartment syndrome was observed in the sedated and intubated patient. Anterior thigh compartment pressures > 40 mm Hg were measured with a needle-based monitor (Stryker, Kalamazoo, MI). Compartment pressures 10–20 mm Hg were observed in the buttock and leg compartments with palpable pedal pulses and diastolic pressure of 65 mm Hg. Bilateral thighs were tense, urine was dark brown, electrocardiogram demonstrated mild peaked T waves, and range of motion of the right knee was reduced. Laboratory studies were notable for creatine kinase > 50,000 U/L and hyperkalemia 7.4 mmol/L consistent with ACST complicated by rhabdomyolysis.

The patient was subsequently taken for emergent fasciotomies of the bilateral anterior and posterior compartments 15.5 h after open reduction of the pelvic fracture. During intraoperative examination before incision, bilateral anterior compartments were tense and bulging, and no significant swelling was visible in the posterior compartments. After fasciotomy, the right thigh demonstrated patches of congested, dark purple areas of muscle without necrosis. No debridement was performed. The left thigh after fasciotomy contained patches of nonviable quadriceps muscle unresponsive to cautery which were debrided. The majority of the left quadricep was viable. Postoperatively, continuous renal replacement therapy was initiated for the metabolic and electrolyte derangements.

The patient developed a Fournier’s gangrenous polybacterial and fungal infection of the right inguinal open fracture wound requiring multidisciplinary management including diverting colostomy, scrotal debridement, and removal of the pubic symphysis and right anterior column implants. The patient developed a ventilator-associated pneumonia with Aspergillus fumigatus and Enterobacter cloacae identified on bronchoalveolar lavage. Despite extensive treatment with broad antibiotic and antifungal agents, his traumatic facial wounds developed a surgical site infection which progressed to a necrotizing soft tissue infection involving the chest wall. The patient expired 44 days after injury due to disseminated intravascular coagulopathy in the context of acute liver failure, multiorgan dysfunction, septic shock, acute respiratory distress syndrome, and anoxic brain injury.

We report bilateral acute compartment syndrome of the thighs associated with intraoperative use of a pelvic binder as a reduction tool during the acute definitive fixation of an open, unstable, volume-expanding pelvis fracture following temporary bilateral internal iliac artery ligation, embolization, and retroperitoneal packing. To our knowledge, bilateral ACST has not been reported as a complication of either early definitive pelvic fracture fixation or application of a pelvic binder/sheet as a reduction tool during pelvis fracture surgery. The etiology of this complication is likely multifactorial, with potential contributions from the timing and technique of the resuscitative open and endovascular interventions, ongoing aggressive resuscitation, swelling from fluid shifts to interstitial “third space,” initial muscle damage, reperfusion injury with release of the internal iliac ligatures and removal of retroperitoneal packing, and the duration and tension of pelvic binder application.

Rapid stabilization of the pelvic ring is crucial to hemorrhage control in unstable pelvic ring injuries. The management of this patient by prompt PCCD application, resuscitation, hemorrhage control, open fracture debridement within 24 h, and early definitive fixation conforms to recommendations put forth by the Eastern and Western trauma society guidelines and a recent international survey [ 14 , 15 , 16 , 17 ]. Early definitive open reduction internal fixation of pelvic ring disruptions and acetabular fractures is also purported to be safe and perhaps preferable to delayed definitive treatment [ 17 , 18 ].

Alternative methods for rapid stabilization of pelvic injuries include external fixation [ 19 ]. A multitude of cadaver and retrospective clinical studies have demonstrated that external fixation does not control C type, complete posterior ring injury nor provide sufficient compression to address ongoing retroperitoneal hemorrhage as seen in this patient [ 19 , 20 , 21 , 22 , 23 ]. In consultation with the anesthesia team, appropriate steps were taken to ensure patient stability prior to open reduction in accordance with early appropriate care.

A PCCD is also an effective reduction tool, as demonstrated by percutaneous fixation of pelvis fractures through working portals made in a PCCD [ 24 ]. Accurate placement and tightening of the PCCD provides a compressive effect which internally rotates, adducts, and medializes each hemipelvis [ 25 , 26 , 27 ]. A well-placed PCCD thereby can effectively reduce a B-type posterior pelvic ring injury using the intact posterior sacroiliac ligaments as a hinge. Pelvic binders, commonly applied for hours to days during resuscitation and temporary fracture stabilization, exert pressure exceeding levels associated with skin breakdown [ 28 , 29 ]. A common practice is alternating pelvic binder placement between the greater trochanters and thighs for 12–24 h to reduce the risk of skin breakdown at either site [ 30 ]. Thus, pelvic binder application to the thighs as an intraoperative reduction aid for the six-hour duration in this case is within the standards of care.

Despite our adherence to current national trauma society guidelines and international standards of practice, our patient developed bilateral ACST following the intraoperative use of a pelvic binder as a reduction aid during the early definitive internal fixation of an unstable volume-expanding pelvic ring injury. We cannot determine whether the pelvic binder played a causal role in the development of ACST in this patient. ACST is a rare but described complication of pelvic fracture and has been observed in stable pelvic ring fracture in the absence of internal fixation or PCCD application [ 12 ]. A concomitant femur fracture is not necessary or sufficient for ACST; indeed, the pressure of body weight alone may be sufficient to cause ACST after trauma [ 13 ]. Reperfusion injury, a known complication in trauma cases involving temporary internal iliac vascular occlusion, is also associated with ACST [ 31 , 32 ].

In this case, reperfusion injury was expected following the exploratory laparotomy and complete ligation of the bilateral iliac system with release of the ligatures in the hours prior to pelvis fracture surgery [ 32 ]. Aggressive resuscitation to address traumatic and surgical blood losses is also a known risk factor for ACST even without extremity injury [ 33 ]. It is plausible crystalloid administration during pelvis fracture fixation shortly after reperfusion of the upper thighs and buttocks by release of the internal iliac ligatures shifted fluid into the extracellular space as the osmolality of the intravascular space declined. This may have been magnified by a reperfusion inflammatory response upon release of the pelvic binder after pelvis fixation in the compressed buttocks and thighs of this muscular patient. However, ACST caused by a vascular injury is very rare and the few reported cases involve the profunda femoris vein, femoral artery dissection, or external iliac arteries [ 13 , 34 , 35 , 36 ]. In this patient, reperfusion injury may have preferentially affected the right thigh as the right internal iliac artery was temporarily ligated, while the left was ligated and then embolized without a period of reperfusion. Despite this, ACST was observed to involve the bilateral thighs. Temporary occlusion of the internal iliac arteries may have contributed to the compartment syndrome. However, the patient’s clinical course is more consistent with alternative etiologies, and the timing of ACST diagnosis in this case correlates with binder release.

In our case review, we noticed development of muscle necrosis nine hours after initiation of the pelvic binder with application of the binder for a total of six consecutive hours. It is possible that the cause of the muscle necrosis was the initial trauma causing crush injury to the muscles. However, the initial injury was restricted primarily to the right inguinal and perineal region and no obvious deformity was noted on the left lower extremity to indicate severe injury necessary to cause muscle damage. In addition, presentation of crush injuries correlates to rhabdomyolysis [ 37 ]. In this patient, an exponential rise in creatinine kinase and potassium occurred only after prolonged binder therapy, likely indicating worsening muscle injury as a direct consequence of ACST rather than an initial presentation of acute crush injury.

PCCDs effectively control hemorrhage and aid in reducing pelvic fractures. However, orthopedic trauma surgeons and surgical intensivists should be aware of the possible risk of ACST in the context of reperfusion following temporary bilateral internal artery ligation, thigh trauma, and volume-expanding pelvic fracture. A surgical strategy for early pelvic fracture fixation which relies on prolonged PCCD application may not be the safest approach early in the care of a patient with recent reperfusion of the internal iliac vessels.

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JTP reports research support from AO North America and Orthopaedic Trauma Association, committee membership with AO North America and Orthopaedic Trauma Association, editorial board membership with the European Journal of Orthopaedic Surgery and Traumatology , and consulting fees from Johnson & Johnson, Stryker, and Globus Medical. PC, IGH, AMD, and SS report no relevant disclosures.

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Chung, P., Hasegawa, I.G., Duong, A.M. et al. Bilateral thigh compartment syndrome following intraoperative pelvic binder reduction of open pelvic fracture: a case report and review of literature. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-04090-7

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Received : 18 March 2024

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DOI : https://doi.org/10.1007/s00590-024-04090-7

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