Pub Date : 2026-03-01Epub Date: 2026-01-02DOI: 10.1016/j.ajem.2025.12.040
Nina Prieto MD, Mai Tantawy MD, Swathi Bhuma MD, MS, Siu Fai Li MD
A 30-year-old woman presented to the ED with a generalized rash, fever, and tachycardia. A detailed review of systems and physical examination revealed symptoms and signs of streptococcal pharyngitis. PCR testing confirmed the diagnosis of streptococcal infection and scarlet fever. Scarlet fever is generally a disease of children, but episodic outbreaks are associated with the disease in adults, sometimes with significant complications. It is important for Emergency Medicine clinicians to be aware of this childhood illness presenting in adults.
{"title":"Adult scarlet fever: Case report and epidemiology","authors":"Nina Prieto MD, Mai Tantawy MD, Swathi Bhuma MD, MS, Siu Fai Li MD","doi":"10.1016/j.ajem.2025.12.040","DOIUrl":"10.1016/j.ajem.2025.12.040","url":null,"abstract":"<div><div>A 30-year-old woman presented to the ED with a generalized rash, fever, and tachycardia. A detailed review of systems and physical examination revealed symptoms and signs of streptococcal pharyngitis. PCR testing confirmed the diagnosis of streptococcal infection and scarlet fever. Scarlet fever is generally a disease of children, but episodic outbreaks are associated with the disease in adults, sometimes with significant complications. It is important for Emergency Medicine clinicians to be aware of this childhood illness presenting in adults.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 121-123"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-18DOI: 10.1016/j.ajem.2025.12.014
Eleny Romanos-Sirakis , Jon Javor
Background
Sensory reactivity and communication challenges can complicate navigating the healthcare system and managing health concerns for autistic individuals.
Methods
Emergency department (ED) encounters for autistic and non-autistic patients from 2023 within 14 hospitals of a large NY healthcare system were evaluated using ICD-10 code F84.0. Outcomes included: percentage of patients accessing care, top primary diagnoses, ED utilization across various ages, admission status, and duration of hospitalization.
Results
The study included 711,254 ED visits from 523,057 patients. 1228 patients were documented autistic (0.23 %), which was statistically significantly less than the expected autistic population proportion (p < 0.0001). We found a significant association between age group and autism diagnosis (p < 0.0001), with there being higher proportions of autistic patients in younger age groups. 12.3 % of encounters with autistic patients resulted in admission to the hospital, compared to 23.3 % of the patients without this documented diagnosis (p < 0.0001). The median length of hospitalization for patients with documented autism was shorter (4 days (IQR 2–7)) and 3 days ((IQR 1–6)) (p < 0.0001) for non-autistic and autistic patients, respectively).
Conclusions
In this study, autistic patients utilized the ED at a lower rate than would be expected given the prevalence of autism. The majority of autistic patients seen in the ED were younger (<30 years old). The primary diagnosis varied between autistic and non-autistic patients. Further study is needed to better characterize the challenges seeking care throughout healthcare settings and ensure adequate healthcare supports for the autistic community.
{"title":"Patterns of emergency department utilization by autistic patients in a large NY health system","authors":"Eleny Romanos-Sirakis , Jon Javor","doi":"10.1016/j.ajem.2025.12.014","DOIUrl":"10.1016/j.ajem.2025.12.014","url":null,"abstract":"<div><h3>Background</h3><div>Sensory reactivity and communication challenges can complicate navigating the healthcare system and managing health concerns for autistic individuals.</div></div><div><h3>Methods</h3><div>Emergency department (ED) encounters for autistic and non-autistic patients from 2023 within 14 hospitals of a large NY healthcare system were evaluated using ICD-10 code F84.0. Outcomes included: percentage of patients accessing care, top primary diagnoses, ED utilization across various ages, admission status, and duration of hospitalization.</div></div><div><h3>Results</h3><div>The study included 711,254 ED visits from 523,057 patients. 1228 patients were documented autistic (0.23 %), which was statistically significantly less than the expected autistic population proportion (<em>p</em> < 0.0001). We found a significant association between age group and autism diagnosis (p < 0.0001), with there being higher proportions of autistic patients in younger age groups. 12.3 % of encounters with autistic patients resulted in admission to the hospital, compared to 23.3 % of the patients without this documented diagnosis (<em>p</em> < 0.0001). The median length of hospitalization for patients with documented autism was shorter (4 days (IQR 2–7)) and 3 days ((IQR 1–6)) (<em>p</em> < 0.0001) for non-autistic and autistic patients, respectively).</div></div><div><h3>Conclusions</h3><div>In this study, autistic patients utilized the ED at a lower rate than would be expected given the prevalence of autism. The majority of autistic patients seen in the ED were younger (<30 years old). The primary diagnosis varied between autistic and non-autistic patients. Further study is needed to better characterize the challenges seeking care throughout healthcare settings and ensure adequate healthcare supports for the autistic community.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 7-9"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-15DOI: 10.1016/j.ajem.2025.12.007
Mengmeng Wu , Lanxin Ouyang , Di Liu , Fen Ai
{"title":"Geriatric emergency medicine education: A survey of practicing emergency medical professionals in Wuhan, Hubei province, China","authors":"Mengmeng Wu , Lanxin Ouyang , Di Liu , Fen Ai","doi":"10.1016/j.ajem.2025.12.007","DOIUrl":"10.1016/j.ajem.2025.12.007","url":null,"abstract":"","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 180-184"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-18DOI: 10.1016/j.ajem.2025.12.018
Hamna Shahbaz MD, Alexandra B. Sherman BA, Terrence Curran MD, FACS, Jana K. Elsawwah BA, Eric J. Charles MD, PhD, Rolando H. Rolandelli MD, FACS, Zoltan H. Nemeth MD, PhD
<div><h3>Background</h3><div>Intentional self-inflicted firearm injuries represent a major public health concern in the United States, with alarming increases among pediatric populations. This study compares trends, risk factors, and outcomes of intentional self-inflicted firearm injuries between pediatric and adult patients. We hypothesized that pediatric patients would demonstrate better outcomes than adults, attributed to greater physiological resilience.</div></div><div><h3>Objectives</h3><div>To compare demographics, risk factors, and clinical outcomes between pediatric (<18 years) and adult (≥18 years) patients with intentional self-inflicted firearm injuries.</div></div><div><h3>Methods</h3><div>We analyzed the 2022–2023 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database, identifying 8404 patients with intentional self-inflicted firearm injuries. Patients were grouped into Adult (≥18 years) and Pediatric (<18 years) cohorts. The primary outcome was mortality; secondary outcomes included length of stay and in-hospital complications. Inclusion was restricted to ICD-10-CM codes X72–X74 (intentional self-harm by firearm); accidental (W32–W34) and undetermined (Y22–Y24) injuries were excluded.</div></div><div><h3>Results</h3><div>We identified 7847 adults and 557 pediatric patients. Both cohorts had a mean Injury Severity Score (ISS) of 21.4. A greater proportion of pediatric patients were Black compared with adults (21.72 % vs. 13.08 %; <em>p</em> < 0.001). Adults more frequently carried diagnoses of mental or personality disorders (16.40 % vs. 9.52 %; p < 0.001). No significant differences were observed between groups in mortality or hospital complications.</div></div><div><h3>Conclusion</h3><div>Adult and pediatric patients sustaining intentional self-inflicted firearm injuries experienced similarly poor outcomes, with mortality exceeding 50 % in both groups. These findings suggest that the presumed protective advantage of higher physiological reserves in pediatric patients may be diminished in the context of firearm trauma. Enhanced prevention, mental health support, and firearm safety measures remain critical.</div></div><div><h3>Article summary</h3><div>Why is this topic important?</div><div>Intentional self-inflicted firearm injuries are highly lethal and are rising among youth.</div><div>What does this study attempt to show?</div><div>Differences in demographics, risk factors, and outcomes between pediatric and adult patients with intentional self-inflicted firearm injuries.</div><div>What are the key findings?</div><div>Pediatric patients were more often Black and injured at home; adults had higher rates of alcohol, substance use, and mental/personality disorders; however, ISS, complications, and mortality were similar.</div><div>How is patient care impacted?</div><div>Supports counseling on secure firearm storage and routine screening for suicidality and mental-health needs in both pediatri
{"title":"Risk factors and clinical outcomes of pediatric versus adult intentional self-inflicted firearm injuries","authors":"Hamna Shahbaz MD, Alexandra B. Sherman BA, Terrence Curran MD, FACS, Jana K. Elsawwah BA, Eric J. Charles MD, PhD, Rolando H. Rolandelli MD, FACS, Zoltan H. Nemeth MD, PhD","doi":"10.1016/j.ajem.2025.12.018","DOIUrl":"10.1016/j.ajem.2025.12.018","url":null,"abstract":"<div><h3>Background</h3><div>Intentional self-inflicted firearm injuries represent a major public health concern in the United States, with alarming increases among pediatric populations. This study compares trends, risk factors, and outcomes of intentional self-inflicted firearm injuries between pediatric and adult patients. We hypothesized that pediatric patients would demonstrate better outcomes than adults, attributed to greater physiological resilience.</div></div><div><h3>Objectives</h3><div>To compare demographics, risk factors, and clinical outcomes between pediatric (<18 years) and adult (≥18 years) patients with intentional self-inflicted firearm injuries.</div></div><div><h3>Methods</h3><div>We analyzed the 2022–2023 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database, identifying 8404 patients with intentional self-inflicted firearm injuries. Patients were grouped into Adult (≥18 years) and Pediatric (<18 years) cohorts. The primary outcome was mortality; secondary outcomes included length of stay and in-hospital complications. Inclusion was restricted to ICD-10-CM codes X72–X74 (intentional self-harm by firearm); accidental (W32–W34) and undetermined (Y22–Y24) injuries were excluded.</div></div><div><h3>Results</h3><div>We identified 7847 adults and 557 pediatric patients. Both cohorts had a mean Injury Severity Score (ISS) of 21.4. A greater proportion of pediatric patients were Black compared with adults (21.72 % vs. 13.08 %; <em>p</em> < 0.001). Adults more frequently carried diagnoses of mental or personality disorders (16.40 % vs. 9.52 %; p < 0.001). No significant differences were observed between groups in mortality or hospital complications.</div></div><div><h3>Conclusion</h3><div>Adult and pediatric patients sustaining intentional self-inflicted firearm injuries experienced similarly poor outcomes, with mortality exceeding 50 % in both groups. These findings suggest that the presumed protective advantage of higher physiological reserves in pediatric patients may be diminished in the context of firearm trauma. Enhanced prevention, mental health support, and firearm safety measures remain critical.</div></div><div><h3>Article summary</h3><div>Why is this topic important?</div><div>Intentional self-inflicted firearm injuries are highly lethal and are rising among youth.</div><div>What does this study attempt to show?</div><div>Differences in demographics, risk factors, and outcomes between pediatric and adult patients with intentional self-inflicted firearm injuries.</div><div>What are the key findings?</div><div>Pediatric patients were more often Black and injured at home; adults had higher rates of alcohol, substance use, and mental/personality disorders; however, ISS, complications, and mortality were similar.</div><div>How is patient care impacted?</div><div>Supports counseling on secure firearm storage and routine screening for suicidality and mental-health needs in both pediatri","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 99-102"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-02DOI: 10.1016/j.ajem.2025.12.035
Stephen Gamboa MD, MPH , Christopher Parsons MD , Christina Shenvi MD, PhD, MBA
We report a case of a 61-year-old man with a history of alcoholic cirrhosis and impaired mobility who presented to the Emergency Department (ED) with hepatic encephalopathy, cellulitis, sepsis, and extensive maggot infestation (myiasis). Maggots were recovered from the patient's skin, urethra, and rectum, and the burden of maggots in the urethra had led to bladder outlet obstruction. Blood cultures revealed polymicrobial bacteremia, including Ignatzschineria larvae.
Ignatzschineria larvae is a commensal bacterium that resides in the digestive tract of maggots. The organism is rarely pathogenic to humans, and case reports of Ignatzschineria larvae bacteremia are rare. This case demonstrates two uncommon complications of wound myiasis: bacteremia and bladder infestation, causing outlet obstruction and urinary retention. Patients who present to the Emergency Department with myiasis are at risk for bacteremia from both typical skin pathogens related to their wounds and pathogens associated with the maggots themselves.
{"title":"Maggot infestation leading to Ignatzschineria larvae bacteremia and bladder outlet obstruction","authors":"Stephen Gamboa MD, MPH , Christopher Parsons MD , Christina Shenvi MD, PhD, MBA","doi":"10.1016/j.ajem.2025.12.035","DOIUrl":"10.1016/j.ajem.2025.12.035","url":null,"abstract":"<div><div>We report a case of a 61-year-old man with a history of alcoholic cirrhosis and impaired mobility who presented to the Emergency Department (ED) with hepatic encephalopathy, cellulitis, sepsis, and extensive maggot infestation (myiasis). Maggots were recovered from the patient's skin, urethra, and rectum, and the burden of maggots in the urethra had led to bladder outlet obstruction. Blood cultures revealed polymicrobial bacteremia, including <em>Ignatzschineria larvae</em>.</div><div><em>Ignatzschineria larvae</em> is a commensal bacterium that resides in the digestive tract of maggots. The organism is rarely pathogenic to humans, and case reports of <em>Ignatzschineria larvae</em> bacteremia are rare. This case demonstrates two uncommon complications of wound myiasis: bacteremia and bladder infestation, causing outlet obstruction and urinary retention. Patients who present to the Emergency Department with myiasis are at risk for bacteremia from both typical skin pathogens related to their wounds and pathogens associated with the maggots themselves.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 129-130"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-03DOI: 10.1016/j.ajem.2025.12.043
Ravi Garg , James M. Brophy
Background
For acute ischemic stroke, national practice guidelines recommend thrombolysis within a 4.5-h time window from symptom onset. Randomized trials with advanced neuroimaging have now examined extended thrombolytic time windows, and multiple meta-analyses have provided positive endorsements. However, these previous meta-analyses have not fully exploited the available data, examined quality of life, or reported the probability of clinically meaningful effects. This meta-analysis addresses these potential shortcomings.
Methods
We performed a i) systematic literature review up to August 1, 2025, of all randomized controlled trials comparing thrombolysis (alteplase or tenecteplase) with the assistance of advanced neuroimaging to standard, non-thrombolytic therapy in acute ischemic stroke patients with unknown time or beyond 4.5 h since symptom onset and ii) an umbrella review of previous meta-analyses addressing this issue. Our primary outcome was the mean difference in the utility-weighted modified Rankin Scale (uw-mRS) scores. Secondary outcomes were the absolute risk difference (ARD) for minor disability status and mortality. Bayesian random effects meta-analyses were performed assuming a normal-normal hierarchical model with non-informative priors, which permitted probability calculations for benefit, harm, and regions of practical equivalence (ROPE).
Results
Six original randomized trials of extended thrombolysis and 7 meta-analyses were identified but none had considered a uw-mRS score or reported direct probability statements regarding benefit or harm. Our primary uw-mRS outcome showed a ROPE probability of 99 % with only a 1 % probability of a clinically beneficial response with extended alteplase. There was also a 72 % probability that mortality increased by at least 1 life / 100 treated with extended thrombolysis.
Conclusions
In contrast with previous publications, this meta-analysis and umbrella review highlights the uncertainty of clinical benefits from extended thrombolysis treatment windows and the need for further high-quality research before this treatment is accepted into routine practice.
{"title":"Extended thrombolysis in acute ischemic stroke: A Bayesian meta-analysis and umbrella review","authors":"Ravi Garg , James M. Brophy","doi":"10.1016/j.ajem.2025.12.043","DOIUrl":"10.1016/j.ajem.2025.12.043","url":null,"abstract":"<div><h3>Background</h3><div>For acute ischemic stroke, national practice guidelines recommend thrombolysis within a 4.5-h time window from symptom onset. Randomized trials with advanced neuroimaging have now examined extended thrombolytic time windows, and multiple meta-analyses have provided positive endorsements. However, these previous meta-analyses have not fully exploited the available data, examined quality of life, or reported the probability of clinically meaningful effects. This meta-analysis addresses these potential shortcomings.</div></div><div><h3>Methods</h3><div>We performed a i) systematic literature review up to August 1, 2025, of all randomized controlled trials comparing thrombolysis (alteplase or tenecteplase) with the assistance of advanced neuroimaging to standard, non-thrombolytic therapy in acute ischemic stroke patients with unknown time or beyond 4.5 h since symptom onset and ii) an umbrella review of previous meta-analyses addressing this issue. Our primary outcome was the mean difference in the utility-weighted modified Rankin Scale (uw-mRS) scores. Secondary outcomes were the absolute risk difference (ARD) for minor disability status and mortality. Bayesian random effects meta-analyses were performed assuming a normal-normal hierarchical model with non-informative priors, which permitted probability calculations for benefit, harm, and regions of practical equivalence (ROPE).</div></div><div><h3>Results</h3><div>Six original randomized trials of extended thrombolysis and 7 meta-analyses were identified but none had considered a uw-mRS score or reported direct probability statements regarding benefit or harm. Our primary uw-mRS outcome showed a ROPE probability of 99 % with only a 1 % probability of a clinically beneficial response with extended alteplase. There was also a 72 % probability that mortality increased by at least 1 life / 100 treated with extended thrombolysis.</div></div><div><h3>Conclusions</h3><div>In contrast with previous publications, this meta-analysis and umbrella review highlights the uncertainty of clinical benefits from extended thrombolysis treatment windows and the need for further high-quality research before this treatment is accepted into routine practice.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 166-172"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-22DOI: 10.1016/j.ajem.2025.12.021
Giacomo Spaziani , Gloria Rozzi , Silvia Baroni , Giulia Napoli , Grazia De Ninno , Davide Della Polla , Nicola Bonadia , Giuseppe De Matteis , Andrea Piccioni , Giuseppe Maria Della Pepa , Andrea Urbani , Antonio Gasbarrini , Francesco Franceschi , Marcello Covino
<div><h3>Background</h3><div>Blood biomarkers such as glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) have been shown to rise after mild traumatic brain injury, improving early detection of intracranial lesions. However, evidence on their role in detecting delayed intracranial hemorrhage, especially in patients on anticoagulants, and on their ability to predict long-term post-concussive symptoms is still limited and remains largely unexplored. Our study is the first to address this gap, evaluating these biomarkers for early detection of delayed bleeding and their association with symptom persistence at 3 and 6 months.</div></div><div><h3>Objective</h3><div>To investigate the diagnostic and prognostic utility of serum biomarkers GFAP and UCH-L1 in adult patients with mild traumatic brain injury (mTBI), focusing on their association with delayed intracranial hemorrhage and post-concussive symptoms at 3 and 6 months.</div></div><div><h3>Methods</h3><div>This prospective, single-center study enrolled adult patients (≥18 years) with mTBI (Glasgow Coma Scale ≥13) presenting within 24 h of injury. All patients were considered at high risk for intracranial bleeding due to blood thinners. Initial head CT and serum biomarker sampling were performed upon emergency department (ED) admission, followed by repeated CT imaging at 24 h. Serum GFAP and UCH-L1 levels were analyzed for their sensitivity and negative predictive value (NPV) in detecting acute and delayed intracranial injury, and for their association with post-concussive symptoms (PCS) assessed at 3 and 6 months using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Symptomatic status was defined by clinically significant worsening relative to the pre-injury baseline.</div></div><div><h3>Results</h3><div>Overall, 441 patients fulfilled the inclusion criteria and were enrolled. Seventy-five patients (17 %) had positive findings on initial CT. These individuals were significantly older and more frequently hypertensive, while other clinical and laboratory parameters showed no significant differences. GFAP levels >30 pg/ml, and UCH-L1 > 360 pg/ml, and combined GFAP/UCH-L1 elevation were strongly associated with CT abnormalities, yielding high sensitivity (96 %; 95 % CI: 88.8–99.2) and NPV (96 %; 95 % CI: 90.6–98.9), though specificity was limited (24 %; 95 % CI: 20–29). Among 366 patients with negative baseline CTs, delayed intracranial hemorrhage occurred in only 3 cases (0.82 %). None of the patients with negative biomarker results at admission developed delayed intracranial hemorrhage. At follow-up, 15–22 % of patients reported persistent mild PCS, with no significant predictive value from baseline biomarkers, clinical features, or imaging findings.</div></div><div><h3>Conclusion</h3><div>GFAP and UCH-L1 demonstrate excellent sensitivity for detecting acute intracranial lesions in mTBI and may support safer, more selective use of CT imaging i
{"title":"Prognostic value of GFAP and UCHL-1 biomarkers in high-risk mild traumatic brain injury: A prospective longitudinal study of short- and long-term outcomes","authors":"Giacomo Spaziani , Gloria Rozzi , Silvia Baroni , Giulia Napoli , Grazia De Ninno , Davide Della Polla , Nicola Bonadia , Giuseppe De Matteis , Andrea Piccioni , Giuseppe Maria Della Pepa , Andrea Urbani , Antonio Gasbarrini , Francesco Franceschi , Marcello Covino","doi":"10.1016/j.ajem.2025.12.021","DOIUrl":"10.1016/j.ajem.2025.12.021","url":null,"abstract":"<div><h3>Background</h3><div>Blood biomarkers such as glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) have been shown to rise after mild traumatic brain injury, improving early detection of intracranial lesions. However, evidence on their role in detecting delayed intracranial hemorrhage, especially in patients on anticoagulants, and on their ability to predict long-term post-concussive symptoms is still limited and remains largely unexplored. Our study is the first to address this gap, evaluating these biomarkers for early detection of delayed bleeding and their association with symptom persistence at 3 and 6 months.</div></div><div><h3>Objective</h3><div>To investigate the diagnostic and prognostic utility of serum biomarkers GFAP and UCH-L1 in adult patients with mild traumatic brain injury (mTBI), focusing on their association with delayed intracranial hemorrhage and post-concussive symptoms at 3 and 6 months.</div></div><div><h3>Methods</h3><div>This prospective, single-center study enrolled adult patients (≥18 years) with mTBI (Glasgow Coma Scale ≥13) presenting within 24 h of injury. All patients were considered at high risk for intracranial bleeding due to blood thinners. Initial head CT and serum biomarker sampling were performed upon emergency department (ED) admission, followed by repeated CT imaging at 24 h. Serum GFAP and UCH-L1 levels were analyzed for their sensitivity and negative predictive value (NPV) in detecting acute and delayed intracranial injury, and for their association with post-concussive symptoms (PCS) assessed at 3 and 6 months using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Symptomatic status was defined by clinically significant worsening relative to the pre-injury baseline.</div></div><div><h3>Results</h3><div>Overall, 441 patients fulfilled the inclusion criteria and were enrolled. Seventy-five patients (17 %) had positive findings on initial CT. These individuals were significantly older and more frequently hypertensive, while other clinical and laboratory parameters showed no significant differences. GFAP levels >30 pg/ml, and UCH-L1 > 360 pg/ml, and combined GFAP/UCH-L1 elevation were strongly associated with CT abnormalities, yielding high sensitivity (96 %; 95 % CI: 88.8–99.2) and NPV (96 %; 95 % CI: 90.6–98.9), though specificity was limited (24 %; 95 % CI: 20–29). Among 366 patients with negative baseline CTs, delayed intracranial hemorrhage occurred in only 3 cases (0.82 %). None of the patients with negative biomarker results at admission developed delayed intracranial hemorrhage. At follow-up, 15–22 % of patients reported persistent mild PCS, with no significant predictive value from baseline biomarkers, clinical features, or imaging findings.</div></div><div><h3>Conclusion</h3><div>GFAP and UCH-L1 demonstrate excellent sensitivity for detecting acute intracranial lesions in mTBI and may support safer, more selective use of CT imaging i","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 41-47"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-23DOI: 10.1016/j.ajem.2025.12.027
Nikita Nunes MS , Hazem Nasef B.S , Samuel Baum B.S , Sarthak Kumar B.S , Alaina Werling BSN , Heli Patel MBA , Stephen G. Hersperger MD, FACS , Adel Elkbuli MD, MBA, MPH
Introduction
This study aims to evaluate clinical outcomes among geriatric and adult trauma patients with severe isolated traumatic brain injury (TBI) treated at Level I and II American College of Surgeons (ACS) verified trauma centers.
Methods
This retrospective cohort study analyzed the ACS Trauma Quality Improvement Program (TQIP) database from 2017 to 2023. Geriatric (age ≥ 65) and adult (age 18–64) trauma patients with severe isolated TBI (Glasgow coma scale (GCS) ≤8, AIS head ≥3, AIS <3 all other body regions) treated at ACS-verified Level I or II trauma centers were included. Primary study outcomes included in-hospital mortality in addition to rates of neurosurgical intervention and intracranial pressure monitoring. Secondary outcomes included rates of early tracheostomy, intensive care unit length-of-stay (ICU-LOS), complications, and discharge disposition.
Results
There was a total of 18,621 patients included in this analysis, with 7780 (41.9 %) geriatric patients and 10,841 (58.2 %) adult patients. At level I trauma centers, geriatric patients had 82 % significantly lower odds of in-hospital mortality (OR 0.180, 95 % CI 0.114–0.284, p < 0.001) and adults had 79 % significantly lower odds of in-hospital mortality (OR 0.205, 95 % CI 0.139–0.301, p < 0.001). However, geriatric patients had 46 % significantly lower odds of neurosurgical intervention (OR 0.535, 95 % 0.333–0.859, p = 0.010) and an ICU-LOS of 1.9 days significantly longer (B = 1.875, 95 % CI 0.634–3.117, p = 0.003), while adults had 79 % significantly lower odds of neurosurgical intervention (OR 0.214, 95 % 0.165–0.277, p < 0.001) and an ICU-LOS of 1.4 days significantly shorter (B = −1.415, 95 % CI −2.187 to −0.644, p < 0.001).
Conclusion
Following severe isolated TBI, geriatric trauma patients experience similar mortality to adult patients at both level I and II trauma centers, but at the expense of higher odds of neurosurgical intervention, complications, prolonged ICU-LOS, and less favorable discharge disposition.
简介：本研究旨在评估在美国外科医师学会（ACS）认证的一级和二级创伤中心治疗的老年和成人严重孤立性创伤性脑损伤（TBI）患者的临床结果。方法：本回顾性队列研究分析了2017年至2023年ACS创伤质量改善计划（TQIP）数据库。老年（≥65岁）和成人（18-64岁）创伤合并严重孤立性TBI患者（格拉斯哥昏迷量表(GCS)≤8，AIS头≥3，AIS）结果：本分析共纳入18621例患者，其中老年患者7780例（41.9%），成人患者10841例（58.2%）。在一级创伤中心，老年患者的住院死亡率显著降低82% （OR 0.180, 95% CI 0.114-0.284, p）。结论：严重孤立性TBI后，老年创伤患者在一级和二级创伤中心的死亡率与成人患者相似，但代价是神经外科干预、并发症、延长ICU-LOS和较不有利的出院处置的可能性较高。
{"title":"Outcomes of adult & geriatric trauma patients with severe traumatic brain injury treated at level I or II ACS-verified trauma centers: Towards optimizing geriatric trauma care","authors":"Nikita Nunes MS , Hazem Nasef B.S , Samuel Baum B.S , Sarthak Kumar B.S , Alaina Werling BSN , Heli Patel MBA , Stephen G. Hersperger MD, FACS , Adel Elkbuli MD, MBA, MPH","doi":"10.1016/j.ajem.2025.12.027","DOIUrl":"10.1016/j.ajem.2025.12.027","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aims to evaluate clinical outcomes among geriatric and adult trauma patients with severe isolated traumatic brain injury (TBI) treated at Level I and II American College of Surgeons (ACS) verified trauma centers.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed the ACS Trauma Quality Improvement Program (TQIP) database from 2017 to 2023. Geriatric (age ≥ 65) and adult (age 18–64) trauma patients with severe isolated TBI (Glasgow coma scale (GCS) ≤8, AIS head ≥3, AIS <3 all other body regions) treated at ACS-verified Level I or II trauma centers were included. Primary study outcomes included in-hospital mortality in addition to rates of neurosurgical intervention and intracranial pressure monitoring. Secondary outcomes included rates of early tracheostomy, intensive care unit length-of-stay (ICU-LOS), complications, and discharge disposition.</div></div><div><h3>Results</h3><div>There was a total of 18,621 patients included in this analysis, with 7780 (41.9 %) geriatric patients and 10,841 (58.2 %) adult patients. At level I trauma centers, geriatric patients had 82 % significantly lower odds of in-hospital mortality (OR 0.180, 95 % CI 0.114–0.284, <em>p</em> < 0.001) and adults had 79 % significantly lower odds of in-hospital mortality (OR 0.205, 95 % CI 0.139–0.301, p < 0.001). However, geriatric patients had 46 % significantly lower odds of neurosurgical intervention (OR 0.535, 95 % 0.333–0.859, <em>p</em> = 0.010) and an ICU-LOS of 1.9 days significantly longer (B = 1.875, 95 % CI 0.634–3.117, <em>p</em> = 0.003), while adults had 79 % significantly lower odds of neurosurgical intervention (OR 0.214, 95 % 0.165–0.277, <em>p</em> < 0.001) and an ICU-LOS of 1.4 days significantly shorter (B = −1.415, 95 % CI −2.187 to −0.644, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Following severe isolated TBI, geriatric trauma patients experience similar mortality to adult patients at both level I and II trauma centers, but at the expense of higher odds of neurosurgical intervention, complications, prolonged ICU-LOS, and less favorable discharge disposition.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 61-70"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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