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}
Pub Date : 2026-03-01Epub Date: 2026-01-02DOI: 10.1016/j.ajem.2025.12.042
Yalcin Golcuk MD (Assoc. Prof.) , Fulden Cantaş Türkiş PhD (Assoc. Prof.) , Meltem Derya Şahin MD (Assoc. Prof.) , Ömer Yasir Boz MD , Sevilay Yerlikaya Boz MD
Background
Intentional drug overdose (IDO) is a major cause of emergency department (ED) presentations. While psychiatric and psychosocial factors are established contributors, many events occur without identifiable triggers. Emerging evidence suggests that rapid environmental changes may act as acute behavioral stressors influencing self-harm risk. This study investigates whether short-term increases in solar insolation and related atmospheric conditions are associated with IDO presentations, using a 15-day harmonic mean (HM15) model to detect individualized environmental deviations.
Methods
This retrospective cohort study included adults presenting with IDO to a tertiary ED in Muğla, Türkiye between July 1, 2019 and July 1, 2024. Environmental data—including solar insolation, temperature at 2 m (T2M), ultraviolet (UV) radiation, and humidity—were obtained from the NASA POWER database. For each case, index-day values were compared to the individual's preceding HM15 baseline.
Results
Among 515 IDO patients, solar insolation, T2M, and UV radiation on the index day were significantly higher than HM15 baselines (all P < 0.001). These deviations were most pronounced in spring and early summer, aligning with established peaks in suicide risk. In spring, a 15.6 % surge in solar insolation was observed, alongside significant increases in T2M and UV exposure. Similar abrupt shifts were noted in summer, while autumn and winter demonstrated mixed environmental patterns.
Conclusions
Acute rises in solar insolation, temperature, and UV radiation are temporally associated with increased IDO risk. The HM15 model may support real-time, meteorologically informed, AI-enhanced risk stratification in ED-based suicide prevention and merits evaluation for integration into clinical decision support systems.
{"title":"Acute solar and atmospheric shifts preceding emergency department presentations for intentional drug overdose","authors":"Yalcin Golcuk MD (Assoc. Prof.) , Fulden Cantaş Türkiş PhD (Assoc. Prof.) , Meltem Derya Şahin MD (Assoc. Prof.) , Ömer Yasir Boz MD , Sevilay Yerlikaya Boz MD","doi":"10.1016/j.ajem.2025.12.042","DOIUrl":"10.1016/j.ajem.2025.12.042","url":null,"abstract":"<div><h3>Background</h3><div>Intentional drug overdose (IDO) is a major cause of emergency department (ED) presentations. While psychiatric and psychosocial factors are established contributors, many events occur without identifiable triggers. Emerging evidence suggests that rapid environmental changes may act as acute behavioral stressors influencing self-harm risk. This study investigates whether short-term increases in solar insolation and related atmospheric conditions are associated with IDO presentations, using a 15-day harmonic mean (HM15) model to detect individualized environmental deviations.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included adults presenting with IDO to a tertiary ED in Muğla, Türkiye between July 1, 2019 and July 1, 2024. Environmental data—including solar insolation, temperature at 2 m (T2M), ultraviolet (UV) radiation, and humidity—were obtained from the NASA POWER database. For each case, index-day values were compared to the individual's preceding HM15 baseline.</div></div><div><h3>Results</h3><div>Among 515 IDO patients, solar insolation, T2M, and UV radiation on the index day were significantly higher than HM15 baselines (all <em>P</em> < 0.001). These deviations were most pronounced in spring and early summer, aligning with established peaks in suicide risk. In spring, a 15.6 % surge in solar insolation was observed, alongside significant increases in T2M and UV exposure. Similar abrupt shifts were noted in summer, while autumn and winter demonstrated mixed environmental patterns.</div></div><div><h3>Conclusions</h3><div>Acute rises in solar insolation, temperature, and UV radiation are temporally associated with increased IDO risk. The HM15 model may support real-time, meteorologically informed, AI-enhanced risk stratification in ED-based suicide prevention and merits evaluation for integration into clinical decision support systems.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 114-120"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927293","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}
An older woman without seizure history presented to the emergency department (ED) after an unwitnessed loss of consciousness, with persistent altered mental status. Initial tests showed profound hypomagnesemia (0.6 mg/dL) with low ionized calcium; lactate declined rapidly. Urine showed low magnesium with a fractional excretion of magnesium (FEMg) ≤2.8 %. She had been taking long-term vonoprazan, a potassium-competitive acid blocker (P-CAB). Perfusion MRI with arterial spin labeling (ASL) showed right-hemispheric hyperperfusion, while conventional sequences showed only a chronic cerebellar infarct. These findings resulted in hospital admission with a suspected postictal state. Vonoprazan was discontinued on admission, and magnesium and calcium were repleted. During hospitalization, she improved steadily and returned to baseline within one week. The initial inpatient electroencephalogram showed diffuse low-amplitude slowing without definite epileptiform discharges; by Day 5 the background was more organized. On Day 8, single-photon emission computed tomography (SPECT) showed reduced perfusion in the previously hyperperfused region. QTc peaked at 603 ms and shortened as electrolytes normalized. No antiseizure medication was started, and outpatient labs remained stable on alternative acid suppression. This case suggests that hypomagnesemia associated with a P-CAB, similar to proton pump inhibitor–associated cases, can be a reversible cause of seizure-related ED presentations. Supported by prior case reports and the absence of other culprit drugs or non-drug losses, it underscores early magnesium testing, prompt magnesium and calcium repletion, and medication review with withdrawal of the suspected agent and follow-up monitoring.
{"title":"Vonoprazan-associated hypomagnesemia presenting to the emergency department with altered mental status and a suspected seizure","authors":"Noriyuki Okamoto , Shinsuke Onishi , Tatsuo Manabe , Shota Satoh , Satoshi Nara","doi":"10.1016/j.ajem.2025.12.034","DOIUrl":"10.1016/j.ajem.2025.12.034","url":null,"abstract":"<div><div>An older woman without seizure history presented to the emergency department (ED) after an unwitnessed loss of consciousness, with persistent altered mental status. Initial tests showed profound hypomagnesemia (0.6 mg/dL) with low ionized calcium; lactate declined rapidly. Urine showed low magnesium with a fractional excretion of magnesium (FEMg) ≤2.8 %. She had been taking long-term vonoprazan, a potassium-competitive acid blocker (P-CAB). Perfusion MRI with arterial spin labeling (ASL) showed right-hemispheric hyperperfusion, while conventional sequences showed only a chronic cerebellar infarct. These findings resulted in hospital admission with a suspected postictal state. Vonoprazan was discontinued on admission, and magnesium and calcium were repleted. During hospitalization, she improved steadily and returned to baseline within one week. The initial inpatient electroencephalogram showed diffuse low-amplitude slowing without definite epileptiform discharges; by Day 5 the background was more organized. On Day 8, single-photon emission computed tomography (SPECT) showed reduced perfusion in the previously hyperperfused region. QTc peaked at 603 ms and shortened as electrolytes normalized. No antiseizure medication was started, and outpatient labs remained stable on alternative acid suppression. This case suggests that hypomagnesemia associated with a P-CAB, similar to proton pump inhibitor–associated cases, can be a reversible cause of seizure-related ED presentations. Supported by prior case reports and the absence of other culprit drugs or non-drug losses, it underscores early magnesium testing, prompt magnesium and calcium repletion, and medication review with withdrawal of the suspected agent and follow-up monitoring.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 131-134"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927294","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: 2026-01-08DOI: 10.1016/j.ajem.2025.12.044
Hande Yigit , Ahmet Ziya Birbilen , Burcu Akbaba , Cansu Demirel , Alper Çiçek , Emel Berksoy , Berke Mutlu , Göksel Vatansever , Deniz Tekin , Sevcan Bilen , Hayri Levent Yılmaz , Gamze Gökulu , Ali Tunç , İlknur Akansu , Emel Ulusoy , Durgül Yılmaz , Murat Duman , İlknur Fidancı , Medine Ayşin Taşar , Murat Doğan , Özlem Tekşam
Background
Suicide is a major cause of morbidity and mortality in adolescents and is increasingly recognized among younger children. Pediatric emergency departments (EDs) are critical points for the identification and management of suicide attempts. This study aimed to evaluate the demographic and clinical characteristics, methods, and temporal trends of suicide attempts among children and adolescents presenting to pediatric EDs in Türkiye.
Methods
We conducted a retrospective, multicenter study across 29 pediatric EDs from July 1, 2017, to June 30, 2022. Patients aged 8–18 years with a confirmed suicide attempt were included. Data collected included demographics, methods, psychiatric history, prior attempts, medications used in self-poisoning, psychiatric consultations, and outcomes. Statistical analyses included chi-square and Mann–Whitney U tests.
Results
During the study period, 6004 suicide attempt presentations were identified among 9,736,825 ED visits (0.5/1000). The median age was 15 years (IQR: 14–16), with 78.8% female (female-to-male ratio 3.7:1). Most patients (92.9%) were aged 13–18 years. Self-poisoning was the predominant method (95.4%), commonly involving NSAIDs, paracetamol, SSRIs, and atypical antipsychotics; 23.5% ingested their own medications, 76.2% of which were psychotropics. A known psychiatric disorder was present in 36.4%, and 16.4% had a prior suicide attempt. Psychiatric consultation was obtained in 73% of cases. Hospitalization occurred in 89.8%, with 15.5% requiring intensive care. Eleven deaths were recorded.
Conclusions
Suicide attempts among children and adolescents are a significant and ongoing public health problem in Türkiye, with self-poisoning as the dominant method. The findings underscore the need for targeted prevention strategies, safe medication storage, and strengthened psychiatric services in pediatric EDs to improve outcomes for this high-risk population.
{"title":"Evaluation of patients admitted to the pediatric emergency departments due to suicide attempts: A multicenter study from Türkiye","authors":"Hande Yigit , Ahmet Ziya Birbilen , Burcu Akbaba , Cansu Demirel , Alper Çiçek , Emel Berksoy , Berke Mutlu , Göksel Vatansever , Deniz Tekin , Sevcan Bilen , Hayri Levent Yılmaz , Gamze Gökulu , Ali Tunç , İlknur Akansu , Emel Ulusoy , Durgül Yılmaz , Murat Duman , İlknur Fidancı , Medine Ayşin Taşar , Murat Doğan , Özlem Tekşam","doi":"10.1016/j.ajem.2025.12.044","DOIUrl":"10.1016/j.ajem.2025.12.044","url":null,"abstract":"<div><h3>Background</h3><div>Suicide is a major cause of morbidity and mortality in adolescents and is increasingly recognized among younger children. Pediatric emergency departments (EDs) are critical points for the identification and management of suicide attempts. This study aimed to evaluate the demographic and clinical characteristics, methods, and temporal trends of suicide attempts among children and adolescents presenting to pediatric EDs in Türkiye.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, multicenter study across 29 pediatric EDs from July 1, 2017, to June 30, 2022. Patients aged 8–18 years with a confirmed suicide attempt were included. Data collected included demographics, methods, psychiatric history, prior attempts, medications used in self-poisoning, psychiatric consultations, and outcomes. Statistical analyses included chi-square and Mann–Whitney <em>U</em> tests.</div></div><div><h3>Results</h3><div>During the study period, 6004 suicide attempt presentations were identified among 9,736,825 ED visits (0.5/1000). The median age was 15 years (IQR: 14–16), with 78.8% female (female-to-male ratio 3.7:1). Most patients (92.9%) were aged 13–18 years. Self-poisoning was the predominant method (95.4%), commonly involving NSAIDs, paracetamol, SSRIs, and atypical antipsychotics; 23.5% ingested their own medications, 76.2% of which were psychotropics. A known psychiatric disorder was present in 36.4%, and 16.4% had a prior suicide attempt. Psychiatric consultation was obtained in 73% of cases. Hospitalization occurred in 89.8%, with 15.5% requiring intensive care. Eleven deaths were recorded.</div></div><div><h3>Conclusions</h3><div>Suicide attempts among children and adolescents are a significant and ongoing public health problem in Türkiye, with self-poisoning as the dominant method. The findings underscore the need for targeted prevention strategies, safe medication storage, and strengthened psychiatric services in pediatric EDs to improve outcomes for this high-risk population.</div></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":"101 ","pages":"Pages 159-165"},"PeriodicalIF":2.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954064","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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