Journal of Emergency Medicine最新文献

{"title":"Evaluating the Prognostic Value of Adding Frailty to Triage Assessment in Elderly Patients With Lower Acuity Presentations in the Emergency Department","authors":"Gamze Nur Taş MD,&nbsp;Murat Pekdemir MD,&nbsp;İbrahim Ulaş Özturan MD,&nbsp;Nurettin Özgür Doğan MD,&nbsp;Elif Yaka MD,&nbsp;Serkan Yılmaz MD","doi":"10.1016/j.jemermed.2024.12.005","DOIUrl":"10.1016/j.jemermed.2024.12.005","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is associated with adverse health outcomes in elderly patients presenting to the emergency department (ED). Assessing frailty in the elderly presenting to the ED, alongside triage, can predict adverse health outcomes.</div></div><div><h3>Objectives</h3><div>The aim of this study was to investigate the prognostic performance of frailty assessment added to triage evaluation in patients with low acuity triage level.</div></div><div><h3>Methods</h3><div>This was a single-center, prospective cohort study conducted between November 2022 and August 2023. Patients ≥65 years old admitted to ED with urgent and nonurgent triage levels were included. The patients were categorized by triage level and frailty status classified by the Clinical Frailty Scale. The prognostic performance of triage, frailty, and the combined use of triage and frailty in predicting 30-day mortality, hospitalization, ED revisit, intensive care unit (ICU) admission, and ED disposition were determined.</div></div><div><h3>Results</h3><div>The study included 1143 patients, of whom 837 (73.2%) were in the urgent triage category. There were 618 (54.1%) in the frail patient group. In predicting 30-day mortality, triage had a relative risk (RR) of 2.22 (95% CI: 1.19–4.15), sensitivity 86% (95% CI: 76–93), specificity 28% (95% CI: 35–30), frailty had an RR of 3.88 (95% CI: 2.20–6.84), sensitivity 82% (95% CI: 71–89), specificity, 48% (95% CI: 45–51), and combined triage and frailty these values were RR 7.08 (95%CI: 2.24–22.37), sensitivity 95% (95% CI: 86–99), specificity 30% (95% CI: 26–33).</div></div><div><h3>Conclusion</h3><div>Adding assessment of frailty to triage may enhance the prognostic performance in predicting 30-day mortality among older adults presenting to the ED with lower acuity triage level.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 1-11"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and Updating Differential Diagnosis Tables in Emergency Medicine for Potentially Life-Threatening Diseases","authors":"Ryota Inokuchi MD, PhD ,&nbsp;Toshihiko Takada MD, MPH, MSc, PhD ,&nbsp;Masao Iwagami MD, MPH, MSc, PhD ,&nbsp;Tetsu Sasaki MD ,&nbsp;Takehiro Sugiyama MD, MSHS, PhD ,&nbsp;Hiromu Maehara MD ,&nbsp;Masataka Gunshin MD, MPH ,&nbsp;Kazuaki Shinohara MD, PhD ,&nbsp;Nanako Tamiya MD, PhD, Msc ,&nbsp;Kent Doi MD, PhD","doi":"10.1016/j.jemermed.2025.01.005","DOIUrl":"10.1016/j.jemermed.2025.01.005","url":null,"abstract":"<div><h3>Background</h3><div>No study has verified whether the published differential diagnosis tables cover all potentially life-threatening diseases observed in real-world clinical practice and updated the tables using real-world data.</div></div><div><h3>Objectives</h3><div>To create initial differential diagnosis tables based on published resources, and to validate and update the tables using the National Hospital and Ambulatory Medical Care Survey (NHAMCS) database as a real-world reference</div></div><div><h3>Methods</h3><div>We created the initial differential diagnosis tables using published textbooks, UpToDate®, BMJ Best Practice, and databases (Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar databases) without language restrictions from their inception to September 22, 2022. Then, we extracted chief complaints and diagnosis lists from the NHAMCS database of emergency patients aged ≥16 years between November 2016 and 2019. Finally, we compared the diagnosis lists from the NAMCS database and the initial tables to cover all potentially life-threatening diseases.</div></div><div><h3>Results</h3><div>We created the initial tables for 78 chief complaints and 2054 differential diagnoses (554 and 1500 in the red and yellow categories, respectively). Additionally, we created 71 chief complaints and 1,468 differential diagnoses from the NHAMCS database. We found 114 potentially life-threatening diseases associated with 39 chief complaints not covered by the initial tables. Finally, the initial tables were updated to include 78 chief complaints and 2168 differential diagnoses.</div></div><div><h3>Conclusions</h3><div>The updated differential diagnosis tables will help prevent missed diagnoses of potentially life-threatening diseases, improve patient outcomes, and facilitate clinical research.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 34-41"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Markers in Severe Organophosphorus Poisoning and Their Association with Mortality","authors":"Ashaq Hussain Parrey MD, FACR,&nbsp;Manzoor Koka MD,&nbsp;Mohd. Ismail MD,&nbsp;Mohd. Ashraf MD,&nbsp;Hyder Lone MD","doi":"10.1016/j.jemermed.2024.12.004","DOIUrl":"10.1016/j.jemermed.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Organophosphorus (OP) poisoning, in addition to its cholinergic manifestations, shows metabolic derangements leading to acidosis, hypokalemia, hyperlactemia, and hyperglycemia. In addition to low acetylcholinesterase, these markers could serve as early predictors of severity of poisoning and mortality.</div></div><div><h3>Objective</h3><div>The objective of this study was to assess the metabolic parameters at presentation in OP poisoning and their association with mortality.</div></div><div><h3>Methods</h3><div>This was a prospective study that recruited 152 patients older than 14 years with a history of OP ingestion within 6 h of presentation.</div></div><div><h3>Results</h3><div>In this study, 11 (6 male and 5 female) of 152 patients died (mortality rate 7.2%).. Mean age of the patients who died was 47 years and mean age of those who survived was 29 years. Ten of 11 patients (90%) who died had fasciculations at presentation. Metabolic parameters that were abnormal at presentation with significant correlation with mortality were acidosis (pH &lt; 7.35) in 8 of 11 patients who died (72.7%) compared with 27.7% in those who survived. Hyperlactemia with serum lactate &gt; 2 mmol/L was seen in 10 of 11 patients (90.1%) who died during hospital stay compared with 39% of patients who survived. Hypokalemia with potassium &lt; 3.5 mmol/L was seen in 8 of 11 patients who died (72.7%) compared with 34.7% of those who survived.</div></div><div><h3>Conclusions</h3><div>Hypokalemia, hyperlactemia, hyperglycemia, fasciculations, and advanced age are early markers predicting poor outcomes in OP poisoning.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 95-101"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Health Care Utilization Among Schizophrenia or Related Conditions and Bipolar Disorder Before, During, and After COVID-19","authors":"Luis A. Ornelas BS,&nbsp;Gary M. Vilke MD,&nbsp;Jesse J. Brennan MA,&nbsp;Melodie Santodomingo MPH,&nbsp;Edward M. Castillo PhD, MPH","doi":"10.1016/j.jemermed.2024.12.006","DOIUrl":"10.1016/j.jemermed.2024.12.006","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments (EDs) often care for patients with acute mental health issues, especially patients with severe mental illness (SMI). This study assessed trends in ED utilization for patients with schizophrenia and bipolar disorder over a 4-year period in California, including during the COVID-19 pandemic.</div></div><div><h3>Objective</h3><div>This study aimed to assess changes in ED visit rates, demographic characteristics, and admission proportions for SMI-related visits before, during, and after COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>A multicenter retrospective analysis of ED utilization among patients 18 years or older with SMI was conducted from 2018 to 2021, using California's Department of Health Care Access and Information ED and inpatient discharged databases. SMI-related visits were identified using <em>International Classification of Diseases</em>, 10^th Revision codes. Demographic variables included age, sex, race and ethnicity, expected payer, and geographic region.</div></div><div><h3>Results</h3><div>Total ED visits increased from 2018 to 2019, then decreased in 2020 and 2021. SMI-related ED visits per 100,000 visits increased from 2019 to 2020 and remained elevated in 2021. Patients aged 25–44 years, non-Hispanic Black individuals, and Medicaid beneficiaries demonstrated the highest SMI-related ED utilization rates. Los Angeles County consistently had the highest rates among geographic regions.</div></div><div><h3>Conclusions</h3><div>Despite an overall reduction in ED visits during the COVID-19 pandemic, SMI-related visits increased, demonstrating the need for mental health resources in EDs, specifically for vulnerable populations, such as non-Hispanic Black individuals and those with lower socioeconomic status.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 87-94"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Stigmatizing Language in the Triage Documentation of Patients Presenting to the Emergency Department with Pain","authors":"Christopher M. Fung MD, MS ,&nbsp;Adrianne Kehne BS ,&nbsp;Colin Macleod MA ,&nbsp;Caroline Logue MPH ,&nbsp;Pooja Lagisetty MD, MS","doi":"10.1016/j.jemermed.2024.12.012","DOIUrl":"10.1016/j.jemermed.2024.12.012","url":null,"abstract":"<div><h3>Background</h3><div>Stigmatizing language in medical documentation is prevalent and associated with race, gender, age, and weight. Triage documentation may impart an outsized effect on downstream care, communicating information to other clinicians prior to their own evaluation.</div></div><div><h3>Objective</h3><div>The goal of this study was to determine the prevalence of stigmatizing language in triage notes for pain-related emergency department (ED) visits.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional study at an urban academic ED. Triage notes between 2017 and 2021 for patients presenting with chest, abdominal, headache, back and injury-related pain were extracted from the electronic health record. A lexicon of stigmatizing words was created <em>a priori</em> from existing literature. Descriptive statistics were used to report the frequency of stigmatizing language by pain type, demographics, and acuity (Emergency Severity Index, ESI). Logistic generalized estimating equations were used to estimate the association between these covariates and stigmatizing language.</div></div><div><h3>Results</h3><div>A total of 51,570 ED visits were included. 2691 triage notes (5.2%) contained at least one stigmatizing word. Male gender (OR: 1.21 95%CI [1.12, 1.31]), Black race (1.11 [1.01, 1.23]), Medicaid (1.29 [1.17, 1.44]) and Medicare (1.22 [1.11, 1.34) insurance were associated with higher odds of stigmatizing language. Back (0.58 [0.49, 0.69]) and injury-related (0.54 [0.47, 0.62]) pain were associated with lower odds compared to visits for abdominal pain. Lower acuity visits (ESI-3 0.77 [0.70, 0.84] and ESI-4 0.52 [0.42, 0.64]) were associated with lower odds when compared to ESI-2.</div></div><div><h3>Conclusions</h3><div>Stigmatizing language is present in roughly 1 in 20 visits for pain and is disproportionality prevalent in males, Black patients, and those with government insurance.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 24-33"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Gpt-4o Accurately Diagnose Trauma X-Rays? A Comparative Study with Expert Evaluations","authors":"Ahmet Öztürk MD ,&nbsp;Serkan Günay MD ,&nbsp;Serdal Ateş MD ,&nbsp;Yavuz Yiğit (Yavuz Yigit) MD","doi":"10.1016/j.jemermed.2024.12.010","DOIUrl":"10.1016/j.jemermed.2024.12.010","url":null,"abstract":"<div><h3>Background</h3><div>The latest artificial intelligence (AI) model, GPT-4o, introduced by OpenAI, can process visual data, presenting a novel opportunity for radiographic evaluation in trauma patients.</div></div><div><h3>Objective</h3><div>This study aimed to assess the efficacy of GPT-4o in interpreting radiographs for traumatic bone pathologies and to compare its performance with that of emergency medicine and orthopedic specialists.</div></div><div><h3>Methods</h3><div>The study involved 10 emergency medicine specialists, 10 orthopedic specialists, and the GPT-4o AI model, evaluating 25 cases of traumatic bone pathologies of the upper and lower extremities selected from the Radiopaedia website. Participants were asked to identify fractures or dislocations in the radiographs within 45 minutes. GPT-4o was instructed to perform the same task in 10 different chat sessions.</div></div><div><h3>Results</h3><div>Emergency medicine specialists and orthopedic specialists demonstrated an average accuracy of 82.8% and 87.2%, respectively, in radiograph interpretation. In contrast, GPT-4o achieved an accuracy of only 11.2%. Statistical analysis revealed significant differences among the three groups (<em>p</em> &lt; 0.001), with GPT-4o performing significantly worse than both groups of specialists.</div></div><div><h3>Conclusion</h3><div>GPT-4o's ability to interpret radiographs of traumatic bone pathologies is currently limited and significantly inferior to that of trained specialists. These findings underscore the ongoing need for human expertise in trauma diagnosis and highlight the challenges of applying AI to complex medical imaging tasks.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 71-79"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olanzapine vs Haloperidol for Management of Acute Agitation in Emergency Department: An Open Label Randomized Controlled Trial","authors":"Yatharth Choudhary MD ,&nbsp;Nayer Jamshed MD ,&nbsp;Roshan Mathew MD ,&nbsp;Satya Prakash Rout MD ,&nbsp;Golak Prasad Patra MD ,&nbsp;Ankit Kumar Sahu MD ,&nbsp;Maroof Ahmad Khan MD","doi":"10.1016/j.jemermed.2024.11.014","DOIUrl":"10.1016/j.jemermed.2024.11.014","url":null,"abstract":"<div><h3>Background</h3><div>Acute agitation is a common presentation in the emergency department (ED), often managed with haloperidol. This study aimed to compare the efficacy and safety of olanzapine versus haloperidol for the initial treatment of acute agitation in the ED.</div></div><div><h3>Objectives</h3><div>Primary outcome was adequate sedation at 15 minutes, defined as Altered Mental Status (AMS) score of zero or less. Secondary outcomes included adequate sedation at 30 minutes, need for rescue medications and reported adverse events.</div></div><div><h3>Methods</h3><div>This open-label, randomized controlled trial included adult patients presenting to the ED with acute agitation, defined with an AMS score ≥ 3. After taking surrogate consent from their legally authorized representative, patients were randomly assigned to receive either intramuscular (IM) olanzapine (10 mg) or IM haloperidol (5 mg).</div></div><div><h3>Results</h3><div>Of the total 94 patients, 47 received IM olanzapine and 47 received IM haloperidol. Similar proportions of patients were adequately sedated at 15 min (olanzapine 31.9% vs haloperidol 25.5%; relative risk [RR] - 1.25, 95% confidence interval [CI] 0.65 to 2.37; p - 0.494) and 30 min (olanzapine 61.7% vs haloperidol 48.9%; RR – 1.26, 95% CI 0.87 to 1.82; p - 0.213). The need for rescue medications was similar (olanzapine 12.7% vs. haloperidol 25.5%; RR 0.5, 95% CI 0.20 to 1.22; p 0.116). Adverse events were uncommon and similar across both arms (olanzapine 4.2% vs. haloperidol 10.6%; RR 0.4, 95% CI 0.08 to 1.96; p 0.238).</div></div><div><h3>Conclusion</h3><div>Intramuscular olanzapine performed better than IM haloperidol in the management of acute agitation in ED. However, the differences were not statistically significant.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"73 ","pages":"Pages 42-51"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Child with Large Midline Abdominal Mass.","authors":"Katherine E Douglas, Joshua K Dodderer, Janine P Amirault, Karen Dull, Katia Genadry","doi":"10.1016/j.jemermed.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.jemermed.2025.05.009","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Suctioning on Oxygenation During Rapid Sequence Intubation in the Emergency Department: A Multi-Center Pilot Randomized Controlled Trial.","authors":"Reuben J Strayer, Matthew Oliver, Aaron Chen, Louis Gerges, Nicholas D Caputo","doi":"10.1016/j.jemermed.2025.04.016","DOIUrl":"https://doi.org/10.1016/j.jemermed.2025.04.016","url":null,"abstract":"<p><strong>Background: </strong>Recent trends in emergency airway management encourage longer periods of suction, and the use of more powerful suction devices. Whether the intensity of oropharyngeal suction during laryngoscopy causes more rapid desaturation is unknown.</p><p><strong>Study objective: </strong>This study aimed to determine whether longer duration of suction leads to more significant desaturation in Emergency Department patients undergoing Rapid Sequence Intubation (RSI).</p><p><strong>Methods: </strong>A multicenter pilot randomized controlled trial was conducted at 3 academic tertiary care level 1 trauma centers. Emergency Department patients undergoing RSI and laryngoscopy were randomized to either as needed suction or constant suction. The primary outcome was the decrease in oxygen saturation from the time the laryngoscope blade entered the mouth until endotracheal tube confirmation.</p><p><strong>Results: </strong>A total of 76 patients were enrolled (37 in as needed suction, 39 in constant suction). The median absolute drop in saturation was 0% (IQR 0-1) in the as needed suction group and also 0% (IQR 0-0) in the constant group (p = 0.321).</p><p><strong>Conclusion: </strong>The study found that constant suctioning during Emergency Department laryngoscopy facilitated by RSI does not cause more rapid desaturation compared to as needed suctioning. However, the reliability of these results is limited by the small sample size and convenience sampling which likely skewed the cohort to patients less likely to develop hypoxia. Further studies are needed to confirm these findings and their implications for emergency airway management.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentation, Evaluation, and Outcomes of Infants Under 3 Months With Skull Fractures.","authors":"Katherine Mandeville, John Naheedy, Zaineb Boulil","doi":"10.1016/j.jemermed.2025.04.027","DOIUrl":"https://doi.org/10.1016/j.jemermed.2025.04.027","url":null,"abstract":"<p><strong>Background: </strong>Head injuries in infants are common but challenging to assess due to minor mechanisms potentially causing significant injury, nonspecific symptoms, and the risk of nonaccidental trauma (NAT).</p><p><strong>Study objectives: </strong>This study evaluates clinical presentations, assessments, and outcomes in infants with skull fractures, with and without intracranial hemorrhage (ICH).</p><p><strong>Methods: </strong>A retrospective chart review was conducted at a tertiary care children's hospital, identifying 291 infants (mean age: 6 weeks) with skull fractures via computed tomography imaging and ICD9/ICD10 codes.</p><p><strong>Results: </strong>Most infants (80%, n = 232) had reported falls, and 83% (n = 240) presented with scalp hematomas. Glasgow Coma Scores were 14 to 15 in 81% (n = 234), while 1.5% (n = 5) scored below 8. ICH was present in 55% (n = 161), with subdural hemorrhage being the most common (53%, n = 86). Vomiting occurred in 8% (n = 23), with loss of consciousness rare (2%, n = 7). Provider-documented normal behavior (84%, n = 244) and parent-reported normal behavior (53%, n = 155) showed relative risks of 1.32 and 1.21 for ICH, respectively. Fracture type (75% nondisplaced/nondepressed, 21% displaced/depressed) did not predict ICH (p = 0.20). Critical care admission was required for 61% (n = 178), and 4% (n = 12) underwent surgery. Child welfare assessments were conducted in 64% (n = 186), more frequently in ICH cases (65%, n = 120 vs. 35%, n = 66; p < 0.001). Skeletal surveys (21%, n = 62) were abnormal in 24% (n = 15).</p><p><strong>Conclusion: </strong>Infants under 3 months with skull fractures often present with minor injury mechanisms and subtle symptoms, yet over half have ICH, and nearly a quarter require evaluations for NAT. Clinicians should exercise caution when assessing head injuries in this age group.</p>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}