Blood biomarkers for mild head injury: high sensitivity, but four in five results were raised

The edition in brief

An Annals of Emergency Medicine validation study, published on 27 October, tested an FDA-cleared GFAP/UCH-L1 plasma test in 104 adults with suspected mild traumatic brain injury undergoing CT at one US trauma centre. Sensitivity for intracranial injury was 0.91 and negative predictive value 0.95, but specificity was 0.22; 83 of 104 results were raised and false positives skewed older. Results came back about two hours faster than CT. It may help rule out injury but will not cut CT use much in older patients. A case report in the same journal describes a man found dead after taking a concentrated 7-hydroxymitragynine kratom product, with an estimated dose 19 to 87 times a high botanical dose, consistent with an opioid-like toxidrome. A NEAR4PEM registry analysis of 642 trainee-led paediatric intubations found emergency medicine residents and paediatric emergency fellows had similar first-attempt success (75% and 74%), while paediatric residents had lower success and more adverse events. In the UK ASPIRED trial of 2,234 patients with unexplained syncope, 14-day ambulatory ECG monitoring did not reduce syncope episodes at one year (IRR 0.89, 95% CI 0.68 to 1.18). The pearl covers the limits of a negative opioid screen.