Mild traumatic brain injury (mTBI) increasingly affects older adults and frequently prompts cranial computed tomography (CT). We assessed CT utilisation, radiological diagnostic yield and short-term clinical outcomes, and examined factors associated with the decision to perform initial CT. We conducted a retrospective single-centre cohort study of patients aged ≥ 14 years with clinically confirmed mTBI presenting to a Spanish emergency department between January 2019 and January 2022. Radiological outcomes were assessed among patients undergoing CT. Multivariable logistic regression evaluated initial CT utilisation (yes/no) in the full cohort. Among 3,088 patients, 1,636 (53.0
Blood‑based biomarkers such as S100B and GFAP + UCH‑L1 have demonstrated high sensitivity for ruling out intracranial injury in mild traumatic brain injury (mTBI). To describe and compare international guidelines on biomarker use in mTBI, identify key similarities and differences, and describe Belgian diagnostic practices, including Computed Tomography (CT) utilisation and attitudes toward biomarker adoption. A pragmatic search of the published and grey literature identified European guidelines or recommendations on integrating blood‑based biomarkers in the management of mTBI. A 2025 questionnaire was sent to heads of Belgian emergency departments to document CT utilisation, application of clinical decision rules, biomarker awareness, perceived utility, and implementation barriers. Guidance varies considerably across Europe. NICE (UK) does not endorse biomarkers due to insufficient evidence; Scandinavian recommendations support S100B in low‑risk adults; French guidelines recommend S100B and GFAP + UCH‑L1 in intermediate‑risk adults; Spanish guidance and a 2024 European consensus support biomarker use as CT‑sparing tools in selected adults. Approximately one‑third of Belgian hospitals responded to our survey. Adult CT utilisation was high ( 60
Acute aortic dissection (AAD) can resemble acute myocardial infarction (AMI) or acute pulmonary embolism (APE). Routine laboratory models may assist differential diagnosis, but their performance may depend on comparator composition. Objective: To explore internal discrimination and case-mix dependence in a hypothesis-generating study. The reanalysis included 977 records from January 1, 2019 to December 31, 2020 (276 AAD, 578 AMI and 123 APE), after exclusion of unresolved duplicate or near-duplicate records. A D-dimer-only baseline and six multivariable models using a 50-predictor laboratory pool were evaluated by five-fold outer validation repeated ten times. Preprocessing was fitted within training folds. The D-dimer baseline was refitted without tuning; four models used archived fold-specific parameters; XGBoost and LightGBM underwent new inner tuning. Analyses assessed calibration, decision curves, cardiac-marker ablation, comparator composition and cross-fitted XGBoost SHAP. Overall AUC was 0.941 (95
Disasters and everyday gaps in emergency care force acute illness and injury to be managed outside of formal emergency medicine (EM) and emergency medical services (EMS) systems. Because EM capacity varies substantially worldwide, this scoping review applies a substitutes-and-complements framework to the mechanisms that deliver acute care in and around formal EM or EMS, classifying their roles as substitutes, complements, or both across levels of EM system maturity and disaster conditions. The resulting typology serves as an inventory of latent disaster surge capacity. Following the PRISMA extension for scoping reviews, five databases (PubMed, Scopus, Web of Science, Embase, and CINAHL) were searched, yielding 11,161 records. After title and abstract screening, 758 full-text articles were assessed for eligibility and 115 studies were included. We charted study type, country, and EM system maturity, using a codebook derived from American College of Emergency Physicians’ (ACEP) International Ambassador country reports, the primary acute-care mechanism, care-delivery context, and COVID-19 relevance. Mechanisms were then classified by whether they substituted for or complemented formal EM. Publications were concentrated in the COVID-19 era (82/115, 71
Despite advances in cardiac arrest management, survival with favorable neurological outcomes remains limited. Physiological monitoring may complement standardized resuscitation by providing real-time information about circulatory effectiveness, reversible causes, and treatment responses. However, whether physiology-guided interventions improve patient-centered outcomes remains uncertain. This narrative review examines the current evidence and clinical applicability of physiological monitoring during resuscitation, physiology-informed rescue strategies, and individualized post-cardiac arrest care. During cardiopulmonary resuscitation, invasive arterial pressure monitoring, waveform capnography, and echocardiography provide complementary information about the circulation generated by chest compressions and potential mechanisms of resuscitation failure. Although observational and experimental studies support their physiological relevance, no adult diastolic pressure target or pressure-guided vasopressor strategy has been validated to improve survival or neurological recovery. Recent randomized trials of transesophageal echocardiography have demonstrated physiological or procedural effects without establishing clinical benefit. Among rescue strategies, extracorporeal cardiopulmonary resuscitation has yielded inconsistent results across randomized trials, with potential benefits dependent on patient selection, intervention timing, and system capabilities. Resuscitative endovascular balloon occlusion of the aorta has not improved clinical outcomes in randomized evaluation, while head-up resuscitation remains investigational. Following the return of spontaneous circulation, randomized trials have challenged the benefits of uniformly higher blood pressure and oxygenation targets, mild hypercapnia, and deeper or prolonged temperature control. Individualized approaches incorporating cerebral autoregulation, venous congestion, and cardiopulmonary physiology are physiologically appealing but lack prospective validation. Physiological assessment may complement established resuscitation algorithms by refining clinical decisions during and after cardiac arrest. However, improvements in physiological measurements should not be equated with improved patient outcomes. Future trials should determine whether predefined, physiology-guided treatment strategies improve survival and neurological recovery.
