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To evaluate the risk and presence of obstructive sleep apnea (OSA) in patients presenting with acute ischemic stroke, and examine the correlation of OSA with age, sex, ischemic stroke subtype, disability, and death, a prospective cohort study was conducted in all consecutive patients presenting with acute ischemic stroke between June 2007 and March 2008. Exclusion criteria were age18 years, refusal of consent for the study, and incomplete questionnaire. The Berlin Sleep Questionnaire was used to identify patients at high risk for OSA. A total of 174 patients with acute ischemic stroke were included; 130 (74.7%) had a modified Rankin Scale (mRS) score ≥ 3 at dismissal, and 11 patients (6.3%) died within 1 month. The Berlin Sleep Questionnaire identified 105 patients (60.4%) at high risk for OSA, along with 7 patients (4%) with a previous diagnosis of OSA. Those with a previous diagnosis of OSA were more likely to die within the first month after stroke (relative risk, 5.3; 95% confidence interval, 1.4-20.1) compared with those without OSA. Patients at high risk for OSA did not demonstrate increased mortality at 30 days (P = 1.0). In multivariate analysis, after adjusting for age and National Institutes of Health Stroke Scale score, previous diagnosis of OSA was an independent predictor of worse functional outcome, that is, worse mRS score at hospital discharge (P = .004). The mRS score was 1.2 points higher (adjusted R², 40%) in those with OSA. Our findings suggest that patients considered at high risk for ischemic stroke should be screened for OSA, the prevalence of which may be as high as 60%. Those with definitive diagnosis of OSA before stroke are at increased risk of death within the first month after an acute ischemic stroke.

Background and Purpose— Coronary artery disease is the leading cause of death after TIA. Reliable estimates of the risk of MI after TIA, however, are lacking. Methods— Our purpose was to determine the incidence of and risk factors for MI after TIA. We cross-referenced preexisting incidence cohorts from the Rochester Epidemiology Project for TIA (1985–1994) and MI (1979–2006) to identify all community residents with incident MI after incident TIA. Incidence of MI after TIA was determined using Kaplan–Meier life-table methods. This was compared to the age-, sex-, and period-specific MI incidences in the general population. Proportional hazards regression analysis was used to examine associations between clinical variables and the occurrence of MI after TIA. Results— Average annual incidence of MI after TIA was 0.95%. Relative risk for incident MI in the TIA cohort compared to the general population was 2.09 (95% CI, 1.52–2.81). This was highest in patients younger than 60 years old (relative risk, 15.1; 95% CI, 4.11–38.6). Increasing age (hazard ratio, 1.51 per 10 years; 95% CI, 1.14–2.01), male sex (hazard ratio, 2.19; 95% CI, 1.18–4.06), and the use of lipid-lowering therapy at the time of TIA (hazard ratio, 3.10; 95% CI, 1.20–8.00) were independent risk factors for MI after TIA. Conclusions— Average annual incidence of MI after TIA is ≈1%, approximately double that of the general population. The relative risk increase is especially high in patients younger than 60 years old. These data are useful for identifying subgroups of patients with TIA at highest risk for subsequent MI.

We have previously reported the association of hyperglycemia and mortality after ischemic stroke. This study attempts to answer the hypothesis, if hyperglycemia at arrival, is associated with early mortality and functional outcome in patients with acute non-traumatic intracerebral hemorrhage (ICH). The study cohort consisted of 237 patients who presented to the ED with ICH and had blood glucose measured on ED presentation. The presence of hyperglycemia on presentation was correlated with outcome measures including volume of hematoma, intraventricular extension of hematoma (IVE), stroke severity, functional outcome at discharge, and date of death. Of the cohort of 237 patients, a total of 47 patients had prior history of Diabetes Mellitus (DM). Median blood glucose at presentation was 140 mg/dl (Inter-quartile range 112–181 mg/dl). DM patients had higher glucose levels on arrival (median 202 mg/dl for DM vs. 132.5 mg/dl for non-DM, P

We sought to examine the relationship of the QTc interval with mortality and functional outcome after acute ischemic stroke, and determine whether a threshold cutoff is present beyond which risk of death increases.The QTc interval was measured for all patients presenting to the emergency department. The outcomes were mortality at 90 days and functional outcome at hospital discharge. The cutoffs were determined plotting martingale residuals.Patients with a prolonged QTc interval were more likely to die within 90 days compared with patients without a prolonged interval (relative risk [RR] 2.5; 95% confidence interval [CI] 1.5-4.1; P.001). The estimated survival at 90 days was 70.5% and 87.1%, respectively. This association retained statistical significance after adjusting for age and National Institutes of Health Stroke Scale score (RR 1.7; 95% CI 1.0-2.9; P = .043). Patients with a prolonged QTc interval were also more likely to have poor functional status compared with patients without a prolonged interval (odds ratio 1.8; 95% CI 1.2-3.0; P = .006). This association was not statistically significant after adjusting for age and National Institutes of Health Stroke Scale score (odds ratio 1.2; 95% CI 0.7-2.4). The identified threshold cutoffs for increased risk of death at 90 days were 440 milliseconds for women and 438 milliseconds for men.There appears to be an increased risk of early death in patients with acute ischemic stroke and a prolonged QTc interval at the time of emergency department presentation. Prognosis appears to be worse with QTc intervals longer than 440 milliseconds in women and longer than 438 milliseconds in men.

Background Statins have been shown to improve the functional outcome of patients after an ischemic stroke. We hypothesized that daily statin intake improves functional outcome after an acute ischemic stroke in patients with low-density lipoprotein (LDL) less than or equal to 100 mg/dL. Methods This was a prospective cohort study during a 22-month period of patients presenting with an acute ischemic stroke and lipid profiles measured. The functional disability was determined using modified Rankin scale score (0-2 good outcome, 3-6 bad outcome) at discharge. Chi-square test for binary data and nonparametric tests for nonnormally distributed variables were used for analysis. Results Of 508 patients, 207 presented with an LDL of 100 mg/dL or less and were included in the analysis. There was no significant difference in admission stroke severity (National Institutes of Health Stroke Scale [NIHSS]; P = .18), age ( P = .31), and sex ( P = .06) between those taking statins and not taking statins. Patients with LDL less than or equal to 100 mg/dL and taking statins (n = 100) were significantly more likely to have a good functional outcome (odds ratio 1.91; 95% confidence interval 1.05-3.47) when compared with those not on the medication. After adjusting for age, sex, and NIHSS, statin intake still predicted a better functional outcome ( P Conclusion Daily statin intake appears to result in a better functional outcome after an ischemic stroke in patients with ideal LDL levels (≤100 mg/dL) before and after adjusting for age and stroke severity. Pleiotropic effects of statins may play a role in this.

Blood pressure fluctuation early in the course of ischemic stroke is a proven independent predictor of morbidity and mortality. Both high and low systolic blood pressures have a detrimental effect on the neurologic outcome. Current guidelines support permissive hypertension in the early course of acute ischemic stroke. For patients with marked elevation in blood pressure, a reasonable goal would be to lower blood pressure by 15% during the first 24 hours after onset of stroke. The level of blood pressure that would mandate such treatment is not known, but consensus exists that medications should be withheld unless the systolic blood pressure is greater than 220 mm Hg or the diastolic blood pressure is greater than 120 mm Hg. For patients undergoing intravenous thrombolysis for acute ischemic stroke, it is recommended that the blood pressure be reduced and maintained below 185 mm Hg systolic for the first 24 hours. The first-line drugs for lowering of blood pressure remain labetalol, nicardi pine, and sodium nitroprusside. These recommendations are based on consensus rather than evidence, however. Comorbid conditions such as myocardial infarction, left ventricular failure, aortic dissection, preeclampsia, or eclampsia would override the guidelines for permissive hypertension; a lower blood pressure would be preferred in these conditions. Children with acute strokes should be managed in the same way as adults, with extrapolated lowering of blood pressures, until further evidence emerges. Current research focuses on both hemodynamic augmentation of low blood pressures and the effects of further lowering the blood pressure after acute ischemic stroke. Until more definitive data are available, a cautious approach to the treatment of arterial hypertension is generally recommended.

Objective: To assess stroke awareness among patients presenting to the emergency department with an acute ischaemic stroke or transient ischaemic attack (TIA). Methods: A consecutive cohort of patients presenting with a cerebrovascular event was prospectively enrolled over a 15-month period and questionnaires were administered. If the patient was unable to respond to the questions or answer the questionnaire, it was administered to the primary caregiver. Comprehension of having a cerebrovascular event, reason for delay in presentation, mode of arrival and knowledge of treatment modalities were determined. Results: Only 42% of 400 patients thought they were having a stroke or TIA. The median time to presentation was 3.4 h. Delayed presentation was almost equal in men and women. When asked about onset, 19.4% thought that a stroke came on gradually and only 51.9% thought immediate presentation was crucial. 20.8% of patients had heard of thrombolysis. Conclusion: Community knowledge of ischaemic stroke needs to be enhanced so that individuals present earlier, leading to timely management.

Dobutamine is commonly administered as a pharmacologic stressor in patients with limitations precluding exercise testing. The case report presented is one of transient complete heart block resulting from dobutamine sestamibi stress testing. Shortly after initiating the dobutamine infusion, the patient became pale and presyncopal, with hypotension and a heart rate of 50 beats per minute. Subsequently, third-degree heart block developed which lasted transiently and resolved. Subsequent cardiac evaluation of the patient revealed no cardiac etiology for her symptoms. Though bradycardia is infrequently noted in patients receiving dobutamine during stress electrocardiogram, complete heart block is a possibility during dobutamine-induced stress echocardiography and must be recognized as a potential risk.

As the marketplace for academic positions in emergency medicine grows more competitive, it becomes increasingly important for residents who desire academic careers to distinguish themselves during their residency. This report attempts to outline a road map for department and residency program leaders to help their houseofficers become successful candidates for an academic emergency medicine position. Specific ways a resident can enhance his or her "academic marketability" include 1) involvement in research, 2) establishment of a track record of productivity via scholarly writing, 3) awareness of the literature in the specialty, 4) involvement in specialty organizations and hospital committees, 5) competition for national awards, 6) gaining education skills, 7) developing an academic niche, and 8) fellowship training.

Objectives: To date, no studies in emergency medicine (EM) have addressed the educational value of the Residency Review Committee for Emergency Medicine's (RRC-EM) requirement for patient follow-up (FU). The authors examined whether performance of patient FU improved EM resident education. Methods: All EM resident FU encounters from September 25, 2001, through September 24, 2002, were documented and analyzed. All EM residents at a regional tertiary referral emergency department (ED) initiated patient FU encounters by entering information regarding patients' initial ED presentations into a Web-based follow-up system (WBFUS), subsequently entered FU information, and indicated whether they thought that the specific FU encounters improved their education (yes/no). Supervising faculty members then reviewed the residents' completed FU entries. Blinded to residents' responses regarding educational utility, faculty members evaluated whether they thought the specific FU encounters were educational for the residents (yes/no). Data entered into the WBFUS were then summarized as percentages. Results: Eight hundred forty-seven FU encounters were completed by 18 EM residents and 29 EM faculty. Ninety-three percent of the FU entries were deemed by at least one evaluator (resident or faculty) to have educational value. Residents found the act of performing FU educational in 81.3% of cases, whereas faculty thought 80.4% were educational for the resident. Although the residents and faculty agreed on the educational value in 75.4% of cases, the overall strength of the agreement was slight to fair (kappa statistic = 0.21). Conclusions: This study indicates that EM residents and faculty believe that the act of performing patient FU has educational value for EM residents; however, the interobserver agreement between residents and faculty was low.

The authors present a case of Trimethoprim-sulfamethoxazole-induced hyperkalemia in a patient with normal renal function. While toxicity of this drug has been reported in patients with renal insufficiency, this case highlights the toxicity associated with normal kidney function. Due to its popularity in the medical field and to the largely unrecognized effect of hyperkalemia, it is important to consider such adverse effects when prescribing TMX-SMX. One must be reminded of the possibility of the development of life-threatening hyperkalemia in relatively healthy patients.

Objective: To determine whether changes in graduate medical education (GME) funding have had an impact on emergency medicine (EM) residency training programs. Methods: A 34-question survey was mailed to the program directors (PDs) of all 115 Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency programs in the United States in the fall of 1998, requesting information concerning the impact of changes in GME funding on various aspects of the EM training. The results were then compared with a similar unpublished survey conducted in the fall of 1996. Results: One hundred one completed surveys were returned (88% response rate). Seventy-one (70%) of the responding EM residency programs were PGY-I through PGY-III, compared with 55 (61%) of the responding programs in 1996. The number of PGY-II through PGY-IV programs decreased from 25 (28%) of responding programs in 1996 to 17 (16%). The number of PGY-I through PGY-IV programs increased slightly (13 vs 10); the number of EM residency positions remained relatively stable. Fifteen programs projected an increase in their number of training positions in the next two years, while only three predicted a decrease. Of the respondents, 56 programs reported reductions in non-EM residency positions and 35 programs reported elimination of fellowship positions at their institutions. Only four of these were EM fellowships. Forty-six respondents reported a reduction in the number of non-EM residents rotating through their EDs, and of these, 11 programs reported this had a moderate to significant effect on their ability to adequately staff the ED with resident physicians. Sixteen programs limited resident recruitment to only those eligible for the full three years of GME funding. Eighty-seven EM programs reported no change in faculty size due to funding issues. Sixty-two programs reported no change in the total number of hours of faculty coverage in the ED, while 34 programs reported an increase. Three EM programs reported recommendations being made to close their residency programs in the near future. Conclusions: Changes in GME funding have not caused a decrease in the number of existing EM residency and fellowship training positions, but may have had an impact in other areas, including: an increase in the number of EM programs structured in a PGY-I through PGY-III format (with a corresponding decrease in the number of PGY-II through PGY-IV programs); a decrease in the number of non-EM residents rotating through the ED; restriction of resident applicants who are ineligible for full GME funding from consideration by some EM training programs; and an increase in the total number of faculty clinical hours without an increase in faculty size.

To date, no studies in emergency medicine (EM) have addressed the educational value of the Residency Review Committee for Emergency Medicine's (RRC-EM) requirement for patient follow-up (FU). The authors examined whether performance of patient FU improved EM resident education.All EM resident FU encounters from September 25, 2001, through September 24, 2002, were documented and analyzed. All EM residents at a regional tertiary referral emergency department (ED) initiated patient FU encounters by entering information regarding patients' initial ED presentations into a Web-based follow-up system (WBFUS), subsequently entered FU information, and indicated whether they thought that the specific FU encounters improved their education (yes/no). Supervising faculty members then reviewed the residents' completed FU entries. Blinded to residents' responses regarding educational utility, faculty members evaluated whether they thought the specific FU encounters were educational for the residents (yes/no). Data entered into the WBFUS were then summarized as percentages.Eight hundred forty-seven FU encounters were completed by 18 EM residents and 29 EM faculty. Ninety-three percent of the FU entries were deemed by at least one evaluator (resident or faculty) to have educational value. Residents found the act of performing FU educational in 81.3% of cases, whereas faculty thought 80.4% were educational for the resident. Although the residents and faculty agreed on the educational value in 75.4% of cases, the overall strength of the agreement was slight to fair (kappa statistic = 0.21).This study indicates that EM residents and faculty believe that the act of performing patient FU has educational value for EM residents; however, the interobserver agreement between residents and faculty was low.

A 30-year-old intellectually challenged woman with recent travel history to Texas presented with intractable nausea and nonprojectile vomiting for 3 weeks. She had diffuse abdominal pain with no change in her bowel movements. Her family noted that she had recently become more withdrawn. On presentation, she was afebrile with a normal abdominal exam. Physical examination was remarkable for subtle bilateral end-gaze nystagmus. An extensive workup at an outside hospital over 2 weeks included upper endoscopy with small bowel follow-through, pelvic sonogram, and a head computed tomography (CT), all of which were reportedly unremarkable. No outside films were accessible at the time. At our facility, laboratory examination was obtained that ruled out an infectious etiology. Abdominal CT showed no gastrointestinal or hepatobiliary abnormalities. Because of reported personality changes and nystagmus on physical exam, magnetic resonance imaging (MRI) of the head was obtained to rule out cerebellar or vestibular pathology.

A 60-year-old woman with a history of chronic back pain presented to the emergency department with headache, slurred speech, and altered sensorium reported by her family. The previous day, she had a lumbar catheter placed for symptomatic relief of her chronic back pain. The patient complained only of headache, but otherwise thought she was unaffected. The patient's past medi- cal history was remarkable for diabetes, hypertension, peripheral neuropathy, gastritis, supraventricular tachycardia, and chronic back pain. On physical examination she was alert, fully orientated, and in no acute distress. Her vital signs were normal. Neurological examination revealed subtle word-finding difficulties and dysarthria. There were no physical signs of raised intracranial pressure (ICP). The remainder of her examination was entirely normal.

u t t b 45-year-old woman had a syncopal episode while reparing for some appointments. The episode was decribed as a gentle “easing down”; the patient’s husband aught her before she hit anything. She did not have any ead trauma. The past medical history was notable for ecently diagnosed carcinoma of the head of the panreas, for which she underwent biliary stent placement at nother instititution a few days before the syncopal episode. Physical examination revealed an extremely tiredppearing woman who was able to answer some quesions but had an altered level of consciousness. Her vital igns were within normal limits except for temperature, hich was 35.8°C. Extremities demonstrated pitting dema up to the knees. The rest of the physical examiation findings were normal. An electrocardiogram (EKG) was obtained immeditely and showed markedly peaked T waves, with a new eft bundle branch block (Figure 1). Because markedly levated T waves are consistent with hyperkalemia, elecrolyte levels were determined immediately and, simulaneously, treatment for hyperkalemia was instituted. he patient received 1 ampule of 10% calcium chloride nd 10 units of regular insulin intravenously, followed by ampule of D50 and 1 nebulizer treatment of 2.5 mg of lbuterol. After these measures, EKG was repeated and howed normalization of the T waves and disappearance f the left bundle branch block (Figure 2). The serum otassium level was 7.3 mEq/L. Arterial blood gas analysis revealed the following: pH .46; PCO2, 27 mm Hg; and bicarbonate, 16 mEq/L. The

This 83-year-old woman with glaucoma and atrial fibrillation was receiving warfarin. She woke up with pain in the right eye and what she thought was a big bruise.

When writing or reading articles, one should be aware whether the statistical tests performed were appropriate for the type of data collected and used, thereby avoiding misleading conclusions. The goal of all statistical tests is to determine whether two (or more) variables are associated with one another or independent from each other at the population level. In this issue of IJEM, our Clinical Research Capsule reviews the most common tests used in published literature and some of the pitfalls associated with their use. This article is intended for non-statisticians. One of the first things to keep in mind is the type of data and outcomes the author wants to measure and correlate. In order to do this, one must define the variables of the study. Are we looking at a continuous variable, one that can be quantified on an infinite scale, such as temperature or age, or is it a categorical variable, one that has to be grouped in classes. Categorical variables can be nominal or ordinal. Nominal variables are data that can be counted, but not ordered or measured. Nominal data can be further broken down into dichotomous (e.g., dead or alive) or have several categories (e.g., blood type). Ordinal data are numerical values that have a natural order and thus can be ranked and ordered. However, the distance between two values on an ordinal scale may not represent an equal degree of difference. For example, the modified Rankin score is a measure of outcome after stroke where a value of 0 is no functional deficit, and a value of 6 is dead. The difference between 0 and 1 is slight; however, the difference between a 2 and a 3 is very significant, as it distinguishes being functionally independent (2) versus dependent (3). Other examples of ordinal variables include birth order and pain severity scales. The second important thing to keep in mind is how the results are distributed. Do they follow a “bell curve” (also called a Gaussian distribution), similar to biological phenomena and exam grading techniques, or do the results tend to cluster resulting in a skewed distribution? (Fig. 1). With normally distributed data, mean and SD are reported. For skewed data, median and interquartile ranges are reported. Fig. 1 Left panel demonstrates a normal distribution of mean arterial pressure (MAP) in patients with acute ischemic stroke; right panel demonstrate skewed distribution of door to computed tomography time in patients with acute ischemic stroke Sometimes, it may be desirable to “normalize” skewed data. This is known as transformation. When data are skewed, the commonly applied transformations are 1/x, log(x), and sqrt(x), exponentiating, squaring, or cubing x, where the x’s are the data values. Also to be considered is whether the data are matched—meaning are sample subjects or data points related to one another, or are they independent? Once these three questions are answered, one is able to choose to the appropriate statistical test and, thus, decipher if an inappropriate test is used. For two dichotomous or binary variables, one will be able to build a 2 × 2 table. If the data follow a normal distribution, the most common test will be Chi-square test. It is used to compare the proportion of subjects in two groups, and verify the independence of each other. For example, if a study about a certain treatment obtains data that shows that it reduces mortality more than placebo for a given disease, one would like to know if the results are true or merely a coincidence. Therefore, we perform a Chi-square test and obtain the p value. One limitation of the Chi-square testing is that its distribution breaks down as the frequencies decrease. If in one of the cells of your table there are five or less observations, the data is considered skewed. In this case, you need to use Fisher’s exact test, specifically designed for small samples. For two continuous variables (e.g., respiratory rate versus age), one can use linear regression or correlation. Linear regression allows us to predict the outcome for a particular value of the predictor. Correlation help us measure the association and direction between the variables. In cases where the outcome or dependent variable (Y axis) is continuous (e.g., high blood pressure) and the independent variable (X axis) is binary (e.g., smoking yes/no); the distribution of the dependent variable will guide one in using (1) parametric tests [t test and analysis of variance (ANOVA)] for normally distributed data, or (2) nonparametric tests (Wilcoxon/Kruskal–Wallis or rank sum tests) for skewed data (Table 1). Table 1 Statistical test suggested In cases where the outcome or dependent variable (Y axis) is binary and the independent variable (X axis) is continuous, one should use logistic regression analyses. When the data is matched (e.g., before and after measurement of a variable in the same patient), the appropriate test would be the McNemar test. There are many sources of errors when selecting a statistical test. The first involves sources of bias. These are conditions or circumstances which affect the external validity of statistical results. The second are errors in methodology, which can lead to inaccurate or invalid results. The third are interpretation of results or how statistical results are applied to real world issues. Common pitfalls: Reporting the skewed data with mean and SD. Normally distributed data should be reported with mean (average) and SD or confidence intervals, and skewed data should be reported with median and interquartile ranges. The study’s overall statistical analyses were not performed to reject the null hypothesis. If the investigator constructs a loose protocol and allows the experimenters to vary how they conduct the experimental procedures or interviews with different subjects, it is likely that the results of the experiment will be misleading. The decision not to use the data was made after inspection of the results and without a predetermined rationale. After an overall analysis had failed to reject the null hypothesis, the investigators perform a large number of new statistical tests on the data. Do not take account of changing levels of significance when many statistical tests were performed on a single set of data (for example, perform 20 comparisons with one set of data) Data omission—i.e., all the data in the analyses are not included (deleting patients with “inconvenient” results) Conclusions cannot be derived form the results of the study Reporting only p values. The mean, median, SD, confidence interval, relative risk, odds ratio, etc. should all be reported, to allow the reader to critique for him/herself the validity of the results. Look at magnitudes rather than p values. Causal inference. Observational studies are very limited in their ability to show causal relationships. We will require a multifaceted approach to the research use of chronologically structured designs (placing variables in the roles of antecedents and outcomes) and ability of replication, to come to any conclusions regarding causality. Precision and accuracy. Precision refers to how finely an estimate is specified; whereas accuracy refers to how close an estimate is to the true value. Estimates can be precise without being accurate. There seems to be an erroneous notion that you can prove anything with statistics. However, this is only true if you use them improperly. Many times the data is overlooked, or the statistical test is not correctly selected. Always keep in mind that the simpler the experiment, the better will be its execution, and the more likely will one be able to see the “real truth” and what the results actually mean.

Background To characterize the patterns of presentation of adults with head injury to the Emergency Department. Methods This is a cohort study that sought to collect injury and outcome variables with the goal of characterizing the very early natural history of traumatic brain injury in adults. This IRB-approved project was conducted in collaboration with our Institution’s Center for Translational Science Institute. Data were entered in REDCap, a secure database. Statistical analyses were performed using JMP 10.0 pro for Windows. Results The cohort consisted of 2,394 adults, with 40% being women and 79% Caucasian. The most common mechanism was fall (47%) followed by motor vehicle collision (MVC) (36%). Patients sustaining an MVC were significantly younger than those whose head injury was secondary to a fall (P < 0.0001). Ninety-one percent had CT imaging; hemorrhage was significantly more likely with worse severity as measured by the Glasgow Coma Score (chi-square, P < 0.0001). Forty-four percent were admitted to the hospital, with half requiring ICU admission. In-hospital death was observed in 5.4%, while neurosurgical intervention was required in 8%. For all outcomes, worse TBI severity per GCS was significantly associated with worse outcomes (logistic regression, P < 0.0001, adjusted for age). Conclusion These cohort data highlight the burden of TBI in the Emergency Department and provide important demographic trends for further research.