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Review of Evidence for Links of Autism with Maternal Acetaminophen Use
Take Home Point: Existing evidence does not clearly link maternal acetaminophen (paracetamol) use during pregnancy with autism or attention deficit hyperactivity disorder (ADHD) in children.
Citation: Sheikh J, Allotey J, Sobhy S, et al. Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews. BMJ. 2025;391:e088141. doi:10.1136/bmj-2025-088141
Relevance: Recent public discussion has suggested that acetaminophen/paracetamol use during pregnancy is associated with an increased risk of autism and ADHD in offspring. This review examines the available evidence to assess these claims.
Study Summary: This umbrella review followed a prospective protocol and follows the recommended methods for rapid reviews. The authors searched Medline, Embase, PsycINFO, the Cochrane Database of Systematic Reviews, Epistemonikos, and grey literature to identify systematic reviews and meta-analyses of studies reporting maternal acetaminophen/paracetamol exposure with autism spectrum disorder or ADHD in offspring.
After review identification process, 9 systematic reviews were included summarizing 40 primary studies (37 prospective cohorts, 2 case-control studies, and 1 ecological study). Four studies were meta-analyses. Across the included primary studies, 6 reported autism outcomes and 17 reported ADHD outcomes.
Overall, the authors found a lack of high quality evidence linking acetaminophen/paracetamol use during pregnancy with autism or ADHD in offspring. Additionally, they report that no well-established molecular mechanisms link exposure to autism or ADHD in offspring. They also noted that familial confounding factors linking acetaminophen/paracetamol exposure to autism or ADHD in offspring may explain positive findings in some of the studies.
Editor’s Comments: As this is a systematic review, conclusions relied on published literature, and thus some covariates and exposure details may have been misclassified or inconsistently defined across studies. Given the review’s narrow scope, the authors could not comment on other neurodevelopmental outcomes. Despite these limitations, the compiled evidence supports current guidance that acetaminophen/paracetamol use in pregnancy is not clearly linked to autism and ADHD in offspring while underscoring ongoing gaps in the underlying evidence base.
Validation of the STUMBL Score
Take Home Point: In this study, the STUMBL (STUdy of the Management of BLunt chest wall trauma) score demonstrated good performance in predicting early adverse outcomes in patients with isolated blunt thoracic trauma (BTT).
Citation: Blais S, Boucher V, Brière R, et al. External retrospective validation of the STUMBL score for patients with isolated blunt thoracic trauma presenting to the emergency department. Injury. 2026;57(1):112761. doi:10.1016/j.injury.2025.112761
Relevance: BTT is a common presentation to emergency departments (EDs) and urgent care centers (UCCs). UC clinicians must appropriately identify patients who may require a higher level of care and coordinate timely transfer.
Study Summary: This retrospective validation cohort study was conducted at a level 1 trauma center in Canada. Adult patients with isolated BTT who presented within 72 hours of injury were included. The primary outcome was a composite of in-hospital mortality, early pulmonary complications identified during the ED visit, intensive care unit admission from the ED, and prolonged hospital length of stay (≥7 days). The STUMBL score assigns points for age, number of rib fractures identified on imaging, history of chronic pulmonary disease, anticoagulant use, and oxygen saturation on arrival. Score categories were predefined as 0–10, 11–15, 16–20, 21–25, 26–29, and >30.
A total of 344 patients were included in the final analysis. The proportion of patients with adverse outcomes increased across categories: 5.1% (0–10), 17.2% (11–15), 41.9% (16–20), and 82.4% (≥21). The STUMBL score showed good discrimination (the area under the receiver operating characteristic curve was 0.87). A cutoff of ≤10 yielded a sensitivity of 90.5% and a negative predictive value of 97.0%. A score of ≥21 had a specificity of 97.9% and a positive predictive value of 82.4%, suggesting high risk of complications in this subgroup.
Editor’s Comments: Generalizability to urgent care settings may be limited. The retrospective design may constrain data accuracy and completeness. Of note, patients with more severe injuries are more likely to present to trauma hospitals, creating potential selection bias. Despite these limitations, this study provides useful external validation of the STUMBL score.
The tool may help urgent care clinicians evaluate BTT, particularly in rural or resource-limited settings where transfers may be more challenging. Incorporating the STUMBL score into clinical decision-making and into conversations with transport and receiving teams may support clearer risk communication and streamlined management for BTT.
POCUS to Risk Stratify Acute and Uncomplicated Renal Colic
Take Home Point: This study created a novel practical risk-stratification tool (ECOLIC) for suspected renal colic that combines point-of-care ultrasound (POCUS) and clinical findings to guide management decisions.
Citation: Griveau B, Papin M, Thibaud C, et al. Point-of-care ultrasound for risk stratification of urgent urological care in acute uncomplicated renal colic. CJEM. 2025;27:984-994. doi:10.1007/s43678-025-01008-y
Relevance: Renal colic is a common presentation to EDs and UCCs, and several current guidelines identify computed tomography (CT) as the imaging modality of choice. With the increasing availability of POCUS, this imaging modality may help identify which patients are more likely to need urgent urological care.
Study Summary: This prospective, multicenter study was conducted in 3 hospitals in France (1 general and 2 academic), where POCUS is routinely used in renal colic care. Patients with acute abdominal or flank pain were enrolled. Initial evaluation included physical examination, urine dipstick testing, and routine blood tests (including serum creatinine). All participants underwent POCUS performed by a trained ED physician. The primary outcome was urgent urological care within 30 days; defined as hospital admission for renal colic after the index ED visit, urological decompression within 24 hours of ED visit, or a repeat ED presentation within 30 days that led to a urological procedure within 24 hours. Follow-up was conducted by reviewing patients’ clinical records. If no follow-up was documented, the team called patients to determine whether they sought care elsewhere.
The authors analyzed 168 patients and identified 3 independent factors for an urgent urologic procedure: age over 65 years; moderate to severe hydronephrosis on POCUS; and persistent pain 4 hours after analgesic administration. From this, they developed the ECOLIC score (range 0-6). Patients with ECOLIC scores ≤1 had a 2% risk of hospitalization or urgent decompression within 30 days. Restricting CT to patients with an ECOLIC score ≥3 could avoid 82% of CT exams. This strategy carried a 5% (95% confidence interval [CI], 3%–10%) risk of 30-day events.
Editor’s Comments: Generalizability may be limited in settings where POCUS training and experience vary, because ultrasound findings are operator dependent. Additionally, CT was performed in only 31.9% of participants, which limited confirmation of urolithiasis in some patients. Even with these limitations, this study highlights how urgent care clinicians might use POCUS to support risk stratification and to develop local pathways for imaging and discharge planning for patients with renal colic.
Treatment of Scabies: Ivermectin vs 5% Permethrin
Take Home Point: In this trial, oral ivermectin did not meet planned noninferiority criteria compared with 5% permethrin cream for day-28 clinical cure of classic scabies; however, permethrin was the statistically superior treatment.
Citation: Boralevi F, Simon G, Bernigaud C, et al. Oral ivermectin versus 5% permethrin cream to treat children and adults with classic scabies: multicentre, assessor-blinded, cluster randomised clinical trial. BMJ. 2026;392:e086277. doi:10.1136/bmj-2025-086277
Relevance: Scabies is common, and outbreaks are a public health concern. Despite limited high-quality comparative data, clinicians often must choose between oral ivermectin and 5% permethrin as first-line options.
Study Summary: This multicenter, cluster-randomized trial began in 16 French pediatric dermatology departments and later expanded to 28 centers, including adult sites. Household clusters were randomly assigned 1:1 to oral ivermectin (200 µg/kg with food; crushed for children) or 5% permethrin cream, administered on day 0 and day 10. Permethrin was applied from head to toe in an amount sufficient to cover the entire skin surface—including hair, genitalia, and face—and left on overnight. The primary endpoint was clinical cure on day 28.
In total, 1,092 individuals from 294 households (clusters) across 23 active departments were screened and randomized: 507 participants from 142 households to ivermectin; and 568 participants from 147 households to 5% permethrin. Day-28 cure rates were 71.8% with ivermectin and 88.5% with permethrin (difference, −16.7 percentage points; 95% CI, −26.3 to −7.1). In this analysis, oral ivermectin did not demonstrate noninferiority to permethrin, however, permethrin was the statistically superior treatment. Post hoc subgroup analyses (including by age) were consistent with the primary finding.
Editor’s Comments: Generalizability may be limited for patients with florid eczema lesions or scabies-associated impetigo, who were excluded. Cultural preferences may also influence treatment selection (eg, reluctance to use topical preparations in favor of oral medication). In addition, the study did not account for nonfamilial contacts within clusters (eg, nonresidential partners). When selecting therapy, urgent care clinicians should consider anticipated adherence, ease of use, tolerability, potential resistance, and the patient’s underlying skin condition to choose the most appropriate option.
Analgesic Choices for Pediatric Musculoskeletal Injuries
Take Home Point: For moderate to severe musculoskeletal (MSK) injury-related pain in children, adding acetaminophen or hydromorphone to ibuprofen provided no additional analgesic benefit compared with ibuprofen alone.
Citation: Ali S, Klassen TP, Candelaria P, et al. Acetaminophen (paracetamol) or opioid analgesia added to ibuprofen for children’s musculoskeletal injury: two randomized clinical trials. JAMA. Published online January 8, 2026. doi:10.1001/jama.2025.25033
Relevance: Ibuprofen is commonly used as first-line therapy for pediatric MSK injuries. A subset of children require additional analgesia, and urgent care clinicians need evidence-based options for escalation.
Study Summary: Two randomized, double-blind, placebo-controlled trials were conducted at 6 Canadian tertiary pediatric EDs. The study used a preference-informed complementary design: caregivers and children first chose participation in either a 3-group opioid-inclusive trial or a 2-group nonopioid trial for pain management. Participants were then randomized within the selected trial (1:1 in the nonopioid trial; 1:1:1 in the opioid trial). In the nonopioid trial, participants received ibuprofen plus acetaminophen or ibuprofen alone. In the opioid trial, participants received ibuprofen plus hydromorphone, ibuprofen plus acetaminophen, or ibuprofen alone. All participants received the appropriate number of placebos to create equal pill burden and maintain blinding.
The primary outcome was self-reported pain score 60 minutes after medication administration. A total of 699 participants were randomized (450 in the nonopioid trial and 249 in the opioid trial). Mean (and standard deviation [SD]) pain scores at 60 minutes were 4.8 (2.6) for ibuprofen plus hydromorphone, 4.6 (2.4) for ibuprofen plus acetaminophen, and 4.6 (2.3) for ibuprofen only (p=0.78). Adverse events were most common with hydromorphone (28.2%), compared with acetaminophen (6.1%) and ibuprofen alone (5.8%).
Editor’s Comments: Limitations include potential selection bias from pooling patients during recruitment. The study also did not account for race and ethnicity or other equity-related factors such as gender, socioeconomic status, or preferred language. Despite these limitations, the results suggest that adding a second analgesic agent does not improve pain scores for children with MSK injuries and increases adverse events when an opioid is used. Urgent care clinicians should carefully weigh risks and benefits when considering opioid analgesia for pediatric MSK pain.