{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T01:17:15Z","timestamp":1766971035295,"version":"3.48.0"},"reference-count":23,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T00:00:00Z","timestamp":1766793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Aspiration pneumonia is among the most frequent medical complications after intracerebral hemorrhage (ICH), yet its role during the ultra-early emergency department (ED) phase remains poorly understood. This study aimed to identify clinical and neurological factors independently associated with radiologically confirmed aspiration pneumonia in patients presenting with acute spontaneous ICH and to evaluate its association with early clinical outcomes. Methods: A retrospective observational cohort study was conducted in the neuro-emergency department of a large tertiary university hospital. All consecutive adults with spontaneous ICH confirmed by neuroimaging between January 2020 and December 2023 were included. Univariable and multivariable logistic regression models were used to identify independent predictors of pneumonia. Results: A total of 184 patients were analyzed (median age 74 years; 46% female). Radiologically confirmed aspiration pneumonia occurred in 37 patients (22.0%). Pneumonia was significantly associated with lower GCS, higher National Institutes of Health Stroke Scale (NIHSS) and ICH scores, shorter ED stay, and more frequent endotracheal intubation (ETI). In multivariable analysis, ETI (OR 5.42, 95% CI 1.57\u201318.63, p = 0.007), higher NIHSS score (OR 1.09, 95% CI 1.01\u20131.20, p = 0.047), and shorter ED stay (OR 0.97, 95% CI 0.95\u20130.99, p = 0.035) were independently associated with pneumonia. Aspiration pneumonia was not independently associated with neurosurgical referral (p = 0.082) or low GCS at discharge (p = 0.650). Conclusions: In this neuro-emergency cohort, aspiration pneumonia was common and strongly associated with neurological severity, particularly with endotracheal intubation and higher NIHSS scores. Although it did not independently predict early neurological deterioration or neurosurgical transfer, it identifies a critical period in which preventive measures\u2014such as dysphagia screening, oral hygiene, and careful airway management\u2014should be systematically applied. Larger multicenter studies with longer follow-up are needed to better define its long-term clinical consequences after ICH.<\/jats:p>","DOI":"10.3390\/jcm15010226","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:50:42Z","timestamp":1766969442000},"page":"226","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of Ultra-Early Aspiration Pneumonia in Acute Intracerebral Hemorrhage Presenting to the Emergency Department"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5921-3180","authenticated-orcid":false,"given":"Giancarlo","family":"Ceccarelli","sequence":"first","affiliation":[{"name":"Department of Public Health and Infectious Diseases, University of Rome Sapienza, and Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3987-2303","authenticated-orcid":false,"given":"Luca","family":"Bortolani","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, University of Rome Sapienza, and Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9485-3877","authenticated-orcid":false,"given":"Francesco","family":"Branda","sequence":"additional","affiliation":[{"name":"Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico, 00100 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia","family":"Albanese","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, University of Rome Sapienza, and Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Civita","family":"Cedrone","sequence":"additional","affiliation":[{"name":"Emergency Medicine Unit, Department of Emergency-Acceptance, Critical Areas and Trauma, University of Rome Sapienza and Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1708-272X","authenticated-orcid":false,"given":"Francesco","family":"Baratta","sequence":"additional","affiliation":[{"name":"Geriatric Unit, Department of Internal Medicine and Medical Specialties, Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Renna","sequence":"additional","affiliation":[{"name":"Emergency Medicine Unit, Department of Emergency-Acceptance, Critical Areas and Trauma, University of Rome Sapienza and Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2191-6862","authenticated-orcid":false,"given":"Giovanni","family":"Giordano","sequence":"additional","affiliation":[{"name":"Department of General and Specialistic Surgery, University of Rome Sapienza, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5133-6650","authenticated-orcid":false,"given":"Anne","family":"Falcou","sequence":"additional","affiliation":[{"name":"Department of Medical and Cardiovascular Sciences, University of Rome Sapienza, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2534-4224","authenticated-orcid":false,"given":"Antonio","family":"Sili Scavalli","sequence":"additional","affiliation":[{"name":"Stroke Unit, Emergency Department, Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4463-4956","authenticated-orcid":false,"given":"Luigi","family":"Petramala","sequence":"additional","affiliation":[{"name":"Emergency Medicine Unit, Department of Emergency-Acceptance, Critical Areas and Trauma, University of Rome Sapienza and Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy"},{"name":"Department of Translational and Precision Medicine, University of Rome Sapienza, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3571-5677","authenticated-orcid":false,"given":"Gabriella","family":"d\u2019Ettorre","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Diseases, University of Rome Sapienza, and Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gioacchino","family":"Galardo","sequence":"additional","affiliation":[{"name":"Emergency Medicine Unit, Department of Emergency-Acceptance, Critical Areas and Trauma, University of Rome Sapienza and Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy"},{"name":"Department of Translational and Precision Medicine, University of Rome Sapienza, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s44158-025-00244-z","article-title":"Golden hour management in the patient with intraparenchymal cerebral hemorrhage: An Italian intersociety document","volume":"5","author":"Morello","year":"2025","journal-title":"J. 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