Adam J Singer

Adam J Singer
Stony Brook University | Stony Brook · Department of Emergency Medicine

MD

About

788
Publications
221,296
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
50,368
Citations

Publications

Publications (788)
Preprint
Objectives: To use deep learning of serial Portable chest x-ray (pCXR) and clinical variables to predict mortality and duration on invasive mechanical ventilation (IMV) for Coronavirus disease 2019 (COVID-19) patients. Methods: This is a retrospective study. Serial pCXR and serial clinical variables were analyzed for data from day 1, day 5, day 1-3...
Article
Surgical excision and grafting of deep partial (DPT) and full thickness (FT) burns is a cornerstone of wound care. Use of commercially available topical enzymatic agents has been limited due to slower and less complete eschar removal than surgical excision. Using a porcine model of DPT and FT burns, we compared the eschar removal efficacy of a brom...
Article
Full-text available
Thermal injuries can occur due to direct exposure to hot objects or liquids, flames, electricity, solar energy and several other sources. If the resulting injury is a deep partial thickness burn, the accuracy of a physician's clinical assessment is as low as 50-76% in determining the healing outcome. In this study, we show that the Terahertz Portab...
Article
Full-text available
Background: Prior data has demonstrated increased mortality in hospitalized patients with acute heart failure (AHF) and troponin elevation. No data has specifically examined the prognostic significance of troponin elevation in patients with AHF discharged after emergency department (ED) management. Objective: Evaluate the relationship between tr...
Article
Full-text available
We present an automatic classification strategy for early and accurate assessment of burn injuries using terahertz (THz) time-domain spectroscopic imaging. Burn injuries of different severity grades, representing superficial partial-thickness (SPT), deep partial-thickness (DPT), and full-thickness (FT) wounds, were created by a standardized porcine...
Article
Introduction Surgical excision and grafting of deep partial thickness (DPT) and full thickness (FT) burns is a cornerstone of modern burn wound care. Use of commercially available topical enzymatic agents has been limited due to slower and less complete eschar removal than surgical excision. Using a porcine model of DPT and FT burns, we compared th...
Article
Introduction Bromelain based debridement (BBD) of deep burns with a concentrate of proteolytic enzymes enriched in Bromelain is approved for use in adults in several regions worldwide. Children are a large part of the patient population in many burn centers around the world. Clinical trial experience and off label reports point to BBD safety and ef...
Article
Full-text available
The accuracy of clinical assessment techniques in diagnosing partial-thickness burn injuries has remained as low as 50–76%. Depending on the burn depth and environmental factors in the wound, such as reactive oxygen species, inflammation, and autophagy, partial-thickness burns can heal spontaneously or require surgical intervention. Herein, it is d...
Article
Background Safe and effective tranquilization of the agitated patient is challenging, and head-to-head comparisons of medications are limited. We aimed to identify the most optimal agent(s) for rapid tranquilization of the agitated patient in the emergency department (ED). Background: Safe and effective tranquilization of the acutely agitated patie...
Article
Full-text available
Deep burns are characterized by the presence of a necrotic eschar that delays healing and results in a local and systemic inflammatory response and following healing by secondary intention: heavy scarring. Early surgical debridement followed by grafting was a major advance in deep burn care and is now the standard of care, reducing mortality and hy...
Article
Full-text available
Despite an estimated 2.8 million annual ED visits, traumatic brain injury (TBI) is a syndromic diagnosis largely based on report of loss of consciousness, post-traumatic amnesia, and/or confusion, without readily available objective diagnostic tests at the time of presentation, nor an ability to identify a patient's prognosis at the time of injury....
Article
Background Occlusion myocardial infarctions (OMIs) of the posterolateral walls are commonly missed by ST‐segment–elevation myocardial infarction (STEMI) criteria, with >50% of patients with circumflex occlusion not receiving emergent reperfusion and experiencing increased mortality. ST‐segment depression maximal in leads V1–V4 (STDmaxV1–4) has been...
Article
Objectives Emergency department (ED) visits for Asthma and Chronic Obstructive Pulmonary Disease (COPD) are common. The designation of Asthma-COPD overlap (ACO) has been used to describe patients with features of both diseases. Studies show that ACO patients may be at increased risk of poor outcomes relative to patients with either disease alone. W...
Article
Introduction Computed tomography (CT) is often ordered for patients in whom the diagnosis of acute pancreatitis (AP) has already been established via elevated lipase levels and typical abdominal pain. We investigated whether early CT imaging performed in the ED altered the diagnosis or management. Methods A retrospective chart review was performed...
Article
Background We conducted a secondary analysis of changes in the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 over 30 days in a randomized trial of self-care coaching versus structured usual care in patients with acute heart failure who were discharged from the emergency department. Methods Patients in 15 emergency departments completed the KC...
Article
Aims We describe the development of a novel porcine eschar model and compare the debridement efficacy of various concentrations of a novel bromelain-based enzymatic agent with collagenase. Methods Full thickness excisional wounds were created on pigs and injected intradermally with various doses of doxorubicin. Wounds were monitored for a period o...
Article
Background Many patients with Coronavirus disease-2019 (Covid-19) present with radiological evidence of pneumonia. Because it is difficult to determine co-existence of bacterial pneumonia, many of these patients are initially treated with antibiotics. We compared the rates of bacterial infections and mortality in Covid-19 patients with pulmonary in...
Article
Full-text available
Background: Respiratory failure due to coronavirus disease of 2019 (COVID-19) often presents with worsening gas exchange over a period of days. Once patients require mechanical ventilation (MV), the temporal change in gas exchange and its relation to clinical outcome is poorly described. We investigated whether gas exchange over the first 5 days of...
Article
Full-text available
Objectives Basal Cell Carcinoma (BCC) is the most common skin cancer generally treated by a variety of surgical and non-surgical destructive therapies. A Concentrate of Proteolytic Enzymes Enriched in Bromelain (CPEEB) derived from the stems of pineapples is approved for use for debriding deep burns. Prior studies suggest that bromelain also has an...
Article
Study objective Ventricular paced rhythm is thought to obscure the electrocardiographic diagnosis of acute coronary occlusion myocardial infarction. Our primary aim was to compare the sensitivity of the modified Sgarbossa criteria (MSC) to that of the original Sgarbossa criteria for the diagnosis of occlusion myocardial infarction in patients with...
Article
Full-text available
Objectives: To characterize the temporal characteristics of clinical variables with time lock to mortality and build a predictive model of mortality associated with COVID-19 using clinical variables. Design: Retrospective cohort study of the temporal characteristics of clinical variables with time lock to mortality. Setting: Stony Brook University...
Article
Full-text available
Objective In the STEMI paradigm of Acute Myocardial Infarction (AMI), many NSTEMI patients have unrecognized acute coronary occlusion MI (OMI), may not receive emergent reperfusion, and have higher mortality than NSTEMI patients without occlusion. We have proposed a new OMI vs. Non-Occlusion MI (NOMI) paradigm shift. We sought to compare the diagno...
Preprint
Early prediction of patients at risk of clinical deterioration can help physicians intervene and alter their clinical course towards better outcomes. In addition to the accuracy requirement, early warning systems must make the predictions early enough to give physicians enough time to intervene. Interpretability is also one of the challenges when b...
Article
Full-text available
Objective: Examine the possible beneficial effects of early, D-dimer driven anticoagulation in preventing thrombotic complications and improving the overall outcomes of COVID-19 intubated patients. Methods: To address COVID-19 hypercoagulability, we developed a clinical protocol to escalate anticoagulation based on serum D-dimer levels. We retrospe...
Article
Background D‐dimer is generally considered positive above 0.5 mg/L irrespective of sex. However, women have been shown to be more likely to have a positive D‐dimer after controlling for other factors. Thus, differences may exist between males and females for using D‐dimer as a marker of venous thromboembolic (VTE) disease. We hypothesized the accur...
Article
Background The actual Emergency Department (ED) dispositions of patients enrolled in observational studies and meeting criteria for rapid acute myocardial infarction (AMI) rule-out are unknown. Additionally, their presenting clinical profiles, cardiac testing/treatments received, and outcomes have not been reported. Methods Patients in the HIGH-US...
Preprint
Full-text available
The accuracy of clinical assessment in partial-thickness burn injuries has remained as low as 50-75%. Depending on the depth and environmental factors in the wound, such as reactive oxygen species, inflammation, and autophagy, partial-thickness burns can heal spontaneously or require surgical intervention. In this study, we demonstrate that Teraher...
Article
Full-text available
Objectives Healthcare workers face distinct occupational challenges that affect their personal health, especially during a pandemic. In this study we compare the characteristics and outcomes of Covid-19 patients who are and who are not healthcare workers (HCW).Methods We retrospectively analyzed a cohort of 2,842 adult patients with known HCW statu...
Article
Background The current ST-elevation myocardial infarction (STEMI) vs. non-STEMI (NSTEMI) paradigm prevents some NSTEMI patients with acute coronary occlusion from receiving emergent reperfusion, in spite of their known increased mortality compared with NSTEMI without occlusion. We have proposed a new paradigm known as occlusion MI vs. nonocclusion...
Article
Full-text available
Importance Up to 20% of patients who present to the emergency department (ED) with acute heart failure (AHF) are discharged without hospitalization. Compared with rates in hospitalized patients, readmission and mortality are worse for ED patients. Objective To assess the impact of a self-care intervention on 90-day outcomes in patients with AHF wh...
Article
Introduction: In the current STEMI paradigm of Acute Myocardial Infarction (AMI), many NonSTEMI patients have unrecognized acute coronary occlusion. Such patients do not receive emergent reperfusion and are known to have higher mortality than NSTEMI patients without occlusion. Thus, we have proposed a new Occlusion MI vs. Non-Occlusion MI (OMI vs....
Article
Full-text available
Background This study aimed to develop a deep-learning model and a risk-score system using clinical variables to predict intensive care unit (ICU) admission and in-hospital mortality in COVID-19 patients. Methods This retrospective study consisted of 5,766 persons-under-investigation for COVID-19 between 7 February 2020 and 4 May 2020. Demographic...
Article
Background: Despite reported higher rates and worse outcomes due to COVID-19 in certain racial and ethnic groups, much remains unknown. We explored the association between Hispanic ethnicity and outcomes in COVID-19 patients in Long Island, New York. Methods: We conducted a retrospective cohort study of 2,039 Hispanic and non-Hispanic Caucasian...
Preprint
Full-text available
Objectives Healthcare workers face distinct occupational challenges that affect their personal health, especially during a pandemic. In this study we compare the characteristics and outcomes of Covid-19 patients who are and who are not healthcare workers (HCW). Methods We retrospectively analyzed a cohort of adult patients with known HCW status and...
Article
Full-text available
This study aimed to develop risk scores based on clinical characteristics at presentation to predict intensive care unit (ICU) admission and mortality in COVID-19 patients. 641 hospitalized patients with laboratory-confirmed COVID-19 were selected from 4997 persons under investigation. We performed a retrospective review of medical records of demog...
Article
Full-text available
Background This study investigated continued and discontinued use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) during hospitalization of 614 hypertensive laboratory-confirmed COVID-19 patients. Methods Demographics, comorbidities, vital signs, laboratory data, and ACEi/ARB usage were analyzed. To acc...
Article
Full-text available
Objective: There is a growing consensus to reduce unnecessary testing among low-risk chest pain patients. The objective of this study was to evaluate the impact of implementing an education-based HEART score pathway in the emergency department (ED) on coronary computed tomography angiography (CCTA) utilization and yield. Methods: A retrospective...
Article
Background Over the last decade the usage of computed tomography (CT) imaging has risen dramatically in emergency department (ED) patients with abdominal pain. Recognizing the potential disadvantages of overuse of CT imaging, efforts are being made to reduce imaging. Objective We determined the operating characteristics for location of abdominal p...
Article
Objective High-sensitivity cardiac troponin assays (hs-cTn) aid in diagnosis of myocardial infarction (MI). These assays have lower specificity for non-ST Elevation MI (NSTEMI) in patients with renal disease. Our objective was to determine an optimized cutoff for patients with renal disease. Methods We conducted an a priori secondary analysis of a...
Article
Whether the depth and healing of scalds and contact burns are similar is controversial. Due to water's greater heat capacity, we hypothesized that when exposed to similar temperatures and durations of exposure, burns caused by hot water would be deeper than those cause by contact with hot metal. 40 standardized burns were created in two anesthetize...
Conference Paper
Full-text available
Background and Objectives: Early exclusion of acute coronary syndromes (ACS) in ED patients with low risk chest pain has been one of the most important goals in the ED. Studies have shown that a number of clinical scores and core lab high-sensitivity cardiac troponins (Hs-cTn) can identify a large proportion of low risk patients safe for early disc...
Conference Paper
Full-text available
Background and Objectives: Diagnosis and risk stratification of patients with suspected acute heart failure (AHF) is problematic; most patients directly admitted to the hospital. We determined whether inability to ambulate and lay flat predicted AHF and admission. Methods: We conducted a prospective, multicenter study of adult ED patients with sus...
Article
Study objective Most COVID-19 reports have focused on SARS-CoV-2 positive patients. However, at the time of initial presentation, most patients’ viral status is unknown. Determination of factors that predict initial and subsequent need for intensive care (ICU) and invasive mechanical ventilation (IMV) are critical for resource planning and allocati...
Article
Full-text available
Aims: Concentrations of insulin-like growth factor binding protein-7 (IGFBP7) have been linked to abnormal cardiac structure and function in patients with chronic heart failure (HF), but cardiovascular correlates of the biomarker in patients with more acute presentations are lacking. We aimed to determine the relationship between IGFBP7 concentrat...
Article
Background Burn injury progression in the secondary zone of ischemia is common leading to delayed healing and increased scarring. We hypothesized that a topical surfactant, would reduce burn injury progression in a validated rat comb burn model compared with topical antibiotic ointment. Methods We created 40 comb burns on 20 rats which were random...
Article
Full-text available
Importance Boarding in the emergency department (ED) is a critical indicator of quality of care for hospitals. It is defined as the time between the admission decision and departure from the ED. As a result of boarding, patients stay in the ED until inpatient beds are available; moreover, boarding is associated with various adverse events. Study o...
Article
Full-text available
Objective: To our knowledge, this is the first comprehensive study using a nationally representative database to estimate the frequency of critical procedures (endotracheal tube intubation [ETI], cardiopulmonary resuscitation [CPR], and central line insertion [CLI]) in children and adults. Methods: The study was based on the secondary analysis o...
Article
Full-text available
Background The accuracy and speed by which acute myocardial infarction (AMI) is excluded are an important determinant of emergency department (ED) length of stay and resource utilization. While high‐sensitivity troponin I (hsTnI) >99th percentile (upper reference level [URL]) represents a “rule‐in” cutpoint, our purpose was to evaluate the ability...
Article
Introduction Prior studies comparing scalds and contact burns rarely address the affect of burn etiology on burn depth. However, it is commonly believed that scalds tend to heal faster than similarly sized contact and flame burns. As a result, expectant therapy is often preferred after scald injuries. We compared the percentages of full-thickness b...
Article
Introduction Clinical evaluation of burns results in about 50–70% accuracy in predicting the final burn progression and healing outcome in partial thickness burns. Early and accurate assessment of burn wounds is critical for determining the course of clinical management. Terahertz (THz) spectral imaging is a promising biomedical imaging modality th...
Article
Introduction Whether the depth and healing of scalds and contact burns are similar is controversial. Prior studies have not compared scalds and contact burns using identical temperatures and durations of exposure limiting direct comparison. We hypothesized that when exposed to similar temepratures and durations of exposure, burns caused by hot wate...
Article
Hyperkalemia is a common electrolyte disorder observed in the emergency department. It is often associated with underlying predisposing conditions, such as moderate or severe kidney disease, heart failure, diabetes mellitus, or significant tissue trauma. Additionally, medications, such as inhibitors of the renin-angiotensin-aldosterone system, pota...
Article
Study objective: We determine the accuracy of high-sensitivity cardiac troponin I (hs-cTnI), European-derived, rapid, acute myocardial infarction, rule-out/rule-in algorithms applied to a US emergency department (ED) population. Methods: Adults presenting to the ED with suspected acute myocardial infarction were included. Plasma samples collecte...
Article
Study objective Shoulder dislocations are a common injury leading to emergency department presentations. Point-of-care ultrasonography has the potential to reduce radiation and time to diagnosis. We determine the accuracy of a novel point-of-care ultrasonographic technique to diagnose dislocated shoulders. We also investigate its accuracy to detect...
Article
Background: Hyperkalemia (HK) is common and associated with mortality. Our purpose was to determine if the rapid correction of elevated serum potassium level (K+) was associated with reduced mortality in emergency department (ED) patients. Methods: Design: We reviewed the electronic medical records (EMR) of ED patients with HK (K+ ≥ 5.5 mEq/L) f...
Article
Several scoring systems, such as the Baux score, help predict outcomes in burn patients. The quick Sequential Organ Failure Assessment (qSOFA) score (composed of a respiratory rate of 22/min or greater, systolic blood pressure of 100 mmHg or less, and altered mental status) is a new bedside index proposed to help identify patients with suspected in...
Conference Paper
Abstract Aims: Concentrations of insulin-like growth factor-binding protein-7 (IGFBP7) have been linked to abnormal cardiac structure and function in patients with chronic heart failure (HF) but cardiovascular correlates of the biomarker in patients with more acute presentations are lacking. Methods and Results: In this pre-specified subgroup anal...