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Publications (142)
Psoriasis is associated with cardiometabolic comorbidities, including obesity, diabetes, hyperlipidemia, and hypertension. Many studies that established these associations originated from primarily White and/or relatively affluent populations. To evaluate whether there is differential risk for cardiometabolic comorbidities in racial/ethnic minoriti...
An accuracy study of a test that produces a wide range of results will often present a receiver operating characteristic (ROC) curve and report the area under the ROC curve (AUROC). The AUROC is a summary measure of how well the test discriminates between those with the condition or disease in question and those without it. A test that perfectly se...
Objectives:
To determine whether implementation of an Emergency Critical Care Program (ECCP) is associated with improved survival and early downgrade of critically ill medical patients in the emergency department (ED).
Design:
Single-center, retrospective cohort study using ED-visit data between 2015 and 2019.
Setting:
Tertiary academic medica...
Unlabelled:
The use of muscle flaps, such as the sartorius muscle, for groin coverage in high-risk vascular patients has been shown to reduce complication rates. However, it remains unknown whether earlier postoperative ambulation is associated with improved postoperative outcomes for groin muscle flaps following infrainguinal vascular surgery.
M...
Introduction:
Cluster surveillance, identification, and containment are primary outbreak management techniques, however, adapting these for low- and middle-income countries is an ongoing challenge. We aimed to evaluate the utility of prehospital call-center ambulance dispatch (CCAD) data for surveillance by examining the correlation between influe...
Background
The gold standard for COVID-19 diagnosis–reverse-transcriptase polymerase chain reaction (RT-PCR)– is expensive and often slow to yield results whereas lateral flow tests can lack sensitivity.
Methods
We tested a rapid, lateral flow antigen (LFA) assay with artificial intelligence read (LFAIR) in subjects from COVID-19 treatment trials...
Objectives:
Ileocolic intussusception can be challenging to diagnose due to vague complaints, but rapid diagnosis and treatment can help prevent morbidity and mortality. Prior research has focused on radiologic ultrasound, with more recent studies focusing on point-of-care ultrasonography (POCUS). This systematic review and meta-analysis assesses...
Background
Advanced Trauma Life Support field triage utilizes the Glasgow Coma Scale (GCS) to assess the level of consciousness. However, prehospital care providers in low- and middle-income countries (LMICs) often use the Alert, Verbal, Pain, and Unresponsive (AVPU) scale to assess the level of consciousness. This study aimed to determine whether...
Objectives:
Estimating mortality risk in hospitalised SARS-CoV-2+ patients may help with choosing level of care and discussions with patients. The Coronavirus Clinical Characterisation Consortium Mortality Score (4C Score) is a promising COVID-19 mortality risk model. We examined the association of risk factors with 30-day mortality in hospitalise...
This retrospective study examines the association of lice infestation with iron-deficiency anemia and risk factors such as homelessness and physical disability.
Opioid-induced respiratory depression (OIRD) confers significant morbidity, but its onset can be challenging to recognize. Pain or stimulation effects of conversation may mask or attenuate common clinical manifestations of OIRD. We asked whether pupillary unrest could provide an objective signal of opioid exposure, and whether this signal would be...
Background:
A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data.
Methods:
We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who...
PURPOSE
Evaluate the effectiveness of compression while receiving chemotherapy compared with chemotherapy alone in the treatment of HIV-associated Kaposi sarcoma (KS) lymphedema.
METHODS
A randomized controlled trial was conducted in a single oncology clinic in western Kenya ( NCT03404297 ). A computer-generated randomization schedule was used to...
Background:
Partial verification bias occurs in studies assessing the accuracy of existing diagnostic tests when a positive index test makes application of the reference standard more likely.
Methods:
This article first describes alternative sampling frames for a diagnostic test accuracy study then discusses partial verification bias.
Results:...
Background
Emergency department (ED) workers have an increased seroprevalence of SARS-CoV-2 antibodies. However, breakthrough infections in ED workers have led to a reduced workforce within a strained healthcare system. By measuring levels of IgG antibodies to the SARS-CoV-2 nucleocapsid and spike antigens in ED workers, we determined the incidence...
Objectives:
Studies have found that prolonged boarding time for intensive care unit (ICU) patients in the emergency department (ED) is associated with higher in-hospital mortality. However, these studies introduced selection bias by excluding patients with ICU admission orders who were downgraded and never arrived in the ICU. Consequently, they ma...
Purpose
The purpose of this study was to determine perspectives of surgeons regarding simultaneous surgery in patients undergoing posterior spine instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS).
Methods
A survey was administered to orthopaedic trainees and faculty regarding simultaneous surgery for primary PSIF for AIS....
Background
The Mortality Probability Model (MPM) is used in research and quality improvement to adjust for severity of illness and can also inform triage decisions. However, a limitation for its automated use or application is that it includes the variable “intracranial mass effect” (IME), which requires human engagement with the electronic health...
Background:
Historically, the ulnar artery has rarely been considered for arterial cannulation as it is less easily palpated than the radial artery. With the current routine use of ultrasound in pediatric patients the ulnar is as accessible as the radial and could be viewed as an equivalent site for cannulation.
Aims:
The purpose of this study w...
Introduction: Point-of-care (POC) echocardiography (echo) is a useful adjunct in the management of cardiac arrest. However, the practice pattern of POC echo utilization during management of cardiac arrest cases among emergency physicians (EP) is unclear. In this pilot study we aimed to characterize the utilization of POC echo and the potential barr...
Many clinical diagnostic tests, such as the joint fluid white blood cell count, produce results on a continuous scale, rather than a mere positive or negative. The accuracy of such tests is often reported as a positive and negative likelihood ratio at each of several potential cutoff points (e.g., ≥25,000/μL vs. not, ≥50,000/μL vs. not; ≥100,000/μL...
Importance
Despite widespread recognition and known harms, serious surgical errors, known as surgical never events, endure. The California Department of Public Health (CDPH) has developed an oversight system to capture never events and a platform for process improvement that has not yet been critically appraised.
Objectives
To examine surgical nev...
Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel o...
Introduction
To evaluate whether outpatient insulin treatment, hemoglobin A1c (HbA1c), glucose on admission, or glycemic control during hospitalization is associated with SARS-CoV-2 (COVID-19) illness severity or mortality in hospitalized patients with diabetes mellitus (DM) in a geographical region with low COVID-19 prevalence.
Research design an...
Objective: Firefighter first responders and other emergency medical services (EMS) personnel have been among the highest risk healthcare workers for illness during the SARS-CoV-2 pandemic. We sought to determine the rate of seropositivity for SARS-CoV-2 IgG antibodies and of acute asymptomatic infection among firefighter first responders in a singl...
Background:
Pupillometers have been proposed as clinical assessment tools. We compared two pupillometers to assess measurement agreement.
Materials & methods:
We enrolled 30 subjects and simultaneously measured the pupil diameter and light reflex amplitude with an iPhone pupillometer and a portable infrared pupillometer. We then enrolled 40 addi...
Background
Boarding of ICU patients in the ED is increasing. Illness severity scores may help emergency physicians stratify risk to guide earlier transfer to the ICU and assess pre-ICU interventions by adjusting for baseline mortality risk. Most existing illness severity scores are based on data that is not available at the time of the hospital adm...
Study hypothesis
We hypothesized that establishing a program of specialized emergency critical care (ECC) nurses in the ED would improve mortality of ICU patients boarding in the ED.
Methods
This was a retrospective before-after cohort study using electronic health record data at an academic medical center. We compared in-hospital mortality betwee...
Aim
To determine the concurrent validity of the Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA‐FS), a criterion‐specified questionnaire that assesses a child's adaptive skills in everyday contexts, and the Bayley Infant and Toddler Scales of Development, Third Edition (Bayley‐III).
Method
In a prospective cohort s...
Background
Recent evidence demonstrates that closed chest compressions directly over the left ventricle (LV) in a traumatic cardiac arrest (TCA) model improve hemodynamics and return of spontaneous circulation (ROSC) when compared with traditional compressions. Resuscitative endovascular balloon occlusion of the aorta (REBOA) also improves hemodyna...
Background: An independent measure of lower motor neuron function that can be monitored over time is essential to evaluating the effect of drugs or stem cell transplantation and to determining prognosis in amyotrophic lateral sclerosis (ALS). Longitudinal changes in forced vital capacity-percent of predicted (FVC%) and motor unit number estimate (M...
Background: Generalized convulsive status epilepticus (GCSE) is a neurologic emergency demanding prehospital identification and treatment. Evaluating real-world practice requires accurately identifying the target population; however, it is unclear whether emergency medical services (EMS) documentation accurately identifies patients with GCSE.
Objec...
Introduction:
Ileocolic intussusception is a common cause of pediatric bowel obstruction in young children but can be difficult to diagnose clinically due to vague abdominal complaints. If left untreated, it may cause significant morbidity. Point-of-care ultrasound (POCUS) is a rapid, bedside method of assessment that may potentially aid in the di...
Cambridge Core - Statistics for Life Sciences, Medicine and Health - Evidence-Based Diagnosis - by Thomas B. Newman
Objectives:
Cardiac arrest is a significant complication of emergent endotracheal intubation (ETI) within the pediatric population. No studies have evaluated risk factors for peri-intubation cardiac arrest (PICA) in a pediatric emergency department (ED) setting. This study identified risk factors for PICA among patients undergoing emergent ETI in...
Objectives
Emergency medicine in low‐ and middle‐income countries (LMICs) is hindered by lack of research into patient outcomes. Chief complaints are fundamental to emergency care but have only recently been uniquely codified for an LMIC setting in Uganda. It is not known whether chief complaints independently predict emergency unit patient outcome...
Introduction:
With the increasing influence of electronic health records in emergency medicine came concerns of decreasing operational efficiencies. Particularly worrisome was increasing patient length of stay (LOS). Medical scribes were identified to be in a good position to quickly address barriers to treatment delivery and patient flow. The obj...
To evaluate the effectiveness of predictive low glucose suspend (PLGS) systems within sensor-augmented insulin infusion pumps at preventing nocturnal hypoglycemia in patients with type 1 diabetes (DM1), we performed a systematic review and meta-analysis of randomized crossover trials. Pubmed and Google Scholar were searched for randomized crossover...
Background
Inpatient hallway beds are one solution to mitigate emergency department (ED) crowding due to boarding of admitted patients. Alternative Care Areas (AltCA) beds are located in inpatient hallways, cardiac catheterization lab, and endoscopy. We examined whether AltCA beds were associated with increased risk of patient safety and quality ou...
Background and Aims
Spontaneous subarachnoid hemorrhage (SAH) from a brain aneurysm, if untreated in the acute phase, leads to loss of functional independence in about 30% of patients and death in 27–44%. To evaluate for SAH, the American College of Emergency Physicians (ACEP) Clinical Policy recommends obtaining a non-contrast brain computed tomog...
Introduction: To rule out sub-arachnoid hemorrhage (SAH) national guidelines for emergency physicians recommends obtaining a non-contrast CT scan and, if negative, a lumbar puncture. However, anecdotal evidence suggests recent adoption of CT non-contrast alone in patients presenting within six hours from symptom onset and an increase in the use of...
Background
Electronic health record (EHR) data is increasingly used to identify patients with chronic kidney disease (CKD). EHR queries used to capture CKD status, identify comorbid conditions, measure awareness by providers, and track adherence to guideline-concordant processes of care have not been validated.
Methods
We extracted EHR data for pr...
Background
HIV-associated Kaposi sarcoma (KS), among the most frequent cancers seen in sub-Saharan Africa, is associated with a high prevalence of lymphedema. Lymphedema causes progressive functional impairment marked by swelling, physical discomfort, disfiguring changes, skin hardening from fibrosis, poor wound healing, and recurrent skin infectio...
The HEART Score is yet another clinical prediction tool to identify emergency department (ED) chest pain patients who are at low risk for a short‐term major cardiac event (MACE).(1) The acronym is clever; HEART: History (H), electrocardiogram (ECG, E), Age (A), Risk Factors (R), and Troponin (T). Each of the five variables is assigned 2 points for...
BACKGROUND:
Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combin...
Objectives:
1. Describe the epidemiology of vestibular migraine (VM) in the United States, using data from the 2008 National Health Interview Survey (NHIS). 2. Characterize the sociodemographic and clinical attributes of people with VM.
Study design:
Population-based nationwide survey study of US adults.
Patients:
Adult respondents to the 2008...
Objective:
Cleared blood glucose monitor systems (BGMs) for personal use may not always deliver levels of accuracy currently specified by international and U.S. regulatory bodies. This study's objective was to assess the accuracy of 18 such systems cleared by the U.S. Food and Drug Administration representing approximately 90% of commercially avai...
Introduction
Exposure to nature may reduce stress in low-income parents. This prospective randomized trial compares the effect of a physician’s counseling about nature with or without facilitated group outings on stress and other outcomes among low-income parents.
Materials and methods
Parents of patients aged 4–18 years at a clinic serving low-in...
Objectives:
The healthcare burden of autoimmune hepatitis (AIH) in the United States has not been characterized. We previously showed that AIH disproportionately affects people of color in a single hospital system. The current study aimed to determine whether the same disparity occurs nationwide.
Methods:
We analyzed hospitalizations with a primar...
Objective:
To estimate D-Dimer interval likelihood ratios (iLRs) for diagnosing pulmonary embolism (PE).
Methods:
The authors used pooled patient-level data from five PE diagnostic management studies to estimate iLRs for the eight D-Dimer intervals with boundaries 250, 500, 750, 1000, 1500, 2500, and 5000 ng/mL. Logistic regression was used to f...
Background:
Inpatient hyperglycemia is common and is linked to adverse patient outcomes. New methods to improve glycemic control are needed.
Objective:
To determine whether a virtual glucose management service (vGMS) is associated with improved inpatient glycemic control.
Design:
Cross-sectional analyses of three 12-month periods (pre-vGMS, tr...
Stay Healthy In Nature Everyday (SHINE): a stress reduction intervention for low-income families.
Introduction: Social inequities and associated toxic stress result in health inequities for families living in poverty. The Stay Healthy In Nature Everyday (SHINE) program is a park prescription program designed by a pediatric clinic and their local park district, and draws on growing research that being in nature decreases stress and improves heal...
Objective:
To assess the prognostic accuracy of early cumulative supplemental oxygen (CSO) exposure for prediction of bronchopulmonary dysplasia (BPD) or death, and to evaluate the independent association of CSO with BPD or death.
Study design:
We performed a secondary analysis of the Trial of Late Surfactant, which enrolled 511 infants born at...
Shortness of breath is a common presenting complaint in the emergency department (ED) with a wide differential diagnosis that includes acute heart failure (AHF), exacerbation of chronic obstructive pulmonary disease (COPD), pneumonia, and pulmonary embolism. The findings for these etiologies of dyspnea overlap, particularly in aging adults with sig...
To determine a current infection rate of dog bite wounds and predictors of wounds at risk for infection that may benefit from prophylactic antibiotics.
A prospective multicentre observational study was conducted over 4.5 years. At the time of treatment Emergency Physicians completed a structured data form evaluating patient, wound and treatment cha...
The real meaning of the word “diagnosis” is naming the disease that is causing a patient’s illness. The cognitive process of assigning this name is a mysterious combination of pattern recognition and the hypothetico-deductive approach that is only remotely related to the mathematical process of using test results to update the probability of a dise...
Ordering and interpreting diagnostic tests is a critical part of emergency medicine (EM). In evaluating a study of diagnostic test accuracy, emergency physicians (EPs) need to recognize whether the study uses case-control or cross-sectional sampling and account for common biases. The authors group biases in studies of test accuracy into five catego...
Background:
Computed tomography (CT)-based indices may be superior to plain radiographs in determining the adequacy of reduction following operative fixation of the syndesmosis in unstable ankle fractures. This study assessed the reliability and accuracy of four CT-based methods for measurement of rotational malreduction of the fibula.
Methods:...
Objective:
To determine risk factors associated with infection and traumatic lacerations and to see if a relationship exists between infection and time to wound closure after injury.
Methods:
Consecutive patients presenting with traumatic lacerations at three diverse emergency departments were prospectively enrolled and 27 variables were collect...
Background:
Impaired growth and delayed puberty are common in pediatric Crohn's disease (CD). Bone age (BA) is important for interpretation of statural growth. Our aims were to 1) determine the distribution of BA-Z scores; 2) identify clinical factors associated with BA-Z scores; and 3) compare anthropometric Z scores based on chronological age (C...
The timing of menarche in Crohn's disease (CD) is poorly described. Our objectives were to study age at menarche onset in CD, and factors associated with this.
We compared the age at menarche of 34 CD patients with that for 545 controls, using data in the National Health and Nutrition Examination Survey (NHANES).
Mean chronological age (CA) of CD p...
To the Editor: The results of the National Lung Screening Trial (NLST) (Aug. 4 issue)(1) showed a relative reduction in lung-cancer mortality of 20% in former and current heavy smokers who underwent screening with low-dose computed tomography (CT), as compared with radiographic screening. The other main causes of morbidity and mortality in heavy sm...
Growth impairment in Crohn's disease (CD) is more common in males than females for unknown reasons. Since insulin-like growth factor-1 (IGF-1) is important for statural growth, we hypothesized that IGF-1 levels are lower in males with CD.
Sex differences in hormone Z-scores based on chronological age (CA-Z) and bone age (BA-Z) were examined in a cr...
