Emergency Medicine Commons^™

Socio-Demographic And Trauma-Related Predictors Of Depression Within Eight Weeks Of Motor Vehicle Collision In The Aurora Study, Jutta Joormann, Samuel A Mclean, Francesca L Beaudoin, Xinming An, Jennifer S Stevens, Donglin Zeng, Thomas C Neylan, Gari Clifford, Sarah D Linnstaedt, Laura T Germine, Scott L Rauch, Paul I Musey, Phyllis L Hendry, Sophia Sheikh, Christopher W Jones, Brittany E Punches, Gregory Fermann, Lauren A Hudak, Kamran Mohiuddin, Vishnu Murty, Meghan E Mcgrath, John P Haran, Jose Pascual, Mark Seamon, David A Peak, Claire Pearson, Robert M Domeier, Paulina Sergot, Roland Merchant, Leon D Sanchez, Niels K Rathlev, William F Peacock, Steven E Bruce, Deanna Barch, Diego A Pizzagalli, Beatriz Luna, Steven E Harte, Irving Hwang, Sue Lee, Nancy Sampson, Karestan C Koenen, Kerry J Ressler, Ronald C Kessler

Faculty, Staff and Students Publications

BACKGROUND: This is the first report on the association between trauma exposure and depression from the

METHODS: We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.

RESULTS: Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger

CONCLUSIONS: These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological …

Care Alert Program In Chronic Recurrent Ed Utilizing Patients, Kaitlyn Phelps, Jonathan Bryan, Jonathan Leggett, Erica Gibbons, Brian Griggs

HCA Healthcare Journal of Medicine

The Care Alert program is designed to help navigate encounters with patient populations that are high utilizers of emergency department (ED) resources. These populations often have chronic medical conditions, have a poor understanding of their conditions, are unfamiliar with the EDs’ role in the management of these conditions, and commonly lack outpatient resources. The Care Alert program intends to address the needs of this challenging patient population by designing individualized care plans that are approved through a multidisciplinary committee. Data from this study showed a 37% decrease in ED visits and a 47% decrease in hospitalizations during the initial 8 …

Examining Racial, Ethnic, And Gender Disparities In The Treatment Of Pain And Injury Emergencies, Laurel A. Wimbish, Janelle R. Simpson, Lauren R. Gilbert, Andria Blackwood, Emily A. Grant

HCA Healthcare Journal of Medicine

Background

Racial, ethnic, and gender disparities in effective pain management have been well-documented across healthcare settings. However, discrepancies in the treatment of patients in prehospital pain management settings have not been well researched. The objective of this study was to determine whether Wyoming emergency medical service (EMS) providers’ use of opioids to treat prehospital pain or injury varies by patient race/ethnicity or gender.

Methods

This cross-sectional study of EMS records examined 27 448 patient care reports (PCRs) generated during emergency medical responses to pain/injury emergencies in the state of Wyoming between January 2016 and March 2019. We included PCRs in …

Endothelial Autophagy In Coronary Microvascular Dysfunction And Cardiovascular Disease, Fujie Zhao, Ganesh Satyanarayana, Zheng Zhang, Jianli Zhao, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

Coronary microvascular dysfunction (CMD) refers to a subset of structural and/or functional disorders of coronary microcirculation that lead to impaired coronary blood flow and eventually myocardial ischemia. Amid the growing knowledge of the pathophysiological mechanisms and the development of advanced tools for assessment, CMD has emerged as a prevalent cause of a broad spectrum of cardiovascular diseases (CVDs), including obstructive and nonobstructive coronary artery disease, diabetic cardiomyopathy, and heart failure with preserved ejection fraction. Of note, the endothelium exerts vital functions in regulating coronary microvascular and cardiac function. Importantly, insufficient or uncontrolled activation of endothelial autophagy facilitates the pathogenesis of …

Paramedics’ Confidence And Perceived Competence When Attending To Varied Patient Presentations: A Mixed-Method Study, Nicholas J. Waltrich, Jade Sheen, Mathew Ling

Internet Journal of Allied Health Sciences and Practice

Purpose: Paramedics are routinely called to patients presenting with mental health concerns. Previous literature suggests paramedics find this patient group challenging. However, no study has investigated whether paramedics find mental health presentations (MHP) more challenging relative to other patient presentations, or whether certain paramedic variables relate to their perceived ability to manage MHP. This study investigates differences in paramedics’ perceived ability to attend to MHP compared to other patient presentations, and whether their perceived ability is related to their level of experience or location of work (metropolitan or rural). The study also explores paramedic’s experiences and perspectives of MHP. Method: …

The Modified Rankin Scale Can Accurately Be Derived From The Electronic Medical Record, Derek Isenberg, Nelson Prus, Frederick Ramsey, Nina T. Gentile

Transformative Medicine

Abstract

Introduction

The modified Rankin Scale (mRS) is used to assess functional outcomes after a stroke and is the primary outcome in many stroke trials. For retrospective stroke research or stroke research in which patients are lost to study follow up, review of the electronic medical record (EMR) may be the sole way to estimate a patient’s functional outcome. The purpose of this study is to determine if a mRS can be accurately derived from the electronic medical record EMR.

Methods

This study used data from completed stroke studies in which in-person 90-day mRS were collected as part of the …

Ems To Trauma Care Transitions: An Investigation Of Patient And Handoff Outcomes, Richard Simonson

Doctoral Dissertations and Master's Theses

The helicopter as a method of emergency medical service transportation of trauma patients has a long history of effective use-cases dating back to its inception during the Vietnam war. Compared to ground-based emergency medical transit, helicopters have been able to reach severely injured patients in environments with challenging terrain features that ground-based medical services cannot traverse. Additionally, the helicopter offers quicker and more direct-route transit options that result in both quicker response and shorter transportation times compared to their ground-based alternative. Further, research has indicated that helicopter ambulance teams utilize paramedics with more experience than ground ambulance paramedics. Prior research …

Validation Of The Termination Of Resuscitation Rules In Detroit, Arqam Husain, Adam D. Chalek, Robert Dunne

Medical Student Research Symposium

Introduction: 326,000 patients suffer from an out of hospital cardiac arrest (OHCA) each year. The Termination of Resuscitation (TOR) criteria guides physicians in determining the futility of continuing CPR and transporting patients to the hospital. We examined compliance with current BLS TOR rules and assessed an alternate set of rules to derive improved TOR guidelines for OHCAs in Detroit.

Methods: A retrospective study was conducted utilizing non-traumatic OHCA cases in Detroit from January 1, 2017 to December 31, 2019, which includes time before and after BLS TOR guidelines were implemented. Patients younger than 18 and arrests of traumatic origin or …

Language Preference Impact On The Outcomes Of Those Lost To Follow-Up After A Diagnosis Of Pregnancy Of Unknown Location, Erin A. Leestma, Mayra A. Shafique, Megan Mcnitt, Annmarie Vilkins

Medical Student Research Symposium

Pregnancy of unknown location (PUL) is a temporary diagnosis when there is a positive pregnancy test but an intrauterine gestational sac and/or fetal pole are not visualized with ultrasonography. The three potential outcomes for such a pregnancy are failed pregnancy, an early intrauterine pregnancy or an ectopic/abnormal pregnancy. Given the serious associated morbidity of ectopic pregnancy, these PUL require strict follow up of bHCG levels to help the clinician determine the likely outcome of the PUL (failed vs early vs ectopic) and choose the best intervention (expectant management, surgical management or medical management). One potential barrier to follow-up identified in …

Challenges Created By The Covid-19 Pandemic: Pediatric Emergency Medicine And Disaster Management Perspectives, Thomas E Tanner, Nichole R Davis, Brent D Kaziny, Erin E Endom, Esther M Sampayo

Faculty, Staff and Students Publications

OBJECTIVE: The coronavirus disease (COVID-19) pandemic has presented unique challenges to pediatric emergency medicine (PEM) departments. The purpose of this study was to identify these challenges and ascertain how centers overcame barriers in creating solutions to continue to provide high-quality care and keep their workforce safe during the early pandemic.

METHODS: This is a qualitative study based on semi-structured interviews with physicians in leadership positions who have disaster or emergency management experience. Participants were identified through purposive sampling. Interviews were recorded and transcribed electronically. Themes and codes were extracted from the transcripts by 2 independent coders. Constant comparison analysis was …

Authorship Representation In Global Emergency Medicine: A Bibliometric Analysis From 2016 To 2020, Stephanie Chow Garbern, Gimbo Hyuha, Catalina González Marqués, Noor Baig, Jennifer L. Chan, Sanjukta Dutta, Masuma A. Gulamhussein, Gloria Paulina López Terán, Hussein Karim Manji, Benjamin Wachira

Emergency Medicine, East Africa

Introduction: High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field.

Methods: We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors' affiliations and funding sources. We compared the …

Impact Of Covid19 On Maxillofacial Fractures In The Province Of L’Aquila, Abruzzo, Italy Review Of 296 Patients Treated With Statistical Comparison Of The Two-Year Pre-Covid19 And Covid19, Filippo Giovannetti, Ettore Lupi, Danilo Di Giorgio, Secondo Scarsella, Antonio Oliva, Desiderio Di Fabio, Paolo Prata, Giada Petricca, Valentino Valentini

Faculty, Staff and Student Publications

The aim of this study was to understand the impact of the COVID-19 pandemic on the epidemiology of maxillofacial trauma in a regional trauma center in L'Aquila, Abruzzo, Italy, during the first wave of the pandemic and comparted it to an equivalent period from 2015 to 2018. The authorshave retrospectively analyzed personal data, site of trauma, etiology, and mechanism of injury. Statistical analysis has been carried out utilizing IBM SPSS Statistics software (IBM Corp., Armonk, NY) and significance was accepted for P values of 0.05) as opposed to the etiology in which the road traffic accidents decreased in favor of …

Impact Of Post-Arrest Care Variation On Hospital Performance After Out-Of-Hospital Cardiac Arrest, Ryan Huebinger, Jordan Thomas, Benjamin S Abella, John Waller-Delarosa, Rabab Al-Araji, Richard Witkov, Normandy Villa, Peter Nikonowicz, Taylor Renbarger, Micah Panczyk, Bentley Bobrow

Faculty, Staff and Student Publications

BACKGROUND: Large variation exists for out-of-hospital-cardiac-arrest (OHCA) prehospital care, but less is known about variations in post-arrest care. We sought to evaluate variation in post-arrest care in Texas as well as factors associated with higher performing hospitals.

METHODS: We analyzed data in Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES), including all adult, non-traumatic OHCAs from 1/1/2014 through 12/31/ 2020 that survived to hospital admission. We first evaluated variability in provisions of post-arrest care and outcomes. We then stratified hospitals into quartiles based on their rate of survival and evaluated the association between improving quartiles and care. Lastly, we evaluated …

Impact Of A Rapid High-Sensitivity Troponin Pathway On Patient Flow In An Urban Emergency Department, Edward Hyun Suh, Aleksandr M Tichter, Lauren S Ranard, Andrew Amaranto, Betty C Chang, Phong Anh Huynh, Alexander Kratz, Rebekah Jihae Lee, Leroy E Rabbani, Dana Sacco, Andrew J Einstein

Faculty, Staff and Students Publications

STUDY OBJECTIVE: To evaluate whether the introduction of a 1-hour high-sensitivity cardiac troponin-T (hs-TnT) pathway for patients who present to the emergency department (ED) with suspected acute coronary syndrome (ACS) improves ED patient flow without changing the rate of "missed" major adverse cardiac events (MACE), compared to use of conventional cardiac troponin with an associated 3-hour pathway.

METHODS: This was a prospective, uncontrolled observational study conducted before and after implementation of a 1-hour hs-TnT pathway at a high-volume urban ED. Patients undergoing evaluation for ACS in the ED were enrolled during their initial visit and clinical outcomes were assessed at …

Finding Acute Coronary Syndrome With Serial Troponin Testing For Rapid Assessment Of Cardiac Ischemic Symptoms (Fast-Trac): A Study Protocol, W Frank Peacock, Alan S Maisel, Christian Mueller, Stefan D Anker, Fred S Apple, Robert H Christenson, Paul Collinson, Lori B Daniels, Deborah B Diercks, Salvatore Di Somma, Gerasimos Filippatos, Gary Headden, Brian Hiestand, Judd Hollander, Juan C Kaski, Joshua M Kosowsky, John T Nagurney, Richard M Nowak, Donald Schreiber, Gary M Vilke, Marvin A Wayne, Martin Than

Department of Emergency Medicine Faculty Papers

Objective: To determine the utility of a highly sensitive troponin assay when utilized in the emergency department.

Methods: The FAST-TRAC study prospectively enrolled >1,500 emergency department patients with suspected acute coronary syndrome within 6 hours of symptom onset and 2 hours of emergency department presentation. It has several unique features that are not found in the majority of studies evaluating troponin. These include a very early presenting population in whom prospective data collection of risk score parameters and the physician's clinical impression of the probability of acute coronary syndrome before any troponin data were available. Furthermore, two gold standard diagnostic …

Emergency Medicine Journal Club, Dave M. Gibbs, Dylan Norton, Kyle Barbour

Advances in Clinical Medical Research and Healthcare Delivery

In this column, we provide a brief review of important papers recently published that relate to the field of Emergency Medicine. The goal is to provide the busy clinician a bullet-like summary of the study, focusing on the research question, methods, results, limitations and bottom line interpretation.

Hemoglobin As A Predictor For Covid-19 Disease Severity, Nicholas Sarcia, Dan Thai, Andrea M. Bodine Md

Advances in Clinical Medical Research and Healthcare Delivery

Background: The dilemma of who is at highest risk for COVID-19 severe disease and death persists. Hemoglobin levels may be an indicator of COVID-19 disease severity. There is inconsistent data on Emergency Department (ED) hemoglobin levels and severity of disease. Our objective was to examine if COVID-19 patients presenting with abnormal hemoglobin levels have an increased risk of severe disease and in-hospital mortality.

Methods: We conducted a retrospective cohort study at Berkshire Medical Center in Pittsfield, MA to investigate the relationship of COVID-19 disease severity with hemoglobin level. Inclusion criteria consisted of ED patients over 18 years with …

Disease Severity In Covid-19 Breakthrough Cases, Dan Thai, Nicholas Sarcia, Andrea M. Bodine Md

Advances in Clinical Medical Research and Healthcare Delivery

Background

Vaccine breakthrough is a phenomenon wherein vaccinated individuals become infected with disease despite adequate protection. During this study period, the Centers for Disease Control (CDC) reported 66.6% of US people have been fully vaccinated. Any measures to improve trust would increase vaccination rates. This study aims to understand vaccine breakthrough cases in COVID-19 by comparing their severity to unvaccinated cases. Our objective is to compare disease severity based on the worst initial vital signs (temperature, respiratory rate, oxygen saturation), length of stay (LOS), and age between vaccinated and unvaccinated COVID-19 cases.

Methods

We conducted a retrospective cohort study at …

Trauma Recidivism: Threat Orientations And Recurrent Injury Perceptions, Molly Bauer, Ann M. Mayo

Dissertations

Purpose: To describe select sociodemographic and clinical variables, threat orientations, and the perceived likelihood of recurrent injury (PLRI) of individuals deemed at risk for trauma recidivism (TR).

Background: Injuries and violence are the leading cause of traumatic death among persons aged 1 to 44 in the United States. Trauma recidivism occurs when an individual experiences more than one significant injury requiring hospital care in a five-year period. The relationship between a trauma recidivist’s perception of recurrent injury and orientation towards a threat remains unclear.

Conceptual Basis: Trauma recidivism risk factors contribute to forming an individual’s PLRI. When individuals acknowledge the …

Cardiology Implications Of Ed Covid-19 Patients In An Underserved Rural Health Care Environment, Pedro Colio

Dissertations

Background/Purpose: Positive COVID-19 patients with chronic comorbidities have been associated with severe cardiac complications (e.g., STEMI, NSTEMI, myocarditis, pericarditis, AF) specifically among underserved communities. Acute STEMI and NSTEMI are cardiac conditions associated with ruptured atherosclerotic plaque leading to significant myocardial injury. AF, the most common arrhythmia leading to cerebrovascular accidents, is also common in hospitalized patients with severe illnesses. Myocarditis and pericarditis are inflammatory heart conditions associated with acute viral infections. According to the literature, these cardiac issues have been linked as complications of COVID-19. COVID 19 is an emerging, complex, and costly public health challenge globally with potential lifelong …

Extracellular Vesicle-Derived Mir-144 As A Novel Mechanism For Chronic Intermittent Hypoxia-Induced Endothelial Dysfunction, Huina Zhang, Lu Peng, Yifan Wang, Wen Zhao, Wayne Bond Lau, Yajing Wang, Yu Li, Yunhui Du, Linyi Li, Yu Huang, Shaoping Nie, Yanwen Qin, Xinliang Ma, Yongxiang Wei

Department of Emergency Medicine Faculty Papers

Rationale: Extracellular vesicles (EVs) play a significant role in cell-cell communication. However, whether and how extracellular vesicles are involved in chronic intermittent hypoxia-induced endothelial dysfunction is unknown. Methods: Comparative transcriptomics analysis and miRNA screening were used to identify the possible pathways or target molecules mediating chronic intermittent hypoxia-induced endothelial function. Serum- or erythrocyte-derived EVs were isolated through ultracentrifugation plus filtration. After in vitro or in vivo treatment with EVs, aortic rings were treated with dihydroethidium staining for superoxidative anion measurement or mounted with wire myography to measure isometric forces. Immunoblotting and qPCR were used for evaluating the molecular mechanism mediating …

Strategies To Combat Ageism In Emergency Medicine, Anita N. Chary, Lauren Cameron Comasco, Anita Rohra, Shan Lliu

Journal of Geriatric Emergency Medicine

N/a

Implementation Of Delirium Bundle On A Hospital Medical/Surgical Unit To Help Decrease The Prevalence Of Delirium, Sanusi Mohammed

Doctor of Nursing Practice Scholarly Projects

Description of the Problem: Delirium is defined as a constellation of symptoms that includes disturbance in attention or awareness, change in cognition, language and perceptual disturbances that develops over a short period of time. Delirium mostly affects adult patients with risk factors including history of dementia, early cognitive impairment, dehydration, and infections. This quality improvement project was implemented on one hospital unit at a large tertiary hospital in the Boston area. This unit has one highest rate of delirium in the entire hospital system. Delirium is associated with high rate of morbidity and mortality. Also, this syndrome leads to longer …

Factors Affecting Emergency Department Mental Health Visits, Logan Daul

Honors Thesis

Research has shown that current quantities of emergency department visits for mental health and substance use are increasing at a startling rate. These increases are acknowledged in quantitative studies and some important information can be gathered from qualitative studies however determining specific causes for these emergent visits are difficult. The purpose of this study is to derive findings from statistical analyses focusing on quantities of emergency department visits for mental health and substance use disorders. Comparisons will be drawn at the state level between the per capita quantity of emergency department visits and poverty rate, climate, psychiatric healthcare infrastructure, urban …

Investigation Of Emergency Department Visits And Hospitalization Rates Of Child Physical Abuse At Cooper University Hospital Prior To And During The Covid-19 Pandemic, Afeerah Ahmad, Rachel Silliman Cohen, Laura Brennan

Rowan-Virtua Research Day

The COVID-19 pandemic has been detrimental for children. Many families have experienced stressors, including unemployment, financial hardship, and familial illness. These factors all pose increased risk for child physical abuse. Limitations in child welfare services affected investigations and provision of services to high-risk families. The extent to which the rates of physical abuse in NJ have been affected is unknown. We sought to answer the question of whether the COVID-19 pandemic affected the severity of physical abuse and the incidence of physical abuse presenting to Cooper University Hospital.

We hypothesized that there would be a higher proportion of severe child …

A Puzzling Case Of Normal Pressure Hydrocephalus In The Outpatient Setting, Shadi Shams, Asim Shafique, Marym Khan, James Bailey

Rowan-Virtua Research Day

Normal Pressure Hydrocephalus (NPH) is a disease of adulthood characterized by the triad of gait disturbance, dementia, and urinary incontinence. Since NPH shares a lot of characteristics with other disorders including neurodegenerative disorders and degenerative-dystrophic spine, it is usually underdiagnosed and undertreated. Combination of ventriculomegaly seen on a computerized tomography (CT) scan or magnetic resonance imaging (MRI) with clinical findings could be used in diagnosis of NPH. However, improvement of symptoms post spinal tap procedure would be a better indication of diagnosis. Currently, shunt placement is the best available modality of treatment for NPH. Here we present a case of …

Case Report: A Patient With Gait Dysfunction With Acute Inflammatory Demyelinating Polyneuropathy Masquerading As Diabetic Polyneuropathy, David Parkes, Russell Mordecai

Rowan-Virtua Research Day

New onset gait dysfunction often prompts admission to the hospital for further evaluation. The typical patient is an elderly person who normally is self-sufficient but had recently experienced a decline in their ability to care for themselves. Sometimes, however, those who present with gait dysfunction do not fit the expected demographic. These individuals raise concern for less common “zebra” presentations of neurological dysfunction. We describe one such rare case of a 39-year-old female with a new onset of type 2 diabetes mellitus and recent COVID-19 infection that presented to the emergency department with a sensation of bilateral lower extremity burning …

Case Report And Review: Spontaneous Coronary Artery Dissection (Scad), Michael Morris, Wayne Tamaska, James Espinosa, Alan Lucerna, Trent Malcolm

Rowan-Virtua Research Day

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome or sudden death. SCAD has a high incidence in a younger, female population with an association with peripartum or postpartum status. Connective tissue disorders and vasculitides are also associated with SCAD. The purpose of this poster will be to examine the presentation and risk factors associated with SCAD and to discuss optimal treatment strategies.

Case Report: How A Vallecular Cyst Could Have Become An Airway Emergency, Adam Kandil, Robin Lahr, Andrew Caravello

Rowan-Virtua Research Day

Vallecular cysts, also known as epiglottic mucous retention cysts are known to be generally self-limiting laryngeal lesion. They can however also be associated with airway obstruction, and dysphagia in infants. In adults, they are usually asymptomatic, and usually incidentally diagnosed. At times they are diagnosed during rapid sequence intubation, as they may contribute to endotracheal intubation difficulty. Moreover, there is question as to the correlation between vallecular cysts and the incidence of acute epiglottitis, as a vallecular cyst may become infected and cause a localized expansion of inflammation and infection. This expansion from the vallecula progresses to epiglottis.

Spontaneous Extraperitoneal Hematoma: An Unexpected Case Of Dysuria And Urinary Retention In A 77-Year-Old Male, Monica Diep, James Lee, James Espinosa, Joseph Pagano, Alan Lucerna

Rowan-Virtua Research Day

Urinary problems are common complaints in the Emergency Department and can present with any combination of lower urinary tract symptoms such as dysuria, hematuria, urgency, frequency, incontinence, or retention. We describe the case of a 77-year-old male who presented to the Emergency Department for five days of worsening dysuria. Two days prior, the patient was seen and evaluated for the same chief complaint, where he received intravenous antibiotics and was admitted to the hospital overnight for observation. The following day, the patient’s urinalysis and cultures were not consistent with a urinary tract infection (UTI) and was subsequently discharged without antibiotics. …