Emergency Medicine Commons^™

Machine Learning To Optimize Use Of Natriuretic Peptides In The Diagnosis Of Acute Heart Failure, Dimitrios Doudesis, Kuan Ken Lee, Mohamed Anwar, Adam J. Singer, Judd E. Hollander, Camille Chenevier-Gobeaux, Yann-Erick Claessens, Desiree Wussler, Dominic Weil, Nikola Kozhuharov, Ivo Strebel, Zaid Sabti, Christopher Defilippi, Stephen Seliger, Evandro Tinoco Mesquita, Jan C. Wiemer, Martin Möckel, Joel Coste, Patrick Jourdain, Komukai Kimiaki, Michihiro Yoshimura, Irwani Ibrahim, Shirley Beng Suat Ooi, Win Sen Kuan, Alfons Gegenhuber, Thomas Mueller, Olivier Hanon, Jean-Sébastien Vidal, Peter Cameron, Louisa Lam, Ben Freedman, Tommy Chung, Sean P. Collins, Christopher J. Lindsell, David E. Newby, Alan G. Japp, Anoop S. V. Shah, Humberto Villacorta, A. Mark Richards, John J V Mcmurray, Christian Mueller, James L. Januzzi, Nicholas L. Mills, Gordon Moe, Carlos Fernando, Hanna K. Gaggin, Antoni Bayes-Genis, Roland Rj Van Kimmenade, Yigal Pinto, Joost H. W. Rutten, Anton H. Van Den Meiracker, Luna Gargani, Nicola R. Pugliese, Pemberton Christopher, Michael Neumaier, Michael Behnes, Ibrahim Akin, Michele Bombelli, Guido Grassi, Peiman Nazerian, Giovanni Albano, Philipp Bahrmann

Department of Emergency Medicine Faculty Papers

AIMS: B-type natriuretic peptide (BNP) and mid-regional pro-atrial natriuretic peptide (MR-proANP) testing are guideline-recommended to aid in the diagnosis of acute heart failure. Nevertheless, the diagnostic performance of these biomarkers is uncertain.

METHODS AND RESULTS: We performed a systematic review and individual patient-level data meta-analysis to evaluate the diagnostic performance of BNP and MR-proANP. We subsequently developed and externally validated a decision-support tool called CoDE-HF that combines natriuretic peptide concentrations with clinical variables using machine learning to report the probability of acute heart failure. Fourteen studies from 12 countries provided individual patient-level data in 8493 patients for BNP and 3899 …

Machine Learning To Optimize Use Of Natriuretic Peptides In The Diagnosis Of Acute Heart Failure, Dimitrios Doudesis, Kuan Ken Lee, Mohamed Anwar, Adam J. Singer, Judd Hollander, Md, Camille Chenevier-Gobeaux, Yann-Erick Claessens, Desiree Wussler, Dominic Weil, Nikola Kozhuharov, Ivo Strebel, Zaid Sabti, Christopher Defilippi, Stephen Seliger, Evandro Tinoco Mesquita, Jan C. Wiemer, Martin Möckel, Joel Coste, Patrick Jourdain, Komukai Kimiaki, Michihiro Yoshimura, Irwani Ibrahim, Shirley Beng Suat Ooi, Win Sen Kuan, Alfons Gegenhuber, Thomas Mueller, Olivier Hanon, Jean-Sébastien Vidal, Peter Cameron, Louisa Lam, Ben Freedman, Tommy Chung, Sean P. Collins, Christopher J Lindsell, David E. Newby, Alan G. Japp, Anoop S V Shah, Humberto Villacorta, A Mark Richards, John J V Mcmurray, Christian Mueller, James L. Januzzi, Nicholas L. Mills

Department of Emergency Medicine Faculty Papers

AIMS: B-type natriuretic peptide (BNP) and mid-regional pro-atrial natriuretic peptide (MR-proANP) testing are guideline-recommended to aid in the diagnosis of acute heart failure. Nevertheless, the diagnostic performance of these biomarkers is uncertain.

METHODS AND RESULTS: We performed a systematic review and individual patient-level data meta-analysis to evaluate the diagnostic performance of BNP and MR-proANP. We subsequently developed and externally validated a decision-support tool called CoDE-HF that combines natriuretic peptide concentrations with clinical variables using machine learning to report the probability of acute heart failure. Fourteen studies from 12 countries provided individual patient-level data in 8493 patients for BNP and 3899 …

A Vomiting And Dyspneic Teenager, Janet Han, Do, Shireen Khan, Md

Jefferson Health - Northeast Posters (formerly Aria Health Posters)

History of Present Illness

CHIEF COMPLAINT: Shortness of Breath

15 y/o female with no pertinent PMHx presents to the emergency department with shortness of breath onset 3 days ago. Patient is also reporting cough, congestion, sore throat, subjective fever and chills, myalgias, as well as nausea and vomiting. Today, she states she is so nauseous she has tried to force herself to throw up several times. Since then, she has been experiencing neck pain with movement. Patient is UTD with all her vaccines. Denies alcohol and drug use. Initially denies vaping/smoking; later states she has vaped daily until her symptoms’ …

Targeted Ehr-Based Communication Of Diagnostic Uncertainty (Tecu) In The Emergency Department: Protocol For An Effectiveness Implementation Trial, Danielle M Mccarthy, Sara Malone, Dimitrios Papanagnou, Benjamin E Leiby, Amandy M B Doty, Phillip Watts, Rahul Yadav, Julia K Pugliese, Jonathan Woodworth, Tracy Esteves Camacho, Efrat Kean, Kristin L Rising

Department of Emergency Medicine Faculty Papers

BACKGROUND: At least 37 % emergency department (ED) patients are discharged without a definitive diagnosis, resulting in diagnostic uncertainty. Transitions of care are high-risk periods for patient safety, especially for patients discharged with diagnostic uncertainty. Effective communication between clinicians and patients improves these care transitions. Previous research developed tools to support high quality discharge in the setting of diagnostic uncertainty, including: a communication checklist, a physician training program, and a patient-facing information sheet.

METHODS: This study aims to enhance transitions for patients leaving the ED with diagnostic uncertainty through an electronic health record (EHR)-based strategy. The intervention, the Targeted EHR-based …

Angiotensin Converting Enzyme Inhibitor Induced Angioedema (Acei-Ae): Emergency Department Treatments, Logan Held, Marcus Blankenspoor, Kristine Her, Jolene Harris

Celebration of Research

Angiotensin Converting Enzyme Inhibitor Induced Angioedema (ACEI-AE) is the acute swelling of the upper airway in patients who are currently or were formerly taking Angiotensin Converting Enzyme Inhibitors (ACEIs) for control of primary hypertension. Though emergency department presenting signs and symptoms have overlap with angioedema associated with anaphylaxis, there are key differences, including the absence of urticaria or hypotension and history of ACEI use, that can guide clinicians in identifying the underlying cause of the angioedema and initiate appropriate treatment. Due to its differing pathophysiology, ACEI-AE must be treated uniquely with Tranexamic Acid (TXA) and Fresh Frozen Plasma (FFP) to …

Evaluating The Efficacy Of Predischarge Referrals In Preventing Emergency Mental Health Hospital Readmissions: A Scoping Review, Pretia Carpenter Bsn, Rn, Stephanie Mays Bsn, Rn, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc, Sharon H. Little, Dnp, Fnp-Bc, Aprn

Doctor of Nursing Practice Projects

Background

Emergency mental health hospital readmissions present significant challenges to healthcare systems, often resulting in increased costs, prolonged hospital stays, and poor patient outcomes. Continuity of care through predischarge referrals to outpatient mental health services, psychosocial support, and community resources has been proposed as a strategy to reduce readmissions. However, the effectiveness of these interventions remains inconsistent across different populations and settings.

Objective

This scoping review aims to evaluate the effectiveness of predischarge referrals in reducing 30-day emergency mental health hospital readmissions, identify key components of successful programs, and assess the influence of demographic factors on readmission rates.

Methods

A …

Examining The Role Of Corticosteroids In The Management Of Acute Interstitial Pneumonia: A Systematic Review., Carlos Valladares, Aalia Narvel, Bianna Koutsenko, Alexa Simonetti, Fatima Mossolem, Alexis Chow, Samrat Gollapudi, Usmaan Al-Shehab, Nicholas Averell, Katherine Chiapaikeo-Poco, Adam Kaplan

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Acute interstitial pneumonia (AIP), also known as Hamman-Rich syndrome, is a rapidly progressive interstitial lung disease. In addition to being challenging to diagnose, AIP is also difficult to treat. The mortality rate of AIP is greater than 70% due to the disease's rapid progression. Furthermore, survivors are likely to develop chronic interstitial lung disease as a sequela. Treatment primarily focuses on supportive care, which consists of oxygenation through mechanical ventilation, administration of broad-spectrum antibiotics, and the use of corticosteroids. Although the use of steroids as empiric treatment is controversial and results on its mortality benefit are variable, some studies …

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenberg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Posters

Background: Antibiotic duration is one of the pillars of antimicrobial stewardship programs (ASP) as it helps to limit unnecessary antibiotic exposure while continuing to provide appropriate care for infections. In our emergency department (ED), clinicians are using first-line guideline-recommended antibiotics as an appropriate choice for most patients (per our ASP report tracking), however, duration continues to be prolonged especially for community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS). National guidelines recommend shortening antibiotic durations to 3-5 days for CAP and 5-7 days for ABRS, however currently only 22% of patients discharged from our ED receive the recommended duration. Objective: …

More Of Less: Optimizing Opioid Prescriptions For Acute Fractures In The Emergency Department At A Children’S Hospital, Mitch Kinkor, Spencer Young, Colton Schwarz, Nicholas Clark, Michelle Dephillips, Elizabeth Edmundson, Ryan Mcdonough, Warren Teachout

Presentations

Introduction: Deaths related to drug overdose are at record highs, with over 110,000 recorded from May 2022-2023.1 75% of drug overdose deaths can be attributed to opioids.1 Pediatric opioid exposure is significant, with 406,000 American teens reporting illicit opioid use in 2022.2 Increased prescription opioids in circulation leads to increased opportunity for ingestion by children and adolescents. Current literature suggests most pediatric patients may only use one-two days’ worth of opioid doses prescribed for acute pain control, with the rest of prescribed doses going unused.3 From 2022-2023 in the Children’s Mercy Emergency Department (ED), 48% of children prescribed opioids for …

The Epidemiology Of Sports And Recreation Related Toe Fractures In The United States, Dogerno Norceide, Gabriel I. Onor, Oluwatomi Akingbola, William Justice, Nana F. Amponsah, Abimbola Okulaja, Ifeanyichukwu Onor, Michael Okoronkwo, Chibuikem Nwizu, David Pedowitz

School of Medicine Faculty Publications

BACKGROUND: Fractures of the toes are among the most frequently diagnosed lower extremity fractures. In sports, toe fractures may present after diverse mechanisms of injury, varying severity, and varying implications for management. This study aimed to discern trends in toe fractures presenting to US emergency departments (EDs) particularly in association with sports and recreational activities. An additional aim of the study was to identify if rates of toe fracture presentation significantly decreased during the year 2020 at the height of the COVID-19 pandemic. METHODS: We queried the National Electronic Injury Surveillance System (NEISS) database to identify toe fractures presented to …

Decreasing Time To Narcotic Pain Medication In Patients With Sickle Cell Disease Presenting With Acute Pain Crises In A Pediatric Emergency Department: A Quality Improvement Initiative, Allison Adam, Lina Patel, Christopher Kaberline, Ibad Siddiqi, Leslie Hueschen

Posters

No abstract provided.

The Lived Experience Of Acute Stroke Advanced Practice Registered Nurses (Aprn) Working In Expanded Roles: A Mixed Methods Study, Terri-Ellen Kiernan

Theses and Dissertations (ETD)

Introduction. Nurse practitioners have made credible gains through the six decades since inception to cover the growing need for outpatient family care. Nurse practitioners are now working in all aspects of medicine by continuing to fill gaps with healthcare needs that persist due to physician shortages. Stroke neurology is a medical specialty plagued by a shortage of physician specialists in hospital acute care which can limit acute stroke diagnosis and treatment capabilities. Stroke nurse practitioners (SNP) are vascular neurology trained specialists who fill relatively new hospital roles to assume traditionally physician-based responsibilities in an expanded role. This study aims to …

The Impact Of Hyperglycemia On Post-Reperfusion Outcomes In Patients With Hyperacute Ischemic Stroke, Nicole Schumacher

Theses and Dissertations (ETD)

Stroke is a major contributor to disability in the United States, with ischemic stroke accounting for approximately 87% of all cases. The use of approved reperfusion therapies, including intravenous thrombolysis with tissue plasminogen activator (tPA) and mechanical thrombectomy, has significantly improved functional outcomes for ischemic stroke patients. However, hyperglycemia at the time of hospital arrival is associated with worse outcomes, including increased infarct growth, higher rates of disability, and elevated mortality. Despite this, current stroke guidelines neither exclude hyperglycemic patients from receiving reperfusion therapy nor recommend glucose management during the hyperacute phase of care. While recent studies suggest that mild …

Navigating Nonlinear Pathways: Challenges And Opportunities For Diversity, Equity, And Inclusion Leaders In Academic Emergency Medicine, Melanie F Molina, Annika Bhananker, Beatrice Torres, Dalia Owda, Edgardo Ordoñez, Anita N Chary

Faculty, Staff and Students Publications

OBJECTIVES: Diversity, equity, and inclusion (DEI) leadership roles have grown in academic emergency medicine (EM). We sought to elucidate specific pathways to DEI leadership roles among current DEI leaders in academic EM.

METHODS: From March to May 2023, we conducted semistructured, qualitative interviews with DEI leaders in academic EM across 5 US regions to investigate their pathways to leadership. Participants were recruited via email using Accreditation Council for Graduate Medical Education-accredited EM residency websites and the Academy for Diversity and Inclusion in EM. After recording and transcribing the interviews, we used an inductive approach to identify major themes.

RESULTS: Of …

Evaluating A Large Language Model’S Accuracy In Chest X-Ray Interpretation For Acute Thoracic Conditions, Adam M. Ostrovsky

SKMC Student Presentations and Publications

BACKGROUND: The rapid advancement of artificial intelligence (AI) has great ability to impact healthcare. Chest X-rays are essential for diagnosing acute thoracic conditions in the emergency department (ED), but interpretation delays due to radiologist availability can impact clinical decision-making. AI models, including deep learning algorithms, have been explored for diagnostic support, but the potential of large language models (LLMs) in emergency radiology remains largely unexamined.

METHODS: This study assessed ChatGPT's feasibility in interpreting chest X-rays for acute thoracic conditions commonly encountered in the ED. A subset of 1400 images from the NIH Chest X-ray dataset was analyzed, representing seven pathology …

Storm-Induced Supply Challenges: A Case Of Hurricane-Driven Iv Fluid Use And Venous Air Embolism, Davin Evanson

Tower Health Research Day

No abstract provided.

Use Of Arrow Clarke Pleuraseal Thoracentesis Kit To Perform A Pericardiocentesis Emergency Medicine Physician Education Quality Improvement On High Acuity Low Occurrence Procedures, Kendall Higgins Md, Joshua Hamilton Do, Grant Nugent Md, Monisha Bindra Do, Shaila Quazi Do

Tower Health Research Day

No abstract provided.

Unlocking Prognostic Potential: Biomarker Predictors Of Admission And Length Of Stay In Pediatric Sickle Cell Vaso-Occlusive Pain Crisis, Jeffrey Hernandez, Abhishek Dutta, Jacob Lowry, Bruce Bernstein, Luis Gamboa, Nataly Apollonsky

Tower Health Research Day

No abstract provided.

Evaluating The Role Of Traditional And Nontraditional Educational Resources In Point-Of-Care Ultrasound Training: A Cross-Sectional Survey Of Educator Preferences And Practices, Arthur Broadstock, Annahieta Kalantari, Almaz S. Dessie, Al'ai Alvarez, Resa E. Lewiss, Josie Acuna, Anthony Weekes, Kaylah Maloney, Uwe Stolz, Lori Stolz, Aalap Shah

Department of Emergency Medicine Faculty Papers

BACKGROUND: Recently, nontraditional educational resources like podcasts, blogs, and online media have gained prominence in medical education and are abundant within the field of point-of-care ultrasound (POCUS). However, the extent to which POCUS educators utilize online resources compared to traditional resources, like textbooks, journal articles, and in-person workshops, is unknown. We aim to define which types of educational resources are used and preferred by POCUS educators to teach trainees.

METHODS: An expert working group developed a survey aimed to characterize the types of materials used by POCUS educators and their perceived importance on a 6-point forced ranking scale. We administered …

Connecting Disciplines: Dermatologists Discuss Skin Cancer Screening In Physical Therapy, Michael T. Robinson, Lindsay Gietzen

Pacific Journal of Health

Background: This study aims to explore dermatologists’ perspectives on the integration of skin cancer screening within physical therapy practice. The hypothesis is that insights from dermatologists can enhance the efficacy and accuracy of skin cancer screening by physical therapists (PTs), thereby improving early detection rates and patient outcomes. Methods: A total of five dermatologists participated in this study, each with between 5 and 18 years of experience and a diverse range of expert opinions and insights. This qualitative study utilized semi-structured interviews with participating dermatologists. The interview questions focused on their knowledge of skin cancer screening, perceptions of its implementation …