2023
Sporadic Creutzfeldt-Jakob Disease Initially Presenting With Posterior Reversible Encephalopathy Syndrome
Mikhaiel J, Parasram M, Manning T, Al-Dulaimi M, Barnes E, Falcone G, Hwang D, Prust M. Sporadic Creutzfeldt-Jakob Disease Initially Presenting With Posterior Reversible Encephalopathy Syndrome. The Neurologist 2023, 29: 14-16. PMID: 37582680, DOI: 10.1097/nrl.0000000000000519.Peer-Reviewed Original ResearchConceptsSporadic Creutzfeldt-Jakob diseaseMagnetic resonance imagingReversible encephalopathy syndromeCreutzfeldt-Jakob diseaseEncephalopathy syndromeAntiseizure medicationsLumbar punctureDiagnosis of sCJDFluid-attenuated inversion recovery changesPosterior reversible encephalopathy syndromeRepeat magnetic resonance imagingCases of sCJDPeriodic dischargesMultiple antiseizure medicationsRepeat lumbar punctureStuporous mental stateInitial lumbar punctureInversion recovery hyperintensityNonconvulsive status epilepticusReal-time quaking-induced conversionFatal neurodegenerative conditionProgressive confusionRadiographic improvementNeurological declineStatus epilepticusEmergent external ventricular drain placement in patients with factor Xa inhibitor-associated intracerebral hemorrhage after reversal with andexanet alfa
Ammar A, Elsamadicy A, Ammar M, Reeves B, Koo A, Falcone G, Hwang D, Petersen N, Kim J, Beekman R, Prust M, Magid-Bernstein J, Acosta J, Herbert R, Sheth K, Matouk C, Gilmore E. Emergent external ventricular drain placement in patients with factor Xa inhibitor-associated intracerebral hemorrhage after reversal with andexanet alfa. Clinical Neurology And Neurosurgery 2023, 226: 107621. PMID: 36791588, DOI: 10.1016/j.clineuro.2023.107621.Peer-Reviewed Original ResearchConceptsAndexanet alfaExtra-axial hemorrhageEVD placementThrombotic eventsNew hemorrhagePrimary safety outcomeExternal ventricular drain placementLarge prospective studiesIntensive care unitIntracerebral hemorrhage patientsVentricular drain placementBolus patientsHospital lengthHospital LOSICU LOSTract hemorrhageRankin scoreSecondary outcomesAdult patientsBolus groupPrimary outcomeCare unitIntracerebral hemorrhageLong administration timeHemorrhage patients
2022
Pilot Randomized Clinical Trial of a Goals-of-Care Decision Aid for Surrogates of Patients With Severe Acute Brain Injury
Muehlschlegel S, Goostrey K, Flahive J, Zhang Q, Pach JJ, Hwang DY. Pilot Randomized Clinical Trial of a Goals-of-Care Decision Aid for Surrogates of Patients With Severe Acute Brain Injury. Neurology 2022, 99: e1446-e1455. PMID: 35853748, PMCID: PMC9576301, DOI: 10.1212/wnl.0000000000200937.Peer-Reviewed Original ResearchConceptsCode status changeTraumatic brain injuryBrain injuryIschemic strokeCare decisionsIntracerebral hemorrhageDA groupAcute brain injury patientsSevere acute brain injuryNeurologic intensive care unitCare decision aidSurrogates of patientsAcute brain injuryAcute ischemic strokeClass IV evidenceLong-term prognosisIntensive care unitBrain injury patientsClinician-family communicationAdditional psychosocial supportPatient-centered careLife-sustaining treatmentPsychological outcomesDecision-making interventionClassification of evidenceTop Ten Tips Palliative Care Clinicians Should Know About Disorders of Consciousness: A Focus on Traumatic and Anoxic Brain Injury
Steinberg A, Hudoba C, Hwang DY, Kramer NM, Mehta AK, Muehlschlegel S, Jones CA, Besbris J. Top Ten Tips Palliative Care Clinicians Should Know About Disorders of Consciousness: A Focus on Traumatic and Anoxic Brain Injury. Journal Of Palliative Medicine 2022, 25: 1571-1578. PMID: 35639356, DOI: 10.1089/jpm.2022.0202.Peer-Reviewed Original ResearchEffect of Early vs Standard Approach to Tracheostomy on Functional Outcome at 6 Months Among Patients With Severe Stroke Receiving Mechanical Ventilation
Bösel J, Niesen WD, Salih F, Morris NA, Ragland JT, Gough B, Schneider H, Neumann JO, Hwang DY, Kantamneni P, James ML, Freeman WD, Rajajee V, Rao CV, Nair D, Benner L, Meis J, Klose C, Kieser M, Suarez JI, Schönenberger S, Seder DB, Ramadan A, Claassen J, Mayer S, Peled H, Christianson T, May T, Riker R, Asgarpur G, Stetefeld H, Kluge S. Effect of Early vs Standard Approach to Tracheostomy on Functional Outcome at 6 Months Among Patients With Severe Stroke Receiving Mechanical Ventilation. JAMA 2022, 327: 1899-1909. PMID: 35506515, PMCID: PMC9069344, DOI: 10.1001/jama.2022.4798.Peer-Reviewed Original ResearchConceptsEarly tracheostomy groupEarly tracheostomyMechanical ventilationSevere strokeFunctional outcomeStandard tracheostomyTracheostomy groupPrimary outcomeControl groupProlonged invasive mechanical ventilationModified Rankin Scale scoreSevere disabilityInvasive mechanical ventilationSerious adverse eventsRankin Scale scoreAirway protective reflexesRate of survivalInvasive ventilationAdverse eventsHemorrhagic strokeWide confidence intervalsAvailable followProtective reflexesCare centerClinical trials
2021
Predictors of Family Dissatisfaction with Support During Neurocritical Care Shared Decision-Making
Weber U, Zhang Q, Ou D, Garritano J, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Huang KB, Vranceanu AM, Rosand J, Hwang DY. Predictors of Family Dissatisfaction with Support During Neurocritical Care Shared Decision-Making. Neurocritical Care 2021, 35: 714-722. PMID: 33821402, PMCID: PMC8021441, DOI: 10.1007/s12028-021-01211-6.Peer-Reviewed Original ResearchConceptsFormal family meetingsICU admissionFamily meetingsNeuro-ICURetrospective observational cohort studyObservational cohort studyUS academic centersFamilies of patientsBroad inclusion criteriaFamily satisfactionTop-box responsesFamily membersNeuroscience ICUICU dischargeICU courseCohort studyIll patientsAvailable patientsPatient variablesFamily dissatisfactionInclusion criteriaPatientsAcademic centersPatient lengthAverage patient lengthPredictors of Surrogate Decision Makers Selecting Life-Sustaining Therapy for Severe Acute Brain Injury Patients: An Analysis of US Population Survey Data
Garg A, Soto AL, Knies AK, Kolenikov S, Schalk M, Hammer H, White DB, Holloway RG, Sheth KN, Fraenkel L, Hwang DY. Predictors of Surrogate Decision Makers Selecting Life-Sustaining Therapy for Severe Acute Brain Injury Patients: An Analysis of US Population Survey Data. Neurocritical Care 2021, 35: 468-479. PMID: 33619667, PMCID: PMC8380750, DOI: 10.1007/s12028-021-01200-9.Peer-Reviewed Original ResearchConceptsSevere acute brain injuryAcute brain injuryLife-sustaining treatmentSurrogate decision makersBrain injuryAcute brain injury patientsPatient's surrogate decision makersSevere disabilityPoor neurological prognosisIntensive care unitSevere brain injuryLife-Sustaining TherapyBrain injury patientsCost of careYounger age groupsCross-sectional survey studyUS population sampleBinary logistic regressionNeurological prognosisIndependent predictorsCare unitInjury patientsPoor prognosisMale genderUnivariate analysis
2020
US Practitioner Attitudes Toward Tracheostomy Timing, Benefits, Risks, and Techniques for Severe Stroke Patients: A National Survey and National Inpatient Sample Analysis
Zhao CW, Hwang DY. US Practitioner Attitudes Toward Tracheostomy Timing, Benefits, Risks, and Techniques for Severe Stroke Patients: A National Survey and National Inpatient Sample Analysis. Neurocritical Care 2020, 34: 669-673. PMID: 33094469, DOI: 10.1007/s12028-020-01127-7.Peer-Reviewed Original ResearchThe impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage.
Reznik ME, Moody S, Murray K, Costa S, Grory BM, Madsen TE, Mahta A, Wendell LC, Thompson BB, Rao SS, Stretz C, Sheth KN, Hwang DY, Zahuranec DB, Schrag M, Daiello LA, Asaad WF, Jones RN, Furie KL. The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage. Neurology 2020, 95: e2727-e2735. PMID: 32913011, PMCID: PMC7734724, DOI: 10.1212/wnl.0000000000010738.Peer-Reviewed Original ResearchConceptsImpact of deliriumIntracerebral hemorrhageLife-sustaining treatmentScore-based modelSingle-center cohort studyCox regression modelCharacteristic curve analysisDSM-5 criteriaHospital daysCohort studyConsecutive patientsMedian timeDelirium groupPoor outcomeDeliriumWLSTPatientsLogistic regressionCurve analysisHemorrhageGoals-of-care decision aid for critically ill patients with TBI: Development and feasibility testing.
Muehlschlegel S, Hwang DY, Flahive J, Quinn T, Lee C, Moskowitz J, Goostrey K, Jones K, Pach JJ, Knies AK, Shutter L, Goldberg R, Mazor KM. Goals-of-care decision aid for critically ill patients with TBI: Development and feasibility testing. Neurology 2020, 95: e179-e193. PMID: 32554766, PMCID: PMC7455326, DOI: 10.1212/wnl.0000000000009770.Peer-Reviewed Original ResearchConceptsCare decision aidSurrogates of patientsEarly feasibilityFeasibility trial protocolTraumatic brain injuryDecision aidConsecutive patientsIll patientsFeasibility trialStudy protocolTrial protocolBrain injuryInterim analysisCare communicationPatientsPaper-based decision aidExcellent usabilityComplete dataFeasibility testingHigh rateFamily membersBehavioral outcomesQualitative studyAcceptabilityIterative revisionsConcerns of surrogate decision makers for patients with acute brain injury: A US population survey.
Hwang DY, Knies AK, Mampre D, Kolenikov S, Schalk M, Hammer H, White DB, Holloway RG, Sheth KN, Fraenkel L. Concerns of surrogate decision makers for patients with acute brain injury: A US population survey. Neurology 2020, 94: e2054-e2068. PMID: 32341190, PMCID: PMC7282883, DOI: 10.1212/wnl.0000000000009406.Peer-Reviewed Original ResearchConceptsSevere acute brain injurySevere functional disabilityAcute brain injurySurrogate decision makersBrain injuryLatent class analysisPatient's wishesVegetative stateLong-term careFunctional disabilityPoor prognosisUS population surveySD groupPrognostic accuracyHypothetical patientsPatientsUS populationAdditional groupOlder adultsFuture interventionsCompletion ratesInjuryFamily consensusPopulation surveyUnique concernsPolicies for Mandatory Ethics Consultations at U.S. Academic Teaching Hospitals: A Multisite Survey Study.
Neal JB, Pearlman RA, White DB, Tolchin B, Sheth KN, Bernat JL, Hwang DY. Policies for Mandatory Ethics Consultations at U.S. Academic Teaching Hospitals: A Multisite Survey Study. Critical Care Medicine 2020, 48: 847-853. PMID: 32317595, PMCID: PMC10765238, DOI: 10.1097/ccm.0000000000004343.Peer-Reviewed Original ResearchConceptsTeaching hospitalMultisite survey studyConsultation serviceExtracorporeal membrane oxygenationDistinct clinical situationsSpecific clinical scenariosAcademic medical centerAcademic teaching hospitalCross-sectional survey studyPrimary teaching hospitalValve replacementCirculatory deathMembrane oxygenationBacterial endocarditisConsensus guidelinesClinical circumstancesInappropriate treatmentMedical CenterStudy recruitmentClinical scenariosInstitutional reviewClinical situationsSurvey studyOrgan donationDecision-making capacity
2019
Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs.
Kleinpell R, Zimmerman J, Vermoch KL, Harmon LA, Vondracek H, Hamilton R, Hanson B, Hwang DY. Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs. Critical Care Medicine 2019, 47: 1692-1698. PMID: 31567354, DOI: 10.1097/ccm.0000000000004009.Peer-Reviewed Original ResearchConceptsICU teamFamily satisfactionNational collaborativeFamily advisory committeeOverall family satisfactionFamily advisory groupsQuality of careFamily membersICU 24Family engagementClinician surveyNational PatientFamily member involvementPICU teamCare teamCommunity hospitalClinicians' perceptionsOpen visitationPatientsClinical settingICUSignificant increaseSelf-Assessment InventoryHospitalAdvisory CommitteeGap Analysis Regarding Prognostication in Neurocritical Care: A Joint Statement from the German Neurocritical Care Society and the Neurocritical Care Society
Wartenberg KE, Hwang DY, Haeusler K, Muehlschlegel S, Sakowitz OW, Madžar D, Hamer HM, Rabinstein AA, Greer DM, Hemphill JC, Meixensberger J, Varelas PN. Gap Analysis Regarding Prognostication in Neurocritical Care: A Joint Statement from the German Neurocritical Care Society and the Neurocritical Care Society. Neurocritical Care 2019, 31: 231-244. PMID: 31368059, PMCID: PMC6757096, DOI: 10.1007/s12028-019-00769-6.Peer-Reviewed Original ResearchConceptsNeurocritical Care SocietyNeurocritical carePrognostic modelNeurocritical care conditionsNumerous prognostic modelsEvidence-based guidelinesCurrent prognostic modelsMost prognostic modelsProcess of prognosticationMedical comorbiditiesMost patientsNeurocritical illnessCare parametersClinical studiesCare conditionsMethodsAs partPrognosticationRoutine partQualitative gap analysisCareFuture studiesSignificant gapJoint statementAbsence of integrationGuidelines
2018
Neuropalliative care
Creutzfeldt CJ, Kluger B, Kelly AG, Lemmon M, Hwang DY, Galifianakis NB, Carver A, Katz M, Curtis JR, Holloway RG. Neuropalliative care. Neurology 2018, 91: 217-226. PMID: 29950434, PMCID: PMC6093769, DOI: 10.1212/wnl.0000000000005916.Peer-Reviewed Original ResearchConceptsPalliative careNeuropalliative careNeurologic illnessComplex symptom managementModel of carePalliative care educationQuality of carePalliative approachPalliative specialistsSymptom managementClinical priorityPatientsInterventional researchEvidence baseCareCare educationImplementation scienceNeurologistsIllnessInternational expertsNeurologyFamily engagementImportant outcomesOutcomesInvestigative effortsMinority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage
Ormseth CH, Falcone GJ, Jasak SD, Mampre DM, Leasure AC, Miyares LC, Hwang DY, James ML, Testai FD, Becker KJ, Tirschwell DL, Langefeld CD, Woo D, Sheth KN. Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage. Neurocritical Care 2018, 29: 419-425. PMID: 29949003, PMCID: PMC6286261, DOI: 10.1007/s12028-018-0554-4.Peer-Reviewed Original ResearchConceptsIntracerebral hemorrhageHematoma volumeAdmission Glasgow Coma ScaleEthnic/Racial VariationsNon-traumatic intracerebral hemorrhageIntracerebral Hemorrhage (ERICH) studyProspective cohort studyGlasgow Coma ScaleIntensive care unitWithdrawal of careSpontaneous intracerebral hemorrhageSimilar mortality ratesLogistic regression analysisRace/ethnicity modifiesRace/ethnicityCMO patientsHospital mortalityCohort studyRankin ScaleWhite patientsComa ScaleBlack patientsCare unitEndotracheal intubationICH patientsDedicated Afternoon Rounds for ICU Patients’ Families and Family Satisfaction With Care
Weber U, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Huang KB, Hamza M, White J, Coppola A, Akgün KM, Greer DM, Marcolini EG, Gilmore EJ, Petersen NH, Timario N, Poskus K, Sheth KN, Hwang DY. Dedicated Afternoon Rounds for ICU Patients’ Families and Family Satisfaction With Care. Critical Care Medicine 2018, 46: 602-611. PMID: 29300237, DOI: 10.1097/ccm.0000000000002963.Peer-Reviewed Original ResearchConceptsOverall family satisfactionNeuroscience ICUFamily satisfactionCoordination of careAfternoon roundsICU admissionPrimary outcomeICU patientsBedside visitsMean prePostimplementation designComfort measuresPatient's familySecondary analysisICUPatientsCareNursing leadersScoresFamily supportFamily membersWeeksEmotional supportPreComplete satisfactionPrimary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care
Huang KB, Weber U, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Poskus K, Sheth KN, Hwang DY. Primary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care. The Journal Of The American Board Of Family Medicine 2018, 31: 64-72. PMID: 29330241, DOI: 10.3122/jabfm.2018.01.170211.Peer-Reviewed Original ResearchConceptsPatient's primary care physicianPatient's PCPPrimary care physiciansIll patientsPCP involvementPrimary care physician involvementMedical decisionsFamilies of patientsFamily satisfactionICU decisionICU patientsCare physiciansClinical informationPatientsMedical teamSatisfaction scoresIndividual survey itemsPhysician involvementICUMean scoreInvolvementFamily membersCareScoresSurvey items
2017
Variability in Gastrostomy Tube Placement for Intracerebral Hemorrhage Patients at US Hospitals
Hwang DY, George BP, Kelly AG, Schneider EB, Sheth KN, Holloway RG. Variability in Gastrostomy Tube Placement for Intracerebral Hemorrhage Patients at US Hospitals. Journal Of Stroke And Cerebrovascular Diseases 2017, 27: 978-987. PMID: 29221969, DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.001.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCerebral HemorrhageClinical Decision-MakingDatabases, FactualFemaleGastrostomyHealthcare DisparitiesHospitalsHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPractice Patterns, Physicians'Process Assessment, Health CareRetrospective StudiesTime FactorsUnited StatesYoung AdultConceptsGastrostomy tube placementTube placementGastrostomy tubeICH patientsIntracerebral hemorrhageUS hospitalsMultilevel multivariable regression modelsHospital random effectsNationwide Inpatient SampleIntracerebral hemorrhage patientsMultivariable regression modelsLocal practice patternsMedian odds ratioICH hospitalizationsHospital factorsHospital covariatesRegression modelsHemorrhage patientsICH admissionsInpatient SampleOdds ratioPlacement ratesPractice patternsMedian increasePatientsFactors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes
Hwang DY, Chu SY, Dell CA, Sparks MJ, Watson TD, Langefeld CD, Comeau ME, Rosand J, Battey TWK, Koch S, Perez ML, James ML, McFarlin J, Osborne JL, Woo D, Kittner SJ, Sheth KN. Factors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes. Neurocritical Care 2017, 27: 316-325. PMID: 28744847, DOI: 10.1007/s12028-017-0430-7.Peer-Reviewed Original ResearchConceptsIntracerebral hemorrhageRadiographic factorsMethodsThis prospective observational studyClinical scalesPre-existing comorbiditiesProspective observational studyIntracerebral hemorrhage outcomesSubjective clinical judgmentJudgment of physiciansRankin ScaleICH patientsFunctional outcomeUS CentersObservational studyPrognostic scalesClinical teamClinical judgmentFUNC scoreNursesPhysiciansExamination componentsPatientsOutcomesPrognosticationClinicians