2023
Development and validation of a novel score to predict brain death after out-of-hospital cardiac arrest
Kitlen E, Kim N, Rubenstein A, Keenan C, Garcia G, Khosla A, Johnson J, Miller P, Wira C, Greer D, Gilmore E, Beekman R. Development and validation of a novel score to predict brain death after out-of-hospital cardiac arrest. Resuscitation 2023, 192: 109955. PMID: 37661012, DOI: 10.1016/j.resuscitation.2023.109955.Peer-Reviewed Original ResearchMeSH KeywordsBrain DeathCardiopulmonary ResuscitationHumansMiddle AgedOut-of-Hospital Cardiac ArrestRetrospective StudiesRisk FactorsConceptsHospital cardiac arrestBrain deathCardiac arrestOptimal cutEtiology of arrestDeath risk scoreNon-shockable rhythmOperator characteristic curveHours of arrestCenter cohortIndependent predictorsSulcal effacementUnResponsiveness (FOUR) scoreValidation cohortDevelopment cohortMAIN OUTCOMEHigh riskRisk scoreAcademic centersNovel scoreOHCACohortInternal validationRadiology reportsCharacteristic curveIdentification of White Matter Hyperintensities in Routine Emergency Department Visits Using Portable Bedside Magnetic Resonance Imaging
de Havenon A, Parasuram N, Crawford A, Mazurek M, Chavva I, Yadlapalli V, Iglesias J, Rosen M, Falcone G, Payabvash S, Sze G, Sharma R, Schiff S, Safdar B, Wira C, Kimberly W, Sheth K. Identification of White Matter Hyperintensities in Routine Emergency Department Visits Using Portable Bedside Magnetic Resonance Imaging. Journal Of The American Heart Association 2023, 12: e029242. PMID: 37218590, PMCID: PMC10381997, DOI: 10.1161/jaha.122.029242.Peer-Reviewed Original ResearchMeSH KeywordsAdultBrainFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedProspective StudiesRetrospective StudiesWhite MatterConceptsWhite matter hyperintensitiesMagnetic resonance imagingSevere white matter hyperintensitiesConventional magnetic resonance imagingResonance imagingRetrospective cohortEmergency departmentMatter hyperintensitiesVascular risk factorsProspective observational studyVascular cognitive impairmentTesla magnetic resonance imagingArea Deprivation IndexProspective cohortAdult patientsAcute careRisk factorsCardiovascular diseaseObservational studyCognitive impairmentPatientsCare magnetic resonance imagingIntermodality agreementCohortDeprivation indexValidation of the rCAST score and comparison to the PCAC and FOUR scores for prognostication after out-of-hospital cardiac arrest
Kim N, Kitlen E, Garcia G, Khosla A, Miller P, Johnson J, Wira C, Greer D, Gilmore E, Beekman R. Validation of the rCAST score and comparison to the PCAC and FOUR scores for prognostication after out-of-hospital cardiac arrest. Resuscitation 2023, 188: 109832. PMID: 37178901, DOI: 10.1016/j.resuscitation.2023.109832.Peer-Reviewed Original ResearchMeSH KeywordsCardiopulmonary ResuscitationHumansHypothermia, InducedOut-of-Hospital Cardiac ArrestPrognosisRetrospective StudiesConceptsPoor neurologic outcomeUnited States cohortHospital cardiac arrestOHCA patientsNeurologic outcomeCardiac arrestPost-cardiac arrest syndromePoor neurological outcomeScore predictive abilityHospital mortalityNeurological outcomeUnResponsiveness (FOUR) scorePoor outcomeRetrospective studyAccurate outcome predictionPrognostic performanceFull OutlineDeLong testOutcome predictionPatientsMortalityOutcomesScoresCohortPredictive ability
2020
Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic
Jasne AS, Chojecka P, Maran I, Mageid R, Eldokmak M, Zhang Q, Nystrom K, Vlieks K, Askenase M, Petersen N, Falcone GJ, Wira CR, Lleva P, Zeevi N, Narula R, Amin H, Navaratnam D, Loomis C, Hwang DY, Schindler J, Hebert R, Matouk C, Krumholz HM, Spudich S, Sheth KN, Sansing LH, Sharma R. Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic. Stroke 2020, 51: 2664-2673. PMID: 32755347, PMCID: PMC7446978, DOI: 10.1161/str.0000000000000347.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBetacoronavirusBrain IschemiaCohort StudiesComorbidityConnecticutCoronary Artery DiseaseCoronavirus InfectionsCOVID-19DyslipidemiasEmergency Medical ServicesEthnicityFemaleHumansHypertensionIncomeInsurance, HealthIntracranial HemorrhagesMaleMedically UninsuredMiddle AgedOutcome and Process Assessment, Health CarePandemicsPneumonia, ViralRetrospective StudiesSARS-CoV-2Severity of Illness IndexStrokeSubstance-Related DisordersTelemedicineThrombectomyThrombolytic TherapyTime-to-TreatmentConceptsComprehensive stroke centerStroke codePatient characteristicsStroke severityStroke code patientsHistory of hypertensionStroke-like symptomsCoronary artery diseaseCoronavirus disease 2019 (COVID-19) pandemicPatient-level dataLower median household incomePublic health initiativesDisease 2019 pandemicCOVID-19 pandemicRace/ethnicityCode patientsHospital presentationPublic health insuranceRankin ScaleStroke centersArtery diseaseReperfusion timeStroke symptomsEarly outcomesConnecticut hospitals
2017
Neurology Concepts: Young Women and Ischemic Stroke—Evaluation and Management in the Emergency Department
Chang BP, Wira C, Miller J, Akhter M, Barth BE, Willey J, Nentwich L, Madsen T. Neurology Concepts: Young Women and Ischemic Stroke—Evaluation and Management in the Emergency Department. Academic Emergency Medicine 2017, 25: 54-64. PMID: 28646558, PMCID: PMC6415947, DOI: 10.1111/acem.13243.Peer-Reviewed Original ResearchConceptsIschemic strokeYoung womenEmergency departmentRisk factorsSex-specific risk factorsIschemic stroke evaluationAcute ischemic strokeOral contraceptive useBoard-certified emergency physiciansPremenopausal womenAcute settingBroad differentialCerebral hemorrhageStroke evaluationVascular neurologistsNonpregnant individualsPostpartum periodLeading causeEmergency physiciansTimely diagnosisContraceptive useThrombolytic agentsCurrent evidenceStrokeOlder populationEvaluation of a novel 5-group classification system of sepsis by vasopressor use and initial serum lactate in the emergency department
Swenson KE, Dziura JD, Aydin A, Reynolds J, Wira CR. Evaluation of a novel 5-group classification system of sepsis by vasopressor use and initial serum lactate in the emergency department. Internal And Emergency Medicine 2017, 13: 257-268. PMID: 28132131, DOI: 10.1007/s11739-017-1607-y.Peer-Reviewed Original ResearchConceptsInitial serum lactate levelSerum lactate levelsEmergency departmentLactate elevationVasoplegic shockLactate levelsCryptic shockVasopressor useInfected patientsShock mortalityHigh-risk ED patientsGroup mortality rateInitial serum lactateVasopressor-dependent patientsIdentifiable risk factorsSepsis-3 definitionRisk-stratify patientsHigh-risk subgroupsInitial lactate levelProximal phaseVasopressor dependenceVasopressor requirementHospital outcomesED patientsSerum lactate
2016
Risk rtPA: An iOS mobile application based on TURN for predicting 90-day outcome after IV thrombolysis
Asuzu D, Nystrӧm K, Schindler J, Wira C, Greer D, Halliday J, Sheth KN. Risk rtPA: An iOS mobile application based on TURN for predicting 90-day outcome after IV thrombolysis. Clinical Neurology And Neurosurgery 2016, 142: 148-152. PMID: 26875069, DOI: 10.1016/j.clineuro.2016.01.030.Peer-Reviewed Original ResearchMissed Ischemic Stroke Diagnosis in the Emergency Department by Emergency Medicine and Neurology Services
Arch AE, Weisman DC, Coca S, Nystrom KV, Wira CR, Schindler JL. Missed Ischemic Stroke Diagnosis in the Emergency Department by Emergency Medicine and Neurology Services. Stroke 2016, 47: 668-673. PMID: 26846858, DOI: 10.1161/strokeaha.115.010613.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrain IschemiaDiagnostic ErrorsEmergency Medical ServicesEmergency MedicineFemaleHumansMaleNeurologyRetrospective StudiesStrokeConceptsEmergency departmentLarge community hospitalCommunity hospitalIschemic strokeStroke diagnosisAcademic hospitalNausea/vomitingSecondary prevention therapiesAcute ischemic strokeRetrospective chart reviewIschemic stroke diagnosisAcademic teaching hospitalEndovascular considerationsChart reviewPrompt treatmentSymptom onsetPosterior circulationPrevention therapyNeurology serviceAcute interventionAnterior strokeAtypical symptomsStroke historyPosterior strokeTeaching hospital
2015
Lactate Clearance Predicts Survival Among Patients in the Emergency Department with Severe Sepsis
Bhat SR, Swenson KE, Francis MW, Wira CR. Lactate Clearance Predicts Survival Among Patients in the Emergency Department with Severe Sepsis. Western Journal Of Emergency Medicine 2015, 16: 1118-1126. PMID: 26759665, PMCID: PMC4703153, DOI: 10.5811/westjem.2015.10.27577.Peer-Reviewed Original ResearchConceptsSevere sepsisSeptic shockLactate clearanceClearance groupLactate levelsPredictors of mortalityEmergency department patientsInitial lactate levelCross-sectional studySepsis registryVasopressor supportED stayDepartment patientsHospital interventionsMechanical ventilationEmergency departmentLactate changesSepsisPatientsMortality rateHigh mortalityHospital floorMortalityClearanceEDTURN Score Predicts 24-Hour Cerebral Edema After IV Thrombolysis
Asuzu D, Nyström K, Sreekrishnan A, Schindler J, Wira C, Greer D, Halliday J, Kimberly WT, Sheth KN. TURN Score Predicts 24-Hour Cerebral Edema After IV Thrombolysis. Neurocritical Care 2015, 24: 381-388. PMID: 26341364, DOI: 10.1007/s12028-015-0198-6.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageBrain swellingIntracerebral hemorrhageCerebral edemaPoor outcomeSevere outcomesOdds ratioLogistic regression reporting odds ratiosNINDS rt-PA trialIschemic stroke patientsReporting odds ratioNew brainNew onsetMidline shiftStroke patientsRt-PAEdemaThrombolysisMortalityOutcomesMass effectCharacteristic curveHemorrhagePatientsStatistical associationCohort-Based Identification of Predictors of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis
Asuzu D, Nyström K, Amin H, Schindler J, Wira C, Greer D, Chi NF, Halliday J, Sheth KN. Cohort-Based Identification of Predictors of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis. Neurocritical Care 2015, 23: 394-400. PMID: 25691004, DOI: 10.1007/s12028-015-0121-1.Peer-Reviewed Original ResearchConceptsRt-PA therapyEarly CT hypodensityHyperdense MCA signCT hypodensityIschemic strokeIndependent predictorsRisk of sICHSymptomatic intracerebral hemorrhageAcute ischemic strokeVisual field deficitsNew independent predictorAdditional independent predictorsCase-control studyIdentification of predictorsLevel of consciousnessTwo-sample t-testMann-Whitney testAntithrombolytic therapyStroke centersField deficitsSerious complicationsIntracerebral hemorrhageClinical parametersIntracranial hemorrhageTherapy
2014
Modest Association between the Discharge Modified Rankin Scale Score and Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis
Asuzu D, Nystrom K, Amin H, Schindler J, Wira C, Greer D, Fang NF, Halliday J, Sheth KN. Modest Association between the Discharge Modified Rankin Scale Score and Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis. Journal Of Stroke And Cerebrovascular Diseases 2014, 24: 548-553. PMID: 25540072, DOI: 10.1016/j.jstrokecerebrovasdis.2014.09.034.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousArea Under CurveBrain IschemiaCerebral HemorrhageChi-Square DistributionConnecticutDecision Support TechniquesDisability EvaluationFemaleFibrinolytic AgentsHumansLogistic ModelsMaleOdds RatioPatient DischargePredictive Value of TestsRetrospective StudiesRisk AssessmentRisk FactorsROC CurveStrokeThrombolytic TherapyTime FactorsTreatment OutcomeConceptsDischarge mRS scoreSymptomatic intracerebral hemorrhageRankin Scale scoreMRS scoreClinical scoresAdverse outcomesIntracerebral hemorrhageScale scoreModified Rankin Scale scoreLong-term adverse outcomesYale-New Haven HospitalIntravenous thrombolytic therapyIschemic stroke patientsUnivariate logistic regressionHosmer-Lemeshow statisticNew Haven HospitalMRS dataIntravenous thrombolysisThrombolytic therapyStroke patientsClinical benefitModest agreementClinical dataLogistic regressionModest associationComparison of 8 Scores for predicting Symptomatic Intracerebral Hemorrhage after IV Thrombolysis
Asuzu D, Nystrom K, Amin H, Schindler J, Wira C, Greer D, Chi NF, Halliday J, Sheth KN. Comparison of 8 Scores for predicting Symptomatic Intracerebral Hemorrhage after IV Thrombolysis. Neurocritical Care 2014, 22: 229-233. PMID: 25168743, DOI: 10.1007/s12028-014-0060-2.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageRt-PA therapyStroke-TPIThrombolytic therapyClinical scoresIntracerebral hemorrhageOdds ratioPredictors of sICHAcute ischemic stroke patientsYale-New Haven HospitalRt-PA treatmentIschemic stroke patientsHosmer-Lemeshow statisticBackgroundIntracerebral hemorrhageConsecutive patientsFeared complicationMethodsClinical dataStroke patientsAdverse outcomesStudy criteriaPatientsTherapyHemorrhageLogistic regressionSPAN-100The Shock Index as a Predictor of Vasopressor Use in Emergency Department Patients with Severe Sepsis
Wira CR, Francis MW, Bhat S, Ehrman R, Conner D, Siegel M. The Shock Index as a Predictor of Vasopressor Use in Emergency Department Patients with Severe Sepsis. Western Journal Of Emergency Medicine 2014, 15: 60-66. PMID: 24696751, PMCID: PMC3952891, DOI: 10.5811/westjem.2013.7.18472.Peer-Reviewed Original ResearchConceptsSevere sepsisEmergency departmentVasopressor useCardiovascular collapseOrgan failureElevation groupEscalation of careEmergency department patientsCross-sectional studySepsis registryVasopressor dependenceED admissionDepartment patientsInitial presentationShock indexED patientsRisk stratificationLeading causeUseful modalityPatientsSepsisDisease escalationEarly identificationMean numberHigh rate
2012
Missed Opportunities for Recognition of Ischemic Stroke in the Emergency Department
Lever NM, Nyström KV, Schindler JL, Halliday J, Wira C, Funk M. Missed Opportunities for Recognition of Ischemic Stroke in the Emergency Department. Journal Of Emergency Nursing 2012, 39: 434-439. PMID: 22633790, DOI: 10.1016/j.jen.2012.02.011.Peer-Reviewed Original ResearchConceptsNontraditional symptomsIschemic strokeEmergency departmentSymptom presentationDiagnostic accuracyYale-New Haven HospitalComprehensive neurological evaluationGeneralized weaknessNeurological evaluationStroke symptomsMedical recordsMental statusEmergency nursesPatientsAppropriate managementSymptomsStrokeDiagnosisStrong associationSymptom typeHospitalPresentationMissed opportunityDescriptive statisticsAssociation
2011
Epidemiology and Outcomes of Fever Burden Among Patients With Acute Ischemic Stroke
Phipps MS, Desai RA, Wira C, Bravata DM. Epidemiology and Outcomes of Fever Burden Among Patients With Acute Ischemic Stroke. Stroke 2011, 42: 3357-3362. PMID: 21980196, DOI: 10.1161/strokeaha.111.621425.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBody TemperatureBrain IschemiaFemaleFeverHospital MortalityHumansMaleMiddle AgedPrognosisRetrospective StudiesStrokeConceptsHigher fever burdenFever burdenFever eventsIschemic strokeStroke patientsAcute ischemic stroke patientsAcute ischemic strokeIschemic stroke patientsOdds of deathPoor patient outcomesAspects of feverFever daysHospital mortalityMedian tmaxClinical characteristicsRetrospective cohortStroke severityFebrile patientsFever episodesOutcome ratesOdds ratioPatient outcomesPatientsFeverLogistic regressionEtomidate use in severe sepsis and septic shock patients does not contribute to mortality
Ehrman R, Wira C, Lomax A, Hayward A, Marcelin J, Ellis T, Przyklenk K, Volturo G, Mullen M. Etomidate use in severe sepsis and septic shock patients does not contribute to mortality. Internal And Emergency Medicine 2011, 6: 253-257. PMID: 21394520, DOI: 10.1007/s11739-011-0553-3.Peer-Reviewed Original ResearchConceptsUse of etomidateSeptic shock patientsSevere sepsisEtomidate useShock patientsSeptic shockEtomidate groupSevere sepsis/septic shock patientsSepsis/septic shock patientsUniversity tertiary care referral centerIntensive care unit lengthRetrospective multi-center studyTertiary care referral centerMechanical ventilation daysAPACHE II scoreUse of corticosteroidsRetrospective chart reviewMulti-center studyHospital mortalityII scorePrimary endpointVentilation daysAdrenal insufficiencyChart reviewPatient demographics
2007
Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients
Donnino MW, Miller J, Goyal N, Loomba M, Sankey SS, Dolcourt B, Sherwin R, Otero R, Wira C. Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients. Resuscitation 2007, 75: 229-234. PMID: 17583412, DOI: 10.1016/j.resuscitation.2007.03.021.Peer-Reviewed Original ResearchConceptsPost-cardiac arrest patientsHigher lactate clearanceArrest patientsLactate clearanceAPACHE II scoreCardiac arrest patientsInitial lactate levelUrban emergency departmentPre-hospital providersEmergency medical servicesHospital mortalityTraumatic arrestHospital courseHospital survivalII scorePrimary endpointHospital dischargeImproved mortalityOverall mortalityMean lactateMultivariable analysisSuccessful resuscitationCardiac arrestEmergency departmentMean age