2020
CT Angiography for Triage of Patients with Acute Minor Stroke: A Cost-effectiveness Analysis.
Wu X, Hughes DR, Gandhi D, Matouk CC, Sheth K, Schindler J, Wira C, Wintermark M, Sanelli P, Malhotra A. CT Angiography for Triage of Patients with Acute Minor Stroke: A Cost-effectiveness Analysis. Radiology 2020, 294: 580-588. PMID: 31934828, DOI: 10.1148/radiol.2019191238.Peer-Reviewed Original ResearchConceptsLarge vessel occlusionAcute minor strokeBest medical managementMinor strokeCT angiographyMedical managementProbabilistic sensitivity analysesLower health benefitsImmediate thrombectomyHealth benefitsHealth outcomesVascular imagingAcute ischemic strokeMarkov decision-analytic modelWorse health outcomesImproved health outcomesDecision analytic modelNet monetary benefitIntravenous thrombolysisIschemic strokeYounger patientsThrombectomy strategyPatientsAngiographyStroke
2018
Is There a Neurologist in the House? A Summary of the Current State of Neurovascular Rotations for Emergency Medicine Residents
Wira CR, Madsen TE, Chang BP, Nomura JT, Marcolini E, Gentile NT, Schreyer KE, Merck LH, Siket M, Greenberg K, Zammit CG, Jauch EC, Bellolio M, Group F. Is There a Neurologist in the House? A Summary of the Current State of Neurovascular Rotations for Emergency Medicine Residents. AEM Education And Training 2018, 2: s56-s67. PMID: 30607380, PMCID: PMC6304277, DOI: 10.1002/aet2.10200.Peer-Reviewed Original ResearchNeurocritical careEmergency medicine residentsHealth Stroke ScaleAcute ischemic strokeMedicine residentsMorbidity/mortalityBoard-certified emergency physiciansNational practice guidelinesEM residency trainingStroke ScaleAcute strokeIschemic strokeIntracerebral hemorrhageLeading causeConsensus reviewEmergency physiciansPractice guidelinesNeurology rotationTherapeutic interventionsCare rotationMajority of programsEducational interventionStrokeClinical timeClinical duties
2017
Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review
McGregor AJ, Beauchamp GA, Wira CR, Perman SM, Safdar B. Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review. Western Journal Of Emergency Medicine 2017, 18: 1079-1090. PMID: 29085541, PMCID: PMC5654878, DOI: 10.5811/westjem.2017.8.34997.Peer-Reviewed Original ResearchConceptsClinical practiceAcute ischemic strokeAcute myocardial infarctionEmergency medicineBrief narrative reviewSex-based researchEmergency medicine researchIschemic strokeTherapy administrationPatient sexMyocardial infarctionEmergency carePatient careNarrative reviewEvidence-based researchCase-based scenariosNational InstituteBiological variablesCareSexMedicine researchSABVInfarctionBody of literatureStrokeNeurology 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 population
2016
Volume of Plasma Expansion and Functional Outcomes in Stroke
Miller JB, Lewandowski C, Wira CR, Taylor A, Burmeister C, Welch R. Volume of Plasma Expansion and Functional Outcomes in Stroke. Neurocritical Care 2016, 26: 191-195. PMID: 27629275, DOI: 10.1007/s12028-016-0316-0.Peer-Reviewed Original ResearchConceptsNeurological recoveryNIHSS scoreIschemic strokeFunctional outcomeFavorable outcomeMultivariable-adjusted logistic regression modelsModified Rankin Scale scoreLarge-vessel ischemic strokeHigher NIHSS scoreIsotonic saline treatmentMedian National InstitutesWorse neurological recoveryHealth Stroke ScaleAcute ischemic strokeMultivariable-adjusted modelsRankin Scale scoreIntravenous volume infusionConclusionsThe present studyLogistic regression modelsStroke ScaleStudy patientsAcute strokeCerebral perfusionClinical outcomesMean ageMissed 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 ResearchConceptsEmergency 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
Cohort-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
2011
Cardiac Complications in Acute Ischemic Stroke
Wira CR, Rivers E, Martinez-Capolino C, Silver B, Iyer G, Sherwin R, Lewandowski C. Cardiac Complications in Acute Ischemic Stroke. Western Journal Of Emergency Medicine 2011, 12: 414-420. PMID: 22224130, PMCID: PMC3236132, DOI: 10.5811/westjem.2011.2.1765.Peer-Reviewed Original ResearchHospital mortality rateCardiac complicationsTroponin elevationIschemic changesAtrial fibrillationAIS patientsEmergency departmentMortality rateSystolic dysfunctionAcute ischemic stroke patientsRetrospective cross-sectional studyActive atrial fibrillationAcute ischemic strokeHours of admissionIschemic stroke patientsUrban emergency departmentCross-sectional studySerum troponin elevationAcute presentationIschemic strokeSymptom onsetEjection fractionStroke patientsSubgroup analysisAdjunctive roleEpidemiology 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 ResearchConceptsHigher 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 regression