2023
Association of Neighborhood-Level Socioeconomic Factors With Delay to Hospital Arrival in Patients With Acute Stroke
Forman R, Okumu R, Mageid R, Baker A, Neu D, Parker R, Peyravi R, Schindler J, Sansing L, Sheth K, de Havenon A, Jasne A, Narula R, Wira C, Warren J, Sharma R. Association of Neighborhood-Level Socioeconomic Factors With Delay to Hospital Arrival in Patients With Acute Stroke. Neurology 2023, 102: e207764. PMID: 38165368, PMCID: PMC10834135, DOI: 10.1212/wnl.0000000000207764.Peer-Reviewed Original ResearchConceptsEmergency department arrival timesEmergency medical servicesLate presentationAcute ischemic stroke therapyYale-New Haven HospitalGuidelines-Stroke registryNeighborhood-level socioeconomic factorsPatient-level factorsRetrospective observational studyIschemic stroke therapyMixed-effects logistic regression modelNon-white patientsNon-white raceUnivariate logistic regressionNew Haven HospitalLogistic regression modelsHospital presentationTreatment ineligibilityStroke RegistryAcute strokeHospital arrivalStroke therapyUnivariate analysisObservational studyPatientsIdentification 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 ResearchConceptsWhite 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 ResearchConceptsPoor 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
2021
Drip-and-ship versus mothership for endovascular treatment of acute stroke: A comparative effectiveness analysis
Wu X, Wira C, Matouk C, Forman H, Gandhi D, Sanelli P, Schindler J, Malhotra A. Drip-and-ship versus mothership for endovascular treatment of acute stroke: A comparative effectiveness analysis. International Journal Of Stroke 2021, 17: 315-322. PMID: 33759645, DOI: 10.1177/17474930211008701.Peer-Reviewed Original ResearchConceptsComprehensive stroke centerPrimary stroke centerAcute stroke patientsNearest comprehensive stroke centerAcute strokeMothership strategyStroke centersStroke patientsPlace of onsetHealth benefitsMarkov decision-analytic modelComparative effectiveness analysisRecent medical literatureMultiple sensitivity analysesDecision analytic modelMothership modelPrimary outcomeEndovascular treatmentPrehospital triageSudden onsetPatientsMedical literatureStrokeShip strategyTarget population
2020
Prehospital Triage of Acute Stroke Patients During the COVID-19 Pandemic
Goyal M, Ospel JM, Southerland AM, Wira C, Amin-Hanjani S, Fraser JF, Panagos P, Committees O. Prehospital Triage of Acute Stroke Patients During the COVID-19 Pandemic. Stroke 2020, 51: 2263-2267. PMID: 32401680, DOI: 10.1161/strokeaha.120.030340.Peer-Reviewed Original ResearchMeSH KeywordsAcute DiseaseAsymptomatic DiseasesBetacoronavirusCanadaCoronavirus InfectionsCOVID-19Delayed DiagnosisEmergency Medical ServicesEquipment ContaminationHealth WorkforceHumansInfectious Disease Transmission, Patient-to-ProfessionalInfectious Disease Transmission, Professional-to-PatientOccupational DiseasesPandemicsPneumonia, ViralProtective DevicesResource AllocationSARS-CoV-2StrokeSymptom AssessmentTime-to-TreatmentTransportation of PatientsTravelTriageUnconsciousnessWorkflowConceptsPatient triageAcute stroke patientsCoronavirus disease 2019 (COVID-19) pandemicEmergency medical services (EMS) providersDisease 2019 pandemicInfectious exposureStroke patientsPrehospital triageMedical service providersStatement paperPatientsTimely transferTriageCOVID-19COVID-19 pandemicHealthcare emergencyPandemicDeployment of Portable, Bedside, Low-field Magnetic Resonance Imaging for Evaluation of Stroke Patients (272)
Cahn B, Shah J, Dyvorne H, O’Halloran R, Poole M, Yuen M, Mazurek M, Ward A, Payabvash S, Beekman R, Brown S, Falcone G, Gobeske K, Petersen N, Jasne A, Sharma R, Schindler J, Sansing L, Gilmore E, Wira C, Matouk C, Sze G, Rosen M, Kimberly W, Sheth K. Deployment of Portable, Bedside, Low-field Magnetic Resonance Imaging for Evaluation of Stroke Patients (272). Neurology 2020, 94 DOI: 10.1212/wnl.94.15_supplement.272.Peer-Reviewed Original ResearchCT 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
2016
The Advanced Reperfusion Era: Implications for Emergency Systems of Ischemic Stroke Care
Miller JB, Merck LH, Wira CR, Meurer WJ, Schrock JW, Nomura JT, Siket MS, Madsen TE, Wright DW, Panagos PD, Lewandowski C. The Advanced Reperfusion Era: Implications for Emergency Systems of Ischemic Stroke Care. Annals Of Emergency Medicine 2016, 69: 192-201. PMID: 27600649, DOI: 10.1016/j.annemergmed.2016.06.042.Peer-Reviewed Original ResearchConceptsStroke careLarge-vessel ischemic strokeEndovascular stroke treatmentIschemic stroke careEmergency medicine cliniciansEndovascular careReperfusion eraIschemic strokeStroke treatmentEndovascular treatmentTreatment paradigmLeading causeMedicine cliniciansTimely treatmentCarePatientsHospitalTreatmentMorbidityStrokeMortalityCliniciansCentral roleValidation of TURN, a simple predictor of symptomatic intracerebral hemorrhage after IV thrombolysis
Asuzu D, Nystrӧm K, Amin H, Schindler J, Wira C, Greer D, Fang NF, Halliday J, Sheth KN. Validation of TURN, a simple predictor of symptomatic intracerebral hemorrhage after IV thrombolysis. Clinical Neurology And Neurosurgery 2016, 146: 71-75. PMID: 27152469, DOI: 10.1016/j.clineuro.2016.04.017.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageIntracerebral hemorrhageRt-PAOdds ratioYale-New Haven HospitalNINDS rt-PA trialIschemic stroke patientsNew Haven HospitalTwo-sample t-testStroke patientsCharacteristic curveThrombolysisHemorrhageSignificant differencesPatientsT-testScoresExternal datasetSimple predictorInternal datasetHospital
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 associationThe Emergency Medicine Debate on tPA for Stroke: What Is Best for Our Patients? Efficacy in the First Three Hours
Miller JB, Heitsch L, Siket MS, Schrock JW, Wira CR, Lewandowski C, Madsen TE, Merck LH, Wright DW, Group. F. The Emergency Medicine Debate on tPA for Stroke: What Is Best for Our Patients? Efficacy in the First Three Hours. Academic Emergency Medicine 2015, 22: 852-855. PMID: 26113369, DOI: 10.1111/acem.12712.Peer-Reviewed Original Research
2014
Early Identification and Management of Patients with Severe Sepsis and Septic Shock in the Emergency Department
Keegan J, Wira CR. Early Identification and Management of Patients with Severe Sepsis and Septic Shock in the Emergency Department. Emergency Medicine Clinics Of North America 2014, 32: 759-776. PMID: 25441033, DOI: 10.1016/j.emc.2014.07.002.Peer-Reviewed Original ResearchComparison 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-100HAT Score Outperforms 7 Other Hemorrhagic Transformation Scores in Ischemic Stroke Patients Treated with Thrombolysis (P3.109)
Asuzu D, Nystrom K, Halliday J, Wira C, Greer D, Schindler J, Sheth K. HAT Score Outperforms 7 Other Hemorrhagic Transformation Scores in Ischemic Stroke Patients Treated with Thrombolysis (P3.109). Neurology 2014, 82 DOI: 10.1212/wnl.82.10_supplement.p3.109.Peer-Reviewed Original ResearchThe 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 rateMeta-analysis of Protocolized Goal-Directed Hemodynamic Optimization for the Management of Severe Sepsis and Septic Shock in the Emergency Department
Wira CR, Dodge K, Sather J, Dziura J. Meta-analysis of Protocolized Goal-Directed Hemodynamic Optimization for the Management of Severe Sepsis and Septic Shock in the Emergency Department. Western Journal Of Emergency Medicine 2014, 15: 51-59. PMID: 24696750, PMCID: PMC3952890, DOI: 10.5811/westjem.2013.7.6828.Peer-Reviewed Original Research
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 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
2008
Clinical risk stratification for gastrointestinal hemorrhage: still no consensus
Wira C, Sather J. Clinical risk stratification for gastrointestinal hemorrhage: still no consensus. Critical Care 2008, 12: 154. PMID: 18533048, PMCID: PMC2481453, DOI: 10.1186/cc6900.Peer-Reviewed Original ResearchConceptsGastrointestinal hemorrhageRisk stratificationLower gastrointestinal hemorrhageComprehensive practice guidelinesClinical risk stratificationHospital complicationsUnstable comorbiditiesOngoing bleedingStable patientsCritical carePractice guidelinesLower riskBLEED criteriaLack of consensusHemorrhagePatientsFurther investigationBleedingComorbiditiesPrevious studiesComplicationsStratificationCare