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 studyPatientsDiagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association
Amin H, Madsen T, Bravata D, Wira C, Johnston S, Ashcraft S, Burrus T, Panagos P, Wintermark M, Esenwa C, Disease O. Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association. Stroke 2023, 54: e109-e121. PMID: 36655570, DOI: 10.1161/str.0000000000000418.Peer-Reviewed Original ResearchConceptsTransient ischemic attackIschemic attackMaximal medical therapyHigh-risk patientsCorrect clinical diagnosisRisk stratification scaleAmerican Heart AssociationEmergency department settingFuture cerebrovascular eventsScientific statementTime of evaluationCerebrovascular eventsSecondary preventionStroke riskMedical therapyNeurological examinationAcute phaseIndex eventHeart AssociationDepartment settingPatient educationAncillary testingCerebral vasculatureConfirmatory testingClinical diagnosis
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
Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care
Rajendram P, Notario L, Reid C, Wira CR, Suarez JI, Weingart SD, Khosravani H. Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care. Neurocritical Care 2020, 33: 338-346. PMID: 32794144, PMCID: PMC7426067, DOI: 10.1007/s12028-020-01057-4.Peer-Reviewed Original ResearchStroke 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 hospitalsPrehospital 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 emergencyPandemicCT 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
2019
Stroke Center Certification and Performance: A Longitudinal Analysis of the Northeast Cerebrovascular Consortium Region.
Wira CR, Melluzzo S, Beasley TM, Magdon-Ismail Z, Day D, Madsen TE, McCullough LD, Stein J, Schwamm LH, Gropen T. Stroke Center Certification and Performance: A Longitudinal Analysis of the Northeast Cerebrovascular Consortium Region. The Yale Journal Of Biology And Medicine 2019, 92: 587-596. PMID: 31866774, PMCID: PMC6913814.Peer-Reviewed Original ResearchThe Future of Minor Stroke and Transient Ischemic Attack: The RAVEN Approach Is Promising but Not Ready for Prime Time
Madsen TE, Wira CR. The Future of Minor Stroke and Transient Ischemic Attack: The RAVEN Approach Is Promising but Not Ready for Prime Time. Annals Of Emergency Medicine 2019, 74: 572-574. PMID: 31543123, DOI: 10.1016/j.annemergmed.2019.08.458.Peer-Reviewed Original Research
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 ageThe 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 datasetHospitalRisk 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 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
On- versus Off-Hour Patient Cohorts at a Primary Stroke Center: Onset-to-Treatment Duration and Clinical Outcomes after IV Thrombolysis
Asuzu D, Nystrӧm K, Amin H, Schindler J, Wira C, Greer D, Fang NF, Halliday J, Sheth KN. On- versus Off-Hour Patient Cohorts at a Primary Stroke Center: Onset-to-Treatment Duration and Clinical Outcomes after IV Thrombolysis. Journal Of Stroke And Cerebrovascular Diseases 2015, 25: 447-451. PMID: 26654664, DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.017.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhagePrimary stroke centerClinical outcomesStroke centersStroke severitySymptom onsetStroke careStroke patientsPatient cohortIntravenous recombinant tissue plasminogen activator (rt-PA) therapyTreatment durationRecombinant tissue plasminogen activator therapyHealth Stroke Scale scoreTissue plasminogen activator therapyConsistent quality careBaseline National InstitutesStroke Scale scoreAcute stroke careIschemic stroke patientsPlasminogen activator therapyMann-Whitney testSICH rateAcute strokeIschemic strokeConsecutive patientsTURN 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 associationTURN Score Predicts 90-day Outcome in Acute Ischemic Stroke Patients After IV Thrombolysis
Asuzu D, Nyström K, Schindler J, Wira C, Greer D, Halliday J, Sheth KN. TURN Score Predicts 90-day Outcome in Acute Ischemic Stroke Patients After IV Thrombolysis. Neurocritical Care 2015, 23: 172-178. PMID: 26032809, DOI: 10.1007/s12028-015-0154-5.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageGOS scoreSevere outcomesConfidence intervalsOdds ratioLogistic regression reporting odds ratiosScale scoreAcute ischemic stroke patientsGlasgow Outcome Scale scoreSPAN-100NINDS rt-PA trialIschemic stroke patientsBarthel Index scoreRankin Scale scoreReporting odds ratioStroke-TPIMRS scoreIntracerebral hemorrhageClinical scoresStroke patientsExcellent outcomesRt-PABI scoreIndex scoreOutcomesTURN: A Simple Predictor 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. TURN: A Simple Predictor of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis. Neurocritical Care 2015, 23: 166-171. PMID: 25869481, DOI: 10.1007/s12028-015-0131-z.Peer-Reviewed Original ResearchConceptsSymptomatic intracerebral hemorrhageBaseline NIHSS scorePrestroke mRS scoreNIHSS scoreMRS scoreIntracerebral hemorrhageRt-PAOdds ratioYale-New Haven HospitalNINDS rt-PA trialIschemic stroke patientsIschemic stroke treatmentIndependent predictorsStroke treatmentStroke patientsClinical parametersPlatelet countHyperacute strokeDerivation datasetThrombolysisLogistic regressionSubstantial riskNew scoreCharacteristic curveHemorrhage