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 ResearchConceptsHospital 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 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 index
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 hospitalsCT 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 ResearchMeSH KeywordsAgedAged, 80 and overComputed Tomography AngiographyCost-Benefit AnalysisHumansMiddle AgedStrokeTriageConceptsLarge 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
Guiding Cardiopulmonary Resuscitation with Focused Echocardiography: A Report of Five Cases
Liu R, Bogucki S, Marcolini EG, Yu CY, Wira CR, Kalam S, Daley J, Moore CL, Cone D. Guiding Cardiopulmonary Resuscitation with Focused Echocardiography: A Report of Five Cases. Prehospital Emergency Care 2019, 24: 297-302. PMID: 31150302, DOI: 10.1080/10903127.2019.1626955.Peer-Reviewed Original ResearchConceptsCardiopulmonary resuscitationCardiac arrestEchocardiography studyFocused echocardiographyAdvanced cardiac life support algorithmLeft ventricular compressionCardiac arrest patientsEnd-tidal carbon dioxide valuesHospital cardiac arrestTransthoracic echocardiography studyFocused transthoracic echocardiographyTidal carbon dioxide valuesTransthoracic echocardiographyVentricular compressionArrest patientsPatient outcomesHemodynamic parametersPulse checksEchocardiographyInadequate compressionResuscitationCarbon dioxide valuesUltrasound timingPhysical performanceUltrasound performance
2017
Evaluation 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
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 ageValidation 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 floorMortalityClearanceEDOn- 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 patientsPrognostication of post-cardiac arrest coma: early clinical and electroencephalographic predictors of outcome
Sivaraju A, Gilmore EJ, Wira CR, Stevens A, Rampal N, Moeller JJ, Greer DM, Hirsch LJ, Gaspard N. Prognostication of post-cardiac arrest coma: early clinical and electroencephalographic predictors of outcome. Intensive Care Medicine 2015, 41: 1264-1272. PMID: 25940963, DOI: 10.1007/s00134-015-3834-x.Peer-Reviewed Original ResearchConceptsBetter outcomesPoor outcomeEpileptiform dischargesPost-cardiac arrest comatose patientsCritical care EEG terminologyPost-cardiac arrest comaMethodsProspective cohort studyContinuous EEG monitoringLow-voltage EEGPositive predictive valueAbsence of reactivityEEG terminologyCohort studySpontaneous circulationBrainstem reflexesClinical outcomesComatose patientsFalse positive ratePoor prognosisPrognostic significanceSuppression burstsClinical variablesClinical correlatesElectroencephalographic patternsElectroencephalographic predictors
2014
Comparison 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 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 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