2022
Effect of Early vs Standard Approach to Tracheostomy on Functional Outcome at 6 Months Among Patients With Severe Stroke Receiving Mechanical Ventilation
Bösel J, Niesen WD, Salih F, Morris NA, Ragland JT, Gough B, Schneider H, Neumann JO, Hwang DY, Kantamneni P, James ML, Freeman WD, Rajajee V, Rao CV, Nair D, Benner L, Meis J, Klose C, Kieser M, Suarez JI, Schönenberger S, Seder DB, Ramadan A, Claassen J, Mayer S, Peled H, Christianson T, May T, Riker R, Asgarpur G, Stetefeld H, Kluge S. Effect of Early vs Standard Approach to Tracheostomy on Functional Outcome at 6 Months Among Patients With Severe Stroke Receiving Mechanical Ventilation. JAMA 2022, 327: 1899-1909. PMID: 35506515, PMCID: PMC9069344, DOI: 10.1001/jama.2022.4798.Peer-Reviewed Original ResearchConceptsEarly tracheostomy groupEarly tracheostomyMechanical ventilationSevere strokeFunctional outcomeStandard tracheostomyTracheostomy groupPrimary outcomeControl groupProlonged invasive mechanical ventilationModified Rankin Scale scoreSevere disabilityInvasive mechanical ventilationSerious adverse eventsRankin Scale scoreAirway protective reflexesRate of survivalInvasive ventilationAdverse eventsHemorrhagic strokeWide confidence intervalsAvailable followProtective reflexesCare centerClinical trials
2021
Predictors of Surrogate Decision Makers Selecting Life-Sustaining Therapy for Severe Acute Brain Injury Patients: An Analysis of US Population Survey Data
Garg A, Soto AL, Knies AK, Kolenikov S, Schalk M, Hammer H, White DB, Holloway RG, Sheth KN, Fraenkel L, Hwang DY. Predictors of Surrogate Decision Makers Selecting Life-Sustaining Therapy for Severe Acute Brain Injury Patients: An Analysis of US Population Survey Data. Neurocritical Care 2021, 35: 468-479. PMID: 33619667, PMCID: PMC8380750, DOI: 10.1007/s12028-021-01200-9.Peer-Reviewed Original ResearchConceptsSevere acute brain injuryAcute brain injuryLife-sustaining treatmentSurrogate decision makersBrain injuryAcute brain injury patientsPatient's surrogate decision makersSevere disabilityPoor neurological prognosisIntensive care unitSevere brain injuryLife-Sustaining TherapyBrain injury patientsCost of careYounger age groupsCross-sectional survey studyUS population sampleBinary logistic regressionNeurological prognosisIndependent predictorsCare unitInjury patientsPoor prognosisMale genderUnivariate analysis
2020
The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage.
Reznik ME, Moody S, Murray K, Costa S, Grory BM, Madsen TE, Mahta A, Wendell LC, Thompson BB, Rao SS, Stretz C, Sheth KN, Hwang DY, Zahuranec DB, Schrag M, Daiello LA, Asaad WF, Jones RN, Furie KL. The impact of delirium on withdrawal of life-sustaining treatment after intracerebral hemorrhage. Neurology 2020, 95: e2727-e2735. PMID: 32913011, PMCID: PMC7734724, DOI: 10.1212/wnl.0000000000010738.Peer-Reviewed Original ResearchConceptsImpact of deliriumIntracerebral hemorrhageLife-sustaining treatmentScore-based modelSingle-center cohort studyCox regression modelCharacteristic curve analysisDSM-5 criteriaHospital daysCohort studyConsecutive patientsMedian timeDelirium groupPoor outcomeDeliriumWLSTPatientsLogistic regressionCurve analysisHemorrhageGoals-of-care decision aid for critically ill patients with TBI: Development and feasibility testing.
Muehlschlegel S, Hwang DY, Flahive J, Quinn T, Lee C, Moskowitz J, Goostrey K, Jones K, Pach JJ, Knies AK, Shutter L, Goldberg R, Mazor KM. Goals-of-care decision aid for critically ill patients with TBI: Development and feasibility testing. Neurology 2020, 95: e179-e193. PMID: 32554766, PMCID: PMC7455326, DOI: 10.1212/wnl.0000000000009770.Peer-Reviewed Original ResearchConceptsCare decision aidSurrogates of patientsEarly feasibilityFeasibility trial protocolTraumatic brain injuryDecision aidConsecutive patientsIll patientsFeasibility trialStudy protocolTrial protocolBrain injuryInterim analysisCare communicationPatientsPaper-based decision aidExcellent usabilityComplete dataFeasibility testingHigh rateFamily membersBehavioral outcomesQualitative studyAcceptabilityIterative revisionsConcerns of surrogate decision makers for patients with acute brain injury: A US population survey.
Hwang DY, Knies AK, Mampre D, Kolenikov S, Schalk M, Hammer H, White DB, Holloway RG, Sheth KN, Fraenkel L. Concerns of surrogate decision makers for patients with acute brain injury: A US population survey. Neurology 2020, 94: e2054-e2068. PMID: 32341190, PMCID: PMC7282883, DOI: 10.1212/wnl.0000000000009406.Peer-Reviewed Original ResearchConceptsSevere acute brain injurySevere functional disabilityAcute brain injurySurrogate decision makersBrain injuryLatent class analysisPatient's wishesVegetative stateLong-term careFunctional disabilityPoor prognosisUS population surveySD groupPrognostic accuracyHypothetical patientsPatientsUS populationAdditional groupOlder adultsFuture interventionsCompletion ratesInjuryFamily consensusPopulation surveyUnique concerns
2019
Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs.
Kleinpell R, Zimmerman J, Vermoch KL, Harmon LA, Vondracek H, Hamilton R, Hanson B, Hwang DY. Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs. Critical Care Medicine 2019, 47: 1692-1698. PMID: 31567354, DOI: 10.1097/ccm.0000000000004009.Peer-Reviewed Original ResearchConceptsICU teamFamily satisfactionNational collaborativeFamily advisory committeeOverall family satisfactionFamily advisory groupsQuality of careFamily membersICU 24Family engagementClinician surveyNational PatientFamily member involvementPICU teamCare teamCommunity hospitalClinicians' perceptionsOpen visitationPatientsClinical settingICUSignificant increaseSelf-Assessment InventoryHospitalAdvisory Committee
2018
Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage
Ormseth CH, Falcone GJ, Jasak SD, Mampre DM, Leasure AC, Miyares LC, Hwang DY, James ML, Testai FD, Becker KJ, Tirschwell DL, Langefeld CD, Woo D, Sheth KN. Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage. Neurocritical Care 2018, 29: 419-425. PMID: 29949003, PMCID: PMC6286261, DOI: 10.1007/s12028-018-0554-4.Peer-Reviewed Original ResearchConceptsIntracerebral hemorrhageHematoma volumeAdmission Glasgow Coma ScaleEthnic/Racial VariationsNon-traumatic intracerebral hemorrhageIntracerebral Hemorrhage (ERICH) studyProspective cohort studyGlasgow Coma ScaleIntensive care unitWithdrawal of careSpontaneous intracerebral hemorrhageSimilar mortality ratesLogistic regression analysisRace/ethnicity modifiesRace/ethnicityCMO patientsHospital mortalityCohort studyRankin ScaleWhite patientsComa ScaleBlack patientsCare unitEndotracheal intubationICH patientsDedicated Afternoon Rounds for ICU Patients’ Families and Family Satisfaction With Care
Weber U, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Huang KB, Hamza M, White J, Coppola A, Akgün KM, Greer DM, Marcolini EG, Gilmore EJ, Petersen NH, Timario N, Poskus K, Sheth KN, Hwang DY. Dedicated Afternoon Rounds for ICU Patients’ Families and Family Satisfaction With Care. Critical Care Medicine 2018, 46: 602-611. PMID: 29300237, DOI: 10.1097/ccm.0000000000002963.Peer-Reviewed Original ResearchConceptsOverall family satisfactionNeuroscience ICUFamily satisfactionCoordination of careAfternoon roundsICU admissionPrimary outcomeICU patientsBedside visitsMean prePostimplementation designComfort measuresPatient's familySecondary analysisICUPatientsCareNursing leadersScoresFamily supportFamily membersWeeksEmotional supportPreComplete satisfactionPrimary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care
Huang KB, Weber U, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Poskus K, Sheth KN, Hwang DY. Primary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care. The Journal Of The American Board Of Family Medicine 2018, 31: 64-72. PMID: 29330241, DOI: 10.3122/jabfm.2018.01.170211.Peer-Reviewed Original ResearchConceptsPatient's primary care physicianPatient's PCPPrimary care physiciansIll patientsPCP involvementPrimary care physician involvementMedical decisionsFamilies of patientsFamily satisfactionICU decisionICU patientsCare physiciansClinical informationPatientsMedical teamSatisfaction scoresIndividual survey itemsPhysician involvementICUMean scoreInvolvementFamily membersCareScoresSurvey items
2017
Variability in Gastrostomy Tube Placement for Intracerebral Hemorrhage Patients at US Hospitals
Hwang DY, George BP, Kelly AG, Schneider EB, Sheth KN, Holloway RG. Variability in Gastrostomy Tube Placement for Intracerebral Hemorrhage Patients at US Hospitals. Journal Of Stroke And Cerebrovascular Diseases 2017, 27: 978-987. PMID: 29221969, DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.001.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overCerebral HemorrhageClinical Decision-MakingDatabases, FactualFemaleGastrostomyHealthcare DisparitiesHospitalsHumansLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPractice Patterns, Physicians'Process Assessment, Health CareRetrospective StudiesTime FactorsUnited StatesYoung AdultConceptsGastrostomy tube placementTube placementGastrostomy tubeICH patientsIntracerebral hemorrhageUS hospitalsMultilevel multivariable regression modelsHospital random effectsNationwide Inpatient SampleIntracerebral hemorrhage patientsMultivariable regression modelsLocal practice patternsMedian odds ratioICH hospitalizationsHospital factorsHospital covariatesRegression modelsHemorrhage patientsICH admissionsInpatient SampleOdds ratioPlacement ratesPractice patternsMedian increasePatientsFactors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes
Hwang DY, Chu SY, Dell CA, Sparks MJ, Watson TD, Langefeld CD, Comeau ME, Rosand J, Battey TWK, Koch S, Perez ML, James ML, McFarlin J, Osborne JL, Woo D, Kittner SJ, Sheth KN. Factors Considered by Clinicians when Prognosticating Intracerebral Hemorrhage Outcomes. Neurocritical Care 2017, 27: 316-325. PMID: 28744847, DOI: 10.1007/s12028-017-0430-7.Peer-Reviewed Original ResearchConceptsIntracerebral hemorrhageRadiographic factorsMethodsThis prospective observational studyClinical scalesPre-existing comorbiditiesProspective observational studyIntracerebral hemorrhage outcomesSubjective clinical judgmentJudgment of physiciansRankin ScaleICH patientsFunctional outcomeUS CentersObservational studyPrognostic scalesClinical teamClinical judgmentFUNC scoreNursesPhysiciansExamination componentsPatientsOutcomesPrognosticationClinicians
2016
Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke
George BP, Kelly AG, Albert GP, Hwang DY, Holloway RG. Timing of Percutaneous Endoscopic Gastrostomy for Acute Ischemic Stroke. Stroke 2016, 48: 420-427. PMID: 27965430, DOI: 10.1161/strokeaha.116.015119.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeTime-limited trialsNasogastric feedingIschemic strokePEG placementPercutaneous endoscopic gastrostomy (PEG) tube placementEndoscopic gastrostomy tube placementEarly PEG placementSurgical feeding tubeDay of admissionHigh-volume hospitalsPercutaneous endoscopic gastrostomyRetrospective observational studyIschemic stroke admissionsGastrostomy tube placementEffect of patientMultivariable regression analysisAdult age groupsOlder adult age groupsPEG recipientsEarly PEGEndoscopic gastrostomyStroke admissionsMedian timePEG tube
2015
Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes
Hwang DY, Dell CA, Sparks MJ, Watson TD, Langefeld CD, Comeau ME, Rosand J, Battey TW, Koch S, Perez ML, James ML, McFarlin J, Osborne JL, Woo D, Kittner SJ, Sheth KN. Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes. Neurology 2015, 86: 126-133. PMID: 26674335, PMCID: PMC4731687, DOI: 10.1212/wnl.0000000000002266.Peer-Reviewed Original ResearchConceptsModified Rankin ScaleICH scoreIntracerebral hemorrhageSubjective clinical judgmentFUNC scorePhysicians' predictionsPrognostic scalesClinical teamClinical judgmentUS tertiary care centerPatient's clinical teamTertiary care centerProspective observational studyIntracerebral hemorrhage outcomesSpontaneous intracerebral hemorrhageRankin ScaleComfort careICH patientsFunctional outcomeCare centerPatient admissionsObservational studyComfort measuresPrognostic instrumentNeurologic practice
2014
Consistency of communication among intensive care unit staff as perceived by family members of patients surviving to discharge
Hwang DY, Yagoda D, Perrey HM, Tehan TM, Guanci M, Ananian L, Currier PF, Cobb J, Rosand J. Consistency of communication among intensive care unit staff as perceived by family members of patients surviving to discharge. Journal Of Critical Care 2014, 29: 134-138. PMID: 24475496, DOI: 10.1016/j.jcrc.2013.09.009.Peer-Reviewed Original ResearchConceptsMedical ICUIntensive care unit staffHours of admissionProspective cohort studyFamily membersNeuroscience ICUEligible patientsICU dischargeAdult patientsCohort studyUniversity HospitalUnit staffICUPatientsAdmissionAdverse effectsMultiple episodesConsistency of communicationEpisodesMedical decisionsStaffHospitalUnit familySatisfaction