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 studyPatientsDevelopment 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 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 abilityDiagnosis, 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 hospitalsPandemic Guidance for Stroke Centers Aiding COVID-19 Treatment Teams
Wira CR, Goyal M, Southerland AM, Sheth KN, McNair ND, Khosravani H, Leonard A, Panagos P, Council O. Pandemic Guidance for Stroke Centers Aiding COVID-19 Treatment Teams. Stroke 2020, 51: 10.1161/strokeaha.120.030749. PMID: 32716826, PMCID: PMC7326321, DOI: 10.1161/strokeaha.120.030749.Peer-Reviewed Original ResearchPrehospital 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 ResearchGuiding 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
2018
A review of micronutrients in sepsis: the role of thiamine, l-carnitine, vitamin C, selenium and vitamin D
Belsky JB, Wira CR, Jacob V, Sather JE, Lee PJ. A review of micronutrients in sepsis: the role of thiamine, l-carnitine, vitamin C, selenium and vitamin D. Nutrition Research Reviews 2018, 31: 281-290. PMID: 29984680, DOI: 10.1017/s0954422418000124.Peer-Reviewed Original ResearchConceptsVitamin CLife-threatening organ dysfunctionRole of micronutrientsCurrent available dataSeptic patientsOrgan dysfunctionSeptic shockVitamin DVitamin D.Clinical trialsRole of thiamineThiamine deficiencySepsisHuman studiesHost responseConclusion statementsCellular dysfunctionNormal physiologyMetabolic demandsCarnitinePotential roleDysfunctionPresent reviewCellular turnoverPivotal role
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 populationEvaluation 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 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 role