Alexander Tan Limkakeng Jr.
Professor of Surgery
My personal research interest is finding new ways to diagnose acute coronary syndrome
. In particular, I am interested in novel biomarkers and precision medicine
approaches to this problem. I also have an interest in sepsis and empirical bioethics. As Vice Chief of Research for the Duke Division of Emergency Medicine, I also work with researchers from many fields spanning global health, innovation, clinical trials, basic discovery, and translational research. The common element is time-sensitive health conditions. I help to oversee a team of research professionals in multicenter emergency department studies funded by the National Institutes of Health, foundations, and industry partners.
Current Research Interests
Acute Coronary Syndrome, Biomarkers, Myocardial Ischemia, Precision Medicine, Septic Shock, Pain Management, Clinical Trials
Current Appointments & Affiliations
- Professor of Surgery, Surgery, Emergency Medicine, Surgery 2021
Contact Information
- 2301 Erwin Road Box 3096, Durham, NC 27710
- 2301 Erwin Road, Box 3096, Durham, NC 27710
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(919) 681-0196
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Duke Emergency Medicine Research
- Background
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Education, Training, & Certifications
- M.H.S., Duke University 2012
- M.D., University of Pennsylvania 2001
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Duke Appointment History
- Professor of Surgery, Surgery, Emergency Medicine, Surgery 2020
- Associate Professor of Surgery, Surgery, Emergency Medicine, Surgery 2013 - 2020
- Assistant Professor of Surgery, Surgery, Emergency Medicine, Surgery 2007 - 2013
- Instructor, Temporary in the Department of Surgery, Surgery, Emergency Medicine, Surgery 2006 - 2007
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Leadership & Clinical Positions at Duke
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Vice Chief of Research
Director, Acute Care Research Team
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Vice Chief of Research
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Academic Positions Outside Duke
- Assistant Director, American College of Emergency Physicians Emergency Medicine Basic Research Skills (EMBRS) Course. 2018
- Vice Chair , American College of Emergency Physicians Research Committee. 2018 - 2019
- Co-Director, American College of Emergency Physicians Research Forum. 2016 - 2018
- Recognition
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In the News
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FEB 4, 2019 Duke Health News -
JUL 11, 2017 Bass Connections
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Awards & Honors
- Expertise
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Subject Headings
- Acute Coronary Syndrome
- Algorithms
- Biological Markers
- Cardiac Catheterization
- Chest Pain
- Chi-Square Distribution
- Clinical Trials as Topic
- Cohort Studies
- Early Diagnosis
- Electrocardiography
- Emergency Medicine
- Emergency Service, Hospital
- Emergency Treatment
- Heart Diseases
- Heart Failure
- Hospitalization
- Logistic Models
- Myocardial Infarction
- Natriuretic Peptide, Brain
- Outcome and Process Assessment (Health Care)
- Predictive Value of Tests
- Prognosis
- Prospective Studies
- Quality Improvement
- Registries
- Research Design
- Research Subjects
- Retrospective Studies
- Risk
- Risk Assessment
- Risk Factors
- Sensitivity and Specificity
- Total Quality Management
- Troponin
- Troponin I
- Research
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Selected Grants
- Duke Pain Early-phase Research Clinical Center (PERC) awarded by National Institutes of Health 2019 - 2024
- Multi-center registry of potential COVID-19 patients presenting in US Emergency Departments awarded by The Trustees of Indiana University 2020 - 2023
- Barriers to myocardial infarction care among persons living with HIV in Tanzania awarded by Society for Academic Emergency Medicine 2021 - 2022
- BD Respiratory Specimen Collection for COVID-19 awarded by Becton Dickinson and Company 2020 - 2021
- 1/2 ICECAP: Influence of Cooling duration on Efficacy in Cardiac Arrest Patients awarded by University of Michigan 2020 - 2021
- Abbott Stress-Delta Biomarkers for ACS Risk Stratification awarded by Abbott Laboratories 2014 - 2021
- Clinical Evaluation of the Lateral Flow COVID-19 Antigen Test awarded by Abbott Disgnostic Scarborough, Inc. 2020 - 2021
- Abbott Rapid Diagnostics - COVID 19 - CATSS Study awarded by Abbott Rapid Diagnostics 2020 - 2021
- Capsule Endoscopy for HEmorrhage in the ER (CHEER) awarded by The George Washington University 2018 - 2021
- Portable motion-stabilized optical coherence tomography for eye care in acute care settings awarded by National Institutes of Health 2018 - 2021
- CCC for NHLBI Prevention and early Treatment of Acute Lung Injury PETAL Network - CLOVERS awarded by Vanderbilt University Medical Center 2017 - 2021
- Biology and Longitudinal Epidemiology of COVID-19 Observational Study, BLUE CORAL awarded by Vanderbilt University Medical Center 2020 - 2021
- RED CORAL: PETAL COVID-19 Observational Study awarded by Vanderbilt University Medical Center 2020 - 2021
- Sc2i awarded by Henry M. Jackson Foundation 2020 - 2021
- Social Determinants of Health and COVID-19 Infection in North Carolina: A Geospatial and Qualitative Analysis awarded by Emergency Medicine Foundation 2020 - 2021
- Prehospital Termination of Resuscitation in Out-of-Hospital Cardiac Arrest awarded by Society for Academic Emergency Medicine 2019 - 2020
- SC2i awarded by Henry M. Jackson Foundation 2014 - 2020
- Specimen Collection in the Emergency Department for The Assessment of Clinical Performance of Troponin Assays awarded by Siemens AG 2014 - 2020
- Comparison of Dyspnea Measurement Instruments in Acute Heart Failure awarded by Heart Failure Society of America 2017 - 2019
- Biomarkers for Acute Stroke Etilogy (BASE) awarded by Ischemia Care LLC 2016 - 2019
- Energize awarded by AstraZeneca AB 2018 - 2019
- CCC for NHLBI Prevention and early Treatment of Acute Lung Injury PETAL Network - VIOLET awarded by Vanderbilt University Medical Center 2017 - 2018
- MultiCenter trial of Rivaroxban for Early Discharge of Pulmonary Embolism from the ER awarded by Janssen Scientific Affairs, LLC. 2016 - 2017
- Clinical Performance of Elecsys Troponin T Gen 5 in Subjects with Symptoms of Acute Coronary Syndrome (ACS): ACS Collection Study for Serum Claim awarded by Roche Diagnostics 2014 - 2017
- ARCHITECT STAT High Sensitive Troponin-I Assay Clinical Evaluation for Specimen Storage in Varying Specimen Tube Types awarded by Abbott Laboratories 2013 - 2015
- D-Dimer DVT/PE Exclusionary Sample Collection Project awarded by Siemens AG 2013 - 2015
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External Relationships
- American College of Emergency Physicians
- Farrell, White, and Legg, PLLC
- Publications & Artistic Works
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Selected Publications
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Academic Articles
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Nazeha, N., Ong, M. E. H., Limkakeng, A. T., Ye, J. J., Joiner, A. P., Blewer, A., … Graves, N. (2021). A hypothetical implementation of ‘Termination of Resuscitation’ protocol for out-of-hospital cardiac arrest (Accepted). Resuscitation Plus, 6, 100092–100092. https://doi.org/10.1016/j.resplu.2021.100092Full Text
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Reagh, J. J., Zheng, H., Stolz, U., Parry, B. A., Chang, A. M., House, S. L., … Fermann, G. J. (2021). Sex-related Differences in D-dimer Levels for Venous Thromboembolism Screening. Acad Emerg Med. https://doi.org/10.1111/acem.14220Full Text Link to Item
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Gerardo, C. J., Silvius, E., Schobel, S., Eppensteiner, J. C., McGowan, L. M., Elster, E. A., … Limkakeng, A. T. (2021). Association of a Network of Immunologic Response and Clinical Features With the Functional Recovery From Crotalinae Snakebite Envenoming. Front Immunol, 12, 628113. https://doi.org/10.3389/fimmu.2021.628113Full Text Link to Item
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Nowak, R. M., Jacobsen, G., Limkakeng, A., Peacock, W. F., Christenson, R. H., McCord, J., … deFilippi, C. R. (2021). Outpatient versus observation/inpatient management of emergency department patients rapidly ruled-out for acute myocardial infarction: Findings from the HIGH-US study. Am Heart J, 231, 6–17. https://doi.org/10.1016/j.ahj.2020.10.067Full Text Link to Item
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Greene, S. J., Mentz, R. J., Limkakeng, A. T., Irons, T., Truong, T., Green, C. L., … Pang, P. S. (2020). Comparison of Dyspnea Measurement Instruments in Acute Heart Failure: The DYSPNEA-AHF Pilot Study. J Card Fail. https://doi.org/10.1016/j.cardfail.2020.10.004Full Text Link to Item
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Horiuchi, Y., Wettersten, N., Patel, M. P., Mueller, C., Neath, S.-X., Christenson, R. H., … Maisel, A. (2020). Biomarkers Enhance Discrimination and Prognosis of Type 2 Myocardial Infarction. Circulation, 142(16), 1532–1544. https://doi.org/10.1161/CIRCULATIONAHA.120.046682Full Text Link to Item
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Theiling, B. J., Kennedy, K. V., Limkakeng, A. T., Manandhar, P., Erkanli, A., & Pitts, S. R. (2020). A Method for Grouping Emergency Department Visits by Severity and Complexity. West J Emerg Med, 21(5), 1147–1155. https://doi.org/10.5811/westjem.2020.6.44086Full Text Open Access Copy Link to Item
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Hertz, J. T., Sakita, F. M., Kweka, G. L., Limkakeng, A. T., Galson, S. W., Ye, J. J., … Bloomfield, G. S. (2020). Acute myocardial infarction under-diagnosis and mortality in a Tanzanian emergency department: A prospective observational study. Am Heart J, 226, 214–221. https://doi.org/10.1016/j.ahj.2020.05.017Full Text Open Access Copy Link to Item
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Peacock, W. F., Baumann, B. M., Rivers, E. J., Davis, T. E., Handy, B., Jones, C. W., … Dinkel-Keuthage, C. (2020). Using Sex-specific Cutoffs for High-sensitivity Cardiac Troponin T to Diagnose Acute Myocardial Infarction. Acad Emerg Med. https://doi.org/10.1111/acem.14098Full Text Open Access Copy Link to Item
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Limkakeng, A. T., Hertz, J., Lerebours, R., Kuchibhatla, M., McCord, J., Singer, A. J., … Nowak, R. M. (2020). Ideal high sensitivity troponin baseline cutoff for patients with renal dysfunction. Am J Emerg Med. https://doi.org/10.1016/j.ajem.2020.06.072Full Text Link to Item
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Peerapornratana, S., Priyanka, P., Wang, S., Smith, A., Singbartl, K., Palevsky, P. M., … Migues, R. M. (2020). Sepsis-Associated Acute Kidney Disease. Kidney International Reports, 5(6), 839–850. https://doi.org/10.1016/j.ekir.2020.03.005Full Text
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Shah, N., Chen, C., Montano, N., Cave, D., Siegel, R., Gentile, N. T., … Meltzer, A. C. (2020). Video capsule endoscopy for upper gastrointestinal hemorrhage in the emergency department: A systematic review and meta-analysis. Am J Emerg Med, 38(6), 1245–1252. https://doi.org/10.1016/j.ajem.2020.03.008Full Text Open Access Copy Link to Item
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Fitzgerald, R. L., Hollander, J. E., Peacock, W. F., Limkakeng, A. T., Breitenbeck, N., Rivers, E. J., … deFilippi, C. (2020). The 99th percentile upper reference limit for the 5th generation cardiac troponin T assay in the United States. Clin Chim Acta, 504, 172–179. https://doi.org/10.1016/j.cca.2020.01.027Full Text Open Access Copy Link to Item
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Christenson, R. H., Duh, S.-H., Apple, F. A., Nowak, R., Peacock, W. F., Limkakeng, A. T., … deFilippi, C. R. (2020). Pivotal findings for a high-sensitivity cardiac troponin assay: Results of the HIGH-US study. Clin Biochem, 78, 32–39. https://doi.org/10.1016/j.clinbiochem.2019.10.013Full Text Link to Item
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Kheang, S., Rodrigues, C. G., Vissoci, J. R. N., Hassan, A., Muller, C., Muller, D., & Limkakeng, A. T. (2020). Stress-delta B-type Natriuretic Peptide Levels as a Test for Inducible Myocardial Ischemia: A Systematic Review and Meta-Analysis. Cureus, 12(3), e7165. https://doi.org/10.7759/cureus.7165Full Text Open Access Copy Link to Item
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Hertz, J. T., Kweka, G. L., Bloomfield, G. S., Limkakeng, A. T., Loring, Z., Temu, G., … Sakita, F. M. (2020). Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital. Glob Heart, 15(1), 9. https://doi.org/10.5334/gh.402Full Text Open Access Copy Link to Item
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Theophanous, R. G., Limkakeng, A. T., & Broder, J. S. (2020). Duplicated or Ectopic Renal Collecting System in Two Adult Emergency Department Patients. J Emerg Med, 58(2), e59–e61. https://doi.org/10.1016/j.jemermed.2019.10.014Full Text Open Access Copy Link to Item
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Hertz, J. T., Sakita, F. M., Limkakeng, A. T., Mmbaga, B. T., Appiah, L. T., Bartlett, J. A., & Galson, S. W. (2019). The burden of acute coronary syndrome, heart failure, and stroke among emergency department admissions in Tanzania: A retrospective observational study. Afr J Emerg Med, 9(4), 180–184. https://doi.org/10.1016/j.afjem.2019.07.001Full Text Open Access Copy Link to Item
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Eppensteiner, J., Kwun, J., Scheuermann, U., Barbas, A., Limkakeng, A. T., Kuchibhatla, M., … Lee, J. (2019). Damage- and pathogen-associated molecular patterns play differential roles in late mortality after critical illness. Jci Insight, 4(16). https://doi.org/10.1172/jci.insight.127925Full Text Link to Item
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Beri, N., Daniels, L. B., Jaffe, A., Mueller, C., Anand, I., Peacock, W. F., … Maisel, A. (2019). Copeptin to rule out myocardial infarction in Blacks versus Caucasians. Eur Heart J Acute Cardiovasc Care, 8(5), 395–403. https://doi.org/10.1177/2048872618772500Full Text Link to Item
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Fitzgerald, R. L., Hollander, J. E., Peacock, W. F., Limkakeng, A. T., Breitenbeck, N., Blechschmidt, K., … deFilippi, C. (2019). Analytical performance evaluation of the Elecsys® Troponin T Gen 5 STAT assay. Clin Chim Acta, 495, 522–528. https://doi.org/10.1016/j.cca.2019.05.026Full Text Open Access Copy Link to Item
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Sandoval, Y., Nowak, R., deFilippi, C. R., Christenson, R. H., Peacock, W. F., McCord, J., … Apple, F. S. (2019). Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I. J Am Coll Cardiol, 74(3), 271–282. https://doi.org/10.1016/j.jacc.2019.05.058Full Text Link to Item
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Christenson, R. H., Peacock, W. F., Apple, F. S., Limkakeng, A. T., Nowak, R. M., McCord, J., & deFilippi, C. R. (2019). Trial design for assessing analytical and clinical performance of high-sensitivity cardiac troponin I assays in the United States: The HIGH-US study. Contemp Clin Trials Commun, 14, 100337. https://doi.org/10.1016/j.conctc.2019.100337Full Text Open Access Copy Link to Item
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Hertz, J. T., Fu, T., Vissoci, J. R., Rocha, T. A. H., Carvalho, E., Flanagan, B., … Staton, C. A. (2019). The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access. Plos One, 14(1), e0210502. https://doi.org/10.1371/journal.pone.0210502Full Text Open Access Copy Link to Item
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Limkakeng, A. T., Henao, R., Voora, D., O’Connell, T., Griffin, M., Tsalik, E. L., … Ginsburg, G. S. (2019). Pilot study of myocardial ischemia-induced metabolomic changes in emergency department patients undergoing stress testing. Plos One, 14(2), e0211762. https://doi.org/10.1371/journal.pone.0211762Full Text Open Access Copy Link to Item
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Puskarich, M. A., Callaway, C., Silbergleit, R., Pines, J. M., Obermeyer, Z., Wright, D. W., … Levy, P. D. (2019). Priorities to Overcome Barriers Impacting Data Science Application in Emergency Care Research. Acad Emerg Med, 26(1), 97–105. https://doi.org/10.1111/acem.13520Full Text Open Access Copy Link to Item
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Limkakeng, A. T., & Granger, C. B. (2018). In patients with chest pain, HEART Pathway-guided and usual care did not differ for MACE or health care use. Ann Intern Med, 169(12), JC69. https://doi.org/10.7326/ACPJC-2018-169-12-069Full Text Link to Item
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Gesell, S. B., Golden, S. L., Limkakeng, A. T., Carr, C. M., Matuskowitz, A., Smith, L. M., & Mahler, S. A. (2018). Implementation of the HEART Pathway: Using the Consolidated Framework for Implementation Research. Crit Pathw Cardiol, 17(4), 191–200. https://doi.org/10.1097/HPC.0000000000000154Full Text Open Access Copy Link to Item
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Massey, M. J., Hou, P. C., Filbin, M., Wang, H., Ngo, L., Huang, D. T., … ProCESS investigators, . (2018). Microcirculatory perfusion disturbances in septic shock: results from the ProCESS trial. Crit Care, 22(1), 308. https://doi.org/10.1186/s13054-018-2240-5Full Text Link to Item
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Darrabie, M. D., Cheeseman, J., Limkakeng, A. T., Borawski, J., Sullenger, B. A., Elster, E. A., … Lee, J. (2018). Toll-like receptor activation as a biomarker in traumatically injured patients. J Surg Res, 231, 270–277. https://doi.org/10.1016/j.jss.2018.05.059Full Text Open Access Copy Link to Item
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Hocker, M. B., Gerardo, C. J., Theiling, B. J., Villani, J., Donohoe, R., Sandesara, H., & Limkakeng, A. T. (2018). NHAMCS Validation of Emergency Severity Index as an Indicator of Emergency Department Resource Utilization. West J Emerg Med, 19(5), 855–862. https://doi.org/10.5811/westjem.2018.7.37556Full Text Link to Item
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Kabrhel, C., Van Hylckama Vlieg, A., Muzikanski, A., Singer, A., Fermann, G. J., Francis, S., … Parry, B. (2018). Multicenter Evaluation of the YEARS Criteria in Emergency Department Patients Evaluated for Pulmonary Embolism. Acad Emerg Med, 25(9), 987–994. https://doi.org/10.1111/acem.13417Full Text Link to Item
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Ziegler, C. E., Painter, D. M., Borawski, J. B., Kim, R. J., Kim, H. W., & Limkakeng, A. T. (2018). Unexpected Cardiac MRI Findings in Patients Presenting to the Emergency Department for Possible Acute Coronary Syndrome. Crit Pathw Cardiol, 17(3), 167–171. https://doi.org/10.1097/HPC.0000000000000148Full Text Open Access Copy Link to Item
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Parry, B. A., Chang, A. M., Schellong, S. M., House, S. L., Fermann, G. J., Deadmon, E. K., … Kabrhel, C. (2018). International, multicenter evaluation of a new D-dimer assay for the exclusion of venous thromboembolism using standard and age-adjusted cut-offs. Thromb Res, 166, 63–70. https://doi.org/10.1016/j.thromres.2018.04.003Full Text Open Access Copy Link to Item
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Peacock, W. F., Baumann, B. M., Bruton, D., Davis, T. E., Handy, B., Jones, C. W., … Dinkel, C. (2018). Efficacy of High-Sensitivity Troponin T in Identifying Very-Low-Risk Patients With Possible Acute Coronary Syndrome. Jama Cardiol, 3(2), 104–111. https://doi.org/10.1001/jamacardio.2017.4625Full Text Open Access Copy Link to Item
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Limkakeng, A. T., Leahy, J. C., Griffin, S. M., Lokhnygina, Y., Jaffa, E., Christenson, R. H., & Newby, L. K. (2018). Provocative biomarker stress test: stress-delta N-terminal pro-B type natriuretic peptide. Open Heart, 5(2), e000847. https://doi.org/10.1136/openhrt-2018-000847Full Text Open Access Copy Link to Item
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de Oliveira, L. L. H., Vissoci, J. R. N., Machado, W. D. L., Rodrigues, C. G., & Limkakeng, A. T. (2017). Are Well-Informed Potential Trial Participants More Likely to Participate? J Empir Res Hum Res Ethics, 12(5), 363–371. https://doi.org/10.1177/1556264617737163Full Text Open Access Copy Link to Item
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Gaspari, R., Weekes, A., Adhikari, S., Noble, V., Nomura, J. T., Theodoro, D., … Raio, C. (2017). A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study. Resuscitation, 120, 103–107. https://doi.org/10.1016/j.resuscitation.2017.09.008Full Text Link to Item
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Boyd, L. R., Borawski, J., Lairet, J., & Limkakeng, A. T. (2017). Critical Care Air Transport Team severe traumatic brain injury short-term outcomes during flight for Operation Iraqi Freedom/Operation Enduring Freedom. J R Army Med Corps, 163(5), 342–346. https://doi.org/10.1136/jramc-2016-000743Full Text Open Access Copy Link to Item
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Borawski, J. B., Graff, L. G., & Limkakeng, A. T. (2017). Care of the Patient with Chest Pain in the Observation Unit. Emerg Med Clin North Am, 35(3), 535–547. https://doi.org/10.1016/j.emc.2017.03.003Full Text Open Access Copy Link to Item
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PRISM Investigators, ., Rowan, K. M., Angus, D. C., Bailey, M., Barnato, A. E., Bellomo, R., … Yealy, D. M. (2017). Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis. N Engl J Med, 376(23), 2223–2234. https://doi.org/10.1056/NEJMoa1701380Full Text Open Access Copy Link to Item
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Gaspari, R., Weekes, A., Adhikari, S., Noble, V. E., Nomura, J. T., Theodoro, D., … Raio, C. (2017). Reply to Letter: Letter to the Editor regarding Gaspari and colleague's "Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest". Resuscitation, 114, e7–e8. https://doi.org/10.1016/j.resuscitation.2017.01.027Full Text Link to Item
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Limkakeng, A. T., Drake, W., Lokhnygina, Y., Meyers, H. P., Shogilev, D., Christenson, R. H., & Newby, L. K. (2017). Myocardial Ischemia on Exercise Stress Echocardiography Testing Is Not Associated with Changes in Troponin T Concentrations. J Appl Lab Med, 1(5), 532–543. https://doi.org/10.1373/jalm.2016.021667Full Text Open Access Copy Link to Item
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Beri, N., Marston, N. A., Daniels, L. B., Nowak, R. M., Schreiber, D., Mueller, C., … Maisel, A. (2017). Necessity of hospitalization and stress testing in low risk chest pain patients. Am J Emerg Med, 35(2), 274–280. https://doi.org/10.1016/j.ajem.2016.10.072Full Text Link to Item
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Mehta, R., Nankivil, D., Zielinski, D. J., Waterman, G., Keller, B., Limkakeng, A. T., … Kuo, A. N. (2017). Wireless, Web-Based Interactive Control of Optical Coherence Tomography with Mobile Devices. Transl Vis Sci Technol, 6(1), 5. https://doi.org/10.1167/tvst.6.1.5Full Text Open Access Copy Link to Item
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Gaspari, R., Weekes, A., Adhikari, S., Noble, V. E., Nomura, J. T., Theodoro, D., … Raio, C. (2016). Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation, 109, 33–39. https://doi.org/10.1016/j.resuscitation.2016.09.018Full Text Open Access Copy Link to Item
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Limkakeng, A. T., Monte, A. A., Kabrhel, C., Puskarich, M., Heitsch, L., Tsalik, E. L., & Shapiro, N. I. (2016). Systematic Molecular Phenotyping: A Path Toward Precision Emergency Medicine? Acad Emerg Med, 23(10), 1097–1106. https://doi.org/10.1111/acem.13027Full Text Open Access Copy Link to Item
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Meyers, H. P., Jaffa, E., Smith, S. W., Drake, W., & Limkakeng, A. T. (2016). Evaluation of T-Wave Morphology in Patients With Left Bundle Branch Block and Suspected Acute Coronary Syndrome. J Emerg Med, 51(3), 229–237. https://doi.org/10.1016/j.jemermed.2016.05.004Full Text Open Access Copy Link to Item
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Broder, J. S., Bhat, R., Boyd, J. P., Ogloblin, I. A., Limkakeng, A., Hocker, M. B., … Repplinger, M. D. (2016). Who explicitly requests the ordering of computed tomography for emergency department patients? A multicenter prospective study. Emerg Radiol, 23(3), 221–227. https://doi.org/10.1007/s10140-016-1382-5Full Text Link to Item
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Tsalik, E. L., Li, Y., Hudson, L. L., Chu, V. H., Himmel, T., Limkakeng, A. T., … Reed, S. D. (2016). Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients. Ann Am Thorac Soc, 13(3), 401–413. https://doi.org/10.1513/AnnalsATS.201504-205OCFull Text Open Access Copy Link to Item
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Kellum, J. A., Chawla, L. S., Keener, C., Singbartl, K., Palevsky, P. M., Pike, F. L., … ProCESS and ProGReSS-AKI Investigators, . (2016). The Effects of Alternative Resuscitation Strategies on Acute Kidney Injury in Patients with Septic Shock. Am J Respir Crit Care Med, 193(3), 281–287. https://doi.org/10.1164/rccm.201505-0995OCFull Text Link to Item
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Marston, N. A., Shah, K. S., Mueller, C., Neath, S.-X., Christenson, R. H., McCord, J., … Maisel, A. S. (2016). Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: results from the CHOPIN trial. Emerg Med J, 33(1), 23–29. https://doi.org/10.1136/emermed-2015-204692Full Text Link to Item
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Hoffman, K., Butt, C. M., Chen, A., Limkakeng, A. T., & Stapleton, H. M. (2015). High Exposure to Organophosphate Flame Retardants in Infants: Associations with Baby Products. Environ Sci Technol, 49(24), 14554–14559. https://doi.org/10.1021/acs.est.5b03577Full Text Link to Item
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Meyers, H. P., Limkakeng, A. T., Jaffa, E. J., Patel, A., Theiling, B. J., Rezaie, S. R., … Smith, S. W. (2015). Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. Am Heart J, 170(6), 1255–1264. https://doi.org/10.1016/j.ahj.2015.09.005Full Text Open Access Copy Link to Item
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Ranney, M. L., Limkakeng, A. T., Carr, B., Zink, B., Kaji, A. H., & ACEP SAEM Research Committees (approved by ACEP-SAEM Board of Directors), . (2015). Improving the Emergency Care Research Investigator Pipeline: SAEM/ACEP Recommendations. Acad Emerg Med, 22(7), 849–851. https://doi.org/10.1111/acem.12699Full Text Open Access Copy Link to Item
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Shah, K. S., Marston, N. A., Mueller, C., Neath, S.-X., Christenson, R. H., McCord, J., … Maisel, A. S. (2015). Midregional proadrenomedullin predicts mortality and major adverse cardiac events in patients presenting with chest pain: results from the CHOPIN trial. Acad Emerg Med, 22(5), 554–563. https://doi.org/10.1111/acem.12649Full Text Link to Item
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Freiermuth, C. E., Chandra, A., Peacock, W. F., & Site Investigators, . (2015). Characteristics of patients that do not initially respond to intravenous antihypertensives in the emergency department: subanalysis of the CLUE trial. West J Emerg Med, 16(2), 276–283. https://doi.org/10.5811/westjem.2015.1.23308Full Text Link to Item
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Limkakeng, A. T., de Oliveira, L. L. H., Moreira, T., Phadtare, A., Garcia Rodrigues, C., Hocker, M. B., … Pietrobon, R. (2014). Systematic review and metasummary of attitudes toward research in emergency medical conditions. J Med Ethics, 40(6), 401–408. https://doi.org/10.1136/medethics-2012-101147Full Text Open Access Copy Link to Item
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Hertz, J. T., Reardon, J. M., Rodrigues, C. G., de Andrade, L., Limkakeng, A. T., Bloomfield, G. S., & Lynch, C. A. (2014). Acute myocardial infarction in sub-Saharan Africa: the need for data. Plos One, 9(5), e96688. https://doi.org/10.1371/journal.pone.0096688Full Text Open Access Copy Link to Item
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Pike, F., Yealy, D. M., Kellum, J. A., Huang, D. T., Barnato, A. E., Eaton, T. L., … ProCESS Investigators, . (2013). Protocolized Care for Early Septic Shock (ProCESS) statistical analysis plan. Crit Care Resusc, 15(4), 301–310.Link to Item
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Chavez, J., Srinivasan, A., Ely, S., Drake, W., Freeman, D., Borawski, J., … Limkakeng, A. T. (2013). Thrombolysis in myocardial infarction risk score in an observation unit setting. Crit Pathw Cardiol, 12(3), 137–140. https://doi.org/10.1097/HPC.0b013e3182998bc1Full Text Open Access Copy Link to Item
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Maisel, A., Mueller, C., Neath, S.-X., Christenson, R. H., Morgenthaler, N. G., McCord, J., … Peacock, W. F. (2013). Copeptin helps in the early detection of patients with acute myocardial infarction: primary results of the CHOPIN trial (Copeptin Helps in the early detection Of Patients with acute myocardial INfarction). J Am Coll Cardiol, 62(2), 150–160. https://doi.org/10.1016/j.jacc.2013.04.011Full Text Link to Item
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Ely, S., Chandra, A., Mani, G., Drake, W., Freeman, D., & Limkakeng, A. T. (2013). Utility of observation units for young emergency department chest pain patients. J Emerg Med, 44(2), 306–312. https://doi.org/10.1016/j.jemermed.2012.07.048Full Text Open Access Copy Link to Item
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Limkakeng, A., Phadtare, A., Shah, J., Vaghasia, M., Wei, D. Y., Shah, A., & Pietrobon, R. (2013). Willingness to participate in clinical trials among patients of Chinese heritage: a meta-synthesis. Plos One, 8(1), e51328. https://doi.org/10.1371/journal.pone.0051328Full Text Open Access Copy Link to Item
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Anderson, K. L., Limkakeng, A., Damuth, E., & Chandra, A. (2012). Cardiac evaluation for structural abnormalities may not be required in patients presenting with syncope and a normal ECG result in an observation unit setting. Ann Emerg Med, 60(4), 478-84.e1. https://doi.org/10.1016/j.annemergmed.2012.04.023Full Text Link to Item
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Hocker, M. B., Villani, J. J., Borawski, J. B., Evans, C. S., Nelson, S. M., Gerardo, C. J., & Limkakeng, A. T. (2012). Dental visits to a North Carolina emergency department: a painful problem. N C Med J, 73(5), 346–351.Link to Item
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Limkakeng, A. T., Glickman, S. W., Shofer, F., Mani, G., Drake, W., Freeman, D., … Cairns, C. B. (2012). Are patients with longer emergency department wait times less likely to consent to research? Acad Emerg Med, 19(4), 396–401. https://doi.org/10.1111/j.1553-2712.2012.01310.xFull Text Open Access Copy Link to Item
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Limkakeng, A. T., Drake, W., Mani, G., Freeman, D., Best, R., Newby, L. K., & Chandra, A. (2012). Left ventricular dysfunction screening in hypertensive patients with N-terminal pro-B-type natriuretic peptide and electrocardiogram. Am J Emerg Med, 30(1), 214–217. https://doi.org/10.1016/j.ajem.2010.11.021Full Text Open Access Copy Link to Item
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Chandra, A., Sieck, S., Hocker, M., Gerardo, C. J., Villani, J., Harrison, D., … Limkakeng, A. (2011). An observation unit may help improve an institution's Press Ganey satisfaction score. Crit Pathw Cardiol, 10(2), 104–106. https://doi.org/10.1097/HPC.0b013e31821c5da8Full Text Link to Item
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Chandra, A., Nicks, B., Maniago, E., Nouh, A., & Limkakeng, A. (2010). A multicenter analysis of the ED diagnosis of pneumonia. Am J Emerg Med, 28(8), 862–865. https://doi.org/10.1016/j.ajem.2009.04.014Full Text Link to Item
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Limkakeng, A. T., & Chandra, A. (2010). Impact of renal dysfunction on acute coronary syndrome evaluation in observation unit patients. Am J Emerg Med, 28(6), 658–662. https://doi.org/10.1016/j.ajem.2009.02.014Full Text Open Access Copy Link to Item
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Chandra, A., Lindsell, C. J., Limkakeng, A., Diercks, D. B., Hoekstra, J. W., Hollander, J. E., … EMCREG i*trACS Investigators, . (2009). Emergency physician high pretest probability for acute coronary syndrome correlates with adverse cardiovascular outcomes. Acad Emerg Med, 16(8), 740–748. https://doi.org/10.1111/j.1553-2712.2009.00470.xFull Text Open Access Copy Link to Item
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Limkakeng, A. T., Glickman, S. W., Cairns, C. B., & Chandra, A. (2009). Unsuspected pulmonary embolism in observation unit patients. West J Emerg Med, 10(3), 130–134.Link to Item
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Takakuwa, K. M., Shofer, F. S., Limkakeng, A. T., & Hollander, J. E. (2008). Preferences for cardiac tests and procedures may partially explain sex but not race disparities. Am J Emerg Med, 26(5), 545–550. https://doi.org/10.1016/j.ajem.2007.08.020Full Text Link to Item
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Limkakeng, A. T., Halpern, E., & Takakuwa, K. M. (2007). Sixty-four-slice multidetector computed tomography: the future of ED cardiac care. Am J Emerg Med, 25(4), 450–458. https://doi.org/10.1016/j.ajem.2006.10.012Full Text Link to Item
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Sherman, S. C., & Limkakeng, A. (2005). Xanthogranulomatous pyelonephritis with a nephrocutaneous fistula. J Emerg Med, 29(3), 337–338. https://doi.org/10.1016/j.jemermed.2005.01.029Full Text Link to Item
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Limkakeng, A., Gibler, W. B., Pollack, C., Hoekstra, J. W., Sites, F., Shofer, F. S., … Hollander, J. E. (2001). Combination of Goldman risk and initial cardiac troponin I for emergency department chest pain patient risk stratification. Acad Emerg Med, 8(7), 696–702. https://doi.org/10.1111/j.1553-2712.2001.tb00187.xFull Text Link to Item
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Book Sections
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Limkakeng, A. T., & Kemnitz, M. G. (2014). Globe rupture. In Rosen and Barkin’s 5-Minute Emergency Medicine Consult: Fifth Edition.
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Other Articles
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ProCESS Investigators, ., Yealy, D. M., Kellum, J. A., Huang, D. T., Barnato, A. E., Weissfeld, L. A., … Angus, D. C. (2014). A randomized trial of protocol-based care for early septic shock. N Engl J Med. United States. https://doi.org/10.1056/NEJMoa1401602Full Text Open Access Copy Link to Item
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Limkakeng, A., Broder, J. S., & Theiling, B. J. (2013). Chicken or egg? Risks of misattribution of cause-effect relationships in studies of association. Acad Emerg Med. United States. https://doi.org/10.1111/acem.12199Full Text Link to Item
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Limkakeng, A. T. (2002). Emergency Medicine national conventions: a medical student's perspective. J Emerg Med. United States. https://doi.org/10.1016/s0736-4679(02)00509-7Full Text Link to Item
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Conference Papers
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Alshaikh, L. M., Apple, F. S., Christenson, R. H., deFilippi, C. R., Jr, L. A. T., McCord, J., … Peacock, W. F. (2020). Non-specific ECG Findings in Patients with Low High-Sensitivity Troponin Values Are Not Associated With Significant 30-day Adverse Outcomes. In Annals of Emergency Medicine (Vol. 76, pp. S2–S2).Link to Item
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Jr, L. A. T., Zhbannikov, I., Douglas, P. S., Hoffman, U., Ferencik, M., Shah, S., … Ginsburg, G. S. (2020). Biomarker Profiling for Obstructive Coronary Artery Disease: A PROMISE Substudy. In Annals of Emergency Medicine (Vol. 76, pp. S116–S116).Link to Item
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Gerardo, C. J., Silvius, E., Schobel, S., Eppensteiner, J., McGowan, L., Limkakeng, A. T., … Elster, E. A. (2020). ASSOCIATION OF A CYTOKINE RESPONSE NETWORK WITH FUNCTIONAL RECOVERY FROM SNAKEBITE ENVENOMING. In Toxicon (Vol. 182, pp. S15–S16).Link to Item
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Hertz, J. T., Sakita, F. M., Kweka, G. L., Galson, S. W., Limkakeng, A. T., Ye, J., … Bloomfield, G. S. (2019). The Prevalence of Acute Myocardial Infarction Among Emergency Department Patients in Northern Tanzania. In Circulation (Vol. 140).Link to Item
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Kennedy, K., Theiling, B. J., Limkakeng, A. T., Manandhar, P., Erkanlu, A., & Pitts, S. (2019). 217 A Method for Stratifying Emergency Department Visits by Severity and Complexity: National Hospital Ambulatory Medical Care Survey Items. In Annals of Emergency Medicine (Vol. 74, pp. S85–S86). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2019.08.385Full Text
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Limkakeng, A. T., Manandhar, P., Erkanli, A., & Voora, D. (2019). 129 United States Emergency Department Use of Medications with Pharmacogenetic Recommendations. In Annals of Emergency Medicine (Vol. 74, pp. S52–S52). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2019.08.134Full Text
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Limkakeng, A. T., Rowlette, L.-L., Ilkayeva, O., Modliszewski, J., Corcoran, D., Leahy, J. C., … Voora, D. (2019). 99EMF Pilot of Integrated Metabolomic and MicroRNA Analysis to Identify Myocardial Ischemia on Emergency Department Cardiac Stress Tests. In Annals of Emergency Medicine (Vol. 74, pp. S40–S40). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2019.08.103Full Text
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Broder, J. S., Jaffa, E., Irons, T., Peethumnongsin, E., Theophanous, R., Limkakeng, A. T., … Dahl, J. J. (2018). 212 3D Volume Ultrasound of the Right Lower Quadrant for Diagnosis of Appendicitis. In Annals of Emergency Medicine (Vol. 72, pp. S85–S85). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2018.08.217Full Text
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Goldberg, D. F., Borawski, J. B., Limkakeng, A. T., Kaji, A. H., Ruderman, B. T., Fantegrossi, A. E., & Griffin, M. (2018). 136 Utilization of Bougie Adjunct Devices in the Emergency Department: A National Emergency Airway Registry Study. In Annals of Emergency Medicine (Vol. 72, pp. S57–S57). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2018.08.141Full Text
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Greene, S. J., Mentz, R. J., Limkakeng, A. T., Irons, T., Truong, T., Green, C. L., … Pang, P. S. (2018). 67EMF Comparison of Dyspnea Measurement Instruments in Acute Heart Failure: Results From the DYSPNEA-AHF Study. In Annals of Emergency Medicine (Vol. 72, pp. S29–S29). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2018.08.072Full Text
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Limkakeng, A. T., Griffin, M., Leahy, C., Hatch, A., Rowlette, L., Voora, D., & Nixon, A. (2018). 32EMF Isolating Micro-Ribonucleic Acids from Peripheral Plasma to Identify Myocardial Ischemia During Stress Testing in Emergency Department Patients. In Annals of Emergency Medicine (Vol. 72, pp. S16–S16). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2018.08.037Full Text
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Ruderman, B. T., Mali, M., Kaji, A., Borawski, J. B., Limkakeng, A. T., Kilgo, R., … Fantegrossi, A. E. (2018). 99 A Comparison of Direct Versus Video Laryngoscopy for Difficult Airway Patients in the Emergency Department: A National Emergency Airway Registry Study. In Annals of Emergency Medicine (Vol. 72, pp. S42–S43). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2018.08.104Full Text
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Fitzgerald, R., deFilippi, C., Hollander, J., Peacock, W. F., Limkakeng, A. T., Breitenbeck, N., … Kareen, B. (2018). OVERALL AND SEX-SPECIFIC REFERENCE RANGES FOR HIGH-SENSITIVITY TROPONIN T GEN 5 STAT IN THE UNITED STATES. In Journal of the American College of Cardiology (Vol. 71, pp. A233–A233). Elsevier BV. https://doi.org/10.1016/s0735-1097(18)30774-5Full Text
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Johnston, B. E., Quigley, C. A., Griffin, S. M., Limkakeng, A. T., Darrabie, M. D., Cheeseman, J. A., … Elster, E. A. (2017). 313 Evaluation of Phenylalanine and Tyrosine Concentrations in Traumatically Injured Patients. In Annals of Emergency Medicine (Vol. 70, pp. S123–S123). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2017.07.384Full Text
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Limkakeng, A. T., Carr, C., Mehrotra, A., Smith, L., Pajewski, N., Burke, G. L., … Mahler, S. (2017). 1 Chest Pain Care Patterns Across the Carolinas: Determining the Readiness for Widespread HEART Pathway Dissemination. In Annals of Emergency Medicine (Vol. 70, pp. S1–S1). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2017.07.025Full Text
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Singer, A. J., Zheng, H., Kabrhel, C., Parry, B. A., Chang, A. M., Fermann, G. J., … Zeserson, E. M. (2017). 73 Clinical Suspicion and D-Dimer Levels in Venous Thromboembolism Patients With Low and High Clot Burden. In Annals of Emergency Medicine (Vol. 70, pp. S31–S31). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2017.07.098Full Text
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Ziegler, C. E., Painter, D. M., Borawski, J. B., Kim, R. J., Kim, H. W., & Limkakeng, A. T. (2017). 105 Unexpected Cardiac Magnetic Resonance Imaging Findings in Patients Presenting to the Emergency Department for Potential Acute Coronary Syndrome. In Annals of Emergency Medicine (Vol. 70, pp. S42–S42). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2017.07.131Full Text
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Darrabie, M. D., Lee, J., Cheeseman, J., Limkakeng, A. T., Vaslef, S. N., Sullenger, B. A., & Kirk, A. D. (2016). Toll-Like Receptor Signaling as a Prognostic Tool in Trauma Patients. In Journal of the American College of Surgeons (Vol. 223, pp. S159–S160). Elsevier BV. https://doi.org/10.1016/j.jamcollsurg.2016.06.346Full Text
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Freeman, D., Diskina, M., Drake, W., Jones, A., & Limkakeng, A. T. (2013). The Protocol Acuity Scoring Tool for Prediction of Emergency Medicine Research Study Workload. In Annals of Emergency Medicine (Vol. 62, pp. S150–S150). Seattle, WA: MOSBY-ELSEVIER.Link to Item
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Chandra, A., Limkakeng, A. T., Barowski, J., Freeman, D., Drake, W., & Mani, G. (2011). 38 Exercise Treadmill Is an Appropriate Risk Stratification Tool in Low Risk Chest Pain Patients. In Annals of Emergency Medicine (Vol. 58, pp. S190–S190). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2011.06.063Full Text
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Ely, S., Chandra, A., Reinstein, A., & Limkakeng, A. T. (2010). 41: Utility of Cardiac Stress Testing In Young Patients In an Observation Unit. In Annals of Emergency Medicine (Vol. 56, pp. S15–S15). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2010.06.071Full Text
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Limkakeng, A. T., Glickman, S. W., Freeman, D., Drake, W., Mani, G., Chandra, A., & Cairns, C. B. (2009). 161: Do Prolonged Emergency Department Waiting Times Reduce Emergency Research Consent Rates? In Annals of Emergency Medicine (Vol. 54, pp. S49–S50). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2009.06.189Full Text
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Limkakeng, A. T., Glickman, S., Greene, V., & Chandra, A. (2008). 303: Incidence and Impact of Renal Dysfunction on Acute Coronary Syndrome in Chest Pain Observation Unit Patients. In Annals of Emergency Medicine (Vol. 52, pp. S134–S134). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2008.06.326Full Text
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Limkakeng, A. T., Saraswat, A., Glickman, S., Molinar, G., Drake, W., Freeman, D., & Chandra, A. (2008). 150: Blood Pressure Response in Hypertensive Emergency Department Patients With a History of End Organ Disease. In Annals of Emergency Medicine (Vol. 52, pp. S89–S89). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2008.06.064Full Text
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Takakuwa, K. M., Limkakeng Jr, A. T., Shofer, F. S., & Hollander, J. E. (2006). Patients' pain and estimate of their risk for cardiac disease do not predict preferences for cardiac tests and procedures. In Annals of Emergency Medicine (Vol. 48, pp. S28–S28). New Orleans, LA: MOSBY-ELSEVIER.Link to Item
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Limkakeng, A. T., Tsai, J., Lindsay, T., Ciavarella, G., Andrade, A. A., Kampe, L. M., … Roberts, R. R. (2004). Effects of implementing a modified electronic medical record and comprehensive patient tracking system on the patient care activities of emergency department staff. In Annals of Emergency Medicine (Vol. 44, pp. S129–S130). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2004.07.415Full Text
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Tsai, J., Limkakeng, A. T., Roberts, R. R., & Schaider, J. (2004). Impact of institution of an electronic hospital information system on nursing quick registration and triage times. In Annals of Emergency Medicine (Vol. 44, pp. S122–S122). Elsevier BV. https://doi.org/10.1016/j.annemergmed.2004.07.392Full Text
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- Teaching & Mentoring
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Teaching Activities
- Assistant Course Director, ACEP Emergency Medicine Basic Research Skills (EMBRS) Course.
- Scholarly, Clinical, & Service Activities
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Presentations & Appearances
- Advanced Use of Biomarkers. Braunwald Rounds. Section of Adult Cardiology, Department of Internal Medicine . August 2019 2019
- Emergency Medicine Research Infrastructure. Duke National University of Singapore. July 2019 2019
- Emergency Medicine Basic Research Skills Course. Emergency Medicine News Live Podcast. Emergency Medicine News. April 16, 2019 2019
- Elements of a Study Protocol, Practicum, Sample Size Calculations, Chart Review Research, Developing your Study Protocol Practicum. Emergency Medicine Basic Research Skills Course. American College of Emergency Physicians. 2019 2019
- Aspectos metodológicos dos ensaios clínicos em acidentes ofídicos (Methodological Aspects of Clinical Trials in Snakebite Envenomations). Seminários Nacional de Pesquisa Clínica em Acidentes por Animais Peçonhentos. November 2018 2018
- American College of Emergency Physicians Research Forum. ACEP Frontline. American College of Emergency Physicians. August 2018 2018
- Low Risk Chest Pain Strategies and the Use of Coronary CT Scans. Observation Medicine: Science and Solutions. Michigan College of Emergency Physicians. September 2015 - September 2015 2015
- Academic-Industry Partnerships: The Industry Perspective . Society for Academic Emergency Medicine Annual Meeting. Society for Academic Emergency Medicine. May 2015 - May 2015 2015
- The Great Chest Pain Debate. Society for Academic Emergency Medicine Annual Meeting. Society for Academic Emergency Medicine. May 2015 2015
- Generating Scholarship Through Industry Partnerships. Society for Academic Emergency Medicine Annual Meeting. Society for Academic Emergency Medicine. May 2014 2014
- Phenotyping in the Era or Personalized Medicine . Society for Academic Emergency Medicine Annual Meeting. Society for Academic Emergency Medicine. May 2014 2014
- Noninvasive Testing for Coronary Artery Disease. CME . Area L AHEC, Wakemed Hospital. January 2011 2011
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Outreach & Engaged Scholarship
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Service to the Profession
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