Scholars@Duke
Alexander Tan Limkakeng Jr.

Alexander Tan Limkakeng Jr.

Professor of Emergency Medicine
Emergency Medicine
2301 Erwin Road Box 3096, Durham, NC 27710
2301 Erwin Road, Box 3096, Durham, NC 27710

Selected Publications

2023 Society for Academic Emergency Medicine Consensus Conference on Precision Emergency Medicine: Development of a policy-relevant, patient-centered research agenda.

Journal Article Acad Emerg Med · August 2024 OBJECTIVES: Precision medicine is data-driven health care tailored to individual patients based on their unique attributes, including biologic profiles, disease expressions, local environments, and socioeconomic conditions. Emergency medicine (EM) has been ... Full text Link to item Cite

Evaluating the performance of the HEART score in a Tanzanian emergency department.

Journal Article Acad Emerg Med · April 2024 OBJECTIVE: The HEART score successfully risk stratifies emergency department (ED) patients with chest pain in high-income settings. However, this tool has not been validated in low-income countries. METHODS: This is a secondary analysis of a prospective ob ... Full text Link to item Cite

RobOCTNet: Robotics and Deep Learning for Referable Posterior Segment Pathology Detection in an Emergency Department Population.

Journal Article Transl Vis Sci Technol · March 1, 2024 PURPOSE: To evaluate the diagnostic performance of a robotically aligned optical coherence tomography (RAOCT) system coupled with a deep learning model in detecting referable posterior segment pathology in OCT images of emergency department patients. METHO ... Full text Link to item Cite

Adapting an Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Co-Design of the MIMIC Intervention.

Journal Article Ann Glob Health · 2024 BACKGROUND: Uptake of evidence-based care for acute myocardial infarction (AMI) is suboptimal in Tanzania, but there are currently no published interventions to improve AMI care in sub-Saharan Africa. OBJECTIVES: Co-design a quality improvement interventio ... Full text Link to item Cite

Provider attitudes towards quality improvement for myocardial infarction care in northern Tanzania.

Journal Article PLOS Glob Public Health · 2024 INTRODUCTION: Myocardial Infarction (MI) is a leading cause of death worldwide. In high income countries, quality improvement strategies have played an important role in increasing uptake of evidence-based MI care and improving MI outcomes. The incidence o ... Full text Link to item Cite

Fixing the leaky physician-scientist pipeline: Integrated-dedicated research period programs in emergency medicine.

Journal Article AEM Educ Train · December 2023 Emergency physicians (EPs) are well positioned to perform medical research. EPs are exposed to a wide range of disease types, medical specialties, and treatment modalities. Furthermore, emergency medicine (EM) serves as the safety net for the U.S. health c ... Full text Link to item Cite

Robotic Optical Coherence Tomography Retinal Imaging for Emergency Department Patients: A Pilot Study for Emergency Physicians' Diagnostic Performance.

Journal Article Ann Emerg Med · April 2023 STUDY OBJECTIVE: To evaluate the diagnostic performance of emergency physicians' interpretation of robotically acquired retinal optical coherence tomography images for detecting posterior eye abnormalities in patients seen in the emergency department (ED). ... Full text Link to item Cite

Six-month blood pressure and glucose control among HIV-infected adults with elevated blood pressure and hyperglycemia in northern Tanzania: A prospective observational study.

Journal Article PLoS One · 2023 BACKGROUND: People with HIV in sub-Saharan Africa are increasingly developing age-related comorbidities. The purpose of this prospective observational study was to describe 6-month outcomes among Tanzanians with HIV and elevated blood pressure or hyperglyc ... Full text Link to item Cite

Longitudinal ECG changes among adults with HIV in Tanzania: A prospective cohort study.

Journal Article PLOS Glob Public Health · 2023 The prevalence of cardiovascular disease (CVD) is rising among people with HIV (PWH) in sub-Saharan Africa (SSA). Despite the utility of the electrocardiogram (ECG) in screening for CVD, there is limited data regarding longitudinal ECG changes among PWH in ... Full text Link to item Cite

Sepsis with liver dysfunction and coagulopathy predicts an inflammatory pattern of macrophage activation

Journal Article Intensive Care Medicine Experimental · December 1, 2022 Background: Interleukin-1 receptor antagonists can reduce mortality in septic shock patients with hepatobiliary dysfunction and disseminated intravascular coagulation (HBD + DIC), an organ failure pattern with inflammatory features consistent with macropha ... Full text Cite

Outcomes in ED patients with non-specific ECG findings and low high-sensitivity troponin.

Journal Article J Am Coll Emerg Physicians Open · December 2022 BACKGROUND: Although some emergency department risk stratification tools consider non-specific ECG findings as an aid in disposition decisions, their clinical value in patients with an initially low high-sensitivity cardiac troponin I (hsTnI) is unclear. O ... Full text Open Access Link to item Cite

Acupuncture for acute musculoskeletal pain management in the emergency department and continuity clinic: a protocol for an adaptive pragmatic randomised controlled trial.

Journal Article BMJ Open · September 23, 2022 INTRODUCTION: Chronic musculoskeletal pain causes a significant burden on health and quality of life and may result from inadequate treatment of acute musculoskeletal pain. The emergency department (ED) represents a novel setting in which to test non-pharm ... Full text Link to item Cite

Stress-Delta B-Type Natriuretic Peptide Does Not Exclude ACS in the ED.

Journal Article J Appl Lab Med · September 1, 2022 Featured Publication BACKGROUND: There are many detectable changes in circulating biomarkers in the setting of myocardial ischemia. We hypothesize that there are associated changes in circulating B-type natriuretic peptide (BNP) level after stress-induced myocardial ischemia, ... Full text Link to item Cite

Predictors of Stress-Delta High-Sensitivity Troponin T in Emergency Department Patients Undergoing Stress Testing.

Journal Article Cureus · September 2022 Featured Publication Background and objective Elevations in high-sensitivity troponin T (hs-TnT) are frequently observed following extreme physical exercise. In light of this, we sought to determine whether specific clinical characteristics are associated with this phenomenon ... Full text Open Access Link to item Cite

Direct vs Video Laryngoscopy for Difficult Airway Patients in the Emergency Department: A National Emergency Airway Registry Study.

Journal Article West J Emerg Med · August 19, 2022 INTRODUCTION: Previous studies suggest improved intubation success using video laryngoscopy (VL) vs direct laryngoscopy (DL), yet recent randomized trials have not shown clear benefit of one method over the other. These studies, however, have generally exc ... Full text Open Access Link to item Cite

Prognosis is worse with elevated cardiac troponin in nonacute coronary syndrome compared with acute coronary syndrome.

Journal Article Coron Artery Dis · August 1, 2022 BACKGROUND: Cardiac troponin (cTn) can be elevated in many patients presenting to the emergency department (ED) with chest pain but without a diagnosis of acute coronary syndrome (ACS). We compared the prognostic significance of cTn in these different popu ... Full text Link to item Cite

A precision medicine approach to stress testing using metabolomics and microribonucleic acids.

Journal Article Per Med · July 2022 Featured Publication Both transcriptomics and metabolomics hold promise for identifying acute coronary syndrome (ACS) but they have not been used in combination, nor have dynamic changes in levels been assessed as a diagnostic tool. We assessed integrated analysis of periphera ... Full text Link to item Cite

Untapped Potential for Emergency Department Observation Unit Use: A National Hospital Ambulatory Medical Care Survey (NHAMCS) Study.

Journal Article West J Emerg Med · January 18, 2022 Featured Publication INTRODUCTION: Millions of people present to the emergency department (ED) with chest pain annually. Accurate and timely risk stratification is important to identify potentially life-threatening conditions such as acute coronary syndrome (ACS). An ED-based ... Full text Open Access Link to item Cite

Impact of dispatcher-assisted cardiopulmonary resuscitation on performance of termination of resuscitation criteria.

Journal Article Resuscitation · January 2022 Featured Publication BACKGROUND: Current Advanced Life Support Termination of Resuscitation (TOR) guidelines suggest when to cease cardiopulmonary resuscitation (CPR). With the significant increase of Dispatch-Assisted CPR (DA-CPR) programs, the impact of DA-CPR on the TOR cri ... Full text Link to item Cite

Prevalence and Correlates of Ischemic ECG Findings among Adults With and Without HIV in Tanzania.

Journal Article Glob Heart · 2022 INTRODUCTION: HIV confers increased risk of myocardial infarction (MI), but there has been little study of ischemic electrocardiogram (ECG) findings among people with HIV in sub-Saharan Africa. OBJECTIVES: To compare the prevalence of ischemic ECG findings ... Full text Link to item Cite

Experiences of COVID-19 infection in North Carolina: A qualitative analysis.

Journal Article PLoS One · 2022 BACKGROUND AND AIM: It has been demonstrated that marginalized populations across the U.S. have suffered a disproportionate burden of the coronavirus disease 2019 (COVID-19) pandemic, illustrating the role that social determinants of health play in health ... Full text Open Access Link to item Cite

The prevalence, management, and thirty-day outcomes of symptomatic atrial fibrillation in a Tanzanian emergency department.

Journal Article Afr J Emerg Med · December 2021 INTRODUCTION: Data describing atrial fibrillation (AF) care in emergency centres (ECs) in sub-Saharan Africa is lacking. We sought to describe the prevalence and outcomes of AF in a Tanzanian EC. METHODS: In a prospective, observational study, adults prese ... Full text Open Access Link to item Cite

Comparison of outcomes between pulseless electrical activity by electrocardiography and pulseless myocardial activity by echocardiography in out-of-hospital cardiac arrest; secondary analysis from a large, prospective study.

Journal Article Resuscitation · December 2021 OBJECTIVE: To measure prevalence of discordance between electrical activity recorded by electrocardiography (ECG) and myocardial activity visualized by echocardiography (echo) in patients presenting after cardiac arrest and to compare survival outcomes in ... Full text Link to item Cite

Thirty-day outcomes and predictors of mortality following acute myocardial infarction in northern Tanzania: A prospective observational cohort study.

Journal Article Int J Cardiol · November 1, 2021 OBJECTIVE: There is a rising burden of myocardial infarction (MI) within sub-Saharan Africa. Prospective studies of detailed MI outcomes in the region are lacking. METHODS: Adult patients with confirmed MI from a prospective surveillance study in northern ... Full text Link to item Cite

Viral Coinfection is Associated with Improved Outcomes in Emergency Department Patients with SARS-CoV-2.

Journal Article West J Emerg Med · October 26, 2021 INTRODUCTION: Coinfection with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) and another virus may influence the clinical trajectory of emergency department (ED) patients. However, little empirical data exists on the clinical outcomes of coi ... Full text Link to item Cite

Risk stratification with video capsule endoscopy leads to fewer hospital admissions in emergency department patients with low-risk to moderate-risk upper gastrointestinal bleed: A multicenter clinical trial.

Journal Article J Am Coll Emerg Physicians Open · October 2021 OBJECTIVE: In US emergency departments (EDs), the physician has limited ability to evaluate for common and serious conditions of the gastrointestinal (GI) mucosa such as a bleeding peptic ulcer. Although many bleeding lesions are self-limited, the majority ... Full text Open Access Link to item Cite

United States Emergency Department Use of Medications with Pharmacogenetic Recommendations.

Journal Article West J Emerg Med · September 23, 2021 Featured Publication INTRODUCTION: Emergency departments (ED) use many medications with a range of therapeutic efficacy and potential significant side effects, and many medications have dosage adjustment recommendations based on the patient's specific genotype. How frequently ... Full text Open Access Link to item Cite

Immune response profiling in patients with traumatic injuries associated with alcohol ingestion.

Journal Article Clinical and translational science · September 2021 Featured Publication Traumatic injuries afflict more than 5 million people globally every year. Current and past animal research has demonstrated association among alcohol, trauma, and impaired immune function, whereas human registries have shown association between alcohol an ... Full text Open Access Cite

Machine Learning and Precision Medicine in Emergency Medicine: The Basics.

Journal Article Cureus · September 2021 Featured Publication As machine learning (ML) and precision medicine become more readily available and used in practice, emergency physicians must understand the potential advantages and limitations of the technology. This narrative review focuses on the key components of mach ... Full text Open Access Link to item Cite

Incidence of Acute Myocardial Infarction in Northern Tanzania: A Modeling Approach Within a Prospective Observational Study.

Journal Article J Am Heart Assoc · August 3, 2021 Background Rigorous incidence data for acute myocardial infarction (AMI) in sub-Saharan Africa are lacking. Consequently, modeling studies based on limited data have suggested that the burden of AMI and AMI-associated mortality in sub-Saharan Africa is low ... Full text Open Access Link to item Cite

Ideal high sensitivity troponin baseline cutoff for patients with renal dysfunction.

Journal Article Am J Emerg Med · August 2021 Featured Publication OBJECTIVE: High-sensitivity cardiac troponin assays (hs-cTn) aid in diagnosis of myocardial infarction (MI). These assays have lower specificity for non-ST Elevation MI (NSTEMI) in patients with renal disease. Our objective was to determine an optimized cu ... Full text Link to item Cite

Sex-related differences in D-dimer levels for venous thromboembolism screening.

Journal Article Acad Emerg Med · August 2021 BACKGROUND: D-dimer is generally considered positive above 0.5 mg/L irrespective of sex. However, women have been shown to be more likely to have a positive D-dimer after controlling for other factors. Thus, differences may exist between males and females ... Full text Link to item Cite

A hypothetical implementation of 'Termination of Resuscitation' protocol for out-of-hospital cardiac arrest.

Journal Article Resusc Plus · June 2021 Featured Publication BACKGROUND: Out-of-hospital cardiac arrests with negligible chance of survival are routinely transported to hospital and many are pronounced dead thereafter. This leads to some potentially avoidable costs. The 'Termination of Resuscitation' protocol allows ... Full text Open Access Link to item Cite

Outpatient versus observation/inpatient management of emergency department patients rapidly ruled-out for acute myocardial infarction: Findings from the HIGH-US study.

Journal Article Am Heart J · January 2021 Featured Publication BACKGROUND: The actual Emergency Department (ED) dispositions of patients enrolled in observational studies and meeting criteria for rapid acute myocardial infarction (AMI) rule-out are unknown. Additionally, their presenting clinical profiles, cardiac tes ... Full text Open Access Link to item Cite

Association of a Network of Immunologic Response and Clinical Features With the Functional Recovery From Crotalinae Snakebite Envenoming.

Journal Article Front Immunol · 2021 BACKGROUND: The immunologic pathways activated during snakebite envenoming (SBE) are poorly described, and their association with recovery is unclear. The immunologic response in SBE could inform a prognostic model to predict recovery. The purpose of this ... Full text Open Access Link to item Cite

Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.

Journal Article PLoS One · 2021 BACKGROUND: The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings. METHODS: In a prospective obser ... Full text Open Access Link to item Cite

Remote retinal imaging of patients from the ER using robotically aligned OCT

Conference INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE · 2021 Cite

Biomarkers Enhance Discrimination and Prognosis of Type 2 Myocardial Infarction.

Journal Article Circulation · October 20, 2020 Featured Publication BACKGROUND: The observed incidence of type 2 myocardial infarction (T2MI) is expected to increase with the implementation of increasingly sensitive cTn assays. However, it remains to be determined how to diagnose, risk-stratify, and treat patients with T2M ... Full text Link to item Cite

A Method for Grouping Emergency Department Visits by Severity and Complexity.

Journal Article West J Emerg Med · August 21, 2020 INTRODUCTION: Triage functions to quickly prioritize care and sort patients by anticipated resource needs. Despite widespread use of the Emergency Severity Index (ESI), there is still no universal standard for emergency department (ED) triage. Thus, it can ... Full text Open Access Link to item Cite

Acute myocardial infarction under-diagnosis and mortality in a Tanzanian emergency department: A prospective observational study.

Journal Article Am Heart J · August 2020 BACKGROUND: Growing evidence suggests that under-diagnosis of acute myocardial infarction (AMI) may be common in sub-Saharan Africa. Prospective studies of routine AMI screening among patients presenting to emergency departments in sub-Saharan Africa are l ... Full text Open Access Link to item Cite

Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study.

Conference Ann Emerg Med · July 2020 Featured Publication STUDY OBJECTIVE: We determine the accuracy of high-sensitivity cardiac troponin I (hs-cTnI), European-derived, rapid, acute myocardial infarction, rule-out/rule-in algorithms applied to a US emergency department (ED) population. METHODS: Adults presenting ... Full text Open Access Link to item Cite

Video capsule endoscopy for upper gastrointestinal hemorrhage in the emergency department: A systematic review and meta-analysis.

Journal Article Am J Emerg Med · June 2020 OBJECTIVE: The assessment of the severity of upper gastrointestinal hemorrhage in emergency department (ED) patients is difficult to assess with commonly available diagnostic tools. Small studies have shown that video capsule endoscopy (VCE) is a promising ... Full text Open Access Link to item Cite

Sepsis-Associated Acute Kidney Disease

Journal Article Kidney International Reports · June 1, 2020 Introduction: About one-third of critically ill patients with acute kidney injury (AKI) develop persistently decreased kidney function, known as acute kidney disease (AKD), which may progress to chronic kidney disease (CKD). Although sepsis is the most com ... Full text Cite

The 99th percentile upper reference limit for the 5th generation cardiac troponin T assay in the United States.

Journal Article Clin Chim Acta · May 2020 Featured Publication BACKGROUND: Determining diagnostic thresholds for cardiac troponin assays is key to interpreting their clinical performance. We describe the calculation of 99th percentile upper reference limits (URLs) for the Elecsys® Troponin T Gen 5 (TnT Gen 5) assay. M ... Full text Open Access Link to item Cite

Pivotal findings for a high-sensitivity cardiac troponin assay: Results of the HIGH-US study.

Journal Article Clin Biochem · April 2020 Featured Publication BACKGROUND: Cardiac troponin (cTn) is the keystone for diagnosis of acute myocardial infarction (AMI). We examined the analytical and diagnostic accuracy of the Atellica IM TnIH assay to determine high-sensitivity performance and appropriate diagnostic per ... Full text Link to item Cite

Stress-delta B-type Natriuretic Peptide Levels as a Test for Inducible Myocardial Ischemia: A Systematic Review and Meta-Analysis.

Journal Article Cureus · March 2, 2020 Featured Publication Background Cardiac ischemia induces myocardial dysfunction and ventricular wall stretch, which causes the release of B-type natriuretic peptide (BNP) into the bloodstream. However, it is unclear whether inducible ischemia produces a significant change in B ... Full text Open Access Link to item Cite

Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital.

Journal Article Glob Heart · February 6, 2020 BACKGROUND: Acute coronary syndrome (ACS) is thought to be a rare diagnosis in sub-Saharan Africa, but little is known about diagnostic practices for patients with possible ACS symptoms in the region. OBJECTIVE: To describe current care practices for patie ... Full text Open Access Link to item Cite

Duplicated or Ectopic Renal Collecting System in Two Adult Emergency Department Patients.

Journal Article J Emerg Med · February 2020 BACKGROUND: Duplicated renal collecting system is a urological anomaly often found in pediatric patients. It is less commonly diagnosed in adulthood, particularly in a pregnant patient. Many point-of-care ultrasonography users may not be aware of this diag ... Full text Open Access Link to item Cite

A Precision Medicine Approach to Stress Testing Using Metabolomics and Microribonucleic Acids

Journal Article · 2020 Featured Publication ABSTRACTBackground Acute coronary syndrome (ACS) is a growing global health problem, and precision medicine techniques hold promise for the development of diagnostic indicators of ACS. In this pilot, we sought to assess the utility of an ... Full text Cite

Detection of Retinal Detachment by ED Clinicians on OCT Images versus Fundus Photos

Conference INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE · 2020 Cite

Biomarker Profiling for Obstructive Coronary Artery Disease: A PROMISE Substudy

Conference ANNALS OF EMERGENCY MEDICINE · 2020 Featured Publication Cite

Serum Procalcitonin Trends in Hospital-Acquired Infections: A Prospective Multi-Center Observational Cohort

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2020 Cite

The burden of acute coronary syndrome, heart failure, and stroke among emergency department admissions in Tanzania: A retrospective observational study.

Journal Article Afr J Emerg Med · December 2019 INTRODUCTION: The prevalence of cardiovascular disease in sub-Saharan Africa is substantial and growing. Much remains to be learned about the relative burden of acute coronary syndrome (ACS), heart failure, and stroke on emergency departments and hospital ... Full text Open Access Link to item Cite

Damage- and pathogen-associated molecular patterns play differential roles in late mortality after critical illness.

Journal Article JCI Insight · August 22, 2019 Featured Publication Multiple organ failure (MOF) is the leading cause of late mortality and morbidity in patients who are admitted to intensive care units (ICUs). However, there is an epidemiologic discrepancy in the mechanism of underlying immunologic derangement dependent o ... Full text Link to item Cite

Copeptin to rule out myocardial infarction in Blacks versus Caucasians.

Journal Article Eur Heart J Acute Cardiovasc Care · August 2019 Featured Publication BACKGROUND: Copeptin in combination with troponin has been shown to have incremental value for the early rule-out of myocardial infarction, but its performance in Black patients specifically has never been examined. In light of a potential for wider use, d ... Full text Link to item Cite

Analytical performance evaluation of the Elecsys® Troponin T Gen 5 STAT assay.

Journal Article Clin Chim Acta · August 2019 Featured Publication BACKGROUND: We report the analytical performance of the Elecsys® Troponin T Gen 5 STAT (TnT Gen 5 STAT; Roche Diagnostics) assay. METHODS: Measuring limits/ranges were determined in lithium-heparin plasma samples per Clinical and Laboratory Standards Insti ... Full text Open Access Link to item Cite

Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I.

Journal Article J Am Coll Cardiol · July 23, 2019 Featured Publication BACKGROUND: Limited data exist on rapid risk-stratification strategies using the U.S. Food and Drug Administration-cleared high-sensitivity cardiac troponin I (hs-cTnI) assays. OBJECTIVES: This study sought to examine single measurement hs-cTnI to identify ... Full text Link to item Cite

Trial design for assessing analytical and clinical performance of high-sensitivity cardiac troponin I assays in the United States: The HIGH-US study.

Journal Article Contemp Clin Trials Commun · June 2019 BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) assays have been developed that quantify lower cTnI concentrations with better precision versus earlier generation assays. hs-cTnI assays allow improved clinical utility for diagnosis and risk strat ... Full text Open Access Link to item Cite

Priorities to Overcome Barriers Impacting Data Science Application in Emergency Care Research.

Journal Article Acad Emerg Med · January 2019 For a variety of reasons including cheap computing, widespread adoption of electronic medical records, digitalization of imaging and biosignals, and rapid development of novel technologies, the amount of health care data being collected, recorded, and stor ... Full text Open Access Link to item Cite

The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access.

Journal Article PLoS One · 2019 BACKGROUND: Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality. METHODS AND RESULTS: Using data from DATASUS, the public national ... Full text Open Access Link to item Cite

Pilot study of myocardial ischemia-induced metabolomic changes in emergency department patients undergoing stress testing.

Journal Article PLoS One · 2019 Featured Publication BACKGROUND: The heart is a metabolically active organ, and plasma acylcarnitines are associated with long-term risk for myocardial infarction. We hypothesized that myocardial ischemia from cardiac stress testing will produce dynamic changes in acylcarnitin ... Full text Open Access Link to item Cite

Implementation of the HEART Pathway: Using the Consolidated Framework for Implementation Research.

Journal Article Crit Pathw Cardiol · December 2018 Featured Publication OBJECTIVE: The HEART Pathway is an evidence-based decision tool for identifying emergency department (ED) patients with acute chest pain who are candidates for early discharge, to reduce unhelpful and potentially harmful hospitalizations. Guided by the Con ... Full text Open Access Link to item Cite

Microcirculatory perfusion disturbances in septic shock: results from the ProCESS trial.

Journal Article Crit Care · November 20, 2018 BACKGROUND: We sought to determine the effects of alternative resuscitation strategies on microcirculatory perfusion and examine any association between microcirculatory perfusion and mortality in sepsis. METHODS: This was a prospective, formally designed ... Full text Link to item Cite

Toll-like receptor activation as a biomarker in traumatically injured patients.

Journal Article J Surg Res · November 2018 BACKGROUND: Surgical insult and trauma have been shown to cause dysregulation of the immune and inflammatory responses. Interaction of damage-associated molecular patterns (DAMPs) with toll-like receptors (TLRs) initiates innate immune response and systemi ... Full text Open Access Link to item Cite

Multicenter Evaluation of the YEARS Criteria in Emergency Department Patients Evaluated for Pulmonary Embolism.

Journal Article Acad Emerg Med · September 2018 BACKGROUND: It may be possible to safely rule out pulmonary embolism (PE) in patients with low pretest probability (PTP) using a higher than standard D-dimer threshold. The YEARS criteria, which include three questions from the Wells PE score to identify l ... Full text Link to item Cite

Unexpected Cardiac MRI Findings in Patients Presenting to the Emergency Department for Possible Acute Coronary Syndrome.

Journal Article Crit Pathw Cardiol · September 2018 Featured Publication BACKGROUND: Stress cardiac magnetic resonance imaging (CMR) has become increasingly used in patients presenting to the emergency department (ED) with symptoms concerning for acute coronary syndrome (ACS). We hypothesized that CMR detects a number of altern ... Full text Open Access Link to item Cite

NHAMCS Validation of Emergency Severity Index as an Indicator of Emergency Department Resource Utilization.

Journal Article West J Emerg Med · September 2018 INTRODUCTION: Triage systems play a vital role in emergency department (ED) operations and can determine how well a given ED serves its local population. We sought to describe ED utilization patterns for different triage levels using the National Hospital ... Full text Link to item Cite

International, multicenter evaluation of a new D-dimer assay for the exclusion of venous thromboembolism using standard and age-adjusted cut-offs.

Journal Article Thromb Res · June 2018 INTRODUCTION: We sought to determine the test characteristics of an automated INNOVANCE D-dimer assay for the exclusion of pulmonary embolism (PE) and deep venous thrombosis (DVT) in emergency department (ED) patients using standard and age-adjusted cut-of ... Full text Open Access Link to item Cite

Evaluation of Transplant Kidneys Using a Novel Point of Care 3D Ultrasound System.

Conference AMERICAN JOURNAL OF TRANSPLANTATION · June 1, 2018 Link to item Cite

Efficacy of High-Sensitivity Troponin T in Identifying Very-Low-Risk Patients With Possible Acute Coronary Syndrome.

Journal Article JAMA Cardiol · February 1, 2018 IMPORTANCE: Physicians need information on how to use the first available high-sensitivity troponin (hsTnT) assay in the United States to identify patients at very low risk for 30-day adverse cardiac events (ACE). OBJECTIVE: To determine whether a negative ... Full text Open Access Link to item Cite

Provocative biomarker stress test: stress-delta N-terminal pro-B type natriuretic peptide.

Journal Article Open Heart · 2018 OBJECTIVE: Stress testing is commonly performed in emergency department (ED) patients with suspected acute coronary syndrome (ACS). We hypothesised that changes in N-terminal pro-B type natriuretic peptide (NT-proBNP) concentrations from baseline to post-s ... Full text Open Access Link to item Cite

Are Well-Informed Potential Trial Participants More Likely to Participate?

Journal Article J Empir Res Hum Res Ethics · December 2017 Featured Publication Bearing in mind the importance of the informed consent, flaws in this process may be a barrier to participants' recruitment. Our objective was to determine the relationship between the degree of comprehension of the informed consent document plus the impor ... Full text Open Access Link to item Cite

A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study.

Journal Article Resuscitation · November 2017 OBJECTIVE: Our objective was to determine whether organized or disorganized cardiac activity is associated with increased survival in patients who present in pulseless electrical activity (PEA) treated with either 1) standard advanced cardiac life support ... Full text Link to item Cite

Critical Care Air Transport Team severe traumatic brain injury short-term outcomes during flight for Operation Iraqi Freedom/Operation Enduring Freedom.

Journal Article J R Army Med Corps · October 2017 INTRODUCTION: Our understanding of the expertise and equipment required to air transport injured soldiers with severe traumatic brain injuries (TBIs) continue to evolve. METHODS: We conducted a retrospective chart review of characteristics, interventions r ... Full text Open Access Link to item Cite

Care of the Patient with Chest Pain in the Observation Unit.

Journal Article Emerg Med Clin North Am · August 2017 Featured Publication Care of the patient presenting to an emergency department (ED) with chest pain remains a common yet challenging aspect of emergency medicine. Acute coronary syndrome presents in nonspecific fashion. The development and evolution of the ED-based observation ... Full text Open Access Link to item Cite

Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis.

Journal Article N Engl J Med · June 8, 2017 BACKGROUND: After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of indiv ... Full text Open Access Link to item Cite

Myocardial Ischemia on Exercise Stress Echocardiography Testing Is Not Associated with Changes in Troponin T Concentrations.

Journal Article J Appl Lab Med · March 1, 2017 Featured Publication BACKGROUND: Some posit that any amount of myocardial ischemia can be detected by high-sensitivity cardiac troponin assays. We hypothesized that patients with myocardial ischemia induced by exercise stress would have significantly higher increases in high-s ... Full text Open Access Link to item Cite

Necessity of hospitalization and stress testing in low risk chest pain patients.

Journal Article Am J Emerg Med · February 2017 Featured Publication BACKGROUND: Copeptin is a marker of endogenous stress including early myocardial infarction(MI) and has value in early rule out of MI when used with cardiac troponin I(cTnI). OBJECTIVES: The goal of this study was to demonstrate that patients with a normal ... Full text Link to item Cite

Wireless, Web-Based Interactive Control of Optical Coherence Tomography with Mobile Devices.

Journal Article Transl Vis Sci Technol · January 2017 PURPOSE: Optical coherence tomography (OCT) is widely used in ophthalmology clinics and has potential for more general medical settings and remote diagnostics. In anticipation of remote applications, we developed wireless interactive control of an OCT syst ... Full text Open Access Link to item Cite

Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest.

Journal Article Resuscitation · December 2016 BACKGROUND: Point-of-care ultrasound has been suggested to improve outcomes from advanced cardiac life support (ACLS), but no large studies have explored how it should be incorporated into ACLS. Our aim was to determine whether cardiac activity on ultrasou ... Full text Open Access Link to item Cite

Systematic Molecular Phenotyping: A Path Toward Precision Emergency Medicine?

Journal Article Acad Emerg Med · October 2016 Featured Publication Precision medicine is an emerging approach to disease treatment and prevention that considers variability in patient genes, environment, and lifestyle. However, little has been written about how such research impacts emergency care. Recent advances in anal ... Full text Open Access Link to item Cite

Toll-Like Receptor Signaling as a Prognostic Tool in Trauma Patients

Conference Journal of the American College of Surgeons · October 2016 Full text Cite

Evaluation of T-Wave Morphology in Patients With Left Bundle Branch Block and Suspected Acute Coronary Syndrome.

Journal Article J Emerg Med · September 2016 Featured Publication BACKGROUND: T-wave morphology in the setting of left bundle branch block (LBBB) has been proposed as an indicator of myocardial ischemia. OBJECTIVES: We sought to identify T-wave morphology findings in patients with LBBB that predict non-ST-segment elevati ... Full text Open Access Link to item Cite

Who explicitly requests the ordering of computed tomography for emergency department patients? A multicenter prospective study.

Journal Article Emerg Radiol · June 2016 Emergency department (ED) computed tomography (CT) use has increased substantially in recent years, resulting in increased radiation exposure for patients. Few studies have assessed which parties contribute to CT ordering in the ED. The objective of this s ... Full text Link to item Cite

Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients.

Journal Article Ann Am Thorac Soc · March 2016 Featured Publication RATIONALE: Limitations in methods for the rapid diagnosis of hospital-acquired infections often delay initiation of effective antimicrobial therapy. New diagnostic approaches offer potential clinical and cost-related improvements in the management of these ... Full text Open Access Link to item Cite

The Effects of Alternative Resuscitation Strategies on Acute Kidney Injury in Patients with Septic Shock.

Journal Article Am J Respir Crit Care Med · February 1, 2016 RATIONALE: Septic shock is a common cause of acute kidney injury (AKI), and fluid resuscitation is a major part of therapy. OBJECTIVES: To determine if structured resuscitation designed to alter fluid, blood, and vasopressor use affects the development or ... Full text Link to item Cite

Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: results from the CHOPIN trial.

Journal Article Emerg Med J · January 2016 Featured Publication BACKGROUND: Copeptin has demonstrated a role in early rule out for acute myocardial infarction (AMI) in combination with a negative troponin. However, management of patients with chest pain with a positive copeptin in the setting of a negative troponin is ... Full text Link to item Cite

High Exposure to Organophosphate Flame Retardants in Infants: Associations with Baby Products.

Journal Article Environ Sci Technol · December 15, 2015 Infant products containing polyurethane foam are commonly treated with organophosphate flame retardants (PFRs), including tris(1,3-dichloro-2-propyl)phosphate (TDCIPP) and triphenyl phosphate (TPHP). Infants may have greater exposure due to greater contact ... Full text Link to item Cite

Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study.

Journal Article Am Heart J · December 2015 Featured Publication BACKGROUND: The modified Sgarbossa criteria were proposed in a derivation study to be superior to the original criteria for diagnosing acute coronary occlusion (ACO) in left bundle branch block (LBBB). The new rule replaces the third criterion (5 mm of exc ... Full text Open Access Link to item Cite

Improving the Emergency Care Research Investigator Pipeline: SAEM/ACEP Recommendations.

Journal Article Acad Emerg Med · July 2015 Featured Publication As representatives of the Society for Academic Emergency Medicine (SAEM) and American College of Emergency Physicians (ACEP) Research Committees, we offer commentary regarding the reasons for, and possible solutions to, the low number of EM applications fo ... Full text Open Access Link to item Cite

Midregional proadrenomedullin predicts mortality and major adverse cardiac events in patients presenting with chest pain: results from the CHOPIN trial.

Journal Article Acad Emerg Med · May 2015 Featured Publication OBJECTIVES: Chest pain is a common complaint to emergency departments (EDs) and clinical risk factors are used to predict which patients are at risk for worse outcomes and mortality. The goal was to assess the novel biomarker midregional proadrenomedullin ... Full text Link to item Cite

Characteristics of patients that do not initially respond to intravenous antihypertensives in the emergency department: subanalysis of the CLUE trial.

Journal Article West J Emerg Med · March 2015 INTRODUCTION: Hypertensive emergency has a high mortality risk and the treatment goal is to quickly lower blood pressure with intravenous (IV) medications. Characteristics that are associated with non-response to IV antihypertensives have not been identifi ... Full text Link to item Cite

Globe rupture

Chapter · July 7, 2014 Cite

A randomized trial of protocol-based care for early septic shock.

Other N Engl J Med · May 1, 2014 Featured Publication BACKGROUND: In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock, mortality was markedly lower among those who were treated according to a 6-hour protocol of ... Full text Open Access Link to item Cite

Acute myocardial infarction in sub-Saharan Africa: the need for data.

Journal Article PLoS One · 2014 Featured Publication BACKGROUND: Trends in the prevalence of acute myocardial infarction in sub-Saharan Africa have not been well described, despite growing recognition of the increasing burden of cardiovascular disease in low- and middle-income countries. The aim of this syst ... Full text Open Access Link to item Cite

Protocolized Care for Early Septic Shock (ProCESS) statistical analysis plan.

Journal Article Crit Care Resusc · December 2013 BACKGROUND: The Protocolized Care for Early Septic Shock study is a randomised, multicentre, prospective, three-arm, parallel-group trial of alternative resuscitation strategies for early septic shock. OBJECTIVE: To state our analysis plan for trial data. ... Link to item Cite

Thrombolysis in myocardial infarction risk score in an observation unit setting.

Journal Article Crit Pathw Cardiol · September 2013 Featured Publication OBJECTIVE: The Thrombolysis in Myocardial Infarction (TIMI) score is a validated tool for risk stratification of acute coronary syndrome. We hypothesized that the TIMI risk score would be able to risk stratify patients in observation unit for acute coronar ... Full text Open Access Link to item Cite

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).

Journal Article J Am Coll Cardiol · July 9, 2013 Featured Publication OBJECTIVES: The goal of this study was to demonstrate that copeptin levels <14 pmol/L allow ruling out acute myocardial infarction (AMI) when used in combination with cardiac troponin I (cTnI) <99 th percentile and a nondiagnostic electrocardiogram at the ... Full text Link to item Cite

Utility of observation units for young emergency department chest pain patients.

Journal Article J Emerg Med · February 2013 Featured Publication BACKGROUND: Determining which patients presenting to the Emergency Department (ED) require further work-up for acute coronary syndrome (ACS) can be difficult. The utility of routine observation for cardiac testing in low-risk young adult patients has been ... Full text Open Access Link to item Cite

Willingness to participate in clinical trials among patients of Chinese heritage: a meta-synthesis.

Journal Article PLoS One · 2013 Featured Publication BACKGROUND: Subjects of Chinese heritage have been found to participate in clinical research at lower rates than other groups despite growing in numbers as a population. While much research has examined research participants' motivation, there has not been ... Full text Open Access Link to item Cite

Cardiac evaluation for structural abnormalities may not be required in patients presenting with syncope and a normal ECG result in an observation unit setting.

Journal Article Ann Emerg Med · October 2012 Featured Publication STUDY OBJECTIVE: Patients with syncope are frequently managed in observation units and receive serial examinations, monitoring for arrhythmias, and structural analysis of the heart. The primary aim of this study is to determine the utility of structural an ... Full text Link to item Cite

Are patients with longer emergency department wait times less likely to consent to research?

Journal Article Acad Emerg Med · April 2012 Featured Publication OBJECTIVES: There are unique challenges to enrolling patients in emergency department (ED) clinical research studies, including the time-sensitive nature of emergency conditions, the acute care environment, and the lack of an established relationship with ... Full text Open Access Link to item Cite

Left ventricular dysfunction screening in hypertensive patients with N-terminal pro-B-type natriuretic peptide and electrocardiogram.

Journal Article Am J Emerg Med · January 2012 Featured Publication OBJECTIVE: Early recognition of left ventricular hypertrophy is important because antihypertensive treatment decreases morbidity and mortality. The ideal screening method for left ventricular hypertrophy in hypertensive emergency department (ED) patients h ... Full text Open Access Link to item Cite

Dental visits to a North Carolina emergency department: a painful problem.

Journal Article N C Med J · 2012 BACKGROUND: Emergency departments (EDs) act as the safety net and alternative care site for patients without insurance who have dental pain. METHODS: We conducted a retrospective chart review of visits to an urban teaching hospital ED over a 12-month perio ... Link to item Cite

An observation unit may help improve an institution's Press Ganey satisfaction score.

Journal Article Crit Pathw Cardiol · June 2011 Featured Publication BACKGROUND: : Hospitals measure patient satisfaction through Press Ganey (PG) surveys. The impact of an emergency department observation unit (EDOU) on patient satisfaction has not been reported to date. We hypothesize that an EDOU has a positive impact on ... Full text Link to item Cite

A multicenter analysis of the ED diagnosis of pneumonia.

Journal Article Am J Emerg Med · October 2010 Featured Publication OBJECTIVES: The objective of this study was to describe the prevalence of pneumonia-like signs and symptoms in patients admitted from the emergency department (ED) with a diagnosis of community acquired pneumonia (CAP) but subsequently discharged from the ... Full text Link to item Cite

Impact of renal dysfunction on acute coronary syndrome evaluation in observation unit patients.

Journal Article Am J Emerg Med · July 2010 Featured Publication OBJECTIVES: The impact of renal disease on risk stratification of patients at low risk for potential acute coronary syndrome has not been well defined. The objective of this study was to document the prevalence of renal dysfunction and assess the associati ... Full text Open Access Link to item Cite

Emergency physician high pretest probability for acute coronary syndrome correlates with adverse cardiovascular outcomes.

Journal Article Acad Emerg Med · August 2009 Featured Publication OBJECTIVES: The value of unstructured physician estimate of risk for disease processes, other than acute coronary syndrome (ACS), has been demonstrated. The authors sought to evaluate the predictive value of unstructured physician estimate of risk for ACS ... Full text Open Access Link to item Cite

Unsuspected pulmonary embolism in observation unit patients.

Journal Article West J Emerg Med · August 2009 Featured Publication OBJECTIVE: Many emergency department (ED) patients with cardiopulmonary symptoms such as chest pain or dyspnea are placed in observation units but do not undergo specific diagnostic testing for pulmonary embolism (PE). The role of observation units in the ... Link to item Cite

Preferences for cardiac tests and procedures may partially explain sex but not race disparities.

Journal Article Am J Emerg Med · June 2008 Featured Publication OBJECTIVE: There are known race and sex differences in emergent cardiac care. Many feel these differences reflect a bias from the physician. We hypothesized these differences may be the result of patient preferences. METHODS: Emergency department (ED) pati ... Full text Link to item Cite

Sixty-four-slice multidetector computed tomography: the future of ED cardiac care.

Journal Article Am J Emerg Med · May 2007 Featured Publication Multidetector computed tomography (MDCT) imaging, a technological advance over traditional CT, is a promising possible alternative to cardiac catheterization for evaluating patients with chest pain in the emergency department (ED). In comparison with tradi ... Full text Link to item Cite

Combination of Goldman risk and initial cardiac troponin I for emergency department chest pain patient risk stratification.

Journal Article Acad Emerg Med · July 2001 Featured Publication BACKGROUND: Accurate identification of low-risk emergency department (ED) chest pain patients who may be safe for discharge has not been well defined. Goldman criteria have reliably risk-stratified patients but have not identified any subset safe for ED re ... Full text Link to item Cite