Scholars@Duke
Mehul Dinesh Patel

Mehul Dinesh Patel

Instructor in the Department of Emergency Medicine
Emergency Medicine

Scholarly Works

Rural-urban differences in prehospital deaths due to injury in North Carolina.

Journal article Am J Emerg Med · June 2026 OBJECTIVE: Rural disparities in in-hospital mortality after traumatic injury are well documented. However, less is known about rural-urban differences in prehospital trauma mortality. We evaluated differences in prehospital injury-related deaths between ru ... Full text Link to item Cite

Stroke Survivor and Caregiver Perspectives on Seeking Emergency Medical Care.

Journal article J Patient Exp · 2026 Early recognition of acute stroke and activation of emergency medical services (EMS) are critical for timely treatment and improved patient outcomes. We aimed to identify facilitators and barriers to calling 9-1-1 for acute stroke from the perspectives of ... Full text Link to item Cite

An Investigation into Demographic Disparities in Emergency Department Disposition Decisions

Journal article Production and Operations Management · April 1, 2025 We investigate the presence of health disparities in emergency department (ED) disposition decisions and if crowding levels might have an exacerbating role. Using data from a large, academic ED, we find statistically significant associations between ED dis ... Full text Cite

Evaluation of the Implementation of a Novel Fluid Resuscitation Device in the Prehospital Care of Sepsis Patients: Application of the Implementation Outcomes Framework.

Journal article Prehosp Emerg Care · 2025 OBJECTIVES: Early identification and fluid resuscitation are recognized performance measures within sepsis care. Despite fluid resuscitation, fluid goals are often not achieved in the prehospital environment. Furthermore, description of implementation proc ... Full text Link to item Cite

Rural-urban differences in emergency medical services bypass routing of stroke in North Carolina.

Journal article J Rural Health · January 2025 PURPOSE: Acute stroke is a serious, time-sensitive condition requiring immediate medical attention. Emergency medical services (EMS) routing and direct transport of acute stroke patients to stroke centers improves timely access to care. This study aimed to ... Full text Open Access Link to item Cite

Rural Emergency Medical Services Perspectives on Improving Acute Stroke Care: A Qualitative Study.

Journal article Prehosp Emerg Care · 2025 OBJECTIVES: For underserved rural communities with limited geographical access to comprehensive stroke centers, emergency medical services (EMS) play a crucial role in timely, high-quality acute stroke care. This qualitative study aimed to understand rural ... Full text Link to item Cite

In-Hospital Code Status Updates: Trends Over Time and the Impact of COVID-19.

Journal article Am J Hosp Palliat Care · November 2024 OBJECTIVE: The primary objective was to evaluate if the percentage of patients with missing or inaccurate code status documentation at a Trauma Level 1 hospital could be reduced through daily updates. The secondary objective was to examine if patient prefe ... Full text Link to item Cite

Patient sex, racial and ethnic disparities in emergency department triage: A multi-site retrospective study.

Journal article Am J Emerg Med · February 2024 OBJECTIVES: There is limited evidence on sex, racial, and ethnic disparities in Emergency Department (ED) triage across diverse settings. We evaluated differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, accoun ... Full text Link to item Cite

Effectiveness of a Novel Rapid Infusion Device and Clinician Education for Early Fluid Therapy by Emergency Medical Services in Sepsis Patients: A Pre-Post Observational Study.

Journal article Prehosp Emerg Care · 2024 OBJECTIVE: Emergency medical services (EMS) clinicians are tasked with early fluid resuscitation for patients with sepsis. Traditional methods for prehospital fluid delivery are limited in speed and ease-of-use. We conducted a comparative effectiveness stu ... Full text Link to item Cite

Occupation, Retirement Age, and 20-Year Cognitive Decline: The Atherosclerosis Risk in Communities Neurocognitive Study.

Journal article Neuroepidemiology · 2024 INTRODUCTION: We examined the association of both midlife occupation and age at retirement with cognitive decline in the Atherosclerosis Risk in Communities (ARIC) biracial community-based cohort. METHODS: Current or most recent occupation at ARIC baseline ... Full text Link to item Cite

Identifying Patient Subpopulations with Significant Race-Sex Differences in Emergency Department Disposition Decisions

Journal article Health Services Insights · January 1, 2024 Background/objectives: The race-sex differences in emergency department (ED) disposition decisions have been reported widely. Our objective is to identify demographic and clinical subgroups for which this difference is most pronounced, which will facilitat ... Full text Cite

Statewide availability of acute stroke treatment, services, and programs: A survey of North Carolina Hospitals.

Journal article J Stroke Cerebrovasc Dis · October 2023 INTRODUCTION: We conducted a statewide assessment of the availability of stroke treatment, services, and programs in North Carolina (NC) hospitals. We also examined differences in stroke care capabilities between urban, suburban, and rural hospitals and tr ... Full text Link to item Cite

Community Socioeconomic and Urban-Rural Disparities in Prehospital Notification of Stroke by Emergency Medical Services in North Carolina.

Journal article South Med J · September 2023 OBJECTIVES: Notification by emergency medical services (EMS) to the destination hospital of an incoming suspected stroke patient is associated with timelier in-hospital evaluation and treatment. Current data on adherence to this evidence-based best practic ... Full text Open Access Link to item Cite

Organizational decision-making during COVID-19: A qualitative analysis of the organizational decision-making system in the United States during COVID-19

Journal article Journal of Contingencies and Crisis Management · June 1, 2023 This study sought to understand COVID-19-related organizational decisions were made across sectors. To gain this understanding, we conducted semi-structured interviews with organizational decision-makers in North Carolina about their experiences responding ... Full text Cite

EMS Involvement in COVID-19 Vaccination Efforts - Results of a North Carolina Statewide Survey.

Journal article Prehosp Emerg Care · 2023 Objective: The COVID-19 pandemic has necessitated the vaccination of large numbers of people across the United States, mobilizing public health resources on a massive scale. The purpose of this study is to determine how emergency medical services (EMS) cli ... Full text Link to item Cite

Prehospital Fluid Administration for Suspected Sepsis in a Large EMS System: Opportunities to Improve Goal Fluid Delivery.

Journal article Prehosp Emerg Care · 2023 OBJECTIVES: Despite EMS-implemented screening and treatment protocols for suspected sepsis patients, prehospital fluid therapy is variable. We sought to describe prehospital fluid administration in suspected sepsis patients, including demographic and clini ... Full text Link to item Cite

Community socioeconomic and urban-rural differences in emergency medical services times for suspected stroke in North Carolina.

Journal article Am J Emerg Med · January 2023 OBJECTIVE: Our objectives were to describe time intervals of EMS encounters for suspected stroke patients in North Carolina (NC) and evaluate differences in EMS time intervals by community socioeconomic status (SES) and rurality. METHODS: This cross-sectio ... Full text Link to item Cite

Disparities in emergency department prioritization and rooming of patients with similar triage acuity score.

Journal article Acad Emerg Med · November 2022 BACKGROUND: We identify patient demographic and emergency department (ED) characteristics associated with rooming prioritization decisions among ED patients who are assigned the same triage acuity score. METHODS: We performed a retrospective analysis of ad ... Full text Link to item Cite

Vaccinating children against COVID-19 is crucial to protect schools and communities

Journal article Pnas Nexus · July 1, 2022 To evaluate the joint impact of childhood vaccination rates and school masking policies on community transmission and severe outcomes due to COVID-19, we utilized a stochastic, agent-based simulation of North Carolina to test 24 health policy scenarios. In ... Full text Cite

User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial.

Journal article BMJ · June 27, 2022 OBJECTIVE: To determine the effect of a user centered clinical decision support tool versus usual care on rates of initiation of buprenorphine in the routine emergency care of individuals with opioid use disorder. DESIGN: Pragmatic cluster randomized contr ... Full text Link to item Cite

Performance of the vision, aphasia, neglect (VAN) assessment within a single large EMS system.

Journal article J Neurointerv Surg · April 2022 BACKGROUND: There is limited evidence on the performance of emergent large-vessel occlusion (LVO) stroke screening tools when used by emergency medical services (EMS) and emergency department (ED) providers. We assessed the validity and predictive value of ... Full text Link to item Cite

Can vaccine prioritization reduce disparities in COVID-19 burden for historically marginalized populations?

Journal article Pnas Nexus · March 1, 2022 SARS-CoV-2 vaccination strategies were designed to reduce COVID-19 mortality, morbidity, and health inequities. To assess the impact of vaccination strategies on disparities in COVID-19 burden among historically marginalized populations (HMPs), e.g. Black ... Full text Cite

Identifying Patient Phenotype Cohorts Using Prehospital Electronic Health Record Data.

Journal article Prehosp Emerg Care · 2022 Objective: Emergency medical services (EMS) provide critical interventions for patients with acute illness and injury and are important in implementing prehospital emergency care research. Retrospective, manual patient record review, the current reference- ... Full text Link to item Cite

Use of Modeling to Inform Decision Making in North Carolina during the COVID-19 Pandemic: A Qualitative Study.

Journal article MDM Policy Pract · 2022 UNLABELLED: Background. The COVID-19 pandemic has popularized computer-based decision-support models, which are commonly used to inform decision making amidst complexity. Understanding what organizational decision makers prefer from these models is needed ... Full text Link to item Cite

Cross-sector decision landscape in response to COVID-19: A qualitative network mapping analysis of North Carolina decision-makers.

Journal article Front Public Health · 2022 INTRODUCTION: The COVID-19 pandemic response has demonstrated the interconnectedness of individuals, organizations, and other entities jointly contributing to the production of community health. This response has involved stakeholders from numerous sectors ... Full text Link to item Cite

Assault-injured youth in the emergency centres of Khayelitsha, South Africa: A prospective study of recidivism and mortality

Journal article African Journal of Emergency Medicine · December 1, 2021 Introduction: Violence is a major cause of death worldwide among youth. The highest mortality rates from youth violence occur in low and middle-income countries (LMICs). We sought to identify risk factors for violent re-injury and emergency centre (EC) rec ... Full text Cite

Disparities in Emergency Medical Services Time Intervals for Patients with Suspected Acute Coronary Syndrome: Findings from the North Carolina Prehospital Medical Information System.

Journal article J Am Heart Assoc · August 3, 2021 Background Timely emergency medical services (EMS) response, management, and transport of patients with suspected acute coronary syndrome (ACS) significantly reduce delays to emergency treatment and improve outcomes. We evaluated EMS response, scene, and t ... Full text Link to item Cite

Association of Simulated COVID-19 Vaccination and Nonpharmaceutical Interventions With Infections, Hospitalizations, and Mortality.

Journal article JAMA Netw Open · June 1, 2021 IMPORTANCE: Vaccination against SARS-CoV-2 has the potential to significantly reduce transmission and COVID-19 morbidity and mortality. The relative importance of vaccination strategies and nonpharmaceutical interventions (NPIs) is not well understood. OBJ ... Full text Link to item Cite

The Joint Impact of COVID-19 Vaccination and Non-Pharmaceutical Interventions on Infections, Hospitalizations, and Mortality: An Agent-Based Simulation

Preprint · January 4, 2021 AbstractBackgroundVaccination against SARS-CoV-2 has the potential to significantly reduce transmission and morbidity and mortality d ... Full text Cite

Modernizing Informed Consent During Emergency Care.

Journal article Ann Emerg Med · September 2020 Full text Link to item Cite

Novel Use of Telemedicine by Hurricane Evacuation Shelters.

Journal article Prehosp Emerg Care · 2020 Introduction: Hurricane Florence made landfall in North Carolina as a Category 1 hurricane on September 14, 2018 causing catastrophic flooding throughout much of eastern North Carolina. Large numbers of evacuees were housed in evacuation shelters establish ... Full text Link to item Cite

Emergency Medical Services Time Intervals for Acute Chest Pain in the United States, 2015-2016.

Journal article Prehosp Emerg Care · 2020 Background: Chest pain is a leading complaint in emergency settings. Timely emergency medical services (EMS) responses can reduce delays to treatment and improve clinical outcomes for acute myocardial infarction patients and other medical emergencies. We i ... Full text Link to item Cite

A Statewide Assessment of Prehospital Electrocardiography Approaches of Acquisition and Interpretation for ST-Elevation Myocardial Infarction Based on Emergency Medical Services Characteristics.

Journal article Prehosp Emerg Care · 2020 Background: The American Heart Association recommends acquiring and interpreting prehospital electrocardiograms (ECG) for patients transported by Emergency Medical Services (EMS) to the emergency department with symptoms highly suspicious of acute coronary ... Full text Link to item Cite

Cardiovascular Risk Factors and Secondary Events Among Acute and Chronic Stable Myocardial Infarction Patients: Findings from a Managed Care Database

Journal article Cardiology and Therapy · December 1, 2019 Introduction: Long-term risk for recurrent cardiovascular events among myocardial infarction (MI) patients in the acute versus chronic stable phase is not well characterized. This study was conducted to evaluate risk factors associated with all-cause morta ... Full text Cite

Assault-injured youth in the emergency centres of Khayelitsha, South Africa: Baseline characteristics & opportunities for intervention.

Journal article Injury · December 2019 INTRODUCTION: Violence is a leading cause of death worldwide for youth age 15-29. A growing body of literature has described assault-injured youth in United States emergency centres, identifying risk factors for re-injury and mortality, and developing targ ... Full text Link to item Cite

Identifying Opioid Use Disorder in the Emergency Department: Multi-System Electronic Health Record-Based Computable Phenotype Derivation and Validation Study.

Journal article JMIR Med Inform · October 31, 2019 BACKGROUND: Deploying accurate computable phenotypes in pragmatic trials requires a trade-off between precise and clinically sensical variable selection. In particular, evaluating the medical encounter to assess a pattern leading to clinically significant ... Full text Link to item Cite

Availability of Hospital Resources and Specialty Services for Stroke Care in North Carolina.

Journal article South Med J · June 2019 OBJECTIVES: Effective regionalization of acute stroke care requires assessment and coordination of limited hospital resources. We described the availability of stroke-specific hospital resources (neurology specialty physicians and neuro-intensive care unit ... Full text Link to item Cite

User-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial.

Journal article BMJ Open · May 30, 2019 INTRODUCTION: The goal of this trial is to determine whether implementation of a user-centred clinical decision support (CDS) system can increase adoption of initiation of buprenorphine (BUP) into the routine emergency care of individuals with opioid use d ... Full text Link to item Cite

Feasibility of prehospital delivery of remote ischemic conditioning by emergency medical services in chest pain patients: Protocol for a pilot study

Journal article Pilot and Feasibility Studies · January 5, 2019 Background: Remote ischemic conditioning (RIC) is a non-invasive procedure with hypothesized therapeutic benefits for patients experiencing an acute ST-elevation myocardial infarction (STEMI). Further study of emergency medical services (EMS) delivery of R ... Full text Cite

Socioeconomic status and access to care and the incidence of a heart failure diagnosis in the inpatient and outpatient settings.

Journal article Ann Epidemiol · June 2018 PURPOSE: Despite well-documented associations of socioeconomic status with incident heart failure (HF) hospitalization, little information exists on the relationship of socioeconomic status with HF diagnosed in the outpatient (OP) setting. METHODS: We used ... Full text Link to item Cite

External validation of the TIMI risk score for secondary cardiovascular events among patients with recent myocardial infarction.

Journal article Atherosclerosis · May 2018 BACKGROUND AND AIMS: Risk stratification of patients with recent myocardial infarction (MI) for subsequent cardiovascular (CV) events helps identify patients most likely to benefit from secondary prevention therapies. This study externally validated a new ... Full text Link to item Cite

Elder Abuse Identification in the Prehospital Setting: An Examination of State Emergency Medical Services Protocols.

Journal article J Am Geriatr Soc · May 2018 OBJECTIVES: To describe statewide emergency medical service (EMS) protocols relating to identification, management, and reporting of elder abuse in the prehospital setting. DESIGN: Cross-sectional analysis. SETTING: Statewide EMS protocols in the United St ... Full text Link to item Cite

Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool.

Journal article J Elder Abuse Negl · 2018 Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple ... Full text Link to item Cite

Measuring a Crisis: Questioning the Use of Naloxone Administrations as a Marker for Opioid Overdoses in a Large U.S. EMS System.

Journal article Prehosp Emerg Care · 2018 OBJECTIVE: The United States is currently experiencing a public health crisis of opioid overdoses. To determine where resources may be most needed, many public health officials utilize naloxone administration by EMS as an easily-measured surrogate marker f ... Full text Link to item Cite

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database.

Journal article Ann Emerg Med · October 2017 STUDY OBJECTIVE: The objective of this study is to characterize repeated emergency medical services (EMS) transports among older adults across a large and socioeconomically diverse region. METHODS: Using the North Carolina Prehospital Medical Information S ... Full text Link to item Cite

Variation in adherence to medications across the healthcare system in two comparative effectiveness research cohorts.

Journal article J Comp Eff Res · October 2017 AIM: To assess heterogeneity in adherence to medications in two example comparative effectiveness research studies. PATIENTS & METHODS: We analyzed data from commercially insured patients initiating a statin or anticoagulant during 2005-2012. We calculated ... Full text Link to item Cite

Changes in Treatment Patterns and Incremental Health Care Utilization Due to P2Y12-Associated Complications in Patients with Acute Coronary Syndrome.

Journal article J Manag Care Spec Pharm · September 2017 BACKGROUND: P2Y12 antiplatelet therapy (APT) is highly efficacious in reducing the incidence of ischemic events in patients with acute coronary syndrome (ACS); however, it is associated with several adverse complications. Data on P2Y12-associated complicat ... Full text Link to item Cite

Antiplatelet Therapy and Clinical Outcomes Following Myocardial Infarction Among Patients in a U.S. Employer-Based Insurance Database.

Journal article J Manag Care Spec Pharm · June 2017 BACKGROUND: Estimates of residual cardiovascular risks among patients who have experienced a recent acute myocardial infarction (MI) are predominantly derived from secondary prevention trial populations, patient registries, and population-based cohorts. OB ... Full text Link to item Cite

Real-world data to assess changes in low-density lipoprotein cholesterol and predicted cardiovascular risk after ezetimibe discontinuation post reporting of the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression trial.

Journal article J Clin Lipidol · 2017 BACKGROUND: The 2008 Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression (ENHANCE) study demonstrated ezetimibe + simvastatin vs simvastatin alone had a neutral effect on the surrogate endpoint of carotid intima-media thic ... Full text Link to item Cite

Social support and cognition in a community-based cohort: the Atherosclerosis Risk in Communities (ARIC) study.

Journal article Age Ageing · July 2016 OBJECTIVE: social support has demonstrated cross-sectional associations with greater cognitive function and a protective effect against cognitive decline in older adults, but exploration of its temporal role in cognitive ageing from mid-life to older adult ... Full text Link to item Cite

Repeatability of Central and Peripheral Pulse Wave Velocity Measures: The Atherosclerosis Risk in Communities (ARIC) Study.

Journal article Am J Hypertens · April 2016 BACKGROUND: Arterial stiffness measures are emerging tools for risk assessment and stratification for hypertension and cardiovascular disease (CVD). Carotid-femoral pulse wave velocity (cfPWV) is an established measure of central arterial stiffness. Other ... Full text Link to item Cite

Characteristics and outcomes of patients with acute decompensated heart failure developing after hospital admission.

Journal article Am J Cardiol · November 15, 2014 There are limited data on acute decompensated heart failure (ADHF) that develops after hospital admission. This study sought to compare patient characteristics, co-morbidities, mortality, and length of stay by timing of ADHF onset. The surveillance compone ... Full text Link to item Cite

Reproductive and hormonal risk factors for antinuclear antibodies (ANA) in a representative sample of U.S. women.

Journal article Cancer Epidemiol Biomarkers Prev · November 2014 BACKGROUND: Autoantibodies are of growing interest in cancer research as potential biomarkers; yet, the determinants of autoimmunity are not well understood. Antinuclear antibodies (ANA) are common in the general population and are more prevalent in women ... Full text Link to item Cite

Impact of differential attrition on the association of education with cognitive change over 20 years of follow-up: the ARIC neurocognitive study.

Journal article Am J Epidemiol · April 15, 2014 Studies of long-term cognitive change should account for the potential effects of education on the outcome, since some studies have demonstrated an association of education with dementia risk. Evaluating cognitive change is more ideal than evaluating cogni ... Full text Link to item Cite

An evaluation of emergency medical services stroke protocols and scene times.

Journal article Prehosp Emerg Care · 2014 BACKGROUND: Acute stroke patients require immediate medical attention. Therefore, American Stroke Association guidelines recommend that for suspected stroke cases, emergency medical services (EMS) personnel spend less than 15 minutes on-scene at least 90% ... Full text Link to item Cite

Emergency medical services capacity for prehospital stroke care in North Carolina.

Journal article Prev Chronic Dis · September 5, 2013 INTRODUCTION: Prior assessments of emergency medical services (EMS) stroke capacity found deficiencies in education and training, use of protocols and screening tools, and planning for the transport of patients. A 2001 survey of North Carolina EMS provider ... Full text Link to item Cite

Neighborhood socioeconomic disparities and 1-year case fatality after incident myocardial infarction: the Atherosclerosis Risk in Communities (ARIC) Community Surveillance (1992-2002).

Journal article Am Heart J · January 2013 BACKGROUND: Declines in case fatality post-myocardial infarction (MI) have been observed over the past 3 decades. Few studies report socioeconomic disparities in survival post-MI. METHODS: We assessed 1-year case fatality among 9,116 incident MI patients i ... Full text Link to item Cite

Bias correction methods for misclassified covariates in the Cox model: Comparison of five correction methods by simulation and data analysis

Journal article Journal of Statistical Theory and Practice · January 1, 2013 Measurement error/misclassification is commonplace in research when variable(s) cannot be measured accurately. A number of statistical methods have been developed to tackle this problem in a variety of settings and contexts. However, relatively few methods ... Full text Cite

Clinical outcomes among stroke patients receiving tissue plasminogen activator therapy beyond the 3-hour time window.

Journal article J Stroke Cerebrovasc Dis · October 2012 BACKGROUND: Tissue plasminogen activator therapy (t-PA) is associated with improved neurologic outcomes and reduced disability from ischemic stroke. The current guidelines stipulate that patients receive t-PA within 3 hours of symptom onset. However, actua ... Full text Link to item Cite

Education and cognitive change over 15 years: the atherosclerosis risk in communities study.

Journal article J Am Geriatr Soc · October 2012 OBJECTIVES: To evaluate whether education level is associated with change in cognitive performance. DESIGN: Prospective cohort study. SETTING: The Atherosclerosis Risk in Communities (ARIC) Study, a community-based cohort. PARTICIPANTS: Nine thousand two h ... Full text Link to item Cite

Performance of automated and manual coding systems for occupational data: a case study of historical records.

Journal article Am J Ind Med · March 2012 BACKGROUND: Occupational data are a common source of workplace exposure and socioeconomic information in epidemiologic research. We compared the performance of two occupation coding methods, an automated software and a manual coder, using occupation and in ... Full text Link to item Cite

Prehospital notification by emergency medical services reduces delays in stroke evaluation: findings from the North Carolina stroke care collaborative.

Journal article Stroke · August 2011 BACKGROUND AND PURPOSE: Individuals with stroke-like symptoms are recommended to receive rapid diagnostic evaluation. Emergency medical services (EMS) transport, compared with private modes, and hospital notification before arrival may reduce delays in eva ... Full text Link to item Cite