Community Disparities in Out-of-Hospital Cardiac Arrest Prehospital Antiarrhythmic Practices.

Objectives: Antiarrhythmic administration is an important treatment for out-of-hospital cardiac arrest (OHCA) with a shockable rhythm, but little is known about disparities in such antiarrhythmic practices. We sought to investigate the association between community race/ethnicity and prehospital antiarrhythmic administration for OHCA.

Methods: We conducted a retrospective study of a national prehospital database, NEMSIS, linked to Census data.

Beyond scale-free networks: integrating multilayer social networks with molecular clusters in the local spread of COVID-19.

This study evaluates the scale-free network assumption commonly used in COVID-19 epidemiology, using empirical social network data from SARS-CoV-2 Delta variant molecular local clusters in Houston, Texas. We constructed genome-informed social networks from contact and co-residence data, tested them for scale-free power-law distributions that imply highly connected hubs, and compared them to alternative models (exponential, log-normal, power-law with exponential cutoff, and Weibull) that suggest more evenly distributed network connections. Although the power-law model failed the goodness of fit test, after incorporating social network ties, the power-law model was at least as good as, if not better than, the alternatives, implying the presence of both hub and non-hub mechanisms in local SARS-CoV-2 transmission.

Pediatric firearm injury epidemiology at a level 1 trauma center from 2019 to 2021: including time of the COVID-19 pandemic.

Background: Firearms are a leading cause of death in children. The demand for firearms increased following COVID-19 "stay-at home orders" in March 2020, resulting in record-breaking firearm sales and background checks. We aim to describe the changes in pediatric firearm-related injuries, demographics, and associated risk factors at a Level 1 trauma center in Houston before and during the COVID 19 pandemic.

National trends in prehospital penetrating trauma in 2020 and 2021.

Objective: Prior studies identified increased penetrating trauma rates during the earlier phase of the COVID-19 pandemic, but there is limited study of penetrating trauma rates in 2021 or at a national level. We evaluated trends in prehospital encounters for penetrating trauma in 2020 and 2021 using a national database.

Methods: We conducted a retrospective analysis of the National Emergency Medicinal Services (EMS) Information System (NEMSIS) combined 2018-2021 databases of prehospital encounters.

Prehospital Ultrasound: Nationwide Incidence from the NEMSIS Database.

Objective: We sought to describe prehospital ultrasound (PHUS) use and trends in PHUS utilization over time using a national database.

Methods: Using the 2018 - 2021 National Emergency Medical Services Information System databases, we identified those EMS activations where PHUS was performed. We evaluated the association between year and number of PHUS exams performed using univariable and multivariable regression analysis.

Non-homogeneous continuous-time Markov chain with covariates: Applications to ambulatory hypertension monitoring.

Hypertension significantly increases the risk for many health conditions including heart disease and stroke. Hypertensive patients often have continuous measurements of their blood pressure to better understand how it fluctuates over the day. The continuous-time Markov chain (CTMC) is commonly used to study repeated measurements with categorical outcomes.

Fast does not imply flawed: Analyzing emergency physician productivity and medical errors.

Objective: To determine whether emergency physician productivity is associated with the risk of medical errors.

Methods: We retrospectively analyzed quality assurance (QA) and billing data over 3 years at 2 urban emergency departments. Faculty physicians working 400 hours or more at either site were included.

Racial/ethnic and gender disparities of the impact of the COVID-19 pandemic in out-of-hospital cardiac arrest (OHCA) in Texas.

Introduction: Prior research shows a greater disease burden, lower BCPR rates, and worse outcomes in Black and Hispanic patients after OHCA. Female OHCA patients have lower rates of BCPR compared to men and other survival outcomes vary. The influence of the COVID-19 pandemic on OHCA incidence and outcomes in different health disparity populations is unknown.

Updated estimates of sepsis hospitalizations at United States academic medical centers.

Objective: Sepsis is a major public health problem. Understanding the epidemiology of sepsis subtypes is important to quantify the magnitude of the problem and identify targets for system wide treatment strategies. We sought to describe the current national epidemiology of community-acquired (CAS), hospital-acquired (HAS) and healthcare-associated sepsis (HCAS) hospitalizations among academic medical centers in the United States using current discharge diagnosis taxonomies.

Computed Tomography of the Chest in Younger Pediatric Patients with Thoracic Blunt Trauma Rarely Changes Surgical Management.

Introduction: Thoracic trauma is the second leading cause of death after traumatic brain injury in children presenting with blunt chest trauma, which represents 80% of thoracic trauma in children. We hypothesized that older children undergo more clinical and surgical changes in management than younger children screened for intrathoracic injury at a single, urban, pediatric Level I trauma center.

Methods: In this retrospective observational study, we determined the frequencies and types of lesions diagnosed only by chest computed tomography (CCT) and resulting changes of clinical and surgical management among different age groups in a pediatric cohort examined for blunt trauma with chest radiograph and CCT.

The impact of COVID-19 on incidence and outcomes from out-of-hospital cardiac arrest (OHCA) in Texas.

Introduction: Emerging research demonstrates lower rates of bystander cardiopulmonary resuscitation (BCPR), public AED (PAD), worse outcomes, and higher incidence of OHCA during the COVID-19 pandemic. We aim to characterize the incidence of OHCA during the early pandemic period and the subsequent long-term period while describing changes in OHCA outcomes and survival.

Methods: We analyzed adult OHCAs in Texas from the Cardiac Arrest Registry to Enhance Survival (CARES) during March 11-December 31 of 2019 and 2020.

Emergency department visits for hemodialysis by insurance status in the United States.

Objective: Many uninsured patients with end-stage kidney disease (ESKD) depend upon the emergency department (ED) for hemodialysis (HD). We sought to characterize ED visits for emergent HD by insurance status.

Methods: We performed a cross-sectional analysis of the 2017 Nationwide Emergency Department Sample, including ED visits by patients ≥18 years old with a length of stay ≤1 day and performance of HD.

Procainamide for shockable rhythm cardiac arrest in the Resuscitation Outcome Consortium.

Background: With recent negative studies of amiodarone and lidocaine for cardiac arrest, research into other antiarrhythmics is warranted. Literature on procainamide in cardiac arrest is limited. We evaluated procainamide for out-of-hospital cardiac arrests (OHCA) from the Resuscitation Outcomes Consortium (ROC).

Time to Antiarrhythmic and Association with Return of Spontaneous Circulation in the United States.

Introduction: Recent clinical trials have failed to identify a benefit of antiarrhythmic administration during cardiac arrest. However, little is known regarding the time to administration of antiarrhythmic drugs in clinical practice or its impact on return of spontaneous circulation (ROSC). We utilized a national EMS registry to evaluate the time of drug administration and association with ROSC.

Epidemiology of out-of-hospital pediatric airway management in the 2019 national emergency medical services information system data set.

Objective: Airway management is an important priority in the care of critically ill children. We sought to provide updated estimates of the epidemiology of pediatric out-of-hospital airway management and ventilation interventions in the United States.

Methods: We used data from the 2019 National Emergency Medical Services Information System (NEMSIS) data set.

Pediatric scapular fractures and associated injuries following blunt chest trauma.

Background: Scapular fractures in the pediatric population are rare, and medical literature is lacking regarding these specific injuries in the pediatric population. Prior studies have shown that scapular fractures resulting from blunt chest trauma have been associated with significant morbidities in adults, and that a majority of scapular fractures are missed on chest X-ray (CXR) and seen on computerized tomography only (SOCTO). Further guidance is needed regarding the prevalence of coinciding injuries in the pediatric population and the modality for diagnosis.

Out-of-hospital, non-invasive, positive-pressure ventilation for acute dyspnea.

Background: Emergency medical services (EMS) patients with acute dyspnea require prompt treatment. Limited data describe out-of-hospital dyspnea treatment with non-invasive, positive-pressure ventilation (NIPPV), including continuous positive airway pressure (CPAP) or bi-level positive air pressure (BPAP). We sought to determine the course and outcomes of out-of-hospital acute dyspnea patients treated with NIPPV.

Community Variations in Out-of-Hospital Cardiac Arrest Care and Outcomes in Texas.

Large and unacceptable variation exists in cardiac resuscitation care and outcomes across communities. Texas is the second most populous state in the US with wide variation in community and emergency response infrastructure. We utilized the Texas-CARES registry to perform the first Texas state analysis of out-of-hospital cardiac arrest (OHCA) in Texas, evaluating for variations in incidence, care, and outcomes.

Characteristics of adult out-of-hospital cardiac arrest in the National Emergency Medical Services Information System.

Background: The national incidence and characteristics of out-of-hospital cardiac arrest in the United States is unclear. We sought to describe the national characteristics of adult out-of-hospital cardiac arrest reported in the National Emergency Medical Services Information System (NEMSIS).

Methods: We used 2016 NEMSIS data, consisting of most emergency medical services (EMS) responses from 46 states and territories.

Characteristics of paediatric out-of-hospital cardiac arrest in the United States.

Background: The absence of nationwide surveillance data on out-of-hospital cardiac arrest (OHCA) in the United States (US) limits understanding of the epidemiology of paediatric OHCA. We investigated the national characteristics of paediatric OHCA using the National Emergency Medical Services Information System (NEMSIS).

Methods: We conducted a cross-sectional study using the 2016 NEMSIS dataset, a national registry of emergency medical services (EMS) activations at 46 states in the US.