The temporal version of the pediatric sepsis biomarker risk model.

Background: PERSEVERE is a risk model for estimating mortality probability in pediatric septic shock, using five biomarkers measured within 24 hours of clinical presentation.

Objective: Here, we derive and test a temporal version of PERSEVERE (tPERSEVERE) that considers biomarker values at the first and third day following presentation to estimate the probability of a "complicated course", defined as persistence of ≥2 organ failures at seven days after meeting criteria for septic shock, or death within 28 days.

Methods: Biomarkers were measured in the derivation cohort (n = 225) using serum samples obtained during days 1 and 3 of septic shock.

Patient perception of whether an HIV test was provided during the emergency department encounter.

This cross-sectional study approached emergency department (ED) patients after the treating physician's disposition decision to measure patient understanding of whether or not they had received an HIV test during their ED encounter. Of the 300 respondents, 24 were excluded due to missing data or because they had received an ED HIV test. Mean age was 41 years, 51% were men, 61% were black, and 29% had no high school degree.

Testing the prognostic accuracy of the updated pediatric sepsis biomarker risk model.

Background: We previously derived and validated a risk model to estimate mortality probability in children with septic shock (PERSEVERE; PEdiatRic SEpsis biomarkEr Risk modEl). PERSEVERE uses five biomarkers and age to estimate mortality probability. After the initial derivation and validation of PERSEVERE, we combined the derivation and validation cohorts (n = 355) and updated PERSEVERE.

A multibiomarker-based outcome risk stratification model for adult septic shock*.

Objectives: Clinical trials in septic shock continue to fail due, in part, to inequitable and sometimes unknown distribution of baseline mortality risk between study arms. Investigators advocate that interventional trials in septic shock require effective outcome risk stratification. We derived and tested a multibiomarker-based approach to estimate mortality risk in adults with septic shock.

ST2 in emergency department patients with noncardiac dyspnea.

Objectives: Serum levels of soluble ST2, a member of the interleukin-1 receptor family, predict mortality in emergency department (ED) patients with dyspnea secondary to acute heart failure and acute coronary syndrome. Elevated levels of ST2 have also been described in pulmonary disease, but it is unclear if these are associated with adverse outcomes. The hypothesis for this study was that elevated ST2 levels would be associated with 180-day mortality and 180-day return ED visits or hospital readmission in patients presenting to the ED with noncardiac causes of dyspnea.

Post-ICU admission fluid balance and pediatric septic shock outcomes: a risk-stratified analysis.

Objective: Observed associations between fluid balance and septic shock outcomes are likely confounded by initial mortality risk. We conducted a risk-stratified analysis of the association between post-ICU admission fluid balance and pediatric septic shock outcomes.

Design: Retrospective analysis of an ongoing multicenter pediatric septic shock clinical and biological database.

Prevalence of prehospital hypoxemia and oxygen use in trauma patients.

Objective: This study estimates the prevalence of injured patients requiring prehospital supplemental oxygen based on existing recommendations, and determines whether actual use exceeds those recommendations.

Patients And Methods: Prehospital oxygen use and continuous peripheral oxygen saturation measurements were prospectively collected on a purposive sample of injured civilians transported to an urban level 1 trauma center by paramedics. Structured chart review determined injury characteristics and outcomes.

An evaluation of a dog bite prevention intervention in the pediatric emergency department.

Background: This study aimed to determine the efficacy of a video-based dog bite prevention intervention at increasing child knowledge and describe any associated factors and to assess the acceptability of providing this intervention in a pediatric emergency department (PED).

Methods: This cross-sectional, quasi-experimental study enrolled a convenience sample of 5-year-old to 9-year-old patients and their parents, presenting to a PED with nonurgent complaints or dog bites. Children completed a 14-point simulated scenario test used to measure knowledge about safe dog interactions before and after a video intervention.

Transient and sustained changes in operational performance, patient evaluation, and medication administration during electronic health record implementation in the emergency department.

Study Objective: Little is known about the transient and sustained operational effects of electronic health records on emergency department (ED) performance. We quantify how the implementation of a comprehensive electronic health record was associated with metrics of operational performance, test ordering, and medication administration at a single-center ED.

Methods: We performed a longitudinal analysis of electronic data from a single, suburban, academic ED during 28 weeks between May 2011 and November 2011.

The incidence of seizures in patients undergoing therapeutic hypothermia after resuscitation from cardiac arrest.

Study Objective: Non-convulsive seizures/status epilepticus occur in approximately 20% of comatose, non-cardiac arrest intensive care unit (ICU) patients, and are associated with increased mortality. The prevalence and clinical significance of seizures in comatose survivors of cardiac arrest undergoing therapeutic hypothermia is not well described.

Methods: At this urban level I trauma center, every patient undergoing therapeutic hypothermia is monitored with continuous video encephalography (cvEEG).

Interleukin 27 as a sepsis diagnostic biomarker in critically ill adults.

Purpose: We previously identified interleukin 27 (IL-27) as a sepsis diagnostic biomarker in critically ill children. The current study tested the performance of IL-27 alone and in combination with procalcitonin (PCT) for diagnosing sepsis in critically ill adults.

Methods: Serum samples were made available from a prior prospective study of sepsis biomarkers in critically ill adults.

Randomized comparison of universal and targeted HIV screening in the emergency department.

Objective: Universal HIV screening is recommended but challenging to implement. Selectively targeting those at risk is thought to miss cases, but previous studies are limited by narrow risk criteria, incomplete implementation, and absence of direct comparisons. We hypothesized that targeted HIV screening, when fully implemented and using maximally broad risk criteria, could detect nearly as many cases as universal screening with many fewer tests.

Performance of a multi-disciplinary emergency department observation protocol for acetaminophen overdose.

The availability of 20-h N-acetylcysteine (NAC) infusion for low-risk acetaminophen (APAP) overdose enabled our center to implement an Emergency Department observation unit (OU) protocol as an alternative to hospitalization. Our objective was to evaluate our early experience with this protocol. This retrospective cohort study included all patients treated for low-risk APAP overdose in our academic hospital between 2006 and 2011.

Factors that Affect Integrity of Authorship of Scientific Meeting Abstracts.

Background: Strict criteria for manuscript authorship exist to guide decisions on who should be considered an author. Less is known about how authorship for scientific meetings is determined. Our goal was to explore factors that influence decisions about authorship of conference abstracts.

Operational data integrity during electronic health record implementation in the ED.

Objective: Operational data are often used to make systems changes in real time. Inaccurate data, however, transiently, can result in inappropriate operational decision making. Implementing electronic health records (EHRs) is fraught with the possibility of data errors, but the frequency and magnitude of transient errors during this fast-evolving systems upheaval are unknown.

Factors associated with hospitalization of patients with angiotensin-converting enzyme inhibitor-induced angioedema.

Angiotensin-converting enzyme inhibitor (ACE-I)-induced angioedema can be life-threatening without emergent intervention. The putative mediator is believed to be bradykinin, similar to hereditary angioedema, so these patients respond poorly to corticosteroids and antihistamines. This study was designed to determine characteristics and clinical outcomes of patients presenting to an emergency department (ED) with ACE-I angioedema.

Individual lytic efficacy of recombinant tissue plasminogen activator in an in vitro human clot model: rate of "nonresponse".

Objectives: Recombinant tissue plasminogen activator (rt-PA) is a lytic medication widely used in the emergency department to treat acute thrombotic disorders such as ischemic stroke and myocardial infarction. It is known in the clinical use of this drug that it can be less effective in approximately 25% of individuals receiving such treatment. However, there are no data on the variation of lytic efficacy of rt-PA in decreasing individuals' clot size over time.

Temperature affects thrombolytic efficacy using rt-PA and eptifibatide, an in vitro study.

The potential for hypothermia as a neuroprotectant during stroke has led to its increase in clinical use. At the same time, combination pharmaceutical therapies for ischemic stroke using recombinant tissue plasminogen activator (rt-PA), and GP IIb-IIIa inhibitors, such as Eptifibatide (Epf ), are under study. However, there is little data on how the reactions triggered by these agents are impacted by temperature.

Strategies for developing biostatistics resources in an academic health center.

Biostatistics--the application of statistics to understanding health and biology-provides powerful tools for developing research questions, designing studies, refining measurements, analyzing data, and interpreting findings. Biostatistics plays an important role in health-related research, yet biostatistics resources are often fragmented, ad hoc, or oversubscribed within academic health centers (AHCs). Given the increasing complexity and quantity of health-related data, the emphasis on accelerating clinical and translational science, and the importance of conducting reproducible research, the need for the thoughtful development of biostatistics resources within AHCs is growing.

Risk stratification in acute heart failure: rationale and design of the STRATIFY and DECIDE studies.

Background: A critical challenge for physicians facing patients presenting with signs and symptoms of acute heart failure (AHF) is how and where to best manage them. Currently, most patients evaluated for AHF are admitted to the hospital, yet not all warrant inpatient care. Up to 50% of admissions could be potentially avoided and many admitted patients could be discharged after a short period of observation and treatment.

The effects of linguistic relationships among paired associates on verbal self-generation and recognition memory.

Previous studies have shown that self-generated information is better remembered than information that has been read passively. To further examine this subsequent memory effect, we investigated the effect of five different linguistic relationships on memory encoding. Ninety subjects were administered 60 paired associates during an encoding condition: 30 of the second words from each pair were to be read aloud and 30 were to be self-generated from clues as to the correct word.

The pediatric sepsis biomarker risk model.

Introduction: The intrinsic heterogeneity of clinical septic shock is a major challenge. For clinical trials, individual patient management, and quality improvement efforts, it is unclear which patients are least likely to survive and thus benefit from alternative treatment approaches. A robust risk stratification tool would greatly aid decision-making.

Galectin 3 complements BNP in risk stratification in acute heart failure.

Background: Galectin 3 (G3) is a mediator of fibrosis and remodeling in heart failure.

Methods: Patients diagnosed with and treated for Acute Heart Failure Syndromes were prospectively enrolled in the Decision Making in Acute Decompensated Heart Failure multicenter trial.

Results: Patients with a higher G3 had a history of renal disease, a lower heart rate and acute kidney injury.