Active Studies

Developing a Decision Instrument to Guide Selective Abdominal/Pelvic Imaging of Blunt Trauma Patients

(IRB#15-001602)

Background

Unrecognized abdominal and pelvic injuries can result in catastrophic disability and death. Sporadic reports of “occult” injuries have generated concern, and physicians, fearing that they may miss such an injury, have adopted the practice of obtaining computed tomography on virtually all patients with significant blunt trauma. This practice exposes large numbers patients to dangerous radiation at considerable expense, while detecting injuries in a small minority of cases. Existing data suggest that a limited number of criteria can reliably identify blunt injury victims who have “no risk” of abdominal or pelvic injuries, and hence no need for computed tomography (CT), without misidentifying any injured patient. It is estimated that nationwide implementation of such criteria could result in an annual reduction in radiographic charges of $75 million, and a significant decrease in radiation exposure and radiation induced malignancies.

Objective

This study seeks to determine whether “low risk” criteria can reliably identify patients who have sustained significant abdominal or pelvic injuries and safely decrease CT imaging of blunt trauma patients.

Our Role

All blunt trauma victims undergoing computed tomography (CT) of the abdomen/pelvis in the emergency department (ED) will undergo routine clinical evaluations prior to radiographic imaging. Our volunteers will observe and record vitals for each trauma patient. We are also responsible for assuring that ED physicians record the presence or absence of specific clinical findings as well as the presence or absence of abdominal or pelvic injuries.

Youth Partners in Care for Suicide Prevention (YPIC-SP)

(IRB #22-000461)

Background

Suicide is currently the second leading cause of death for US youth ages 15-24, but evidence is limited regarding optimal interventions in the ED for reducing their risk of future suicide attempts. Current evidence supports some tested interventions for reducing later suicide attempts and encouraging further mental health treatment, but it is not yet known whether it is sufficient to provide only an evidence-based intervention in the ED, or whether additional therapeutic follow-up contacts are needed to improve youth outcomes.

Treatments

The study addresses this knowledge gap by comparing two evidence-based interventions for reducing suicide attempts and improving outcomes for youth presenting to EDs with suicidal episodes: (a) Safety-Acute(A), a crisis therapy session in the ED focused on enhancing safety (previously called Family Intervention for Suicide Prevention, FISP); and (b) SAFETY-A + Coping Long-term with Active Suicide Program (CLASP), comprised of brief therapeutic follow-up contacts after discharge from the ED/hospital.

Objective

The first aim is to evaluate whether SAFETY-A combined with CLASP aftercare is superior to SAFETY-A alone (with usual site referral and aftercare) for reducing the risk of suicide attempts and increasing initiation of follow-up mental health treatment. Second, the team will examine differences in how well the two study intervention approaches work for different groups of youth, especially those who are racial or ethnic minorities, from rural communities, or socioeconomically disadvantaged. Third, the team aims to increase the value and relevance of the study by engaging patients, parents, family members, providers, and system stakeholders involved in health and mental health care in project leadership and activities throughout the study.

Our Role

We screen the ED trackboard to identify adolescents presenting to the ED with suicidal ideation or behavior all days of the week at all times. If the patient meets inclusion criteria, we coordinate with both ED residents and the psychiatry department to help enroll the candidate.

Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients (ICECAP)

(IRB#20-001122)

Background

More than 380,000 patients suffer an out of hospital cardiac arrest (OHCA) each year in the US. Significantly improved outcomes in cardiac arrest are associated with early and aggressive resuscitation and treatment for these patients. Currently, early cardiac resuscitation is limited by the ability of physicians to protect the brain from global cerebral ischemia during resuscitation. Two recent trials have shown that early therapeutic cooling in comatose OHCA patients that present with shockable heart rhythms increases good neurological outcomes. These results have not been shown for patients with asystole or pulseless electrical activity (PEA). Duration of cooling and its effect on outcomes have also not been assessed.

Objective

There are two primary objectives relating to characterization of the duration-response curve for hypothermia in OHCA patients. The first is to determine the shortest duration of cooling that will provide maximal treatment effect. The second is to determine if cooling is more effective than non-cooling. There are three secondary objectives. The first is to characterize the safety of the various durations of cooling used. The second is to characterize the neuropsychological outcomes resulting from cooling and non-cooling in OHCA patients. The third is to characterize the effect of cooling on patient-reported quality of life.

Our Role

EMRAs will identify potential post-cardiac arrest comatose patients. EMRAs will subsequently head down to the ED where EMRAs will be in charge of gathering the paperwork and information needed to verify a patient is eligible. In the ED, EMRAs will also remind staff to initiate cooling and confirm that the care team has spoken with the family. Once EMRA confirms this and eligibility is confirmed, a Shepherd (resident working as a co-investigator for the trial) will be activated to obtain informed consent.

Published and Completed Studies

Crystalloid Liberal Or Vasopressors Early Resuscitation in Sepsis (CLOVERS)
Emergency Medicine Palliative Care Access 6/2022
Netrin-1 Myocardial Infarction (MI) Biomarker 3/2022
Pediatric Pulse Oximetry Variation Between Respiratory Diseases 2/2020
Diverticulitis Evaluation of Patient Burden, Utilization, and Trajectory 4/2020
Outpatient Venous Thromboembolism Management (Outpatient VTE) 3/2020
Evaluation of the High Sensitivity Troponin Test on Alinity 4/2020
Derivation and Validation of Two Decision Instruments for Selective Chest CT in Blunt Trauma: A Multicenter Prospective Observational Study (NEXUS Chest CT) 10/2015 PLOS
NEXUS Chest Validation of a Decision Instrument for Selective Chest Imaging in Blunt Trauma 10/2013 JAMA Network
External Validation of the San Francisco Syncope Rule 11/2006 Research Gate
Defining “therapeutically inconsequential” head computed tomographic findings in patients with blunt head trauma 07/2014 Annals of Emergency Medicine
Developing a Decision Instrument to Guide Computed Tomographic Imaging of Blunt Head Injury Patients 10/2005 The Journal of Trauma
Using Serial Hemoglobin Levels to Detect Occult Blood Loss in the Early Evaluation of Blunt Trauma Patients 9/2017 The Journal of Emergency Medicine
Emergency medicine and psychiatry agreement on diagnosis and disposition of emergency department patients with behavioral emergencies. 04/2011 Link: Pubmed
Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome. 05/2019 Link: New England Journal of Medicine