Recent Research Updates

July, 2010

We've had an outstanding first-half of 2010!

Our two Research Fellows, Karis Tekwani, MD, and Hannah Watts, MD, have completed an accomplishment-filled year, completing a tremendous number of projects and advancing our department significantly forward in the research arena.

In addition to their ongoing work in a number of research efforts, lecture contributions, and teaching, a quick review of just a few of the highlights of the year:

• Karis Tekwani, MD was accepted as a peer reviewer for the Western Journal of Emergency
  Medicine.
• Hannah Watts, MD was accepted and continues to serve as a peer reviewer for the American
  Journal of Emergency Medicine.
• Their landmark study of etomidate has culminated in the acceptance of the manuscript "A
  Comparison of the Effects of Etomidate and Midazolam on Hospital Length of Stay in Patients
  With Suspected Sepsis: A Prospective, Randomized Study" for publication in the Annals of
  Emergency Medicine.
• The Research Fellows have worked tirelessly in getting our hospital accepted as the newest site
  for the Protocolized Care for Early Septic Shock (ProCESS) study, a multi-center trial funded by
  the National Institutes of Health, and coordinated by the University of Pittsburgh's Departments
  of Critical Care Medicine and Emergency Medicine, with a grant totaling more than $8.4 million
  over five years. This promises to be a landmark trial, and the fact that our hospital will be
  involved raises our academic profile substantially and provides an opportunity for us to make an
  important contribution to emergency medicine.

Please congratulate the Research Fellows for their excellent work!

Publications

We continue to have our department's work published in a wide number of scholarly journals:

In Print

• Kulstad EB, Sikka R, Sweis RT, Kelley KM, Rzechula KH. ED overcrowding is associated with an increased frequency of medication errors. Am J Emerg Med. 2010 Mar;28(3):304-9.
• Kulstad EB, Kelley KM. Overcrowding is associated with delays in percutaneous coronary intervention for acute myocardial infarction. Int J Emerg Med. 2009 Jun 5;2(3):149-54.
• Strasburger D, Hall H, McCann N, Girzadas DV Jr. Emergency department medical evidence collection following sexual assault. Acad Emerg Med. 2010 Jan;17(1):111.
• Tekwani K, Sikka R. High-risk chief complaints III: abdomen and extremities. Emerg Med Clin North Am. 2009 Nov;27(4):747-65
• Hugl-Wajek JA, Cairo D, Shah S, McCreary B. Detection of Domestic Violence by a Domestic Violence Advocate in the ED. J Emerg Med. 2009 Sep 24. [Epub ahead of print]
• Chan CW, Tekwani KL, Watts HF, Kulstad EB. Emergency physicians report infrequent use of alphablockade for the treatment of ureteral stones. Am J Emerg Med. 2009 Sep;27(7):776-8.
• Girzadas DV Jr, Delis S, Bose S, Hall J, Rzechula K, Kulstad EB. Measures of stress and learning seem to be equally affected among all roles in a simulation scenario. Simul Healthc. 2009 Fall;4(3):149-54.
• Tekwani KL, Lambert MJ. Emergency department diagnosis of an interstitial ectopic pregnancy aided by goal-directed bedside ultrasound. Acad Emerg Med. 2009 Sep;16(9):919.
• Girzadas DV Jr, Antonis MS, Zerth H, Lambert M, Clay L, Bose S, Harwood R. Hybrid simulation
  combining a high fidelity scenario with a pelvic ultrasound task trainer enhances the training and evaluation of endovaginal ultrasound skills. Acad Emerg Med. 2009 May;16(5):429-35.
• Watts HF, Tekwani KL, Chan CW, Rzechula KH, Kulstad EB. The effect of alpha-blockade in emergency department patients with ureterolithiasis. J Emerg Med. 2010 Apr;38(3):368-73.
  

In Press

• Karis Tekwani, MD; Hannah Watts, MD; Rolla Sweis, PharmD; Kathleen Rzechula, RN, Erik Kulstad, MS, MD. A Comparison of the Effects of Etomidate and Midazolam on Hospital Length of Stay in Patients With Suspected Sepsis: A Prospective, Randomized Study. In Press, Annals of Emergency Medicine, July 2010.
• Sikka R, Kaucky C, Mehta S, Kulstad E. Emergency department overcrowding is associated with an increased time to pneumonia treatment. In Press, Amer J Emerg Med, June 2009.
• Hart M, Waghchoure S, Kulstad E. Occupancy rate and EDWIN scores correlate with patients leaving a community emergency department without being seen. In Press, West J of Emerg Med, October 2009.
• Kulstad E, Kalimullah E, Tekwani K, Courtney M. Etomidate as an induction agent in septic patients: red flags or false alarms? In Press, West J of Emerg Med, December 2009.
• Crowe C, Kulstad E, Mistry C, Kulstad C. Comparison of severity of illness scoring systems in the prediction of hospital mortality in severe sepsis and septic shock. In Press, J Emerg Trauma Shock, February 2010.
• Christine Kulstad, Shannon C. Holt, Aaron A. Abrahamsen, and Elise O. Lovell. Use of a Therapeutic Hypothermia Protocol in a Community Hospital Emergency Department. In Press, West J of Emerg Med, March, 2010.
• Adam B. Sivitz, Samuel H.F. Lam, Daniela Ramirez-Schrempp, Jonathan H. Valente, Arun D. Nagdev. Effect of bedside ultrasound on management of pediatric soft-tissue infection. J of Emerg Med, Feb 2010.
• Erik Kulstad, MD, MS. Current Guidelines for Diagnosis and Management of Abdominal Pain in the Emergency Department. EM Practice Guidelines Update, May 2010, Vol 2, Number 5.
• Christine Kulstad, MD, Blaine Hannafin, MD. Dizzy and Confused: A Step-by step Evaluation of the Clinician's Favorite Chief Complaint. Accepted for publication in Emergency Medicine Clinics of North America, December 2010.

In Submission or Preparation

• Frederic Adnet, Robin Renault, Patricia Jabre, Erik Kulstad, Michel Galinski, and Frederic Lapostolle.
  Incidence of acute myocardial infarction resulting in sudden death outside the hospital. Submitted to
  Emerg Med J, March 2010.
• Patricia Jabre, M.D., Ph.D, Alexandre Avenel, M.D., Xavier Combes, M.D., Erik Kulstad, M.D., Ixchel
  Mazariegos, M.D., Benoit Bertrand, M.D., Frédéric Lapostolle, M.D., Ph.D, Frédéric Adnet, M.D., Ph.D.
  Morbidity related to difficult emergency endotracheal intubation. Submitted to Annals of Emergency
  Medicine, April 2010.
• Rishi Sikka, MD, Rolla Sweis, PharmD, Carleen Kaucky RN, Erik Kulstad MD, MS. Automated Dispensing Cabinet Alert Improves Compliance with Obtaining Blood Cultures Prior to Antibiotic Administration for Patients Admitted with Pneumonia. Submitted to the Joint Commission Journal on Quality and Patient Safety, April 2010.
• Antone Eason, MD, Vytautas Vaicys, MD, and Erik Kulstad, MD, MS. Development of a computational
  method to automatically acquire ED crowding data.
• Rishi Sikka MD, Laura H. Tommaso MD, Carleen Kaucky RN, Erik B. Kulstad MD MS. Correlation Between Emergency Department and Final Discharge Diagnosis of Pneumonia is Poor Despite Use of the “Diagnostic Uncertainty” Documentation.
• Simon Waghchoure, MBBS, Shannon Holt, MD, Rolla Sweis, PharmD, Erik Kulstad, MD, MS. Application of a New Scoring Instrument to Predict Intracerebral Hemorrhage and Outcome After Thrombolysis for Acute Ischemic Stroke in a Community Hospital Emergency Department.
  Conferences

We've presented our work at a number of regional and national conferences this year:

Recent Conferences

The AAEM Scientific Assembly was held February 15-17, at Caesars Palace, Las Vegas. We had a
number of oral and poster presentations.

M&M Case Presentation and Analysis session:

• Eastvold J, Kulstad E. M&M Case: Spinal Cord Injury
• Herron S, Lam S. Don’t Listen to the Voices: A Psychiatric M&M

Poster presentations:

• AH Nelson, L Hardy, EO Lovell A Longitudinal Analysis of Racial Bias Trends During Emergency
  Medicine Residency Training.
• AC Cho, LH Cho, EB Kulstad An Analysis of Staffing Inefficiencies and the Effects on ED Patient
  Flow and Waiting Room Volume.
  

The 2010 Advocate Research Forum was held at Advocate Christ Medical Center on May 17, 2010. We had 12 posters displayed out of the 56 total accepted.

• Ben Harris, MD, Erik Kulstad, MD, MS. Crowding Does Not Adversely Affect Time toPercutaneous Coronary Intervention for Acute Myocardial Infarction
• Ejaaz Kalimullah, MD, Karis Tekwani, MD, Erik Kulstad, MD, MS. The Effect of Etomidate on
  Mortality in Sepsis: A Meta Analysis
• Shannon C. Holt, MD, Cindy Bakker, PharmD, Rolla Sweis, PharmD, Melvin Wichter, MD, Kathleen
  Rzechula, RN, and Erik Kulstad, MD, MS. Application of a New Scoring Instrument to Predict
  Intracerebral Hemorrhage and Outcome After Thrombolysis for Acute Ischemic Stroke in a
  Community Hospital Emergency Department
• Antone Eason, MD, Vytautas Vaicys, MD, Erik Kulstad, MD, MS. Development of a Computational
  Method to Automatically Acquire ED Crowding Data
• Rishi Sikka, MD, Rolla Sweiss PharmD, Carleen Kaucky RN, Erik Kulstad MD, MS. Medication
  Dispenser Alert Improves Compliance with Obtaining Blood Cultures Prior to Antibiotics
  Administration for Patients Admitted with Pneumonia
• Karis Tekwani, MD, Chintan Mistry, MD, Brian Sayger, DO, and Erik Kulstad, MD, MS. Emergency
  Department Crowding is Associated with Reduced Patient Satisfaction Scores
• Christine Kulstad, MD, Shannon Holt, MD, Aaron Abrahamsen, MD, and Elise Lovell, MD. Use of a
  Therapeutic Hypothermia Protocol in a Community Hospital Emergency Department
• Joshua Eastvold, MD, Jason Tomasello, MD, Chintan Mistry, MD, Brian Sayger, DO, and Erik
  Kulstad, MD, MS. Analysis of the Association Between Physician Productivity and Patient
  Satisfaction
• Andy Nelson, MD, Lisa Hardy, MD, and Elise Lovell, MD. Racial Bias May Increase During
  Emergency Medicine Residency Training
• Karis Tekwani, MD, Hannah Watts, MD, Rolla Sweis, PharmD, Kathleen Rzechula, RN, and Erik
  Kulstad, MD, MS. The Effect of Etomidate on Hospital Length of Stay of Patients with Sepsis: A
  Prospective, Randomized Study
• Joshua Eastvold, MD, Diana Strausburger, MD, Deann Faragoi, RN, and Sean Motzny, MD. The
  Role of Pre-hospital Electrocardiograms in the Recognition of ST-Elevation Myocardial Infarctions
  and Reperfusion Times
• Herb Zerth, MD, Daniel V. Girzadas Jr., MD, and Robert Harwood, MD, MPH. An Inexpensive,
  Easily Constructed, Reusable Task Trainer for Simulating Ultrasound-Guided Pericardiocentesis

The SAEM Annual Meeting was held in Phoenix, AZ, June 3 to 6, 2010. We had an impressive number of presentations, including:

• Erin Zimny, MD, who presented the Department's CPC case.
• Samuel H.F. Lam, MD, who discussed the CPC case given to our Department.
• Drew Dean, who presented "A Simply Constructed, Economical, and Reusable Task Trainer for
  Simulating Intracompartmental Pressure Measurements", done with Steve Delis, MD, Lamont
  Clay, MD, and Dan Girzadas Jr., MD, which was one of only 20 Innovations in Emergency
  Medicine Education (IEME) exhibits accepted for presentation.
• Ben Harris, who presented "Crowding Does Not Adversely Affect Time to Percutaneous Coronary
  Intervention for Acute Myocardial Infarction", done with E. Kulstad.
• Abbi Balger, who presented "Emergency Department Crowding Is Not Correlated With Time to
  Antibiotics in Septic Patients Treated with EGDT", done with Christine Kulstad, MD.
  

Grants

• Our department has been invited to be a part of a multi-site study that will evaluate the PERC rule and
  the potential impact that it may have if incorporated into Picis as a pop-up screen. The PI is Jessie Pines, MD with Jeff Kline, MD, (the creator of the PERC rule), as a Co-Investigator, with funding requested through the AHRQ for a total of $2 million over 3 years.
• Our department is the newest site added to the ProCESS study, with Hannah Watts, MD, as our site PI.
  Enrollment is expected to begin August 2010.

Ongoing and Upcoming Studies

• Cindy Chan, Michael J. Lambert, Diana Strasburger, Samuel Lam. Evaluation of suspected renal colic in low-risk patients: A prospective comparison of clinical diagnosis after history, physical and bedside
  ultrasound compared to non-enhanced computer tomography
• Chris Kerwin, MD, Cindy Chan, MD, Katherine Paquette, MD, Michael Lambert, MD, and Kathleen
  Rzechula,RN, are continuing to gather data and enroll patients in the Bedside Ultrasonography
  Performed by Emergency Physicians Plus Modified Appendicitis Score to Evaluate for Possible Acute
  Appendicitis study.
• Kathleen Rzechula, RN, is continuing to head up the efforts of our department with
  the Illinois Emergency Department Asthma Surveillance Project (IEDASP).
• Kathleen Rzechula, RN, Daniel Girzadas, MD, Lamont Clay, MD, Steve Delis, MD, Erik Kulstad, MD, Ben Harris MD, Andrew Dean, MD are initiating a further investigation analyzing the Correlation Between Stress Responses and Residents Performance In High Fidelity Simulation
• PI: Sam Lam; Co-investigators: Mike Lambert, Cindy Chan. Bedside Ultrasound Assisted Pediatric
  Lumbar Puncture in the Emergency Department. Status: IRB approved, ongoing
• PI: Sam Lam; Co-investigator: Mike Lambert. Multi-site Validation of an Ultrasound Image Rating Scale
  Status: IRB approved, ongoing. ACMC Med Fund sponsored
• PI: Sam Lam; Co-investigators: Mike Lambert, Cindy Chan, John Konicki, Martha Villalba, Chris Kerwin, Diana Strasburger. REASON Trial: Sonography in Cardiac Arrest. Status: IRB application submitted
• PI: Tyler Ayalin. Coinvestigators: Dan Girzadas, Lamont Clay, Steve Delis. Effects of Ambient Noise on
  High Fidelity Simulation. Status: IRB pending, ongoing
• PI: Tyler Ayalin. Coinvestigator: Sam Lam. Comparison of FAST exam rates for Pediatric and Adult Blunt Abdominal trauma patients. Status: IRB preparation

Sponsored Studies:

• Our department is working with cardiology to enroll patients in the Tracer study, evaluating a new, yet unnamed, platelet inhibitor.
• Enrollment of patients into the POTENT registry, with Rolla Sweis, PharmD, as PI, is ongoing. A total of
  22 patients have completed the entire registry requirements.
• We are evaluating the possibility of participation in a study sponsored by Beckman Coulter, Inc., entitled "Evaluation of the Beckman Coulter AccuTnI® Assay as an Aid in the Diagnosis and Treatment of Myocardial Infarction (MI) and Cardiac Muscle Damage".

Miscellaneous

A study from our department was highlighted by the AHRQ in their Patient Safety Network news: "ED
overcrowding is associated with an increased frequency of medication errors" by Kulstad EB, Sikka R,
Sweis RT, Kelley KM, and Rzechula KH, and published in the American Journal of Emergency Medicine, 2010;28:304-309.

We have a number of faculty that continue substantial contributions as peer reviewers to a wide array of
journals, including Ejaaz Kalimullah, MD, as a reviewer for the Western Journal of Emergency Medicine,
Critical Care Medicine and Clinical Toxicology, Andrea Carlson, MD, as a reviewer for Critical Care
Medicine, Erik Kulstad, MD, MS as a reviewer for the Annals of Emergency Medicine, American Journal of Emergency Medicine, and the Journal of Emergencies, Trauma, and Shock, and Christine Kulstad, MD, as a reviewer for the American Journal of Emergency Medicine.

Both Elise Lovell, MD, and Christine Kulstad, MD, recently completed the Medical Education Research
Certificate (MERC) Program, sponsored by the AAMC, which is geared to provide the knowledge
necessary to understand the purposes and processes of medical education research, to become
informed consumers of the medical education research literature, and to be effective collaborators in
medical education research.

Upcoming Conferences

The ACEP Scientific Assembly will be held September 28 to October 1, 2010 at Mandalay Bay, Las Vegas, NV. We have 3 abstracts accepted for presentation:

• Erik Kulstad, MD, MS, Donald Waller, PhD. Induction and Reversal of Hypothermia with an
  Esophageal Device in an Animal Model.
• Vytautas Vaicys, MD, Antone Eason, MD, Jay Schieber, PhD, Erik Kulstad, MD, MS.Computer
  Simulation of the Induction of Hypothermia via an Esophageal Route.
• Hannah Watts, MD, Rishi Sikka, MD, Rolla Sweis, PharmD, Erik Kulstad, MD, MS. Further
  Characterization of the Influence of Crowding on Medication Errors.

The 20th Annual Midwest Regional SAEM Meeting will be held November 8, 2010 at Wright State
University in Dayton, Ohio.

The AAEM Scientific Assembly will be held February 28 to March 2, 2011, in Orlando, Florida.

The Council of Residency Directors Academic Assembly will be held in San Diego, March 3-5, 2011. Elise Lovell, MD, is Co-Program Chair for this meeting.

The next SAEM Annual Meeting will be June 1st - 5th, 2011 at the Boston Marriott Copley Place.

 

Great work everyone!

Prepared by Erik Kulstad.
Formatted for the web by Rohit Gupta.

Last updated: 7/20/2010