Research Update
2011
Highlights
Congratulations to everyone for such a great job this past year, and for the tremendous number of achievements we accomplished in 2011. The year has truly been outstanding for the Department of Emergency Medicine at Advocate Christ Medical Center!
Our department has amassed over 20 publications in peer - reviewed journals, from authors including:
• Aaron Abrahamsen
• Steve Anneken
• Tyler Ayalin
• Christian Badillo
• Deborah Cairo
• Cindy Chan
• Lamont Clay
• Colleen Crowe
• Steve Delis
• Dan Girzadas
• Hannah Hall
• Ben Harris
• Robert Harwood
• Erika Havelka
• Kathleen Hesse
• Shannon Holt
• Jessica Hugl -Wajek
• Ejaaz Kalimullah
• Carleen Kaucky
• Ken Kelley
• Chris Kerwin
• Erik Kulstad
• Christine Kulstad
• Brad Kutka
• Sam Lam
• Mike Lambert
• Elise Lovell
• Barbara McCreary
• Dan Miller
• Chintan Mistry
• Brian Sayger
• Rishi Sikka
• Diana Strasburger
• Rolla Sweis
• Karis Tekwani
• Laura Tommaso
• Hanna Watts
• Kelly Williamson
• Herb Zerth
• Our department continues to have one of the highest enrollment rate of all sites involved with the ProCESS study, having surpassed many prestigious institutions in absolute enrollment numbers and maintaining an outstanding enrollment rate.
• Our department has completed the multi- center study of the AccuTnI® Assay sponsored by Beckman Coulter, Inc., achieving one of the highest enrollments of all sites involved, with over 240 patients enrolled.
• We continue to increase the number of faculty offering substantial contributions as peer reviewers to a wide array of journals and conferences. These currently include:
o Andrea Carlson, MD, as a reviewer for Critical Care Medicine;
o Ejaaz Kalimullah, MD, as a reviewer for the Western Journal of Emergency Medicine, Critical Care Medicine and Clinical Toxicology;
o Christine Kulstad, MD, a s a reviewer for the American Journal of Emergency Medicine, the Journal of Emergencies, Trauma, and Shock, the Journal of Critical Care, the European Journal of Neurology, and the Council of Residency Directors Academic Assembly abstract submission review group;
o Erik Kulstad, MD, MS as a reviewer for the Annals of Emergency Medicine, American Journal of Emergency Medicine, the Western Journal of Emergency Medicine, and the Journal of Emergencies, Trauma, and Shock;
o Sam Lam, MD as a reviewer for Academic Emergency Medicine;
o Elise Lovell, MD, as a reviewer for the Council of Residency Directors Academic Assembly abstract submission review group;
o Karis Tekwani, MD, as a peer reviewer for the Western Journal of Emergency Medicine;
o Hannah Watts, MD, as a peer reviewer for the American Journal of Emergency Medicine and the Western Journal of Emergency Medicine;
• Sam Lam, MD, has had a didactic submission accepted by the SAEM Program Committee, Jelly on the Belly: Cutting Edge Pediatric Ultrasound Applications, for the 2012 SAEM Annual Meeting to be held here in Chicago in May 9- 12, 2012 .
• Our department has one of the Top 25 Downloads for Annals of Emergency Medicine this year! The landmark study directed by Karis Tekwani, MD, entitled A Comparison of the Effects of Etomidate and Midazolam on Hospital Length of Stay in Patients With Suspected Sepsis: A Prospective, Randomized Study, with co - authors Hannah Watts, MD, Kathleen Hesse, RN, Rolla Sweis, PharmD, and Erik Kulstad, MD, MS, which was published in the Annals of Emergency Medicine in November 2010, is #14 in the current top 25 list located on the Annals home page at www.annemergmed.com.
• The study “Correlation between impedance cardiography and B -type natriuretic peptide levels in dyspneic patients” by Havelka EG, Rzechula KH, Bryant TO, Anneken SM, and Kulstad EB, and published in the Journal of Emergency Medicine in February 2011 was featured in the August 2011 edition of EM Abstracts, with a very nice review and commentary (http://ccme.org/EMA/) .
• We had a tremendous showing of our department’s work at multiple local and national meetings, including the 2011 Advocate Research Forum, the ICEP Spring Symposium, and the SAEM 2011 Annual Meeting. (See below for details.)
• Studies performed by our department and presentations given by our members have been featured in a wide variety of venues and by national news media, including Reuters, ACEP News, EM Abstracts, EMCrit, Emergency Physicians Monthly, Critical Care Smart Brief, Emergency Medicine Today, and Medscape News.
Additional Accolades
• The podcast Critical Care Perspectives in Emergency Medicine (CCPEM, http://www.ccpem.com/) listed our department’s article by Karis Tekwani, MD, entitled A Comparison of the Effects of Etomidate and Midazolam on Hospital Length of Stay in Patients With Suspected Sepsis: A Prospective, Randomized Study , with co - authors Hannah Watts, MD, Kathleen Hesse, RN, Rolla Sweis, PharmD, and Erik Kulstad, MD, MS in their "best literature of 2010”. The article also has been selected and evaluated by the Faculty of 1000, which places this work in the library of the top 2% of published articles in biology and medicine.
• Elise Lovell, MD, served as Co- Program Chair for the Council of Residency Directors Academic Assembly held in San Diego, March 3-5, 2011.
• The Illinois Emergency Department Asthma Surveillance Project has exceeded the target for the period for surveillance , thanks in part to our department and the spearheading efforts of Kathleen Hesse, RN.
• Erik Kulstad, MD, MS, was a small group leader for the 2011 SAEM Consensus Conference, Interventions to Improve Quality in the Crowded ED, held in Boston, MA, covering the subtopic “Interventions to safeguard efficiency of care in the crowded ED” .
• Tyler Ayalin, MD, served as an author on the Volume 16, Number 2 / February 2011 Pediatric Emergency Medicine Reports issue “ Minor Head Trauma in Pediatric Patients ”.
Publications - 2011
• Ayalin T , Kiang C, Gharabaghian L, and Wang NE. Pediatric Emergency Medicine Reports - Minor Head Trauma in Pediatric Patients , Volume 16, Number 2 / February 2011.
• Kessler C, Tolia VM, Xie X , Kasi R, Kutka B. Academic practice of emergency medicine in the nation's Veteran's Affairs Hospitals, Am J Emerg Med . 2011 Mar;29(3):283 - 5.
• Kessler C, Kutka BM, Badillo C. Consultation in the Emergency Department: A Qualitative Analysis and Review. J Emerg Med. 2011 May 25. [Epub ahead of print]
• Kerwin C, Tommaso L, and Kulstad E. A Brief Training Module Improves Recognition of Echocardiographic Wall Motion Abnormalities by Emergency Medicine Physicians. Emerg Med International, In Press.
• Vaicys V, Eason A, Schieber JD, Kulstad EB. Therapeutic hypothermia induction via an esophageal route - a computer simulation. Am J Emerg Med. 2011.
• Kulstad EB, Tekwani KL. In reply. Ann Emerg Med. 2011;57(6):706.
• Jabre P, Galinski M, Ricard- Hibon A, Devaud ML, Ruscev M, Kulstad E, et al. Out - of -hospital tracheal intubation with single - use versus reusable metal laryngoscope blades: a multicenter randomized controlled trial. Ann Emerg Med. 2011;57(3):225 - 31.
• Jabre P, Avenel A, Combes X, Kulstad E, Mazariegos I, Bertrand L, et al. Morbidity related to emergency endotracheal intubation-- a substudy of the KETAmine SEDation trial. Resuscitation. 2011;82(5):517 - 22.
• Eason A, Vaicys V, Kulstad E. Development of a computational method to automatically acquire ED crowding data. Am J Emerg Med. 2011;29(4):457- 9.
• Ayalin T, Lam SH. Ultrasound- assisted lumbar puncture in infants. Acad Emerg Med. 2011;18(4):e36.
• Miller DG, Lovell EO. Antibiotic- induced serotonin syndrome. J Emerg Med. 2011;40(1):25- 7.
• Havelka EG, Rzechula KH, Bryant TO, Anneken SM, Kulstad EB. Correlation between impedance cardiography and B -type natriuretic peptide levels in dyspneic patients. J Emerg Med. 2011;40(2):146- 50.
• Harris B, Bai JC, Kulstad E. Crowding Does Not Adversely Affect Time to Percutaneous Coronary Intervention for Acute Myocardial Infarction in a Community Emergency Department, Ann Emerg Med, In Press.
• Moore R, Williamson K, Sochor M, and Brady WJ. Large - Event Medicine - Event Characteristics Impacting Medical Need. AJEM. 2011 Nov; 29 (9): 1217- 1221.
• Sikka R, Tommaso L, Kulstad E. Pneumonia Diagnosis in the Emergency Department has Limited Accuracy Despite Diagnostic Uncertainty, Amer J of Emerg Med, In Press.
• Whitney- Cashio P, Sartin M, Brady WJ, Williamson K, Alibertis K, Somers G, and O’Connor Re. Correspondance: The Introduction of Public Access Defibrillation to a University Community: The University of Virginia Public Access Defibrillation Program. AJEM. 2012 Jan; 30 (1): 240 - 242.
• Williamson K, Breed M, Alibertis K, Brady WJ. “The Impact of the Code Drugs: Cardioactive Medications in Cardiac Arrest Resuscitation”. Emerg Med Clin North Am. 2012 Feb; 30 (1): 65- 75.
• Zerth H, Girzadas D, Tommaso L, Harwood R. An Inexpensive, Easily Constructed, Reusable Task Trainer for Simulating Ultrasound- Guided Pericardiocentesis. Journal of Emerg Med, In Press.
Abstracts and Presentations
The ICEP Spring Symposium was held May 12, 2011, at Northwestern Memorial Hospital.
• David A Barounis, MD, presented his abstract A Comparison Of The Effects Of Etomidate And Midazolam On The Duration Of Pressor Use In Patients With Suspected Sepsis , done with Karis Tekwani, MD, Hannah Watts, MD, and Erik Kulstad, MD, MS.
• Sam Lam, MD, presented his poster A Multi- site Validation Of An Ultrasound Image Rating Scale-- a Pilot St udy , done with Mike Lambert, MD, Mila Felder, MD, Christopher Kerwin, MD, P. John Konicki, DO, RDMS, Martha Villalba, MD, John Bailitz, MD, David Blehar, MD, J. Christian Fox, MD, RDMS, Beatrice Hoffmann, MD, PhD, RDMS, Andrew S. Liteplo, MD, RDMS, and Rebecca Roberts, MD.
The 2011 Advocate Research Forum was held at Advocate Christ Medical Center on May 18, 2011.
• Hannah Watts, MD, presented Further Characterization of the Influence of Crowding on Medication Errors done with Rishi Sikka, MD, Rolla Sweis, PharmD, and Erik Kulstad, MD, MS
• Dave Barounis, MD, presented A Comparison Of The Effects Of Etomidate And Midazolam On The Duration Of Pressor Use In Patients With Suspected Sepsis, done with Karis Tekwani, MD, Hannah Watts, MD, and Erik Kulstad, MD, MS.
• Drew Dean presented A Simply Constructed, Economical, and Reusable Task Trainer for Simulating Intracompartmental Pressure Measurements, done with Daniel V. Girzadas Jr., MD, Steve Delis, MD, and Lamont Clay, MD.
• Dan Gromis, MD, presented More Than Just a Hemorrhoid: Perirectal Abscess , done with Joe Maslar, MD.
• Mark Hinton, MD, presented A systematic review of the literature on the use of Tamsulosin for the treatment of Patients with Ureterolithiasis in US Emergency Departments done with David Barounis, MD, and Erik Kulstad, MD, MS.
• Janna Hoffman , MD, presented A Case of Scombroid Poisoning in the Emergency Department, with Steve Delis, MD.
• Sam Lam, MD, presented A Multi- site Validation Of An Ultrasound Image Rating Scale--a Pilot Study , done with Mike Lambert, MD, Mila Felder, MD, Christopher Kerwin, MD, P. John Konicki, DO, RDMS, Martha Villalba, MD, John Bailitz, MD, David Blehar, MD, J. Christian Fox, MD, RDMS, Beatrice Hoffmann, MD, PhD, RDMS, Andrew S. Liteplo, MD, RDMS, and Rebecca Roberts, MD.
• David Barounis, MD, presented Implementation of a Therapeutic Hypothermia Protocol in a Community Hospital Emergency Department, done with Christine Kulstad, MD, and Elise Lovell, MD.
The SAEM 2011 Annual Meeting was held June 1- 5 in Boston, Massachusetts, where we had a number of presentations.
• Mark Hinton, MD, presented his CPC case on chronic aspirin overdose, where he competed with residents from 71 other programs.
• Hannah Watts, MD, served as faculty discussant for the CPC case of “A 57 year old female with several days of right eye pain”.
• David A Barounis, MD, presented his abstract in an Oral Presentation at the SAEM 2011 Annual Meeting in Boston, Massachusetts, on Saturday, June 4, - A Comparison Of The Effects Of Etomidate And Midazolam On The Duration Of Pressor Use In Patients With Suspected Sepsis, done with Karis Tekwani, MD, Hannah Watts, MD, and Erik Kulstad, MD, MS.
• Sam Lam, MD, presented his abstract in a Lightning Oral Presentation at the SAEM 2011 Annual Meeting in Boston, Massachusetts, on Saturday, June 4, - Multi- site Validation Of An Ultrasound Image Rating Scale-- a Pilot Study , done with Mike Lambert, MD, Mila Felder, MD, Christopher Kerwin, MD, P. John Konicki, DO, RDMS, Martha Villalba, MD, John Bailitz, MD, David Blehar, MD, J. Chr istian Fox, MD, RDMS, Beatrice Hoffmann, MD, PhD, RDMS, Andrew S. Liteplo, MD, RDMS, and Rebecca Roberts, MD.
The Sixth Mediterranean Emergency Medicine Congress (MEMC VI ) was held at the Kos International Congress Centre Kos , Greece 10- 14 September 2011.
The 2011 American College of Emergency Physicians Scientific Assembly, was held in San Francisco, Oct. 15 – 18, 2011 .
The Illinois College of Emergency Physicians 2011 Academic Forum was held November 3, 2011, with location once again at Advocate Christ Medical Center.
• Erik Kulstad, D. Mark Courtney, and Mark Mycyk presented a panel discussion “Abstract Writing 101: How to Make Abstracts Not So Abstract”.
• Dave Barounis, MD presented the research “ Therapeutic hypothermia protocol: A retrospective review of outcomes over a 5 year period ”, done with Christine Kulstad, MD, and Elise Lovell, MD.
Grant support - Active
Protocolized Care for Early Septic Shock (ProCESS) Study
This study is 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 to determine whether specific interventions can halt the progression to severe sepsis and septic shock.
Site PI: Hannah Watts, MD
Site Co- PI: Christine Kulstad, MD
Coordinators: Kathy Hesse, RN, Laura Tommaso, MD
Additional Investigators: Ejaaz Kalimullah, Diana Strasburger, Dan Nelson, Cindy Chan, Sam Lam, Jeane Scoleri, Linda Follenweider, Lisa Michel, Dan Gromis, Brian Sayger, Robert Harwood, David Barounis, Elise Lovell, and Erik Kulstad.
Investigating microcirculatory dysfunction in ER and ICU sepsis patients using new Microscan imaging technology
This is a prospective, cohort study initiated at Harvard University that will analyze the microcirculation of the sublingual mucosa in ED and ICU patients with suspected infection and compare them to healthy controls. The primary outcome measure will be a calculated microcirculatory flow index. Secondary outcome measures will be ICU admission, organ failure, length of stay, SOFA score, and APACHE - II disease severity) score.
Site PI: Hannah Watts, MD
Site Co- PI: Christine Kulstad, MD
Coordinators: Kathy Hesse, RN, Laura Tommaso, MD
An Esophageal Device for the Induction of Mild Therapeutic Hypothermia
Awarded as an SBIR Phase I grant proposal to NSF in June 201 1, with an award amount of
$150,000. PI - Erik Kulstad, MD, MS, and Consultant - D. Mark Courtney, MD, MS
Grant support - Submitted
Using real -time, computerized decision support and direct provider feedback to reduce unnecessary testing for pulmonary embolism in the emergency department
Submitted to AHRQ, with PI Jesse Pines, MD, and 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, for multi - center support to examine the effects of incorporating the PERC decision rules into the EMR.
The Procalcitonin Antibiotic Consensus Trial - ProACT
ProACT seeks to determine the efficacy and safety of implementation of a procalcitonin- based antibiotic algorithm for clinically diagnosed lower respiratory tract infection (LRTI - community acquired pneumonia, acute exacerbation of asthma + COPD, acute bronchitis) patients for whom the treating ED attending physician has not already started antibiotics. Submitted to NIH, with David Huang, MD as PI at the University of Pittsburgh.
The Influence of Hyperglycemia and Diabetes on Sepsis Morbidity and Mortality
This study seeks to evaluate the utility of the Microscan technology in patients with varying degrees of sepsis and hyperglycemia. Submitted to NIH, with Nate Shapiro, MD, MS as PI at Beth Israel Deaconess Medical Center.
Proposal for Participation in a Clinical Site Hub in the Neurological Emergencies Treatment Trials (NETT) Network
The goal of this project is to develop and implement efficacious treatments for patients with a broad spectrum of neurological emergencies in order to decrease the morbidity and mortality associated with neurological disease. This project is being led by Ed Sloan, MD, at the University of Illinois, and will involve widespread collaborations throughout Chicago and across multiple disciplines within Advocate Christ Medical Center.
Grant support - Completed
Evaluation of the Beckman Coulter AccuTnI® Assay as an Aid in the Diagnosis and Treatment of Myocardial Infarction (MI) and Cardiac Muscle Damage
The major goal of this study is to evaluate the clinical utility of the Beckman Coulter AccuTnI® assay as an aid in the diagnosis and treatment of myocardial infarction and cardiac muscle damage.
Site PI: Erik Kulstad, MD, MS ; Co- investigators: Hannah Watts, MD, Christine Kulstad, MD, Chintan Mistry, MD; Coordinators: Kathy Hesse, RN, Laura Tommaso, MD
Ongoing 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 G irzadas, 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.
PI: Sam Lam; Co - investigator: Mike Lambert. Multi - site Validation of an Ultrasound Image Rating Scale
PI: Sam Lam; Co- invest igators: Mike Lambert, Cindy Chan, John Konicki, Martha Villalba, Chris Kerwin, Diana Strasburger. REASON Trial: Sonography in Cardiac Arrest.
PI: Tyler Ayalin. Coinvestigators: Dan Girzadas, Lamont Clay, Steve Delis. Effects of Ambient Noise on High Fidelity Simulation.
PI: Tyler Ayalin. Coinvestigator: Sam Lam. Comparison of FAST exam rates for Pediatric and Adult Blunt Abdominal trauma patients.
Upcoming Conferences
The AAEM 19th Annual Scientific Assembly will be held February 8- 10, 2012 , i n San Diego, California.
The ICEP Spring Symposium will be held Thursday, April 26, 2012, at Advocate Christ Medical Center.
The 2012 SAEM Annual Meeting will be held May 9- 13, 2012 at the Sheraton Chicago Hotel and Towers, Chicago, IL.
The ACEP Scientific Assembly will be held October 8- 11, 2012 , in Denver, Colorado.
Outstanding work everyone! Please continue to let us know of ongoing work you’re involved with, and accept our apologies for any omissions!