Joseph S Stapczynski

Interests

Teaching

Research study design

Research

Clinical research on acute and emergency conditions

Courses

Scholarly Contributions

Books

• Stapczynski, J. S., Tintinalli, J. E., Yealy, D. M., Meckler, G. D., Cline, D. M., & Thomas, S. H. (2020). Tintinalli’s Emergency Medicine. A Comprehensive Study Guide. Ninth edition. New York: McGraw-Hill Education.
• Stapczynski, J. S. (2020). Tintinalli's Emergency Medicine. New York: McGraw Hill Education.

Journals/Publications

• Geren, K. I., Lovecchio, F., Knight, J., Fromm, R., Moore, E., Tomlinson, C., Valdez, A., Hobohm, D., & Stapczynski, J. S. (2014). Identification of acute HIV infection using fourth-generation testing in an opt-out emergency department screening program. Annals of emergency medicine, 64(5), 537-46.
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  Acute HIV infection is a clinical diagnosis aided by technology. Detecting the highly infectious acute stage of HIV infection is critical to reducing transmission and improving long-term outcomes. The Maricopa Integrated Health System implemented nontargeted, opt-out HIV screening with a fourth-generation antigen/antibody combination HIV assay test in our adult emergency department (ED) at Maricopa Medical Center to assess the prevalence of both acute and chronic unrecognized HIV.
• Spaite, D. W., Bobrow, B. J., Stolz, U., Berg, R. A., Sanders, A. B., Kern, K. B., Chikani, V., Humble, W., Mullins, T., Stapczynski, J. S., Ewy, G. A., & , A. C. (2014). Statewide regionalization of postarrest care for out-of-hospital cardiac arrest: association with survival and neurologic outcome. Annals of emergency medicine, 64(5), 496-506.e1.
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  For out-of-hospital cardiac arrest, authoritative, evidence-based recommendations have been made for regionalization of postarrest care. However, system-wide implementation of these guidelines has not been evaluated. Our hypothesis is that statewide regionalization of postarrest interventions, combined with emergency medical services (EMS) triage bypass, is associated with improved survival and neurologic outcome.
• Roque, P. J., Wu, T. S., Barth, L., Drachman, D., Khor, K. N., Lovecchio, F., & Stapczynski, S. (2012). Optic nerve ultrasound for the detection of elevated intracranial pressure in the hypertensive patient. The American journal of emergency medicine, 30(8), 1357-63.
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  We sought to determine whether dilation of the optic nerve sheath diameter (ONSD), as detected at the bedside by emergency ultrasound (US), could reliably correlate with patient blood pressure and whether there was a blood pressure cutoff point where you would start to see abnormal dilation in the ONSD.
• Roque, P., Oliver, B., Anderson, L., Mulrow, M., Drachman, D., Stapczynski, S., & LoVecchio, F. (2012). Inpatient utilization of blood cultures drawn in an urban ED. The American journal of emergency medicine, 30(1), 110-4.
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  Bloodstream infections are now ranked as the 10th leading cause of death in the United States. Given the severity of bacteremia, physicians routinely order multiple sets of blood cultures in the emergency department. This is a retrospective chart review on 1124 patients admitted to the hospital for suspected bacteremia during calendar year 2004. The aims of the present investigation were to investigate the overall utility of blood cultures by the admitting services and to identify patient factors that might influence culture yield. Data were collected regarding patient demographics, comorbidities, vital signs, laboratory results, antibiotic use, blood culture results, and notation of blood culture results by admitting physicians. Increased age, elevated heart rate, use of chemotherapy, decreased sodium, and increased blood urea nitrogen significantly increased the likelihood of yielding a positive blood culture in our patient population. Culture results were noted in 517 patient charts by the primary medical team (46.0%) and were adjusted in 223 patients (43.3%). Of 1124 cultures, 10.3% were positive in at least 1 bottle for a pathogenic organism (true positive), and 6.3% were contaminants (false positive). In conclusion, cultures must be followed closely by the admitting physician after being obtained. Our data emphasize that blood cultures are currently not well used by the admitting physicians and that measures need to be taken to improve the overall utility of blood culture data by the admitting physician.
• Balls, A., LoVecchio, F., Kroeger, A., Stapczynski, J. S., Mulrow, M., Drachman, D., & , C. L. (2010). Ultrasound guidance for central venous catheter placement: results from the Central Line Emergency Access Registry Database. The American journal of emergency medicine, 28(5), 561-7.
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  Ultrasound guidance of central venous catheter (CVC) insertion improves success rates and reduces complications and is recommended by several professional and regulatory organizations.
• Bobrow, B. J., Spaite, D. W., Berg, R. A., Stolz, U., Sanders, A. B., Kern, K. B., Vadeboncoeur, T. F., Clark, L. L., Gallagher, J. V., Stapczynski, J. S., LoVecchio, F., Mullins, T. J., Humble, W. O., & Ewy, G. A. (2010). Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA, 304(13), 1447-54.
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  Chest compression-only bystander cardiopulmonary resuscitation (CPR) may be as effective as conventional CPR with rescue breathing for out-of-hospital cardiac arrest.
• Balls, A., LoVecchio, F., Stapczynski, S. J., Mulrow, M., Levine, B., Berkeley, R. P., Panacek, E., Miller, A., Norquist, C., Riviello, R., Ary, R., Rodriguez, E., Young, J., Gross, E., Mills, L., Zeger, W., & , C. I. (2009). CLEAR: Central Line Emergency Access Registry. The CLEAR project protocol methods paper. The American journal of emergency medicine, 27(1), 119-122.
• Humphries, R. L., Stone, C. K., Stapczynski, J. S., & Florea, S. (2006). An assessment of pediatric all-terrain vehicle injuries.. Pediatric emergency care, 22(7), 491-4. doi:10.1097/01.pec.0000227383.69014.36
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  All-terrain vehicle (ATV) related injuries and deaths have been increasing since 1996. The objective of this study is to define the impact on the morbidity and mortality of the pediatric population of the referral area of one of Kentucky's level-1 trauma centers..Data were collected retrospectively from the University of Kentucky Trauma Registry on all patients younger than 18 years of age admitted to the level 1 trauma center between 1996 and 2000 with ATV related injuries..One hundred fifty-one pediatric patients were hospitalized from an ATV-related injury during the study period. There were five deaths. The male/female ratio was 3.2:1. The mean revised trauma score was 7.3 +/- 1.3. The mean injury severity score was 12.3 +/- 8.9. Helmet use was only 4%. The average hospitalization was 4.4 +/- 5.2 days, 32% went to the intensive care unit and 52% to the operating room. Forty percent of patients had multisystem injuries. Passengers were younger than drivers (9.3 +/- 4.9 and 13.3 +/- 2.7 years, respectively). Hospital charges exceeded dollar 2.1 million..All-terrain vehicle-related injuries led to significant morbidity and mortality for the pediatric population of southern and southeastern Kentucky. Encouraging helmet use and discouraging passengers from riding through safety education or a new state law may help to reduce ATV related mortality and morbidity. Prohibiting children younger than 16 years from operating or riding on an ATV seems justified.
• Stapczynski, J. S. (2005). Antibiotic prescribing for lower respiratory tract infection. JAMA, 294(16), 2032; author reply 2032.
• Stapczynski, J. S. (2004). Is the prudent layperson standard really a "standard"?. Annals of emergency medicine, 43(2), 163-5.
• D'Alessandri, R. M., Albertsen, P., Atkinson, B. F., Dickler, R. M., Jones, R. F., Kirch, D. G., Longnecker, D. E., McAnarney, E. R., Parisi, V. M., Selby, S. E., Stapczynski, J. S., Thompson, J. W., Wasserman, A. G., & Zuza, K. L. (2000). Measuring contributions to the clinical mission of medical schools and teaching hospitals. Academic medicine : journal of the Association of American Medical Colleges, 75(12), 1231-7.
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  This is the final report of a panel convened as part of the Association of American Medical College's (AAMC's) Mission-based Management Program to examine the use of metrics (i.e., measures) in assessing faculty and departmental contributions to the clinical mission. The authors begin by focusing on methods employed to estimate clinical effort and calculate a "clinical full-time equivalent," a prerequisite to comparing productivity among faculty members and departments. They then identify commonly used metrics, including relative-value units, total patient-care gross charges, total net patient fee-for-service revenue, total volume per CPT (current procedural terminologies) code by service category and number of patients per physician, discussing their advantages and disadvantages. These measures reflect the "twin pillars" of measurement criteria, those based on financial or revenue information, and those based on measured activity. In addition, the authors urge that the assessment of quality of care become more highly developed and integrated into an institution's measurement criteria. The authors acknowledge the various ways users of clinical metrics can develop standards against which to benchmark performance. They identify organizations that are sources of information about external national standards, acknowledge various factors that confound the interpretation of productivity data, and urge schools to identify and measure secondary service indicators to assist with interpretation and provide a fuller picture of performance. Finally, they discuss other, non-patient-care, activities that contribute to the clinical mission, information about which should be incorporated into the overall assessment. In summary, the authors encourage the use of clinical productivity metrics as an integral part of a comprehensive evaluation process based upon clearly articulated and agreed-upon goals and objectives. When carefully designed, these measurement systems can provide critical information that will enable institutional leaders to recognize and reward faculty and departmental performance in fulfillment of the clinical mission.
• Koury, R., Stone, C. K., Stapczynski, J. S., & Blake, J. (1999). Sympathetic overactivity from fenfluramine-phentermine overdose. European journal of emergency medicine : official journal of the European Society for Emergency Medicine, 6(2), 149-52.
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  A 24-year-old male presented to the emergency department with hyperadrenergic manifestations of fenfluramine-phentermine overdose: tachycardia, mydriasis, fever, diaphoresis, hyperventilation, and combativeness. Sedatives, neuromuscular paralytics, adrenergic antagonists, and mechanical ventilation were required to care for the patient. In addition, the patient had self-inflicted 15% TBSA second-degree burns and developed adult respiratory distress syndrome which required continued intubation and mechanical ventilation for 12 days. The patient had split thickness skin grafts for his leg burns on day 11. He was discharged after a 26-day hospital stay. We are unaware of any previously reported cases of fenfluramine-phentermine overdose with such profound degree of sympathetic storm.
• Koury, S. I., Moorer, L., Stone, C. K., Stapczynski, J. S., & Thomas, S. H. (1998). Air vs ground transport and outcome in trauma patients requiring urgent operative interventions. Prehospital emergency care, 2(4), 289-92.
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  To study trauma patients requiring urgent operative interventions to determine whether transport mode was associated with outcome difference.
• Schneider, S. M., Hamilton, G. C., Moyer, P., & Stapczynski, J. S. (1998). Definition of emergency medicine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 5(4), 348-51.
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  This SAEM position paper clarifies the role of emergency medicine in health care delivery. It builds upon the working definition of emergency medicine developed by the American College of Emergency Physicians in 1994 by describing the health care role of emergency physicians (EPs). EPs are first-contact providers who care for all patients regardless of age, gender, time of presentation, or ability to pay. They remain the only continuously accessible specialty for patients seeking help and solace in the health care system. They are an essential link in the health care continuum between primary care physicians, specialists, the out-of-hospital system, the patient, inpatient services, and communication services. The EP's role is in organizing and monitoring the emergency care delivery system. Part of this role is to better align the health care provider training and ability with the specific medical needs of a patient. The emergency health care system remains the essential medical safety net for all individuals needing care in this country.
• Stapczynski, J. S., Svenson, J. E., & Stone, C. K. (1997). Population density, automated external defibrillator use, and survival in rural cardiac arrest. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 4(6), 552-8.
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  To determine whether population density is an independent predictor of survival from out-of-hospital cardiac arrest managed by basic life support (BLS) services using automated external defibrillators (AEDs).
• Svenson, J., Besinger, B., & Stapczynski, J. S. (1997). Critical care of medical and surgical patients in the ED: length of stay and initiation of intensive care procedures. The American journal of emergency medicine, 15(7), 654-7.
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  Little is known about the extent of critical care delivered to patients in the emergency department (ED) and its impact on ED lengths of stay or patient outcomes. The purpose of this study was to characterize the timing of care for critically ill patients, both medical and surgical, in the ED. The design was a retrospective review. The setting was a university teaching hospital. The subjects were ED patients subsequently admitted to a medical or surgical intensive care unit (ICU). The average length of stay in the ED was 367 minutes. Thirty percent of patients were boarded in the ED because of lack of beds in the ICU. Stabilization procedures were performed on 45 (27%) patients, on average 102 minutes after ED admission. Monitoring procedures were performed on 35 (21%), on average 170 minutes after ED admission. There were no significant differences in length of stay, use, and timing of critical procedures in medical and surgical patients. Critically ill patients represent a significant portion of ED patients and may remain in the ED for prolonged periods of time. One of the major contributors to these prolonged stays are lack of beds. Both resuscitative and monitoring procedures are often performed in the ED setting for all types of critical patients. The timing of these procedures indicates that they are performed when necessary for patient care regardless of ED or ICU setting. Thus, ICU care is often initiated and maintained in the ED setting. EDs must be staffed adequately with appropriately trained personnel to care for these patients.
• Stapczynski, J. S. (1996). Capitation for emergency physicians. Annals of emergency medicine, 27(4), 501-5.
• Stone, C. K., Stapczynski, J. S., Thomas, S. H., & Koury, S. I. (1996). Rate of patient workups by non-emergency medicine residents in an academic emergency department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 3(2), 153-6.
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  To quantify the number of patients seen per hour by non-emergency medicine (non-EM) residents in a university hospital ED.
• Svenson, J. E., Stapczynski, J. S., Nypaver, M., & Calhoun, R. (1996). Development of a statewide trauma system: classification of levels of care available to injured patients. The Journal of the Kentucky Medical Association, 94(2), 63-9.
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  To categorize the level of care offered in emergency settings at acute care hospitals in Kentucky.
• Stapczynski, J. S., Burklow, M., Calhoun, R. P., & Svenson, J. E. (1995). Automated external defibrillators used by emergency medical technicians: report of the 1992 experience in Kentucky. The Journal of the Kentucky Medical Association, 93(4), 137-41.
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  Automated external defibrillators (AED) have been authorized for use by Emergency Medical Technicians (EMT) in Kentucky since March 1991. Emergency Medical Services (EMS) which use these devices are required to submit annual reports to the EMS Branch. During 1992, 17 services were approved to use AEDs. The device was used by 12 services on 93 victims of out-of-hospital cardiac arrest. Of the 93 victims, 27 were defibrillated, eight were resuscitated to hospital admission, and three survived to hospital discharge. The overall survival rate was 3/93 (3.2%). For patients receiving defibrillatory shocks, the survival rate was 3/27 (11%). This percentage is comparable with the survival rates reported from other predominately rural states where AEDs have been used by EMTs. Possible protocol violations and inadequate documentation were also identified from these reports. In summary, EMTs in predominately rural Kentucky can use AEDs to achieve survival rates for out-of-hospital cardiac arrest comparable with other rural states.
• Dickens, G. R., McCoy, R. A., West, R., Stapczynski, J. S., & Clifton, G. D. (1994). Effect of nebulized albuterol on serum potassium and cardiac rhythm in patients with asthma or chronic obstructive pulmonary disease. Pharmacotherapy, 14(6), 729-33.
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  To evaluate the metabolic and cardiopulmonary effects of nebulized albuterol in patients suffering moderate to severe exacerbations of asthma or chronic obstructive pulmonary disease.
• Svenson, J., & Stapczynski, J. S. (1994). Childhood back pain: diagnostic evaluation of an unusual case. The American journal of emergency medicine, 12(3), 334-6.
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  Low back pain is uncommon in children. The case of a 5-year-old boy presenting with back pain that proved to be caused by a metastatic primitive neuroectodermal tumor is presented and the evaluation of such patients is discussed.
• Roberts, S. A., Diaz, C., Nolan, P. E., Salerno, D. M., Stapczynski, J. S., Zbrozek, A. S., Ritz, E. G., Bauman, J. L., & Vlasses, P. H. (1993). Effectiveness and costs of digoxin treatment for atrial fibrillation and flutter. The American journal of cardiology, 72(7), 567-73.
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  Clinical outcomes and costs associated with the use of digoxin in atrial fibrillation and flutter were evaluated in a prospective, observational study at 18 academic medical centers in the United States. Data were collected on 115 patients (aged > 18 years) with atrial fibrillation or flutter who were treated with digoxin for rapid ventricular rate (> or = 120 beats/min). The median time to ventricular rate control (i.e., resting ventricular rate < 100 beats/min, decrease in ventricular rate of > 20%, or sinus rhythm) was 11.6 hours from the first dose of digoxin for all evaluable patients (n = 105) and 9.5 hours for those only receiving digoxin (n = 64). Before ventricular rate control, the mean +/- SD dose of digoxin administered was 0.80 +/- 0.74 mg, and a mean of 1.4 +/- 1.8 serum digoxin concentrations were ordered per patient. Concomitant beta-blocker or calcium antagonist therapy was instituted in 47 patients (41%); in 19 of these, combination therapy was initiated within 2 hours. Adenosine was administered to 13 patients (11%). Patients spent a median of 4 days (range 1 to 25) in the hospital; 28% spent time in a coronary/intensive care unit and 79% in a telemetry bed. Loss of control (i.e., resting ventricular rate returned to > 120 beats/min) occurred at least once in 50% of patients and was associated with a longer hospital stay (p < 0.05). Based on 1991 data, the estimated mean hospital bed cost for patients with atrial fibrillation or flutter was $3,169 +/- $3,174.(ABSTRACT TRUNCATED AT 250 WORDS)
• Stapczynski, J. S. (1991). "Misconceptions" about AIDS. Annals of internal medicine, 115(5), 411.
• Stapczynski, J. S. (1991). Localized depigmentation after steroid injection of a ganglion cyst on the hand. Annals of emergency medicine, 20(7), 807-9.
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  Presented is the case of a man who had localized depigmentation after local injection of triamcinolone diacetate. Search of the literature indicates that this is a rare complication of such therapy. Localized depigmentation may have important cultural implications for dark-skinned patients. There is some experimental evidence that less-potent and shorter-acting steroid preparations have a lower likelihood for depigmenting side effects, and such agents may be more appropriate when injecting subcutaneous structures to prevent this complication.

Poster Presentations

• McQuilkin, M., Stapczynski, J., Wagner, K., Kang, P., McEchron, M., & vanSonnenberg, E. (2017, January). Is Family Medicine Mentorship of a Medical Student Mandatory Scholarly Project Related to Matching Into a Primary Care Residency?. Society of Teachers of Family Medicine Conference on Medical Student Education. Phoenix, AZ: Society of Teachers of Family Medicin.