Kurt R Denninghoff

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• Gaither, J. B., Spaite, D. W., Bobrow, B. J., Barnhart, B., Chikani, V., Denninghoff, K. R., Bradley, G. H., Rice, A. D., Howard, J. T., Keim, S. M., & Hu, C. (2024). EMS Treatment Guidelines in Major Traumatic Brain Injury With Positive Pressure Ventilation. JAMA surgery.
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  The Excellence in Prehospital Injury Care (EPIC) study demonstrated improved survival in patients with severe traumatic brain injury (TBI) following implementation of the prehospital treatment guidelines. The impact of implementing these guidelines in the subgroup of patients who received positive pressure ventilation (PPV) is unknown.
• Rice, A. D., Hu, C., Spaite, D. W., Barnhart, B. J., Chikani, V., Gaither, J. B., Denninghoff, K. R., Bradley, G. H., Howard, J. T., Keim, S. M., & Bobrow, B. J. (2022). Correlation between prehospital and in-hospital hypotension and outcomes after traumatic brain injury. The American journal of emergency medicine, 65, 95-103.
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  Hypotension has a powerful effect on patient outcome after traumatic brain injury (TBI). The relative impact of hypotension occurring in the field versus during early hospital resuscitation is unknown. We evaluated the association between hypotension and mortality and non-mortality outcomes in four cohorts defined by where the hypotension occurred [neither prehospital nor hospital, prehospital only, hospital only, both prehospital and hospital].
• Spaite, D. W., Hu, C., Bobrow, B. J., Barnhart, B., Chikani, V., Gaither, J. B., Denninghoff, K. R., Bradley, G. H., Rice, A. D., Howard, J. T., & Keim, S. M. (2022). Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension. Annals of emergency medicine, 80(1), 46-59.
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  Little is known about the out-of-hospital blood pressure ranges associated with optimal outcomes in traumatic brain injuries (TBI). Our objective was to evaluate the associations between out-of-hospital systolic blood pressure (SBP) and multiple hospital outcomes without assuming any predefined thresholds for hypotension, normotension, or hypertension.
• Denninghoff, K. R. (2021). Randomized trial of the feasibility of ED-initiated school-based asthma medication supervision (ED-SAMS). Pilot and Feasibility Studies, 7(179). doi:https://doi.org/10.1186/s40814-021-00913-0
• Gaither, J. B., Spaite, D. W., Bobrow, B. J., Keim, S. M., Barnhart, B. J., Chikani, V., Sherrill, D., Denninghoff, K. R., Mullins, T., Adelson, P. D., Rice, A. D., Viscusi, C., & Hu, C. (2021). Effect of Implementing the Out-of-Hospital Traumatic Brain Injury Treatment Guidelines: The Excellence in Prehospital Injury Care for Children Study (EPIC4Kids). Annals of emergency medicine, 77(2), 139-153.
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  We evaluate the effect of implementing the out-of-hospital pediatric traumatic brain injury guidelines on outcomes in children with major traumatic brain injury.
• Gerald, L. B., Gerald, J. K., VanBuren, J. M., Lowe, A., Guthrie, C. C., Klein, E. J., Morrison, A., Startup, E., & Denninghoff, K. (2021). Randomized trial of the feasibility of ED-initiated school-based asthma medication supervision (ED-SAMS). Pilot and feasibility studies, 7(1), 179.
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  While using an inhaled corticosteroid (ICS) in the weeks after an ED visit reduces repeat visits, few children receive a needed prescription. Because a prescription may not be filled or used, dispensing ICS at discharge and supervising its use at school could overcome both barriers until follow-up care is established. To assess the feasibility of such an intervention, we conducted a pilot study among elementary-age school children with persistent asthma who were discharged from the ED following an asthma exacerbation.
• Chamberlain, J. M., Kapur, J., Shinnar, S., Elm, J., Holsti, M., Babcock, L., Rogers, A., Barsan, W., Cloyd, J., Lowenstein, D., Bleck, T. P., Conwit, R., Meinzer, C., Cock, H., Fountain, N. B., Underwood, E., Connor, J. T., Silbergleit, R., , N. E., & , P. E. (2020). Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial. Lancet (London, England), 395(10231), 1217-1224.
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  Benzodiazepine-refractory, or established, status epilepticus is thought to be of similar pathophysiology in children and adults, but differences in underlying aetiology and pharmacodynamics might differentially affect response to therapy. In the Established Status Epilepticus Treatment Trial (ESETT) we compared the efficacy and safety of levetiracetam, fosphenytoin, and valproate in established status epilepticus, and here we describe our results after extending enrolment in children to compare outcomes in three age groups.
• Denninghoff, K. R., Nuño, T., Pauls, Q., Yeatts, S. D., Silbergleit, R., Palesch, Y. Y., Merck, L. H., Manley, G. T., & Wright, D. W. (2020). Prehospital Intubation is Associated with Favorable Outcomes and Lower Mortality in ProTECT III. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 21(5), 539-544.
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  Traumatic brain injury (TBI) causes more than 2.5 million emergency department visits, hospitalizations, or deaths annually. Prehospital endotracheal intubation has been associated with poor outcomes in patients with TBI in several retrospective observational studies. We evaluated the relationship between prehospital intubation, functional outcomes, and mortality using high quality data on clinical practice collected prospectively during a randomized multicenter clinical trial.
• Gaither, J. B., Chikani, V., Stolz, U., Viscusi, C., Denninghoff, K., Barnhart, B., Mullins, T., Rice, A. D., Mhayamaguru, M., Smith, J. J., Keim, S. M., Bobrow, B. J., & Spaite, D. W. (2020). Body Temperature after EMS Transport: Association with Traumatic Brain Injury Outcomes. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 21(5), 575-582.
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  Low body temperatures following prehospital transport are associated with poor outcomes in patients with traumatic brain injury (TBI). However, a minimal amount is known about potential associations across a range of temperatures obtained immediately after prehospital transport. Furthermore, a minimal amount is known about the influence of body temperature on non-mortality outcomes. The purpose of this study was to assess the correlation between temperatures obtained immediately following prehospital transport and TBI outcomes across the entire range of temperatures.
• Spaite, D. W., Rice, A. D., Mullins, T., Keim, S. M., Hu, C., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bradley, G., Bobrow, B. J., Barnhart, B. J., Spaite, D. W., Rice, A. D., Mullins, T., Keim, S. M., Hu, C., Gaither, J. B., Denninghoff, K. R., Chikani, V., , Bradley, G., et al. (2020). Abstract 362: Differential Effect of the Prehospital Traumatic Brain Injury Guidelines on Survival in Isolated and Multisystem Traumatic Brain Injury. Circulation, 142(Suppl_4). doi:10.1161/circ.142.suppl_4.362
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  Introduction: The Prehospital TBI Guidelines (PTGs) are intended for both isolated and multisystem TBI (ITBI/MTBI). However, uncontrolled hemorrhage and potential detrimental effects of fluid resus...
• Hu, C., Rice, A. D., Denninghoff, K., Spaite, D. W., Bobrow, B., Gaither, J. B., Keim, S. M., Barnhart, B. J., Chikani, V., Mullins, T., Adelson, D., & Viscusi, C. (2019). Abstract 320: Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: The EPIC4Kids Study. Circulation, 140(Suppl_2). doi:10.1161/circ.140.suppl_2.320
• Hu, C., Viscusi, C., Denninghoff, K. R., Barnhart, B., Bobrow, B. J., Spaite, D. W., Keim, S. M., Chikani, V., Gaither, J. B., Sherrill, D., Mullins, T., Adelson, P. D., & Rice, A. D. (2019). Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury: The Excellence in Prehospital Injury Care (EPIC) Study. JAMA Surgery, 154(7), e191152. doi:10.1001/jamasurg.2019.1152
• Johnston, K. C., Bruno, A., Pauls, Q., Hall, C. E., Barrett, K. M., Barsan, W., Fansler, A., Van de Bruinhorst, K., Janis, S., Durkalski-Mauldin, V. L., & , N. E. (2019). Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke: The SHINE Randomized Clinical Trial. JAMA, 322(4), 326-335.
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  Hyperglycemia during acute ischemic stroke is common and is associated with worse outcomes. The efficacy of intensive treatment of hyperglycemia in this setting remains unknown.
• Kapur, J., Elm, J., Chamberlain, J. M., Barsan, W., Cloyd, J., Lowenstein, D., Shinnar, S., Conwit, R., Meinzer, C., Cock, H., Fountain, N., Connor, J. T., Silbergleit, R., & , N. a. (2019). Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. The New England journal of medicine, 381(22), 2103-2113.
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  The choice of drugs for patients with status epilepticus that is refractory to treatment with benzodiazepines has not been thoroughly studied.
• Sobel, J., Bates, J., Ng, V., Berkman, M., Nuño, T., Denninghoff, K., Stoneking, L., & Kingsley, K. (2019). Effect of Real-Time Surveys on Patient Satisfaction Scores in the Emergency Department. Education Research International, 2019, 6132698.
• Spaite, D. W., Bobrow, B. J., Keim, S. M., Barnhart, B., Chikani, V., Gaither, J. B., Sherrill, D., Denninghoff, K. R., Mullins, T., Adelson, P. D., Rice, A. D., Viscusi, C., & Hu, C. (2019). Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury: The Excellence in Prehospital Injury Care (EPIC) Study. JAMA surgery, 154(7), e191152.
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  Traumatic brain injury (TBI) is a massive public health problem. While evidence-based guidelines directing the prehospital treatment of TBI have been promulgated, to our knowledge, no studies have assessed their association with survival.
• , M. o., Adelgais, K. M., Hansen, M., Lerner, E. B., Donofrio, J. J., Yadav, K., Brown, K., Liu, Y. T., Denslow, P., Denninghoff, K., Ishimine, P., & Olson, L. M. (2018). Establishing the Key Outcomes for Pediatric Emergency Medical Services Research. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 25(12), 1345-1354.
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  The evidence supporting best practices when treating children in the prehospital setting or even the effect emergency medical services (EMS) has on patient outcomes is limited. Standardizing the critical outcomes for EMS research will allow for focused and comparable effort among the small but growing group of pediatric EMS investigators on specific topics. Standardized outcomes will also provide the opportunity to collectively advance the science of EMS for children and demonstrate the effect of EMS on patient outcomes. This article describes a consensus process among stakeholders in the pediatric emergency medicine and EMS community that identified the critical outcomes for EMS care in five clinical areas (traumatic brain injury, general injury, respiratory disease/failure, sepsis, and seizures). These areas were selected based on both their known public health importance and their commonality in EMS encounters. Key research outcomes identified by participating stakeholders using a modified nominal group technique for consensus building, which included small group brainstorming and independent voting for ranking outcomes that were feasible and/or important for the field.
• Barata, I., Auerbach, M., Badaki-Makun, O., Benjamin, L., Joseph, M. M., Lee, M. O., Mears, K., Petrack, E., Wallin, D., Ishimine, P., & Denninghoff, K. R. (2018). A Research Agenda to Advance Pediatric Emergency Care Through Enhanced Collaboration Across Emergency Departments. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 25(12), 1415-1426.
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  In 2018, the Society for Academic Emergency Medicine and the journal Academic Emergency Medicine (AEM) convened a consensus conference entitled, "Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps." This article is the product of the breakout session, "Emergency Department Collaboration-Pediatric Emergency Medicine in Non-Children's Hospital"). This subcommittee consisting of emergency medicine, pediatric emergency medicine, and quality improvement (QI) experts, as well as a patient advocate, identified main outcome gaps in the care of children in the emergency departments (EDs) in the following areas: variations in pediatric care and outcomes, pediatric readiness, and gaps in knowledge translation. The goal for this session was to create a research agenda that facilitates collaboration and partnering of diverse stakeholders to develop a system of care across all ED settings with the aim of improving quality and increasing safe medical care for children. The following recommended research strategies emerged: explore the use of technology as well as collaborative networks for education, research, and advocacy to develop and implement patient care guidelines, pediatric knowledge generation and dissemination, and pediatric QI and prepare all EDs to care for the acutely ill and injured pediatric patients. In conclusion, collaboration between general EDs and academic pediatric centers on research, dissemination, and implementation of evidence into clinical practice is a solution to improving the quality of pediatric care across the continuum.
• Denninghoff, K. R. (2018). 2018 Academic Emergency Medicine Consensus Conference: Advancing Pediatric Emergency Medicine Education Through Research and Scholarship. Academic Emergency Medicine, 25, 1327-1335. doi:doi.org/10.1111/acem.13632
• Denninghoff, K. R., Barnhart, B. J., Bobrow, B. J., Hu, C., Spaite, D. W., Chikani, V., Gaither, J. B., Rice, A. D., & Keim, S. M. (2018). Abstract 230: Differential Effects of Prehospital Hypotension and Injury Severity in Isolated vs. Multisystem Major Traumatic Brain Injury. Circulation, 138(Suppl_2). doi:10.1161/circ.138.suppl_2.230
• Gerald, J. K., & Denninghoff, K. R. (2018). Emergency Department Recidivism and Asthma: Revisiting an Old Problem. The journal of allergy and clinical immunology. In practice, 6(6), 1914-1915.
• Ishimine, P., Adelgais, K., Barata, I., Klig, J., Kou, M., Mahajan, P., Merritt, C., Stoner, M. J., Cloutier, R., Mistry, R., & Denninghoff, K. R. (2018). Executive Summary: The 2018 Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 25(12), 1317-1326.
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  Emergency care providers share a compelling interest in developing an effective patient-centered, outcomes-based research agenda that can decrease variability in pediatric outcomes. The 2018 Academic Emergency Medicine Consensus Conference "Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps (AEMCC)" aimed to fulfill this role. This conference convened major thought leaders and stakeholders to introduce a research, scholarship, and innovation agenda for pediatric emergency care specifically to reduce health outcome gaps. Planning committee and conference participants included emergency physicians, pediatric emergency physicians, pediatricians, and researchers with expertise in research dissemination and translation, as well as comparative effectiveness, in collaboration with patients, patient and family advocates from national advocacy organizations, and trainees. Topics that were explored and deliberated through subcommittee breakout sessions led by content experts included 1) pediatric emergency medical services research, 2) pediatric emergency medicine (PEM) research network collaboration, 3) PEM education for emergency medicine providers, 4) workforce development for PEM, and 5) enhancing collaboration across emergency departments (PEM practice in non-children's hospitals). The work product of this conference is a research agenda that aims to identify areas of future research, innovation, and scholarship in PEM.
• Johnston, S. C., Easton, J. D., Farrant, M., Barsan, W., Conwit, R. A., Elm, J. J., Kim, A. S., Lindblad, A. S., Palesch, Y. Y., & , C. R. (2018). Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. The New England journal of medicine, 379(3), 215-225.
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  Combination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combination in an international population.
• Jones, A. R., Patel, R. P., Marques, M. B., Donnelly, J. P., Griffin, R. L., Pittet, J. F., Kerby, J. D., Stephens, S. W., DeSantis, S. M., Hess, J. R., Wang, H. E., & , P. S. (2018). Older Blood Is Associated With Increased Mortality and Adverse Events in Massively Transfused Trauma Patients: Secondary Analysis of the PROPPR Trial. Annals of emergency medicine.
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  The transfusion of older packed RBCs may be harmful in critically ill patients. We seek to determine the association between packed RBC age and mortality among trauma patients requiring massive packed RBC transfusion.
• Nuño, T., Denninghoff, K. R., Pauls, Q., Yeatts, S. D., Silbergleit, R., Palesch, Y. Y., Merck, L. H., Manley, G., & Wright, D. W. (2018). Reply to: Prehospital Intubation: Further Confounders in Trial Results. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 22(4), 537.
• Stoner, M. J., Mahajan, P., Bressan, S., Lam, S. H., Chumpitazi, C. E., Kornblith, A. E., Linakis, S. W., Roland, D., Freedman, S. B., Nigrovic, L. E., Denninghoff, K., Ishimine, P., & Kuppermann, N. (2018). Pediatric Emergency Care Research Networks: A Research Agenda. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 25(12), 1336-1344.
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  Pediatric emergency care research networks have evolved substantially over the past two decades. Some networks are specialized in specific areas (e.g., sedation, simulation) while others study a variety of medical and traumatic conditions. Given the increased collaboration between pediatric emergency research networks, the logical next step is the development of a research priorities agenda to guide global research in emergency medical services for children (EMSC).
• Tilley, B. C., Denninghoff, K. R., Redford, D. T., O'keeffe, T., Hoyt, D. B., Zhu, J. G., Zhu, H., Yang, H., Wong, M. D., Wilson, S., Wilson, A., Williams, C. R., White, N. J., Welch, T. J., Weinberg, J. A., Wei, S., Watters, J. M., Warner, K. J., Wang, Y. W., , Wang, H. E., et al. (2018). Elevated Syndecan-1 after Trauma and Risk of Sepsis: A Secondary Analysis of Patients from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial.. Journal of the American College of Surgeons, 227(6), 587-595. doi:10.1016/j.jamcollsurg.2018.09.003
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  Endotheliopathy of trauma is characterized by breakdown of the endothelial glycocalyx. Elevated biomarkers of endotheliopathy, such as serum syndecan-1 (Synd-1) ≥ 40 ng/mL, have been associated with increased need for transfusions, complications, and mortality. We hypothesized that severely injured trauma patients who exhibit elevated Synd-1 levels shortly after admission have an increased likelihood of developing sepsis..We analyzed a subset of patients from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial who survived at least 72 hours after hospital admission, and we determined elevated Synd-1 levels (≥ 40 ng/mL) 4 hours after hospital arrival. Sepsis was defined a priori as meeting systemic inflammatory response criteria and having a known or suspected infection. Univariate analysis was performed to identify variables associated with elevated Synd-1 levels and sepsis. Significant variables at a value of p < 0.2 in the univariate analysis were chosen by purposeful selection and analyzed in a mixed effects multivariate logistic regression model to account for the 12 different study sites..We included 512 patients. Of these, 402 (79%) had elevated Synd-1 levels, and 180 (35%) developed sepsis. Median Synd-1 levels at 4 hours after admission were 70 ng/dL (interquartile range [IQR] 36 to 157 ng/dL) in patients who did not develop sepsis, and 165 ng/dL [IQR 67 to 336 ng/dL] in those who did (p < 0.001). Adjusting for treatment arm and site, multivariable analyses revealed that elevated Synd-1 status, Injury Severity Score (ISS), and total blood transfused were significantly associated with an increased likelihood of developing sepsis..Elevated Synd-1 levels 4 hours after admission in severely injured adult trauma patients who survived the initial 72 hours after hospital admission are associated with subsequent sepsis.
• Bobrow, B. J., Viscusi, C., Spaite, D. W., Sherrill, D. L., Mullins, T., Hu, C., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, P. D. (2017). Mortality and Prehospital Blood Pressure in Patients With Major Traumatic Brain Injury: Implications for the Hypotension Threshold.. JAMA surgery, 152(4), 360-368. doi:10.1001/jamasurg.2016.4686
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  Current prehospital traumatic brain injury guidelines use a systolic blood pressure threshold of less than 90 mm Hg for treating hypotension for individuals 10 years and older based on studies showing higher mortality when blood pressure drops below this level. However, the guidelines also acknowledge the weakness of the supporting evidence..To evaluate whether any statistically supportable threshold between systolic pressure and mortality emerges from the data a priori, without assuming that a cut point exists..Observational evaluation of a large prehospital database established as a part of the Excellence in Prehospital Injury Care Traumatic Brain Injury Study. Patients from the preimplementation cohort (January 2007 to March 2014) 10 years and older with moderate or severe traumatic brain injury (Barell Matrix Type 1 classification, International Classification of Diseases, Ninth Revision head region severity score of 3 or greater, and/or Abbreviated Injury Scale head-region severity score of 3 or greater) and a prehospital systolic pressure between 40 and 119 mm Hg were included. The generalized additive model and logistic regression were used to determine the association between systolic pressure and probability of death, adjusting for significant/important confounders..The main outcome measure was in-hospital mortality..Among the 3844 included patients, 2565 (66.7%) were male, and the median (range) age was 35 (10-99) years. The model revealed a monotonically decreasing association between systolic pressure and adjusted probability of death across the entire range (ie, from 40 to 119 mm Hg). Each 10-point increase of systolic pressure was associated with a decrease in the adjusted odds of death of 18.8% (adjusted odds ratio, 0.812; 95% CI, 0.748-0.883). Thus, the adjusted odds of mortality increased as much for a drop from 110 to 100 mm Hg as for a drop from 90 to 80 mm Hg, and so on throughout the range..We found a linear association between lowest prehospital systolic blood pressure and severity-adjusted probability of mortality across an exceptionally wide range. There is no identifiable threshold or inflection point between 40 and 119 mm Hg. Thus, in patients with traumatic brain injury, the concept that 90 mm Hg represents a unique or important physiological cut point may be wrong. Furthermore, clinically meaningful hypotension may not be as low as current guidelines suggest. Randomized trials evaluating treatment levels significantly above 90 mm Hg are needed.
• Bobrow, B. J., Viscusi, C., Spaite, D. W., Sherrill, D. L., Rice, A. D., Perez, O., Keim, S. M., Hu, C., Helfenbein, E., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Babaeizadeh, S. (2017). Accuracy of EMS Hypoxia Documentation Compared to Continuous Non-Invasive Monitor Data in Major Traumatic Brain Injury. Journal of Emergency Medicine, 53(3), 443. doi:10.1016/j.jemermed.2017.08.063
• DeLuca, L. A., Walsh, P., Davidson, D. D., Stoneking, L. R., Yang, L. M., Grall, K. J., Gonzaga, M. J., Larson, W. J., Stolz, U., Sabb, D. M., & Denninghoff, K. R. (2017). Impact and feasibility of an emergency department-based ventilator-associated pneumonia bundle for patients intubated in an academic emergency department. American journal of infection control, 45(2), 151-157.
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  Ventilator-associated pneumonia (VAP) has been linked to emergency department (ED) intubation and length of stay (LOS). We assessed VAP prevalence in ED intubated patients, feasibility of ED VAP prevention, and effect on VAP rates.
• McCully, B. H., Connelly, C. R., Fair, K. A., Holcomb, J. B., Fox, E. E., Wade, C. E., Bulger, E. M., Schreiber, M. A., & , P. S. (2017). Onset of Coagulation Function Recovery Is Delayed in Severely Injured Trauma Patients with Venous Thromboembolism. Journal of the American College of Surgeons, 225(1), 42-51.
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  Altered coagulation function after trauma can contribute to development of venous thromboembolism (VTE). Severe trauma impairs coagulation function, but the trajectory for recovery is not known. We hypothesized that enhanced, early recovery of coagulation function increases VTE risk in severely injured trauma patients.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Keim, S. M., Viscusi, C., Mullins, T., & Sherrill, D. (2017). The Effect of Combined Out-of-Hospital Hypotension and Hypoxia on Mortality in Major Traumatic Brain Injury. Annals of emergency medicine, 69(1), 62-72.
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  Survival is significantly reduced by either hypotension or hypoxia during the out-of-hospital management of major traumatic brain injury. However, only a handful of small studies have investigated the influence of the combination of both hypotension and hypoxia occurring together. In patients with major traumatic brain injury, we evaluate the associations between mortality and out-of-hospital hypotension and hypoxia separately and in combination.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Keim, S. M., Viscusi, C., Mullins, T., Rice, A. D., & Sherrill, D. (2017). Association of Out-of-Hospital Hypotension Depth and Duration With Traumatic Brain Injury Mortality. Annals of emergency medicine, 70(4), 522-530.e1.
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  Out-of-hospital hypotension has been associated with increased mortality in traumatic brain injury. The association of traumatic brain injury mortality with the depth or duration of out-of-hospital hypotension is unknown. We evaluated the relationship between the depth and duration of out-of-hospital hypotension and mortality in major traumatic brain injury.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B. J., Adelson, P. D., Denninghoff, K. R., Rice, A. D., Mullins, T., Sherrill, D., & Keim, S. M. (2017). Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Circulation.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart B, Adelson PD, Denninghoff KR, Rice AD, Mullins T, Sherrill D, Keim SM: Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Circulation 2017
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Sherrill, D., Barnhart, B., Gaither, J. B., Denninghoff, K. R., Viscusi, C., Mullins, T., & Adelson, P. D. (2017). Mortality and Prehospital Blood Pressure in Patients With Major Traumatic Brain Injury: Implications for the Hypotension Threshold. JAMA surgery, 152(4), 568-74. doi:10.1001/jamasurg.2016.4686
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  Current prehospital traumatic brain injury guidelines use a systolic blood pressure threshold of less than 90 mm Hg for treating hypotension for individuals 10 years and older based on studies showing higher mortality when blood pressure drops below this level. However, the guidelines also acknowledge the weakness of the supporting evidence.
• Spaite, D. W., Spaite, D. W., Bobrow, B. J., Bobrow, B. J., Keim, S. M., Keim, S. M., Smith, J. J., Smith, J. J., Mhayamaguru, K., Mhayamaguru, K., Rice, A., Rice, A., Mullins, T., Mullins, T., Barnhart, B., Barnhart, B., Denninghoff, K. R., Denninghoff, K. R., Viscusi, C. D., , Viscusi, C. D., et al. (2017). Body Temperature after EMS Transport: Association with Traumatic Brain Injury Outcomes. Prehospital Emergency Care, 21(5), 575-582. doi:10.1080/10903127.2017.1308609
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  Gaither JB, Chikani V, Stolz U, Viscusi C, Denninghoff K, Barnhart B, Mullins T, Rice AD, Mhayamaguru M, Smith JJ, Keim SM, Bobrow BJ, Spaite DW: Body Temperature after EMS Transport: Association with Traumatic Brain Injury Outcomes. Prehosp Emerg Care. 2017 Sep-Oct;21(5):575-582. doi: 10.1080/10903127.2017.1308609. Epub 2017 May 8. PubMed PMID: 28481163; NIH Manuscript System ID: NIHMS910946; PubMed Central PMCID: PMC5638643.
• Bobrow, B. J., Viscusi, C., Spaite, D. W., Sherrill, D. L., Mullins, T., Keim, S. M., Hu, C., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, P. D. (2016). Abstract 15910: Evaluation of Prehospital Hypotension Depth-duration Dose and Mortality in Major Traumatic Brain Injury. Circulation, 134.
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  Objective: Prehospital hypotension [systolic BP (SBP)
• Bobrow, B. J., Viscusi, C., Spaite, D. W., Sherrill, D. L., Perez, O., Keim, S. M., Hu, C., Helfenbein, E., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Babaeizadeh, S. (2016). Abstract 15795: Prehospital Use of Nasal Cannula End-tidal CO2 Monitoring in Non-intubated Major Traumatic Brain Injury Patients. Circulation.
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  Background: Little is known about end-tidal CO2 monitoring using nasal cannula sensors in non-intubated patients (NC-ETCO2). Objective: To describe the patterns of NC-ETCO2 seen during the EMS care...
• Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamagru, M., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., Bobrow, B. J., & Gaither, J. B. (2016). Elevated Initial Trauma Center Body Temperatures Are Associated With Poor Non-Mortality Outcomes Following Major Traumatic Brain Injury. Prehospital Emergency Care.
• Qureshi, A. I., Palesch, Y. Y., Barsan, W. G., Hanley, D. F., Hsu, C. Y., Martin, R. L., Moy, C. S., Silbergleit, R., Steiner, T., Suarez, J. I., Toyoda, K., Wang, Y., Yamamoto, H., & Yoon, B. W. (2016). Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. The New England journal of medicine, 375(11), 1033-43.
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  Background Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage. Methods We randomly assigned eligible participants with intracerebral hemorrhage (volume,
• Sherrill, D. L., Bobrow, B. J., Viscusi, C., Spaite, D. W., Sherrill, D. L., Perez, O., Keim, S. M., Hu, C., Helfenbein, E., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Babaeizadeh, S. (2016). Abstract 13835: Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Circulation.
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  Background: It is well established that prehospital hypoxia dramatically increases mortality in Traumatic Brain Injury (TBI). Thus, in EMS TBI research, case ascertainment and risk-adjustment are highly dependent upon documentation of in-field O2 saturation. Objective: To compare the rate of hypoxia identified by EMS personnel and documented in EMS patient care records (PCR) vs the actual rate of hypoxia recorded by continuous, non-invasive monitor in TBI. Methods: A subset of major TBI cases (moderate/severe) in the EPIC EMS TBI Study (NIH 1R01NS071049) were evaluated (3/30/13-6/26/15). Cases from 4 EMS agencies that report continuous monitor data (Philips MRx™) as part of EPIC were included. All monitor data available for post-hoc review were displayed and accessible to the providers during EMS care. We compared PCR documentation of hypoxia (O2 sat
• Undurraga Perl, V. J., Leroux, B., Cook, M. R., Watson, J., Fair, K., Martin, D. T., Kerby, J. D., Williams, C., Inaba, K., Wade, C. E., Cotton, B. A., Del Junco, D. J., Fox, E. E., Scalea, T. M., Tilley, B. C., Holcomb, J. B., Schreiber, M. A., & , P. S. (2016). Damage-control resuscitation and emergency laparotomy: Findings from the PROPPR study. The journal of trauma and acute care surgery, 80(4), 568-74; discussion 574-5.
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  The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial has demonstrated that damage-control resuscitation, a massive transfusion strategy targeting a balanced delivery of plasma-platelet-red blood cell in a ratio of 1:1:1, results in improved survival at 3 hours and a reduction in deaths caused by exsanguination in the first 24 hours compared with a 1:1:2 ratio. In light of these findings, we hypothesized that patients receiving 1:1:1 ratio would have improved survival after emergency laparotomy.
• Biros, M. H., Dickert, N. W., Wright, D. W., Scicluna, V. M., Harney, D., Silbergleit, R., Denninghoff, K., & Pentz, R. D. (2015). Balancing ethical goals in challenging individual participant scenarios occurring in a trial conducted with exception from informed consent. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 22(3), 340-6.
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  In 1996, federal regulations were put into effect that allowed enrollment of critically ill or injured patients into Food and Drug Administration (FDA)-regulated clinical trials using an exception from informed consent (EFIC) under narrowly prescribed research circumstances. Despite the low likelihood that a legally authorized representative (LAR) would be present within the interventional time frame, the EFIC regulations require the availability of an informed consent process, to be applied if an LAR is present and able to provide prospective consent for patient enrollment into the trial. The purpose of this article is to describe a series of unanticipated consent-related questions arising when a potential surrogate decision-maker appeared to be available at the time of patient enrollment into a trial proceeding under EFIC.
• Bobrow, B. J., Stolz, U., Viscusi, C., Stolz, U., Spaite, D. W., Sherrill, D. L., Mullins, T., Hu, C., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, P. D. (2015). Abstract 14938: Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury. Circulation.
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  Introduction: Little is known about prehospital EMS blood pressure patterns in TBI and the effect of serial trends in BP during EMS care remains entirely unclear. Using the comprehensive, linked EM...
• Denninghoff, K. R., Sabb, D. M., Stolz, U., Larson, W. J., Gonzaga, M. J., Grall, K. J., Yang, L. M., Stoneking, L. R., Davidson, D. D., Walsh, P., & Deluca, L. A. (2017). Ventilator-Associated Pneumonia Rates Are Significantly Reduced by The Deployment of a VAP Prevention Bundle in an Academic Emergency Department. American Journal of Infection Control, 45(2), 151-157. doi:http://doi.org/10.1016/j.ajic.2016.05.037
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  Published online: September 21, 2016
• Durns, T., Yeaton, J., Roward, Z., Pickering, A., Miller, R. C., Durns, T., Denninghoff, K. R., & Deluca, L. A. (2015). Presenting illness and mortality outcomes for patients intubated in an academic emergency department.. Intensive Care Medicine Experimental, 3(1), 1-2. doi:10.1186/2197-425x-3-s1-a667
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  Patients who are intubated during the course of hospital care have a high mortality rate. 70% of critically ill Emergency Department (ED) patients are intubated in the ED or a prehospital, but little data describes mortality risk. Identification of mortality risk based on presenting illness would allow providers to improve both resuscitative efforts and advanced care planning.
• Durns, T., Yeaton, J., Sabb, D., Roward, Z., Pickering, A., Miller, R. C., Durns, T., Denninghoff, K. R., & Deluca, L. A. (2015). The effect of presenting complaint on the risk of developing ventilator-associated pneumonia for patients intubated in an academic emergency department. Intensive Care Medicine Experimental, 3(1), 1-2. doi:10.1186/2197-425x-3-s1-a99
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  Ventilator associated pneumonia (VAP) is a complication of mechanical ventilation that increased ICU length of stay and mortality. Eckert found 26% of trauma patients intubated in the ED develop VAP as compared to 6.5% of those intubated in the ICU. Green demonstrated that 70% of critically ill patients were intubated pre-hospital or in the ED and 18.2% remained in the ED for more than 4 hours.
• Durns, T., Yeaton, J., Walsh, P., Sabb, D., Pickering, A., Miller, R. C., Durns, T., Denninghoff, K. R., & Deluca, L. A. (2015). 48: REDUCTION OF EARLY VAP AFTER BUNDLE DEPLOYMENT FOR PATIENTS INTUBATED IN THE EMERGENCY DEPARTMENT. Critical Care Medicine, 43, 13. doi:10.1097/01.ccm.0000473876.55708.32
• Jones, A. R., Patel, R. P., Marques, M. B., Donnelly, J. P., Griffin, R. L., Pittet, J. F., Kerby, J. D., Stephens, S. W., DeSantis, S. M., Hess JR, ., & Wang, H. E. (2019). Older Blood Is Associated With Increased Mortality and Adverse Events in Massively Transfused Trauma Patients: Secondary Analysis of the PROPPR Trial.. Annals of Emergency Medicine, 73(6), 650-661. doi:10.1016/j.annemergmed.2018.09.033
• Merritt, C., Dietrich, A. M., Bogie, A. L., Wu, F., Khanna, K., Ballasiotes, M. K., Gerardi, M., Ishimine, P. T., Denninghoff, K. R., & Saidinejad, M. (2019). 2018 Academic Emergency Medicine Consensus Conference: A Workforce Development Research Agenda for Pediatric Care in the Emergency Department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 26(9), 1063-1073. doi:https://doi.org/10.1111/acem.13638
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  Each year, more than 30 million children visit U.S. emergency departments (EDs). Although the number of pediatric emergency medicine specialists continues to rise, the vast majority of children are cared for in general EDs outside of children's hospitals. The diverse workforce of care providers for children must possess the knowledge, experience, skills, and systemic support necessary to deliver excellent pediatric emergency care. There is a crucial need to understand the factors that drive the professional development and support systems of this diverse workforce. Through the iterative process culminating with the 2018 Academic Emergency Medicine consensus conference, we have identified five key research themes and prioritized a specific research agenda. These themes represent critical gaps in our understanding of the development and maintenance of the pediatric emergency care workforce and allow for a prioritization of future research efforts. Only by more fully understanding the gaps in workforce needs, and the necessary steps to address these gaps, can outcomes be optimized for children in need of emergency care.
• Smith, J. J., Bobrow, B. J., Viscusi, C., Spaite, D. W., Smith, J. J., Mhayamaguru, M., Gaither, J. B., Denninghoff, K. R., Curry, M., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, P. D. (2015). Abstract 16144: Association Between Elevated Initial Trauma Center Body Temperature and Non-mortality Outcomes Following Major Traumatic Brain Injury. Circulation, 132.
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  Introduction: During prolonged hospitalization for Traumatic Brain Injury (TBI), fever has been identified as a possible cause of secondary brain injury and previous reports have identified an association between elevated body temperature and increased mortality following TBI. However, little is known about the relationship between an elevated initial trauma center body temperature (ITCT), measured immediately after EMS transport, and non-mortality outcomes. The purpose of this study was to determine if a correlation exists between elevated ITCT and various important patient outcomes. Methods: All moderate/severe TBI cases (CDC Barell Matrix Type 1) in the Arizona State Trauma Registry (ASTR; 1/1/07-12/31/12) were analyzed by the following ITCT categories: 36.5-37.9°C (normal-NT), 38.0-38.9°C (elevated-ET) and ≥39.0°C (very elevated-VET). Outcomes included: Trauma Center (TC) length-of-stay (LOS), Intensive Care Unit (ICU) LOS, and total TC charges. For continuous variables, non-parametric Kruskal-Wallis test was used to assess the median difference between the ET and VET cohorts and the NT group (reference). Wilcoxon two-sample tests identified groups with significant differences (alpha = 0.05). Results: 22,925 cases met inclusion criteria (exclusions: missing ITCT-2,885; missing demographics-700; ITCT Conclusion: In this statewide study, ET or VET were associated with longer ICU LOS, longer hospital LOS and increased hospital charges. Future work is needed to identify the causes of temperature elevations that occur during prehospital TBI care (e.g., environmental factors versus autonomic dysregulation) and whether initiation of in-field measures to prevent temperature elevation might improve outcome.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B., Adelson, P. D., Denninghoff, K. R., Rice, A. D., Viscusi, C. D., Sherrill, D. L., & Keim, S. M. (2017). Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart B, Adelson PD, Denninghoff KR, Rice AD, Viscusi C, Sherrill D, Keim SM: Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emerg Care 2018;22(1):105-106.
• Stoneking, L. R., Winkler, J. P., DeLuca, L. A., Stolz, U., Stutz, A., Luman, J. C., Gaub, M., Wolk, D. M., Fiorello, A. B., & Denninghoff, K. R. (2015). Physician documentation of sepsis syndrome is associated with more aggressive treatment. The western journal of emergency medicine, 16(3), 401-7.
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  Timely recognition and treatment of sepsis improves survival. The objective is to examine the association between recognition of sepsis and timeliness of treatments.
• Berkman, M. R., Stolz, U., Smith, J. J., Waterbrook, A. L., Stolz, U., Smith, J. J., Larsen, J., Denninghoff, K. R., Caldwell, J., & Berkman, M. R. (2014). 369 Ketamine and Morphine versus Morphine Alone for Treatment of Acute Pain in the Emergency Department. Annals of Emergency Medicine, 64(4), S131-S132. doi:10.1016/j.annemergmed.2014.07.397
• Bobrow, B. J., Stolz, U., Viscusi, C., Stolz, U., Spaite, D. W., Sotelo, M., Sherrill, D. L., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, P. D. (2014). Evaluation of the impact of implementing the emergency medical services traumatic brain injury guidelines in Arizona: the Excellence in Prehospital Injury Care (EPIC) study methodology.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 21(7), 818-30. doi:10.1111/acem.12411
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  Traumatic brain injury (TBI) exacts a great toll on society. Fortunately, there is growing evidence that the management of TBI in the early minutes after injury may significantly reduce morbidity and mortality. In response, evidence-based prehospital and in-hospital TBI treatment guidelines have been established by authoritative bodies. However, no large studies have yet evaluated the effectiveness of implementing these guidelines in the prehospital setting. This article describes the background, design, implementation, emergency medical services (EMS) treatment protocols, and statistical analysis of a prospective, controlled (before/after), statewide study designed to evaluate the effect of implementing the EMS TBI guidelines-the Excellence in Prehospital Injury Care (EPIC) study (NIH/NINDS R01NS071049, "EPIC"; and 3R01NS071049-S1, "EPIC4Kids"). The specific aim of the study is to test the hypothesis that statewide implementation of the international adult and pediatric EMS TBI guidelines will significantly reduce mortality and improve nonmortality outcomes in patients with moderate or severe TBI. Furthermore, it will specifically evaluate the effect of guideline implementation on outcomes in the subgroup of patients who are intubated in the field. Over the course of the entire study (~9 years), it is estimated that approximately 25,000 patients will be enrolled.
• Durns, T., Gerlach, E., Durns, T., Denninghoff, K. R., Deluca, L. A., & Davidson, D. D. (2014). 391: THE IMPACT OF ADVANCED DIRECTIVES ON NON-SURVIVORS WHO ARE INTUBATED IN THE EMERGENCY DEPARTMENT. Critical Care Medicine, 42, A1454. doi:10.1097/01.ccm.0000457888.21104.a9
• Fiorello, A. B., Stoneking, L. R., Munzer, B., Fiorello, A. B., Denninghoff, K. R., Deluca, L. A., & Baker, N. (2014). Alternative methods to central venous pressure for assessing volume status in critically ill patients.. Journal of emergency nursing, 40(2), 115-23. doi:10.1016/j.jen.2012.04.018
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  Early goal-directed therapy increases survival in persons with sepsis but requires placement of a central line. We evaluate alternative methods to measuring central venous pressure (CVP) to assess volume status, including peripheral venous pressure (PVP) and stroke volume variation (SVV), which may facilitate nurse-driven resuscitation protocols..Patients were enrolled in the emergency department or ICU of an academic medical center. Measurements of CVP, PVP, SVV, shoulder and elbow position, and dichotomous variables Awake, Movement, and Vented were measured and recorded 7 times during a 1-hour period. Regression analysis was used to predict CVP from PVP and/or SVV, shoulder/elbow position, and dichotomous variables..Twenty patients were enrolled, of which 20 had PVP measurements and 11 also had SVV measurements. Multiple regression analysis demonstrated significant predictive relationships for CVP using PVP (CVP = 6.7701 + 0.2312 × PVP - 0.1288 × Shoulder + 12.127 × Movement - 4.4805 × Neck line), SVV (CVP = 14.578 - 0.3951 × SVV + 18.113 × Movement), and SVV and PVP (CVP = 4.2997 - 1.1675 × SVV + 0.3866 × PVP + 18.246 × Awake + 0.1467 × Shoulder = 0.4525 × Elbow + 15.472 × Foot line + 10.202 × Arm line)..PVP and SVV are moderately good predictors of CVP. Combining PVP and SVV and adding variables related to body position, movement, ventilation, and sleep/wake state further improves the predictive value of the model. The models illustrate the importance of standardizing patient position, minimizing movement, and placing intravenous lines proximally in the upper extremity or neck.
• Panchal, A. R., Munger, B. S., Keim, S. M., & Denninghoff, K. R. (2014). Scholar quest: a residency research program aligned with faculty goals.. The western journal of emergency medicine, 15(3), 299-305. doi:10.5811/westjem.2013.8.16155
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  The ACGME requires that residents perform scholarly activities prior to graduation, but this is difficult to complete and challenging to support. We describe a residency research program, taking advantage of environmental change aligning resident and faculty goals, to become a contributor to departmental cultural change and research development..A research program, Scholar Quest (SQ), was developed as a part of an Information Mastery program. The goal of SQ is for residents to gain understanding of scholarly activity through a mentor-directed experience in original research. This curriculum is facilitated by providing residents protected time for didactics, seed grants and statistical/staff support. We evaluated total scholarly activity and resident/faculty involvement before and after implementation (PRE-SQ; 2003-2005 and POST-SQ; 2007-2009)..Scholarly activity was greater POST-SQ versus PRE-SQ (123 versus 27) (p
• Pritchard, T. G., Waterbrook, A. L., Stoneking, L. R., Pritchard, T. G., Grall, K. H., Denninghoff, K. R., & Deluca, L. A. (2014). An innovative longitudinal curriculum to increase emergency medicine residents' exposure to rarely encountered and technically challenging procedures.. Advances in medical education and practice, 5, 229-36. doi:10.2147/amep.s58073
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  Procedural skills have historically been taught at the bedside. In this study, we aimed to increase resident knowledge of uncommon emergency medical procedures to increase residents' procedural skills in common and uncommon emergency medical procedures and to integrate cognitive training with hands-on procedural instruction using high- and low-fidelity simulation..We developed 13 anatomically/physiologically-based procedure modules focusing on uncommon clinical procedures and/or those requiring higher levels of technical skills. A departmental expert directed each session with collaboration from colleagues in related subspecialties. Sessions were developed based on Manthey and Fitch's stages of procedural competency including 1) knowledge acquisition, 2) experience/technical skill development, and 3) competency evaluation. We then distributed a brief, 10-question, online survey to our residents in order to solicit feedback regarding their perceptions of increased knowledge and ability in uncommon and common emergency medical procedures, and their perception of the effectiveness of integrated cognitive training with hands-on instruction through high- and low-fidelity simulation..Fifty percent of our residents (11/22) responded to our survey. Responses indicated the procedure series helped with understanding of both uncommon (65% strongly agreed [SA], 35% agreed [A]) and common (55% SA, 45% A) emergency medicine procedures and increased residents' ability to perform uncommon (55% SA, 45% A) and common (45% SA, 55% A) emergency medical procedures. In addition, survey results indicated that the residents were able to reach their goal numbers..Based on survey results, the procedure series improved our residents' perceived understanding of and perceived ability to perform uncommon and more technically challenging procedures. Further, results suggest that the use of a cognitive curriculum model as developed by Manthey and Fitch is adaptable and could be modified to fit the needs of other medical specialties.
• Stolz, U., Bobrow, B. J., Viscusi, C., Stolz, U., Spaite, D. W., Sotelo, M., Sherrill, D. L., Mullins, T., Humble, W., Gaither, J. B., Denninghoff, K. R., Chikani, V., Bobrow, B. J., Barnhart, B. J., & Adelson, P. D. (2014). Abstract 4: The Effect of Prehospital Hypoxia and Hypotension on Outcome in Major Traumatic Brain Injury: A Deadly Combination. Circulation, 130.
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  BACKGROUND: Hypoxia (HOx) or hypotension (HT) occurring during the EMS management of major traumatic brain injury-TBI reduces survival. However, little is known about the impact of both HOx and HT, occurring together, on outcome. Only a handful of reports have studied the combination of prehospital HOx/HT in TBI and the largest of these only had 14 cases with both. Objectives: To evaluate the associations between mortality and prehospital HOx and HT, both separately and in combination. METHODS: All moderate/severe TBI cases (CDC Barell Matrix Type-1) in the Excellence in Prehospital Injury Care (EPIC) TBI Study (a statewide, before/after controlled study of the impact of implementing the EMS TBI Treatment Guidelines-NIH/NINDS: 1R01NS071049) from 1/1/08-6/30/12 were evaluated [exclusions: age
• Stolz, U., Stolz, U., Rhodes, S. M., Mayfield, T. R., Denninghoff, K. R., Bourn, S., Birrer, B., & Beskind, D. L. (2014). When should you test for and treat hypoglycemia in prehospital seizure patients?. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 18(3), 433-41. doi:10.3109/10903127.2013.864358
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  Seizure is a frequent reason for activating the Emergency Medical System (EMS). Little is known about the frequency of seizure caused by hypoglycemia, yet many EMS protocols require glucose testing prior to treatment. We hypothesized that hypoglycemia is rare among EMS seizure patients and glucose testing results in delayed administration of benzodiazepines..This was a retrospective study of a national ambulance service database encompassing 140 ALS capable EMS systems spanning 40 states and Washington DC. All prehospital calls from August 1, 2010 through December 31, 2012 with a primary or secondary impression of seizure that resulted in patient treatment or transport were included. Median regression with robust and cluster (EMS agency) adjusted standard errors was used to determine if time to benzodiazepine administration was significantly related to blood glucose testing..Of 2,052,534 total calls, 76,584 (3.7%) were for seizure with 53,505 (69.9%) of these having a glucose measurement recorded. Hypoglycemia (blood glucose
• Grall, K. H., Yang, L. M., Stoneking, L. R., Sabb, D., Munzer, B., Grall, K., Gonzaga, J., Denninghoff, K. R., & Deluca, L. A. (2013). 814: Incidence of Ventilator-Associated Pneumonia compared to Ventilator-Associated Events in the ED. Critical Care Medicine, 41, A203. doi:10.1097/01.ccm.0000440052.76840.db
• Stolz, U., Stolz, U., Simpson, A., Matheson, L., John, A. S., Denninghoff, K. R., & Deluca, L. A. (2013). The distribution of the h-index among academic emergency physicians in the United States.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 20(10), 997-1003. doi:10.1111/acem.12226
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  Hirsch's h-index (h) attempts to measure the combined academic impact and productivity of a scientist by counting the number of publications by an author, ranked in descending order by number of citations, until the paper number equals the number of citations. This approach provides a natural number or index of the number of publications and the number of citations per publication. H was first described in physics and was demonstrated to be highly predictive of continued academic activity, including recognized measures of scientific excellence such as membership in the National Academy of Sciences and being a Nobel laureate. Citation rates, research environments, and years of experience all affect h, making any comparisons appropriate only for scientists working in the same field for a similar time period. The authors are unaware of any report describing the distribution of h among academic emergency physicians (AEPs)..The objective was to describe the distribution of h for AEPs and to determine whether Hirsch's demonstration of the h-index as a predictor of continued scholarly activity among physicists would also apply to AEPs..Academic EPs were identified from lists provided on allopathic U.S. emergency medicine (EM) residency program websites. "Harzing's Publish or Perish," a free program available on the Web that queries Google Scholar, was used to calculate h for each AEP. Agreement between raters was analyzed on a subset of 100 EPs. An analysis of the 20 EPs with the top h-indices was performed to characterize the entire body of their scholarly work, and their h-indices were calculated at 12 and 24 years into their careers..A total of 4,744 AEPs from 136 programs were evaluated. Nine programs did not publicly list the faculty at their institutions and were excluded. A linear weighted kappa was used to measure rater concordance, with agreement of 98.3% and κ = 0.92 (95% confidence interval [CI] = 0.861 to 0.957). The majority of AEPs had h-indices of zero or one (59%), 85% had h-indices less than six, 95% less than 13, and 99% less than 24. Ten percent of AEPs had h/(years in publication) of 0.5 or greater. For the top 20 EPs, the mean (± standard deviation [±SD]) h-index increased from 7.6 (±4.6) to 23.5 (±9.4) between years 12 and 24. The mean (±SD) increase in h-index was 15.8 (±7.6)..The h-index can be used to characterize the academic productivity of AEPs. An h/year of 0.5 or greater is characteristic of the most productive EPs and represents only 10% of all AEPs. The 12-year h-index of top-performing EPs was strongly related to their future academic productivity. The distribution of h among EPs may provide a means for individual investigators and academic leaders to evaluate performance and identify EPs with future success in EM research.
• Zaleski, E. Z., Spaite, D. W., Silbergleit, R., Siewart, N., Pinnawin, A., Mcmullan, J. T., Jones, E. B., & Denninghoff, K. R. (2013). The 60-day temperature-dependent degradation of midazolam and Lorazepam in the prehospital environment.. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 17(1), 1-7. doi:10.3109/10903127.2012.722177
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  The choice of the optimal benzodiazepine to treat prehospital status epilepticus is unclear. Lorazepam is preferred in the emergency department, but concerns about nonrefrigerated storage limits emergency medical services (EMS) use. Midazolam is increasingly popular, but its heat stability is undocumented..This study evaluated temperature-dependent degradation of lorazepam and midazolam after 60 days in the EMS environment..Lorazepam or midazolam samples were collected prior to (n = 139) or after (n = 229) 60 days of EMS deployment during spring-summer months in 14 metropolitan areas across the United States. Medications were stored in study boxes that logged temperature every minute and were stored in EMS units per local agency policy. Mean kinetic temperature (MKT) exposure was derived for each sample. Drug concentrations were determined in a central laboratory by high-performance liquid chromatography. Concentration as a function of MKT was analyzed by linear regression..Prior to deployment, measured concentrations of both benzodiazepines were 1.0 relative to labeled concentration. After 60 days, midazolam showed no degradation (mean relative concentration 1.00, 95% confidence interval [CI] 1.00-1.00) and was stable across temperature exposures (adjusted R(2) -0.008). Lorazepam experienced little degradation (mean relative concentration 0.99, 95% CI 0.98-0.99), but degradation was correlated to increasing MKT (adjusted R(2) 0.278). The difference between the temperature dependence of degradation of midazolam and lorazepam was statistically significant (T = -5.172, p < 0.001)..Lorazepam experiences small but statistically significant temperature-dependent degradation after 60 days in the EMS environment. Additional study is needed to evaluate whether clinically significant deterioration occurs after 60 days. Midazolam shows no degradation over this duration, even in high-heat conditions.
• Bobrow, B. J., Stolz, U., Meislin, H. W., Stolz, U., Spaite, D. W., Meislin, H. W., Gaither, J. B., Denninghoff, K. R., Bobrow, B. J., & Beskind, D. L. (2012). Balancing the potential risks and benefits of out-of-hospital intubation in traumatic brain injury: the intubation/hyperventilation effect.. Annals of emergency medicine, 60(6), 732-6. doi:10.1016/j.annemergmed.2012.06.017
• Bobrow, B. J., Stolz, U., Zhang, J., Stolz, U., Spaite, D. W., Sayre, M. R., Sasson, C., Rea, T. D., Mcnally, B., Denninghoff, K. R., Cudnik, M. T., & Bobrow, B. J. (2012). Increasing hospital volume is not associated with improved survival in out of hospital cardiac arrest of cardiac etiology.. Resuscitation, 83(7), 862-8. doi:10.1016/j.resuscitation.2012.02.006
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  Resuscitation centers may improve patient outcomes by achieving sufficient experience in post-resuscitation care. We analyzed the relationship between survival and hospital volume among patients suffering out-of-hospital cardiac arrest (OHCA)..This prospective cohort investigation collected data from the Cardiac Arrest Registry to Enhance Survival database from 10/1/05 to 12/31/09. Primary outcome was survival to discharge. Hospital characteristics were obtained via 2005 American Hospital Association Survey. A hospital's use of hypothermia was obtained via direct survey. To adjust for hospital- and patient-level variation, multilevel, hierarchical logistic regression was performed. Hospital volume was modeled as a categorical (OHCA/year≤10, 11-39, ≥40) variable. A stratified analysis evaluating those with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) was also performed..The cohort included 4125 patients transported by EMS to 155 hospitals in 16 states. Overall survival to hospital discharge was 35% among those admitted to the hospital. Individual hospital rates of survival varied widely (0-100%). Unadjusted survival did not differ between the 3 hospital groups (36% for ≤10 OHCA/year, 35% for 11-39, and 36% for ≥40; p=0.75). After multilevel adjustment, differences in survival across the groups were not statistically significant. Compared to patients at hospitals with ≤10 OHCA/year, adjusted OR for survival was 1.04 (CI(95) 0.83-1.28) among 11-39 annual volume and 0.97 (CI(95) 0.73-1.30) among the ≥40 volume hospitals. Among patients presenting with VF/VT, no difference in survival was identified between the hospital groups..Survival varied substantially across hospitals. However, hospital OHCA volume was not associated with likelihood of survival. Additional efforts are required to determine what hospital characteristics might account for the variability observed in OHCA hospital outcomes.
• Chipman, R. A., Voss, K., Ririe, T., Munzer, B., Juan, B., Hendryx, J., Denninghoff, K. R., Deluca, L. A., & Chipman, R. A. (2012). 210: RAPID DEVELOPMENT OF SEPTIC SHOCK IN A SWINE MODEL USING CECAL LIGATION AND PERFORATION PLUS FECAL INOCULATION. Critical Care Medicine, 40, 1-328. doi:10.1097/01.ccm.0000424430.13172.8e
• Chipman, R. A., Voss, K., Ririe, T., Munzer, B., Juan, B., Hendryx, J., Denninghoff, K. R., Deluca, L. A., & Chipman, R. A. (2012). 269: MEASUREMENT OF RETINAL VENOUS OXYGEN SATURATION DURING PROGRESSIVE HYPOXIA IN SWINE IN VIVO USING THE BLUE-GREEN MINIMA TECHNIQUE. Critical Care Medicine, 40, 1-328. doi:10.1097/01.ccm.0000424487.10425.e3
• Chipman, R. A., Voss, K., Ririe, T., Munzer, B., Juan, B., Hendryx, J., Denninghoff, K. R., Deluca, L. A., & Chipman, R. A. (2012). 273: LACK OF AGREEMENT BETWEEN SWAN GANZ CONTINUOUS CARDIAC OUTPUT AND FLOTRAC VIGILEO CARDIAC OUTPUT IN A SWINE MODEL OF SEPTIC SHOCK. Critical Care Medicine, 40, 1-328. doi:10.1097/01.ccm.0000424491.63790.72
• Nolan, P. E., Skrepnek, G. H., Sherrill, D. L., Olvey, E. L., Nolan, P. E., Denninghoff, K. R., Bootman, J. L., & Armstrong, E. P. (2012). PCV77 Utilization of Medications for Secondary Prevention of Cardiovascular Morbidity and Mortality in Medicare Beneficiaries. Value in Health, 15(4), A126. doi:10.1016/j.jval.2012.03.680
• Stolz, U., Grall, K. H., Stoneking, L. R., Stolz, U., Spaite, D. W., Simpson, A., Panchal, A. R., Grall, K., Denninghoff, K. R., Deluca, L. A., & Beskind, D. L. (2012). Analysis of automated external defibrillator device failures reported to the Food and Drug Administration.. Annals of emergency medicine, 59(2), 103-11. doi:10.1016/j.annemergmed.2011.07.022
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  Automated external defibrillators are essential for treatment of cardiac arrest by lay rescuers and must determine when to shock and if they are functioning correctly. We seek to characterize automated external defibrillator failures reported to the Food and Drug Administration (FDA) and whether battery failures are properly detected by automated external defibrillators..FDA adverse event reports are catalogued in the Manufacturer and User Device Experience (MAUDE) database. We developed and internally validated an instrument for analyzing MAUDE data, reviewing all reports in which a fatality occurred. Two trained reviewers independently analyzed each report, and a third resolved discrepancies or passed them to a committee for resolution..One thousand two hundred eighty-four adverse events were reported between June 1993 and October 2008, of which 1,150 were failed defibrillation attempts. Thirty-seven automated external defibrillators never powered on, 252 failed to complete rhythm analysis, and 524 failed to deliver a recommended shock. In 149 cases, the operator disagreed with the device's rhythm analysis. In 54 cases, the defibrillator stated the batteries were low and in 110 other instances powered off unexpectedly. Interrater agreement between reviewers 1 and 2 ranged by question from 69.0% to 98.6% and for most likely cause was 55.9%. Agreement was obtained for 93.7% to 99.6% of questions by the third reviewer. Remaining discrepancies were resolved by the arbitration committee..MAUDE information is often incomplete and frequently no corroborating data are available. Some conditions not detected by automated external defibrillators during self-test cause units to power off unexpectedly, causing defibrillation delays. Backup units frequently provide shocks to patients.
• Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Ramsey, B., Potts, J., Denninghoff, K. R., Chikani, V., Brazil, P. R., Bobrow, B. J., & Abella, B. S. (2011). The effectiveness of ultrabrief and brief educational videos for training lay responders in hands-only cardiopulmonary resuscitation: implications for the future of citizen cardiopulmonary resuscitation training.. Circulation. Cardiovascular quality and outcomes, 4(2), 220-6. doi:10.1161/circoutcomes.110.959353
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  Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA) but often is not performed. We hypothesized that subjects viewing very short Hands-Only CPR videos will (1) be more likely to attempt CPR in a simulated OHCA scenario and (2) demonstrate better CPR skills than untrained individuals..This study is a prospective trial of 336 adults without recent CPR training randomized into 4 groups: (1) control (no training) (n=51); (2) 60-second video training (n=95); (3) 5-minute video training (n=99); and (4) 8-minute video training, including manikin practice (n=91). All subjects were tested for their ability to perform CPR during an adult OHCA scenario using a CPR-sensing manikin and Laerdal PC SkillReporting software. One half of the trained subjects were randomly assigned to testing immediately and the other half after a 2-month delay. Twelve (23.5%) controls did not even attempt CPR, which was true of only 2 subjects (0.7%; P=0.01) from any of the experimental groups. All experimental groups had significantly higher average compression rates (closer to the recommended 100/min) than the control group (P38 mm) than the control group (P
• Chipman, R. A., Sieluzycka, K. B., Ririe, T. J., Hendryx, J. K., Denninghoff, K. R., Deluca, L. A., & Chipman, R. A. (2011). Retinal oximeter for the blue-green oximetry technique.. Journal of biomedical optics, 16(10), 107004. doi:10.1117/1.3638134
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  Retinal oximetry offers potential for noninvasive assessment of central venous oxyhemoglobin saturation (SO(2)) via the retinal vessels but requires a calibrated accuracy of ±3% saturation in order to be clinically useful. Prior oximeter designs have been hampered by poor saturation calibration accuracy. We demonstrate that the blue-green oximetry (BGO) technique can provide accuracy within ±3% in swine when multiply scattered light from blood within a retinal vessel is isolated. A noninvasive on-axis scanning retinal oximeter (ROx-3) is constructed that generates a multiwavelength image in the range required for BGO. A field stop in the detection pathway is used in conjunction with an anticonfocal bisecting wire to remove specular vessel reflections and isolate multiply backscattered light from the blood column within a retinal vessel. This design is tested on an enucleated swine eye vessel and a retinal vein in a human volunteer with retinal SO(2) measurements of ∼1 and ∼65%, respectively. These saturations, calculated using the calibration line from earlier work, are internally consistent with a standard error of the mean of ±2% SO(2). The absolute measures are well within the expected saturation range for the site (-1 and 63%). This is the first demonstration of noninvasive on-axis BGO retinal oximetry.
• Chipman, R. A., Sieluzycka, K., Ririe, T., Hendryx, J., Denninghoff, K. R., & Chipman, R. A. (2011). A Retinal Oximetry for Red Blood Cells Utilizing the Blue-Green Oximetry Technique. Investigative Ophthalmology & Visual Science, 52(14), 2905-2905.
• Stoneking, L. R., Munger, B. S., Keim, S. M., Denninghoff, K. R., & Deluca, L. A. (2011). Sepsis bundles and compliance with clinical guidelines.. Journal of intensive care medicine, 26(3), 172-82. doi:10.1177/0885066610387988
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  Realizing the vast medical benefits of validated protocols, recommendations and practice guidelines requires acceptance and implementation by frontline care providers. Knowledge translation is the science of accelerating the transfer of knowledge to practice by understanding and creatively addressing the barriers that prevent adoption of new professional standards. In an attempt to improve patient care and reduce mortality, the Surviving Sepsis Campaign and The Institute for Healthcare Improvement created the resuscitation and management bundles for patients with severe sepsis and septic shock. These bundles have been accepted as best practice by many clinicians since multiple clinical trials have produced similar positive results when they were implemented. However, transferring these research outcomes-based guidelines to the clinical practice arena has been associated with poor compliance due to important barriers to implementation. Delays in the adoption of sepsis bundles are not surprising since the time from validation to implementation of a new clinical practice is typically 17 years. Using sepsis bundles as a model, this article explores why guidelines are important, examines physician adherence to protocols, and reviews the literature on strategies to improve clinical compliance and enhance knowledge translation.
• Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Ramsey, B., Potts, J., Denninghoff, K. R., Chikani, V., Brazil, P. R., Bobrow, B. J., & Abella, B. S. (2010). Abstract 114: The Effectiveness of Ultra-Brief and Brief Educational Videos for Training Lay Responders in Hands-OnlyTM Cardiopulmonary Resuscitation: Implications for the Future of Citizen CPR Training. Circulation, 122.
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  Background: Bystander cardiopulmonary resuscitation (CPR) improves survival from out-of-hospital cardiac arrest (OHCA) but is often not performed. Hypotheses: Subjects viewing very short Hands-Only...
• Bobrow, B. J., Vadeboncoeur, T. F., Spaite, D. W., Ramsey, B., Potts, J., Denninghoff, K. R., Chikani, V., Brazil, P. R., Bobrow, B. J., & Abella, B. S. (2010). Impact of brief or ultra-brief Hands-Only CPR video training on the confidence of lay citizens to perform CPR. Resuscitation, 81(2), S96. doi:10.1016/j.resuscitation.2010.09.392
• Rosen, P., Tranquada, K. E., Rosen, P., King, M. E., Denninghoff, K. R., & Davis, S. M. (2010). Emergency department workload increase: dependence on primary care?. The Journal of emergency medicine, 38(3), 279-85. doi:10.1016/j.jemermed.2008.11.031
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  Increasing demand for emergency care and crowded emergency departments (EDs) lead some planners to conclude that inconvenient primary care scheduling increases the number of "unnecessary" ED visits. The reasons that the planners argue for more primary care are: to increase funding for primary care; the unfounded notion that it is less expensive to see a primary care physician (PCP) than an Emergency Physician; and the impractical goal that the ED should be used only by intellectually interesting life- or limb-threatened patients or "true emergencies.".To explore the rates of patient-reported access to primary care in ambulatory presentations to a rural tertiary care ED..An observational study was performed in which an anonymous survey was given to a convenience sample of patients who presented by walking into the ED..Overall, 70.4% (686/975) of respondents stated that they had a PCP, and 38.1 % (252/661) of the sample had attempted to contact their physicians before presenting to the ED. Of the group who attempted to contact their physicians, 62.8% (130) were neither spoken to nor seen by any doctor. These rates did not change by time of presentation or by day of the week..The results suggest that it is neither a lack of primary care, nor the time of day or night that drives patients to come to the ED.
• Bobrow, B. J., Wells, G. A., Vadeboncoeur, T. F., Stiell, I. G., Spaite, D. W., Maloney, J., Dreyer, J., Denninghoff, K. R., Boer, M. D., & Bobrow, B. J. (2009). Effect of transport interval on out-of-hospital cardiac arrest survival in the OPALS study: implications for triaging patients to specialized cardiac arrest centers.. Annals of emergency medicine, 54(2), 248-55. doi:10.1016/j.annemergmed.2008.11.020
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  To identify any association between out-of-hospital transport interval and survival to hospital discharge in victims of out-of-hospital cardiac arrest..Data from the Ontario Prehospital Advanced Life Support Study (January 1, 1991, to December 31, 2002), an Utstein-compliant registry of out-of-hospital cardiac arrest patients from 21 communities, were analyzed. Logistic regression identified factors that were independently associated with survival in consecutive adult, nontraumatic, out-of-hospital cardiac arrest patients and in the subgroup with return of spontaneous circulation..A total of 18,987 patients met criteria and 15,559 (81.9%) had complete data for analysis (study group). Return of spontaneous circulation was achieved in 2,299 patients (14.8%), and 689 (4.4%) survived to hospital discharge. Median transport interval was 4.0 minutes (25th quartile 3.0 minutes; 75th quartile 6.2 minutes) for survivors and 4.2 minutes (25th quartile 3.0, 75th quartile 6.2) for nonsurvivors. Logistic regression revealed multiple factors that were independently associated with survival: witnessed arrest (odds ratio 2.61; 95% confidence interval [CI] 2.05 to 3.34), bystander cardiopulmonary resuscitation (odds ratio 2.22; 95% CI 1.82 to 2.70), initial rhythm of ventricular fibrillation/tachycardia (odds ratio 2.22; 95% CI 1.97 to 2.50), and shorter emergency medical services (EMS) response interval (odds ratio 1.26; 95% CI 1.20 to 1.33). There was no association between transport interval and survival in either the study group (odds ratio 1.01; 95% CI 0.99 to 1.05) or the return of spontaneous circulation subgroup (odds ratio 1.04; 95% CI 0.99, 1.08)..In a large out-of-hospital cardiac arrest study from demographically diverse EMS systems, longer transport interval was not associated with decreased survival. Given the growing evidence showing major influence from specialized postarrest care, these findings support conducting clinical trials that assess the effectiveness and safety of bypassing local hospitals to take patients to regional cardiac arrest centers.
• Chipman, R. A., Zhou, Y., Twietmeyer, K. M., Lam, W. S., Elsner, A. E., Denninghoff, K. R., Chipman, R. A., & Burns, S. A. (2009). Depolarization Properties of the Normal Human Fovea Measured by the GDx-MM. Proceedings of SPIE, 7461. doi:10.1117/12.828480
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  A custom imaging Mueller matrix retinal polarimeter (the GDx-MM) is built. Mueller matrix images of normal human fovea were acquired with the GDx-MM over a 9° field at 780nm and have been analyzed for depolarization index and the variation of degree of polarization with incident polarization state. The degree of polarization (DoP) was often above 50% and varied in complex ways as a function of the incident polarization states. The depolarization properties around the macula loosely correlated with the retardance image. High spatial frequency depolarizing structures were evident throughout the fovea.
• Chipman, R. A., Salyer, D. A., Park, R. I., Denninghoff, K. R., Chipman, R. A., & Basavanthappa, S. (2008). Blue-green spectral minimum correlates with oxyhemoglobin saturation in vivo.. Journal of biomedical optics, 13(5), 054059. doi:10.1117/1.3005390
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  An imaging multi-spectral retinal oximeter with intravitrial illumination is used to perform the first in vivo test of the blue-green minima shift oximetry method (BGO) in swine eyes [K. R. Dennighoff, R. A. Chipman, and L. W. Hillman, Opt. Lett. 31, 924-926 (2006); J. Biomed. Opt. 12, 034020 (2007).] A fiber optic intravitreal illuminator inserted through the pars plana was coupled to a monochromator and used to illuminate the retina from an angle. A camera viewing through the cornea recorded a series of images at each wavelength. This intravitreal light source moves the specular vessel glint away from the center of the vessel and directly illuminates the fundus behind most blood vessels. These two conditions combine to provide accurate measurements of vessel and perivascular reflectance. Equations describing these different light paths are solved, and BGO is used to evaluate large retinal vessels. In order to test BGO calibration in vivo, data were acquired from swine with varied retinal arterial oxyhemoglobin saturations (60-100% saturation.). The arterial saturations determined using BGO to analyze the multispectral image sets showed excellent correlation with co-oximeter data (r2=0.98, and residual error +/-3.4% saturation) and are similar to results when hemoglobin and blood were analyzed using this technique.
• Chipman, R. A., Salyer, D. A., Park, R. I., Denninghoff, K. R., Chipman, R. A., Beaudry, N. A., & Basavanthappa, S. (2008). Diffuse spectral fundus reflectance measured using subretinally placed spectralon.. Journal of biomedical optics, 13(4), 044004. doi:10.1117/1.2966953
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  The diffuse fundus reflectance and the spectral transmittance of the swine sensory retina was measured in vivo using intravitreal illumination. Pars plana vitrectomy and intravitreal manipulations were performed on a female American Yorkshire domestic swine. Light from a scanning monochromator was coupled into a fiber optic intraocular illuminator inserted into the vitreous. A 1.93-mm(2) region of the illuminated fundus was imaged from an oblique illumination angle. Multispectral retinal images were acquired for four experimental conditions: the eye (1) prior to vitrectomy, (2) after vitrectomy, (3) after insertion of a Spectralon disk super-retinally, and (4) after subretinal insertion of the disk. The absorption of melanin and hemoglobin in the red wavelengths was used to convert relative spectral reflectance to absolute reflectance. The flux scattered from the super-retinal Spectralon was used to correct for scattering in the globe. The transmittance of the sensory retina was measured in vivo using the scatter corrected subretinal Spectralon disk reflectance. The hemoglobin and melanin components of the spectrum due to scattered light were removed from the retinal transmission spectrum. The in vivo spectral transmittance of the sensory retina in this swine was essentially flat across the visible spectrum, with an average transmittance >90%.
• Chipman, R. A., Walter, F. G., Langa, A. J., He, Y., Denninghoff, K. R., & Chipman, R. A. (2008). Spectrophotometry of hydroxocobalamin and hemoglobin reveals production of an unanticipated methemoglobin variant.. Clinical toxicology (Philadelphia, Pa.), 46(6), 545-50. doi:10.1080/15563650701846270
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  Cyanide-poisoned patients often require pulse oximetry and co-oximetry to measure oxyhemoglobin, deoxyhemoglobin, carboxyhemoglobin, and methemoglobin. These and other critical laboratory measurements can be confounded by the cyanide antidote hydroxocobalamin. The postulated mechanism of this confounding is direct optical interference..The spectra of swine hemoglobin with and without hydroxocobalamin were measured from 450-800 nm. The resulting complex spectrum was divided into hemoglobin, hydroxocobalamin, and a remainder spectrum..The remainder spectrum appears to be a methemoglobin variant quantitatively dependant on the amount of hydroxocobalamin added to the hemoglobin solution and the presence of oxygen. The Pearson's correlation coefficient comparing the known swine methemoglobin spectrum with the remainder spectrum reveals a very high degree of correlation (r(2) = 0.986). CONCLUSION. This is the first study to document methemoglobin formation caused by hydroxocobalamin. Further studies are needed in vitro and in vivo to assess this previously unreported methemoglobin variant.
• Lobello, S. G., Griffin, M. J., Fine, P. R., Denninghoff, K. R., & Bartolucci, A. A. (2008). Emergent endotracheal intubation and mortality in traumatic brain injury.. The western journal of emergency medicine, 9(4), 184-9.
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  To determine the relationship between emergent intubation (emergency department and field intubation cases combined) and mortality in patients with traumatic brain injury while controlling for injury severity..Retrospective observational study of 981 (35.2% intubated, 64.8% not intubated) patients with TBI evaluating the association between intubation status and mortality. Logistic regression was used to analyze the data. Injury severity measures included Head/Neck Abbreviated Injury Scale (H-AIS), systolic blood pressure, type of head injury (blunt vs. penetrating), and a propensity score combining the effects of several other potential confounding variables. Age was also included in the model..The simple association of emergent endotracheal intubation with death had an odds ratio (OR) of 14.3 (95% CI = 9.4-21.9). The logistic regression model including relevant covariates and a propensity score that adjusted for injury severity and age yielded an OR of 5.9 (95% CI = 3.2-10.9)..This study indicates that emergent intubation is associated with increased risk of death after controlling for a number of injury severity indicators. We discuss the need for optimal paramedic training, and an understanding of the factors that guide patient selection and the decision to intubate in the field.
• Walter, F. G., Tsai, J. L., Lin, T. J., Hung, D. Z., Hu, S. C., Denninghoff, K. R., Deng, J. F., Chase, P. B., Chase, J. S., Chang, J. S., & Chan, H. M. (2008). Epidemiology of organophosphate pesticide poisoning in Taiwan.. Clinical toxicology (Philadelphia, Pa.), 46(9), 794-801. doi:10.1080/15563650801986695
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  The nationwide epidemiology of organophosphate pesticide (OP) poisoning has never been reported in detail for Taiwan..This study retrospectively reviewed all human OP exposures reported to Taiwan's Poison Control Centers (PCCs) from July 1985 through December 2006..There were 4799 OP exposures. Most OP exposures were acute (98.37%) ingestions (74.50%) of a single OP (80.37%) to attempt suicide (64.72%) in adults (93.25%). Males were the most common gender (64.95%). Most patients (61.97%) received atropine and/or pralidoxime. The mortality rate for all 4799 OP exposures was 12.71%. Exposures to single OPs without co-intoxicants caused 524 deaths; of these, 63.36% were due to dimethyl OPs..Dimethyl OPs cause the majority of deaths in Taiwan.
• Winegard, B., Walter, F. G., Shirazi, F., Denninghoff, K. R., Chow, Y. Y., Chase, P. B., Chan, J. T., & Boer, M. D. (2008). Hazmat disaster preparedness in Hong Kong: what are the hazardous materials on Lantau, Lamma, and Hong Kong Islands?. American journal of disaster medicine, 3(4), 213-233. doi:10.5055/ajdm.2008.0028
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  Objective: Hazmat disaster preparedness is critical, especially as Hong Kong prepares for major international events, such as the 2008 Olympic Equestrian Games. No published medical study describes the identities and quantities of hazardous materials (HMs) in Hong Kong and lists what antidotes are needed for these dangerous goods (DGs). This study describes what HMs are most common in Hong Kong to prioritize disaster preparedness and training. Design: A descriptive, cross-sectional study. Setting: The Hong Kong Special Administrative Region, specifically Lantau, Lamma, and Hong Kong Islands. Sample: The Hong Kong Fire Services Department (HKFSD) Dangerous Goods Database (DGD). Interventions: Descriptive statistical analyses with Stata 9.2. Main Outcome Measures: Identifying and quantifying HMs in the HKFSD DGD. Results: Most HMs do not have antidotes. The most common HMs with recognized antidotes are carbon monoxide, methylene chloride, fluorides, cyanides, nitriles, hydrazine, methanol, and nitrates. The most common categories of DGs are substances giving off inflammable vapors, compressed gases, and corrosive and poisonous substances. Conclusions: Hazmat disaster preparedness and training should emphasize these most common categories of DGs. Disaster planning should ensure adequate antidotes for HMs with recognized antidotes, ie, oxygen for carbon monoxide and methylene chloride; calcium gluconate and calcium chloride for fluorides; hydroxocobalamin or amyl nitrite, sodium nitrite, and sodium thiosulfate for cyanides and nitriles; pyridoxine for hydrazine; fomepizole or ethanol for methanol; and methylene blue for methemoglobinemia produced by nitrates. Supportive care is essential for patients exposed to HMs because most DGs do not have antidotes.
• Winegard, B., Walter, F. G., Shirazi, F., Denninghoff, K. R., Chow, Y., Chase, P. B., Chan, J., & Boer, M. D. (2008). Hazmat emergency preparedness in Hong Kong: What are the dangerous goods in Kowloon?. Hong Kong Journal of Emergency Medicine, 15(3), 156-176. doi:10.1177/102490790801500307
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  Introduction: Hazmat emergency preparedness is critical, especially as Hong Kong prepares for major international events, such as the 2008 Olympic Equestrian Games. No published medical study has described the identities and quantities of dangerous goods (DG) in the Kowloon area and listed what antidotes are needed for these DG. This study describes what hazardous materials are most common in Kowloon to prioritise emergency preparedness and training. Materials & methods: Design: A descriptive, cross-sectional study. Setting: The Hong Kong Special Administrative Region, specifically Kowloon. Sample: The Hong Kong Fire Services Department (HKFSD) Dangerous Goods Database (DGD). Interventions: Descriptive statistical analyses with Stata 9.2. Chief outcome: Identifying and quantifying dangerous goods in the HKFSD DGD. Results: Most DG do not have antidotes. The most common DG with recognised antidotes are carbon monoxide, methylene chloride, fluorine, fluorides, fluoroboric acid, cyanides, nitriles, methanol, nitrobenzene, nitrites, and nitrates. The most common categories of DG are substances giving off inflammable vapours, compressed gases, and corrosive and poisonous substances. Conclusions: Hazmat emergency preparedness and training should emphasize these most common categories of DG. Disaster planning should ensure adequate antidotes for DG with recognised antidotes, i.e., oxygen for carbon monoxide and methylene chloride; calcium gluconate or calcium chloride for fluorine, fluorides, and fluoroboric acid; hydroxocobalamin for cyanides and nitriles; ethanol for methanol; and methylene blue for methaemoglobinaemia produced by nitrobenzene, nitrites, and nitrates. Supportive care is essential for patients exposed to hazardous materials because most dangerous goods do not have antidotes. (Hong Kong j.emerg.med. 2008;15:156-176)
• Chipman, R. A., Hillman, L. W., Denninghoff, K. R., & Chipman, R. A. (2007). Blood oxyhemoglobin saturation measurements by blue-green spectral shift.. Journal of biomedical optics, 12(3), 034020. doi:10.1117/1.2745312
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  Previous work describing a resilient method for measuring oxyhemoglobin saturation using the blue-green spectral shift was performed using cell free hemoglobin solutions. Hemoglobin solution and whole blood sample spectra measured under similar conditions in a spectrophotometer are used here to begin evaluating the impact of cellular scattering on this method. The blue-green spectral shift with changing oxyhemoglobin saturation was preserved in these blood samples and the blue-green spectral shift was relatively unaffected by physiological changes in blood pH (6.6, 7.1, and 7.4), path length through blood (100 and 200 microm), and blood hematocrit (19 to 48%). The packaging of hemoglobin in red blood cells leads to a decreased apparent path length through hemoglobin, and an overall decrease in scattering loss with increasing wavelength from 450 to 850 nm. The negative slope of the scattering loss in the 476 to 516-nm range leads to a +3.0 nm shift in the oxyhemoglobin saturation calibration line when the blue-green spectral minimum in these blood samples was compared to cell free hemoglobin. Further research is needed to fully evaluate the blue green spectral shift method in cellular systems including in vivo testing.
• Chipman, R. A., Twietmeyer, K., Salyer, D., Park, R. I., Denninghoff, K. R., Chipman, R. A., & Basavanthappa, S. (2007). Diffuse Spectral Fundus Reflectance Measured Using Subretinally-Placed Spectralon. Investigative Ophthalmology & Visual Science, 48(13), 3843-3843.
• Chipman, R. A., Hillman, L. W., Denninghoff, K. R., & Chipman, R. A. (2006). Oxyhemoglobin saturation measurements by green spectral shift.. Optics letters, 31(7), 924-6. doi:10.1364/ol.31.000924
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  From an analysis of new hemoglobin solution transmission spectra at various oxygen saturations (SO2), path lengths, and pH, we find the determination of SO2 by using the classical oximetry technique to be poorly calibrated. We used this data set to develop a proposed method for SO2 determination based on the spectral shift of the hemoglobin transmission minimum between 475 and 510 nm. The method does not require accurate knowledge of hemoglobin extinction coefficients and is linear in relation to SO2 despite changes in path length, pH, or hemoglobin concentration.
• Chipman, R. A., Salyer, D., Park, R. I., Karen, T., Denninghoff, K. R., Chipman, R. A., & Beaudry, N. A. (2006). A New Spectral Oxyhemoglobin Saturation Method Applied to the Swine Retina. Investigative Ophthalmology & Visual Science, 47(13), 492-492.
• Chipman, R. A., Twietmeyer, K., Salyer, D. A., Park, R. I., Eskandari, M., Denninghoff, K. R., Chipman, R. A., Beaudry, N. A., & Basavanthappa, S. (2006). Retinal oximetry using intravitreal illumination.. Current eye research, 31(7-8), 617-27. doi:10.1080/02713680600760493
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  To demonstrate spectroscopic retinal oximetry measurements on arteries and veins in swine using intravitreal illumination. Retinal arterial and venous saturations are measured for a range of inspired O2 levels after pars plana vitrectomy..Pars plana vitrectomy and intravitreal manipulations were performed on two female American Yorkshire domestic swine. Light from a scanning monochromator was coupled into a fiberoptic intraocular illuminator inserted into the vitreous. The retinal vessels were illuminated obliquely, minimizing vessel glints. Multispectral images of the retinal vasculature were obtained as the swine's arterial blood oxygen saturation was decreased from 100% to 67% in decrements of approximately 10%. Retinal vessel spectra were used to calculate oxygen saturation in selected arteries and veins. Arterial oxygen saturations were calibrated using blood gas analysis on blood drawn from a Swan-Ganz catheter placed in the femoral artery..Oblique illumination of retinal vessels using an intravitreal fiberoptic illuminator provided a substantial reduction in the central vessel glint usually seen in fundus images, thus simplifying the analysis of spectral data. The vessel shadows were displaced from the vessel image simplifying the light paths in the eye. Using a full spectral analysis simplified by the light path reductions, we calculated retinal vessel saturations. The reduction of glint allowed for increased accuracy in measuring retinal vessel spectral optical density. Abnormally low retinal venous oxygen saturations were observed shortly after pars plana vitrectomy..Retinal oximetry using intravitreal illumination has been demonstrated. As a research tool, intravitreal illumination addresses several difficulties encountered when performing retinal oximetry with transcorneal illumination.
• Hillman, L. W., & Denninghoff, K. R. (2005). Absorption Spectra of Hemoglobin with Intermediate Oxygenation. Frontiers in Optics. doi:10.1364/fio.2005.ftuaa6
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  Oximetry assumes that absorption spectra of hemoglobin depend linearly on oxygenation and is therefore the weighted average of the fully oxygenated and de-oxygenated hemoglobin spectra. We demonstrate how intermediately oxygenated hemoglobin spectra change nonlinearly.
• Smith, M. H., Lompado, A., Hillman, L. W., & Denninghoff, K. R. (2003). Retinal venous oxygen saturation and cardiac output during controlled hemorrhage and resuscitation.. Journal of applied physiology (Bethesda, Md. : 1985), 94(3), 891-6. doi:10.1152/japplphysiol.01197.2001
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  The objective was to test calibration of an eye oximeter (EOX) in a vitiligo swine eye and correlate retinal venous oxygen saturation (Srv(O(2))), mixed venous oxygen saturation (Sv(O(2))), and cardiac output (CO) during robust changes in blood volume. Ten anesthetized adult Sinclair swine with retinal vitiligo were placed on stepwise decreasing amounts of oxygen. At each oxygen level, femoral artery oxygen saturation (Sa(O(2))) and retinal artery oxygen saturation (Sra(O(2))) were obtained. After equilibration on 100% O(2), subjects were bled at 1.4 ml. kg(-1). min(-1) for 20 min. Subsequently, anticoagulated shed blood was reinfused at the same rate. During graded hypoxia, exsanguination, and reinfusion, Sra(O(2)) and Srv(O(2)) were measured by using the EOX, and CO and Sv(O(2)) were measured by using a pulmonary artery catheter. During graded hypoxia, Sra(O(2)) correlated with Sa(O(2)) (r = 0.92). Srv(O(2)) correlated with Sv(O(2)) (r = 0.89) during exsanguination and reinfusion. Sv(O(2)) and Srv(O(2)) correlated with CO during blood removal and resuscitation (r = 0.92). Use of vitiligo retinas improved the calibration of EOX measurements. In this robust hemorrhage model, Srv(O(2)) correlates with CO and Sv(O(2)) across the range of exsanguination and resuscitation.
• Zun, L. S., & Denninghoff, K. R. (2003). Competencies for youth violence prevention and control [2] (multiple letters). Academic Emergency Medicine, 10(4), 406-407. doi:10.1197/aemj.10.4.406
• Partain, S., Knox, L., Denninghoff, K. R., & Cunningham, R. M. (2002). Emergency medicine: competencies for youth violence prevention and control.. Academic Emergency Medicine, 9(9), 947-956. doi:10.1197/aemj.9.9.947
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  By any standard one wishes to apply, the impact of violence on the health and safety of the public is significant. The expression of violence among children in the United States has increased significantly during the modern era. Homicide and suicide are the second and third leading causes of death in youths 15-24 years of age. The emergency department (ED) is a common site for the care of these victims, and because victims often become assailants, the emergency care provider needs to know the epidemiology, treatment, and methods for prevention of youth violence in order to curtail the cycle. A multidisciplinary task force was convened by the Centers for Disease Control and Prevention (CDC)-funded Southern California Center of Academic Excellence on Youth Violence Prevention and the Keck School of Medicine at the University of Southern California to define competencies for health professionals in youth violence prevention and control. Three levels of competence were identified: the generalist level, which should be obtained by all health professionals; the specialist level, which should be obtained by health professionals such as emergency medicine providers, who frequently work with populations affected by violence; and a third, or scholar level, to be acquired by health professionals who wish to become experts not only in the care, but also in research and advocacy. This article reports the details of this group's efforts and applies them to emergency care provider education. These competencies should shape the development of curricula for the span of emergency medical training from emergency medical services scholastic training to postgraduate continuous medical education.
• Denninghoff, K. R. (2000). Enrollment of sudden cardiac death victims into a limited cardiac autopsy study in the emergency department.. Journal of the National Medical Association, 92(1), 36-8.
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  The lack of balanced recruitment for racial and ethnic groups in research protocols is an important ethical issue. African Americans have a history of forced participation, unethical research, and unwilling human dissection/demonstration that leads to a lack of participation in clinical research. We have embarked on a study of the pathophysiology of sudden death among African Americans which requires a limited autopsy of the heart. Our objective was to improve the recruitment rate in this study when compared with historical rates seen in clinical research and organ donation. We have screened 14 and enrolled 10 African Americans with sudden death (95% CI 0.41-0.91). By addressing the concerns of the African-American community and involving qualified input in the planning stages of the study we have been able to significantly improve the recruitment rate for this important population subgroup.
• Smith, M. H., & Denninghoff, K. R. (2000). Optical model of the blood in large retinal vessels.. Journal of biomedical optics, 5(4), 371-4. doi:10.1117/1.1289144
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  Several optical techniques that investigate blood contained within the retinal vessels are available or under development. We present a mechanical model that simulates the optical properties of the eye, the retinal vessels, and the ocular fundus. A micropipette is chosen as the retinal vessel model, and a mechanical housing is constructed to simulate the eyeball. Spectralon is used to simulate the retinal layers. Filling the eye with fluid index matched to the glass pipette eliminates reflection and refraction effects from the pipette. An apparatus is constructed and used to set the oxygen, nitrogen, and carbon dioxide concentrations in whole human blood. These whole blood samples are pumped through the pipette at 34 microL/min. Measurements made in the model eye closely resemble measurements made in the human eye. This apparatus is useful for developing the science and testing the systems that optically investigate blood and blood flow in the large retinal vessels.
• Smith, M. H., Hillman, L. W., & Denninghoff, K. R. (2000). Retinal imaging techniques in diabetes.. Diabetes technology & therapeutics, 2(1), 111-3. doi:10.1089/152091599316810
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  Diabetic retinopathy is progressive, and detection early is essential for the prevention of blindness. Doppler flowmetry, retinal photography, scanning laser ophthalmoscopy, and retinal oximetry measurements may identify proliferative disease early. Drawbacks of these methods include lack of compliance, failure to refer, and failure to identify disease early. As a result, diabetic retinopathy is a leading cause of blindness. Our retinal oximeter measures the blood oxygen saturation in the large vessels of the retina near the optic disc. Retinal vessel oxygen saturations measured with our instrument are sensitive indicators of blood loss and hypoxia in swine. We are generating scientific data that suggests that retinal vessel oxygen saturations may be used to identify retinal hypoxia prior to changes in retinal vessel architecture. We expect to study humans within the next two years, and a clinically useful eye oximeter should be available in the near future.
• Smith, M. H., Lompado, A., Hillman, L. W., & Denninghoff, K. R. (2000). Effect of multiple light paths on retinal vessel oximetry.. Applied optics, 39(7), 1183-93. doi:10.1364/ao.39.001183
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  Techniques for noninvasively measuring the oxygen saturation of blood in retinal arteries and veins are reported in the literature, but none have been sufficiently accurate and reliable for clinical use. Addressing the need for increased accuracy, we present a series of oximetric equations that explicitly consider the effects of backscattering by red blood cells and lateral diffusion of light in the ocular fundus. The equations are derived for the specific geometry of a scanning-beam retinal vessel oximeter; however, the results should also be applicable to photographic oximeters. We present in vitro and in vivo data that suggest the validity of these equations.
• Chipman, R. A., Smith, M. H., Hillman, L. W., Denninghoff, K. R., & Chipman, R. A. (1998). Oxygen Saturation Measurements of Blood in Retinal Vessels during Blood Loss.. Journal of biomedical optics, 3(3), 296-303. doi:10.1117/1.429856
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  We describe a noninvasive technique and instrumentation for measuring the oxygen saturation of blood in retinal arteries and veins. The measurements are made by shining low-power lasers into the eye, and scanning the beams across a retinal blood vessel. The light reflected and scattered back out of the eye is collected and measured. The oxygen saturation of blood within the vessel is determined by analyzing the vessel absorption profiles at two wavelengths. A complete saturation measurement can be made in less than 1 s, allowing real-time measurement during physiologic changes. The sensitivity of this measurement technique to changes in retinal saturation has been demonstrated through a series of pilot studies in anesthetized swine. We present data indicating that retinal venous oxygen saturation decreases during ongoing blood loss, demonstrating a potential application of an eye oximeter to noninvasively monitor blood loss. © 1998 Society of Photo-Optical Instrumentation Engineers.
• Moye, P. K., & Denninghoff, K. R. (1998). Teaching students during an emergency walk-in clinic rotation does not delay care.. Academic medicine : journal of the Association of American Medical Colleges, 73(12), 1311. doi:10.1097/00001888-199812000-00024
• Smith, M. H., Rue, L. W., Redden, D. T., Hillman, L. W., & Denninghoff, K. R. (1998). Retinal venous oxygen saturation correlates with blood volume.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 5(6), 577-82. doi:10.1111/j.1553-2712.1998.tb02464.x
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  To evaluate the sensitivity of retinal venous O2 saturation (SrvO2) for early blood loss and reinfusion. A secondary objective was to measure the correlation between SrvO2 and mixed venous O2 saturation (SvO2) during blood loss and reinfusion..Seven anesthetized swine were bled at 0.8 mL/kg/min to 16 mL/kg. Shed blood was re-infused at the same rate and the swine were allowed to equilibrate. After equilibration, repeat hemorrhages were performed at 1.6 mL/kg/min and 2.4 mL/kg/min. SrvO2 was measured using an eye oximeter (EOX) and SvO2 was measured using a fiber-optic catheter..During blood loss, SrvO2 correlated with blood removed (r = -0.88, -0.97, -0.96) and SvO2 (r = 0.87, 0.98, 0.92). During reinfusion, SrvO2 correlated with blood re-infused (r = 0.63, 0.76, 0.82) and SvO2 (r = 0.80, 0.93, 0.96). SrvO2 decreased 1.22 +/- 0.60%/mL/kg of blood removed. The rate of decrease in SrvO2 per minute (deltaSrvO2) when blood was removed at 2.4 mL/kg/min was significantly greater than deltaSrvO2 when blood was removed at 0.8 mL/kg/min (p < 0.007). The rates of change in blood pressure (BP) and pulse were not significantly different at any rate of blood removal..In this model, retinal venous O2 saturation correlated with blood volume and central venous O2 saturation. Unlike the rate of change in BP and heart rate, deltaSrvO2 values were significantly different at different rates of blood removal. Use of an EOX to monitor for blood loss, estimate the rate of hemorrhage, and evaluate the response to therapy during resuscitation warrants further study.
• Chipman, R. A., Smith, M. H., Rue, L. W., Kuhn, F., Jester, P. M., Hughes, C. E., Hillman, L. W., Denninghoff, K. R., & Chipman, R. A. (1997). Retinal large vessel oxygen saturations correlate with early blood loss and hypoxia in anesthetized swine.. The Journal of trauma, 43(1), 29-34. doi:10.1097/00005373-199707000-00009
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  Noninvasive monitoring would likely improve trauma care. Using laser technology, we monitored the oxygen saturation in retinal vessels during exsanguination and hypoxia..Seven anesthetized swine were bled at 0.4 mL/kg/min for 40 minutes. During exsanguination, retinal venous saturation (SrvO2) was measured using an eye oximeter, and central venous saturation (SvO2) was measured using a fiber-optic catheter. After the shed blood was reinfused, the FiO2 was progressively decreased from 0.97 to 0.07. Femoral artery oxygen saturation (SaO2) and retinal artery oxygen saturation (SraO2) were measured at each increment..During exsanguination, SrvO2 correlated with blood loss (r = -0.93) and SvO2 (r = 0.94). SraO2 correlated with SaO2 during incremental hypoxia (R2 = 0.93 +/- 0.15)..In this model of exsanguination, retinal venous oxygen saturation correlates with blood volume and with central venous oxygen saturation. The SraO2 correlates with SaO2 during graded hypoxia. Use of an eye oximeter to noninvasively monitor trauma patients appears promising and warrants further study.
• Chipman, R. A., Smith, M. H., Denninghoff, K. R., & Chipman, R. A. (1996). Oxygen saturation measurements of retinal arteries and veins during physiologic changes. Investigative Ophthalmology & Visual Science, 37(3).

Proceedings Publications

• Spaite, D. W., Bobrow, B. J., Gaither, J. B., Barnhart, B. J., Keim, S. M., Chikani, V., Denninghoff, K. R., Mullins, T., Adelson, P. D., Rice, A., Viscusi, C. D., & Hu, C. (2020, Jan). Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: Results of the EPIC4Kids Study. In Annual Meeting of the National Association of EMS Physicians.
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  Spaite DW, Bobrow BJ, Gaither JB, Barnhart BJ, Keim SM, Chikani V, Denninghoff K, Mullins T, Adelson PD, Rice AD, Viscusi C, Hu C: Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: Results of the EPIC4Kids Study. Presented at the Annual Meeting of the National Association of EMS Physicians, January 7-11, 2020, San Diego, California.
• W, S. D., Bentley, B., B, G. J., M, K. S., J, B. B., Vatsal, C., Kurt, D., Terry, M., David, A., D, R. A., Chad, V., & Chengcheng, H. (2019, 2020/01/28). Abstract 320: Statewide Implementation of the Prehospital Traumatic Brain Injury Guidelines in Children: The EPIC4Kids Study. In Circulation, 140, A320-A320.
• Denninghoff, K. R. (2018, November). Abstract 230: Differential Effects of Prehospital Hypotension and Injury Severity in Isolated vs. Multisystem Major Traumatic Brain Injury. In AHA 2018, 138, A230.
• Denninghoff, K. R. (2018, November). Abstract 232: Three-Dimensional Models of Complex Interactions Between Age, Prehospital Blood Pressure, and Mortality in Major Traumatic Brain Injury. In AHA Circulation 2018, 138, A232.
• Barnhart, B. J., Bobrow, B. J., Sherrill, D. L., Spaite, D. W., Helfenbein, E., Viscusi, C. D., Perez, O., Keim, S. M., Babaeizadeh, S., Denninghoff, K. R., Gaither, J. B., Hu, C., Chikani, V., Chikani, V., Hu, C., Gaither, J. B., Babaeizadeh, S., Denninghoff, K. R., Barnhart, B. J., , Keim, S. M., et al. (2017, September). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major TBI Patients. In Mediterranean Emergency Medicine Congress.
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  Perez O, Spaite DW, Helfenbein E, Barnhart BJ, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Sherrill D, Bobrow BJ: Accuracy of EMS Hypoxia Documentation Compared to Continuous Non-Invasive Monitor Data in Major TBI. Presented to the Mediterranean Emergency Medicine Congress, September 6-10, 2017, Lisbon, Portugal.
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherrill, D., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2017, January). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. In Annual Meeting of the National Association of EMS Physicians.
• Bobrow, B. J., Rice, A. D., Sherrill, D. L., Viscusi, C. D., Keim, S. M., Denninghoff, K. R., Gaither, J. B., Chikani, V., Hu, C., Babaeizadeh, S., Barnhart, B., Helfenbein, E., Spaite, D. W., & Perez, O. (2017, Jan). Prehospital Use of Nasal Cannula End-Tidal Co2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. In National Association of EMS Physicians Annual Meeting.
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  Perez O, Spaite DW, Helfenbein E, Barnhart BJ, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Sherrill D, Denninghoff KR, Keim SM, Viscusi C, Rice AD, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Presented at the Annual Meeting of the National Association of EMS Physicians, January 24-26, 2017, New Orleans, LA.
• Bobrow, B. J., Rice, A. D., Viscusi, C. D., Keim, S. M., Denninghoff, K. R., Sherrill, D. L., Gaither, J. B., Chikani, V., Hu, C., Babaeizadeh, S., Perez, O., Helfenbein, E., Spaite, D. W., & Barnhart, B. (2017, Jan). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. In National Association of EMS Physicians Annual Meeting.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Sherrill D, Denninghoff KR, Keim SM, Viscusi C, Rice AD, Bobrow BJ: Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Presented at the Annual Meeting of the National Association of EMS Physicians, January 24-26, 2017, New Orleans, LA.
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhart, B. J., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherrill, D., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2017, January). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. In Annual Meeting of the National Association of EMS Physicians.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B. J., Adelson, P. D., Rice, A. D., Grady, K., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Mullins, T., & Sherrill, D. (2017, January). Evaluation of Prehospital Hypoxia “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. In Annual Meeting of the National Association of EMS Physicians.
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., & Bobrow, B. J. (2016, November). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions, 133, A15795.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation 2016;133:A15795
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., & Bobrow, B. J. (2016, November). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions.
• Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamaguru, M., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., Bobrow, B. J., Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamaguru, M., Barnhart, B. J., Adelson, P. D., , Viscusi, C. D., et al. (2016, January). Elevated Initial Trauma Center Body Temperatures Are Associated With Poor Non-Mortality Outcomes Following Major Traumatic Brain Injury. In Annual Meeting of the National Association of EMS Physicians.
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhart, B. J., Babaeizadeh, S., Hu, C., Vatsal, C., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Sherril, D., & Bobrow, B. J. (2016, November). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Keim, S. M., Viscusi, C. D., Mullins, T., & Sherrill, D. (2016, November). Evaluation of Prehospital Hypotension Depth-Duration Dose and Mortality in Major Traumatic Brain Injury. In American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions.
• Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamaguru, M., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Bobrow, B. J. (2015, November). Association Between Elevated Initial Trauma Center Body Temperature and Non-Mortality Outcomes Following Major Traumatic Brain Injury. In Resuscitation Science Symposium of the American Heart Association, 132.
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  Gaither JB, Chikani V, Spaite DW, Smith JJ, Curry M, Mhayamaguru M, Barnhart B, Adelson PD, Viscusi C, Denninghoff KR, Bobrow B; Association Between Elevated Initial Trauma Center Body Temperature and Non-Mortality Outcomes Following Major Traumatic Brain Injury. Circulation 2015;132:A.
• Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamaguru, M., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., Bobrow, B. J., Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamaguru, M., Barnhart, B. J., Adelson, P. D., , Viscusi, C. D., et al. (2015, November). Association Between Elevated Initial Trauma Center Body Temperature and Non-Mortality Outcomes Following Major Traumatic Brain Injury. In Resuscitation Science Symposium of the American Heart Association.
• Gaither, J. B., Chikani, V., Spaite, D. W., Stolz, U., Garison, S., Smith, J., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Bobrow, B. J. (2015, January). Association Between Initial Trauma Center Body Temperature and Mortality from Major Traumatic Brain Injury. In Annual Meeting of the National Association of EMS Physicians.
• Spaite, D. W., Hu, C., Bobrow, B. J., Sherrill, D. L., Chikani, V., Barnhart, B. J., Martinez, R. A., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Viscusi, C. D., Mullins, T., & Stolz, U. (2015, November). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury. In Resuscitation Science Symposium of the American Heart Association.
• Stolz, U., Spaite, D. W., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Gaither, J. B., Adelson, P. D., Viscusi, C. D., Mullins, T., Humble, W. O., & Denninghoff, K. R. (2015, January). Association Between Lowest Prehospital Systolic Blood Pressure and Non-Mortality Outcomes in Major Traumatic Brain Injury: Is There a “Hypotension” Threshold?. In Annual Meeting of the National Association of EMS Physicians.
• Chipman, R. A., Zhou, Y., Twietmeyer, K. M., Lam, W. S., Elsner, A. E., Denninghoff, K. R., Chipman, R. A., & Burns, S. A. (2009). Depolarization properties of the normal human fovea. In Optical Coherence Tomography and Coherence Domain Optical Methods in Biomedicine XIII, 7168.
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  Depolarization data is provided for several normal retinas. Mueller matrix images of normal human fovea were acquired with a custom imaging Mueller matrix retinal polarimeter (the GDx-MM) over a 9° field at 780nm and have been analyzed for depolarization index and the variation of degree of polarization with incident polarization state. The degree of polarization (DoP) was often above 50% and varied in complex ways as a function of the incident polarization states. The depolarization properties around the macula loosely correlated with the retardance image. High spatial frequency depolarizing structures were evident throughout the fovea.
• Woodruff, J. B., Smith, M. H., Lompado, A., Hillman, L. W., & Denninghoff, K. R. (2001). Minimizing the influence of fundus pigmentation on retinal vessel oximetry measurements. In Ophthalmic Technologies XI, 4245, 135-145.
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  The goal of making calibrated oxygen saturation measurements of blood in retinal arteries and veins via a noninvasive spectroscopic technique has nearly been realized. Semi-continuous advancement in the field of retinal vessel oximetry over the last three decades has resulted in several technologies that seem poised for commercialization. In this paper, we present our instrumentation and technique for making well-calibrated saturation measurements of the blood in retinal vessels. The Eye Oximeter (EOX) is a confocal scanning laser ophthalmoscope capable of acquiring multi-spectral images. Analysis of these spectral vessel images allows spectroscopic determination of the oxygen saturation of blood within each vessel. The primary emphasis of this paper is to illustrate the effect of fundus pigmentation on these oximetric measurements. We show that decreasing fundus reflectivity is mathematically similar to decreasing the vessel thickness. The apparent decreased vessel thickness is a direct consequence of scattering by red blood cells. We present in vitro and in vivo measurements that demonstrate an instrument calibration that is nearly independent of vessel diameter and fundus reflectivity.
• Smith, M. H., Hillman, L. W., Heaton, L. C., & Denninghoff, K. R. (2000). Handheld four-wavelength retinal vessel oximeter. In Ophthalmic Technologies X, 3908, 227-233.
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  Several techniques for measuring the oxygen saturation of blood in retinal vessels have been reported. One interesting application of retinal vessel oximetry is the identification of occult blood loss in trauma victims. However, all the devices described to date are too bulky and cumbersome to be used in a trauma bay or in the field. We present a design for a handheld instrument that performs four-wavelength retinal vessel oximetry. This device is comparable in size and weight to a commercially available camcorder, and is suitable for use in the trauma bay. The compact size of this device could also extend its applications beyond traditional clinical settings, as it could be used by primary care physicians and home health care workers for the screening and monitoring of ophthalmic diseases. Principles of operation and preliminary data from the device will be described.
• Smith, M. H., Lompado, A., Hillman, L. W., & Denninghoff, K. R. (2000). In-plane scatterometry of small caliber blood column. In Optical Diagnostics of Biological Fluids V, 3923, 44-53.
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  The scattering of He-Ne laser light incident on a flowing column of whole human blood has been measured and analyzed. An automated scatterometer whose sample chamber simulates a small caliber blood vessel was used to perform the measurements and is described. Angular scattered light distributions due to flowing blood columns for two independently varied parameters, blood oxygenation and hemoglobin concentration, are presented. It is found that the dependence of the scattering distribution on blood oxygenation is minimal while the dependence on hemoglobin concentration is strong. A nominally transparent sample of human plasma has also been investigated to quantify its scattering characteristics. The whole blood scattering results are compared to theoretical predictions obtained using a Monte Carlo simulation employing the Mie single particle phase function and macroscopic transport coefficients obtained from published literature. The best correlation was found when the largest published scattering coefficient was employed in the simulation. However, a strong correlation between the measured and predicted scattering distributions was only obtained when unphysically high values of the scattering coefficient were used in the simulation.
• Smith, M. H., Lompado, A., Hillman, L. W., & Denninghoff, K. R. (2000). Multispectral confocal scanning laser ophthalmoscope for retinal vessel oximetry. In Spectral Imaging: Instrumentation, Applications, and Analysis, 3920, 67-73.
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  Scanning laser microscopy is a widely used technique in ophthalmoscopy for providing high-resolution real time images of the retina. We describe a scanning laser ophthalmoscope that acquires retinal images at four wavelengths for the purpose of measuring the oxygen saturation of blood in retinal arteries and veins. Images at all four wavelengths are obtained across a single video frame using a temporal interlacing technique. An extraction procedure then permits analysis of four monochromatic images. A technique for calculating oxygen saturation from a multi-spectral image set is presented, along with preliminary measurements. The choice of wavelengths dramatically affects the oxygen saturation calculation accuracy and we present an optimized wavelength set and the calculated oxygen saturation results. The potential applications for this technology range from the diagnosis of various ophthalmic diseases to the detection of blood loss in trauma victims.
• Smith, M. H., Lompado, A., Hillman, L. W., & Denninghoff, K. R. (2000). Retinal vessel oximetry: toward absolute calibration. In Ophthalmic Technologies X, 3908, 217-226.
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  Accurately measuring the oxygen saturation of blood within retinal arteries and veins has proven to be a deceptively difficult task. Despite the excellent optical accessibility of the vessels and a wide range of reported instrumentation, we are unaware of any measurement technique that has proven to be calibrated across wide ranges of vessel diameter and fundus pigmentation. We present an overview of our retinal oximetry technique, present the results of an in vitro calibration experiment, and present preliminary human data.
• Smith, M. H., Hillman, L. W., Drewes, J. J., & Denninghoff, K. R. (1999). Instrument for the measurement of retinal vessel oxygen saturation. In Ophthalmic Technologies IX, 3591, 114-120.
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  Retinal vessel oxygen saturation has been suggested as a parameter for monitoring a wide range of conditions including occult blood los and a variety of ophthalmic diseases. We have developed an Eye Oximeter (EOX), that noninvasively measures the oxygen saturation of the blood in individual large retinal vessels using scanning lasers. 1D vessel extinction profiles are obtained at four wavelengths (629, 678, 821 and 899 nm), and the vessel transmittances computed. The oxygen saturation of blood within the vessel is then calculated from the transmittance data. We have performed an in vitro experiment on human blood which demonstrates the calibration of the EOX measurements and validates our oximetry equations. Retinal vessel oxygen saturation was measured in a human subject and found to be 65%O 2 Sat and 101 - 102%O 2 Sat in the veins and arteries on the optic disk. Irregularities in the background measured away from the optic disk resulted in a large variance in the calculated saturation when compared to measurements made on the disk.
• Chipman, R. A., Smith, M. H., Minninch, T. E., Hughes, C. E., Hillman, L. W., Denninghoff, K. R., & Chipman, R. A. (1997). Technique for noninvasive monitoring of blood loss via oxygen saturation measurements in the eye. In Optical Diagnostics of Biological Fluids and Advanced Techniques in Analytical Cytology, 2982, 46-52.
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  We describe a noninvasive technique and instrumentation for measuring the oxygen saturation of blood in retinal arteries and veins. A white-light image of a subject's retina is presented to an operator. The operator targets a particular retinal artery or vein and initiates the measurement procedure. The measurements are made by scanning low-power lasers into the eye and across the retinal vessel. The light reflected and scattered back out of the eye is collected and measured. The oxygen saturation of blood within the vessel is spectroscopically determined by analyzing the vessel absorption profiles at two or more wavelengths. A complete saturation measurement can be made in less than one second, allowing real-time measurement during physiological changes. The sensitivity of this measurement technique to changes in retinal saturation has been demonstrated through a series of pilot studies in anesthetized swine. We present data indicating that retinal venous oxygen saturation decreases predictably during ongoing blood loss, indicating a potential application of an eye oximeter to nonivasively monitor blood loss. Current invasive techniques for monitoring bleeding, such as fiber optic pulmonary catheters, are not suited for use early in trauma situations. A portable eye oximeter may therefore provide a new technique for reducing mortality in the emergency department setting.

Presentations

• Barnhart, B., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherrill, D. L., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2017, Jan). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. National Association of EMS Physicians Annual Meeting. New Orleans, LA.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Sherrill D, Denninghoff KR, Keim SM, Viscusi C, Rice AD, Bobrow BJ. 2017. Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Prehospital Emerg Care, 2017;21(1):95.
• Bobrow, B. J., Viscusi, C. D., Keim, S. M., Denninghoff, K. R., Gaither, J. B., Chikani, V., Hu, C., Babaeizadeh, S., Perez, O., Helfenbein, E., Spaite, D. W., & Barnhart, B. J. (2016, Nov). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation 2016;133:A15795
• Deluca, L. A., Durns, T., Miller, R., Roward, Z., Pickering, A., Yeaton, J., & Denninghoff, K. R. (2016, March). Effect of Presenting Complaint on the Risk of Developing Ventilator-Associated Pneumonia for Patients Intubated in an Academic Emergency Department. SAEM Western Regional Meeting. Los Angeles, CA: Society for Academic Emergency Medicine.
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  Analysis of chief complaints (medical vs. surgical) and subsequent VAP risk.
• Deluca, L. A., Durns, T., Miller, R., Yeaton, J., Pickering, A., Roward, Z., Sabb, D., & Denninghoff, K. R. (2016, March). Presenting Illness and Mortality Outcomes for Patients Intubated in an Academic Emergency Department. SAEM Western Regional Meeting. Los Angeles, CA: Society for Academic Emergency Medicine.
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  Analysis of chief complaints (medical vs. surgical) and risk of mortality during subsequent hospital admission.
• Deluca, L. A., Walsh, P., Davidson, D. D., Stoneking, L. R., Yang, L. M., Grall, K., Gonzaga, M. J., Larson, W. J., Durns, T., Miller, R., Pickering, A., Yeaton, J., Stolz, U., Sabb, D. M., & Denninghoff, K. R. (2016, March). VAP Rates are Significantly Reduced by an ED-Based VAP Prevention. SAEM Western Regional Meeting. Los Angeles, CA: Society for Academic Emergency Medicine.
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  ED-Based VAP prevention lowers VAP rates.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Viscusi, C. D., Mullins, T., Martinez, R. A., & Adelson, P. D. (2015, Summer). Comparison of the Performance of Prehospital Systolic Blood Pressure Versus Calculated Mean Arterial Pressure in Predicting Mortality in Major Traumatic Brain Injury. Prehospital Emergency Care.
• Spaite, D. W., Hu, C., Bobrow, B. J., Sherrill, D. L., Chikani, V., Barnhart, B. J., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Viscusi, C. D., Mullins, T., & Stolz, U. (2015, Fall). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury: New Findings From the EPIC Study.. Prehospital Emergency Care.
• Spaite, D. W., Hu, C., Bobrow, B. J., Sherrill, D. L., Chikani, V., Barnhart, B., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Viscusi, C. D., Mullins, T., & Stolz, U. (2015, November). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury.. Resuscitation Science Symposium of the American Heart Association. Orlando, Florida: American Heart Association.

Poster Presentations

• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherril, D., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2017, Jan). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Sherrill D, Denninghoff KR, Keim SM, Viscusi C, Rice AD, Bobrow BJ: Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Prehospital Emerg Care 2017:21(1):95.
• Bates, J., Sobel, J., Ng, V., Berkman, M. R., Nuno, T., & Stoneking, L. R. (2017, April). Effect of Real-time Patient Satisfaction Surveys on Emergency Physician Behavior. Arizona Medical Education Scholars Research Day. Tucson, AZ.
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  Approximately 7.5 hours spent on project for 2017Abstract invited and presented at AMES, April 28, 2017.
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., & Bobrow, B. J. (2016, Nov). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation 2016;133:A15795
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., & Bobrow, B. J. (2016, November). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
• Fukushima, H., Silver, A., Gould, J., Edgell, K., Appleby, D., Iwami, T., Mullins, M., McDannold, R., & Bobrow, B. J. (2016, November). Predictors of Resuscitation Success Prior to EMS Arrival in Out-of-Hospital Cardiac Arrest Patients Treated with a Public Access AED. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
• Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamaguru, M., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Bobrow, B. J. (2016, January). Elevated Initial Trauma Center Body Temperatures Are Associated With Poor Non-Mortality Outcomes Following Major Traumatic Brain Injury. Annual Meeting of the National Association of EMS Physicians. San Diego.
• Denninghoff, K. R., & Deluca, L. A. (2015, December). REDUCTION OF EARLY VAP AFTER BUNDLE DEPLOYMENT FOR PATIENTS INTUBATED IN THE EMERGENCY DEPARTMENT. Society for Critical Care Medicine Annual meeting. Published in December 2015Critical Care Medicine.
• Gaither, J. B., Hu, C., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Spaite, D. W. (2015, Fall). Age-Related Risk of Death in Patients With Major TBI: Implications for Trauma Triage Guidelines.. Prehospital Emergency Care.
• Berkman, M. R., Berkman, M. R., Larsen, J., Larsen, J., Smith, J., Smith, J., Caldwell, J., Caldwell, J., Waterbrook, A. L., Waterbrook, A. L., Stolz, U., Stolz, U., Denninghoff, K. R., & Denninghoff, K. R. (2014, June). Ketamine and Morphine versus Morphine Alone for Treatment of Acute Pain in the Emergency Department. American College of Emergency Physicians Annual Conference.
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  Chicago, IL

Others

• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Sherril, D., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Rice, A. D., & Bobrow, B. J. (2017, Jan). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Sherrill D, Denninghoff KR, Keim SM, Viscusi C, Rice AD, Bobrow BJ: Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Prehospital Emerg Care 2017:21(1):95.
• Bobrow, B. J., Rice, A. D., Viscusi, C. D., Keim, S. M., Denninghoff, K. R., Sherill, D., Gaither, J. B., Chikani, V., Hu, C., Babaeizadeh, S., Barnhardt, B. J., Helfenbein, E., Spaite, D. W., & Perez, O. (2017, Jan). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Prehospital Emergency Care.
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  Perez O, Spaite DW, Helfenbein E, Barnhart BJ, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Sherrill D, Rice AD, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Prehospital Emerg Care 2017:21(1):97.
• Sherril, D., Mullins, T., Viscusi, C. D., Keim, S. M., Denninghoff, K. R., Grady, K., Rice, A. D., Adelson, P. D., Barnhart, B. J., Gaither, J. B., Chikani, V., Bobrow, B. J., Hu, C., & Spaite, D. W. (2017, Jan). Evaluation of Prehospital Hypoxia “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emergency Care.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart BJ, Adelson PD, Rice AD, Grady K, Denninghoff KR, Keim SM, Viscusi C, Mullins T, Sherrill D: Evaluation of Prehospital Hypoxia “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emerg Care 2017:21(1):91.
• Barnhardt, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., & Bobrow, B. J. (2016, June). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation.
• Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., & Bobrow, B. J. (2016, Nov). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation.
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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Bobrow BJ: Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation 2016;A15795
• Gaither, J. B., Gaither, J. B., Chikani, V., Chikani, V., Spaite, D. W., Spaite, D. W., Smith, J. J., Smith, J. J., Curry, M., Curry, M., Mhayamagru, M., Mhayamagru, M., Barnhart, B. J., Barnhart, B. J., Adelson, P. D., Adelson, P. D., Viscusi, C. D., Viscusi, C. D., Denninghoff, K. R., , Denninghoff, K. R., et al. (2016, Spring). Elevated Initial Trauma Center Body Temperatures Are Associated With Poor Non-Mortality Outcomes Following Major Traumatic Brain Injury. Prehospital Emergency Care.
• Gaither, J. B., Gaither, J. B., Chikani, V., Chikani, V., Spaite, D. W., Spaite, D. W., Smith, J., Smith, J., Curry, M., Curry, M., Mhayamaguru, K. M., Mhayamaguru, K. M., Barnhart, B., Barnhart, B., Adelson, P. D., Adelson, P. D., Viscusi, C. D., Viscusi, C. D., Denninghoff, K. R., , Denninghoff, K. R., et al. (2016, June). Elevated Initial Trauma Center Body Temperatures Are Associated With Poor Non-Mortality Outcomes Following Major Traumatic Brain Injury. Prehospital Emergency Care.
• Gaither, J. B., Hu, C., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Spaite, D. W. (2016, Spring). Age-Related Risk of Death in Patients With Major TBI: Implications for Trauma Triage Guidelines.. Prehospital Emergency Care.
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhardt, B. J., Babaeizadeh, S., Hu, C., Vatsal, C., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Sherill, D., & Bobrow, B. J. (2016, June). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Circulation.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Barnhardt, B. J., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Keim, S. M., Viscusi, C. D., Mullins, T., & Sherrill, D. (2016, June). Evaluation of Prehospital Hypotension Depth-Duration Dose and Mortality in Major Traumatic Brain Injury. Circulation.
• Spaite, D. W., Hu, C., Bobrow, B. J., Sherrill, D. L., Chikani, V., Barnhart, B. J., Gaither, J. B., Adelson, P. D., Viscusi, C. D., Mullins, T., Denninghoff, K. R., & Stolz, U. (2016, Spring). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury: New Findings From the EPIC Study. Prehospital Emergency Care.
• Spaite, D. W., Hu, C., Bobrow, B. J., Sherrill, D. L., Chikani, V., Barnhart, B. J., Martinez, R. A., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Viscusi, C. D., Mullins, T., & Stolz, U. (2016, Spring). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury. Circulation.
• Spaite, D. W., Spaite, D. W., Hu, C., Hu, C., Bobrow, B. J., Bobrow, B. J., Chikani, V., Chikani, V., Sherrill, D. L., Sherrill, D. L., Barnhart, B. J., Barnhart, B. J., Gaither, J. B., Gaither, J. B., Denninghoff, K. R., Denninghoff, K. R., Viscusi, C. D., Viscusi, C. D., Mullins, T., , Mullins, T., et al. (2016, Spring). Comparison of the Performance of Prehospital Systolic Blood Pressure Versus Calculated Mean Arterial Pressure in Predicting Mortality in Major Traumatic Brain Injury. Prehospital Emergency Care.
• Spaite, D. W., Viscusi, C. D., Denninghoff, K. R., Barnhart, B. J., Stolz, U., Hu, C., Gaither, J. B., Bobrow, B. J., Sherrill, D. L., Chikani, V., Adelson, P. D., & Mullins, T. (2016, Spring). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury: New Findings From the EPIC Study.. Circulation.
• Spaite, D. W., Viscusi, C. D., Denninghoff, K. R., Barnhart, B. J., Stolz, U., Hu, C., Gaither, J. B., Bobrow, B. J., Sherrill, D. L., Chikani, V., Adelson, P. D., & Mullins, T. (2016, Spring). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury: New Findings From the EPIC Study.. Prehospital Emergency Care.
• Deluca, L. A., Durns, T., Davidson, D., Gerlach, E., & Denninghoff, K. R. (2015, June). The Impact of Advanced Directives on Non-Survivors who are Intubated in the Emergency Department. Academic Emergency Medicine.
• Deluca, L. A., Durns, T., Miller, R., Roward, Z., Pickering, A., Yeaton, J., & Denninghoff, K. R. (2015, June). Presenting Illness and Mortality Outcomes for Patients Intubated in an Academic Emergency Department. Intensive Care Medicine.
• Deluca, L. A., Durns, T., Miller, R., Yeaton, J., Pickering, A., Roward, Z., Saab, D., & Denninghoff, K. R. (2015, June). The Effect of Presenting Complaint on the Risk of Developing Ventilator-Associated Pneumonia for Patients Intubated in an Academic Emergency Department. Intensive Care Medicine.
• Deluca, L. A., Stoneking, L. R., Grall, K., Tran, A., Rosell, J., Vira, A., Davidson, D., Cox, L., Gerlach, E., Gonzaga, J., Munzer, B., Larson, W., Westergard, A., & Denninghoff, K. R. (2015, June). Ventilator-Associated Pneumonia (VAP) Rates are Significantly Reduced by Deploying the VAP Bundle in an Academic Emergency Department. Academic Emergency Medicine.
• Gaither, J. B., Chikani, V., Spaite, D. W., Smith, J. J., Curry, M., Mhayamaguru, M., Barnhart, B. J., Adelson, P. D., Viscusi, C. D., Denninghoff, K. R., & Bobrow, B. J. (2015, Spring). Association Between Elevated Initial Trauma Center Body Temperature and Non-Mortality Outcomes Following Major Traumatic Brain Injury. Circulation.
• Gaither, J. B., Gaither, J. B., Chikani, V., Chikani, V., Spaite, D. W., Spaite, D. W., Stolz, U., Stolz, U., Garison, S., Garison, S., Smith, J., Smith, J., Barnhart, B. J., Barnhart, B. J., Adelson, P. D., Adelson, P. D., Viscusi, C. D., Viscusi, C. D., Denninghoff, K. R., , Denninghoff, K. R., et al. (2015, Spring). Association Between Initial Trauma Center Body Temperature and Mortality from Major Traumatic Brain Injury. Prehospital Emergency Care.
• Spaite, D. W., Chengcheng, H., Bobrow, B. J., Sherrill, D. L., Chikani, V., Barnhart, B. J., Martinez, R. A., Gaither, J. B., Denninghoff, K. R., Adelson, P. D., Viscusi, C. D., Mullins, T., & Stolz, U. (2015, Spring). Association Between Survival and Increases in Prehospital Systolic Blood Pressure After Its Nadir in Major Traumatic Brain Injury. Prehospital Emergency Care.
• Stolz, U., Spaite, D. W., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Gaither, J. B., Adelson, P. D., Viscusi, C. D., Mullins, T., Humble, W. O., & Denninghoff, K. R. (2015, Spring). Association Between Lowest Prehospital Systolic Blood Pressure and Non-Mortality Outcomes in Major Traumatic Brain Injury: Is There a “Hypotension” Threshold?. Prehospital Emerg Care.
• Stolz, U., Spaite, D. W., Bobrow, B. J., Chikani, V., Sherrill, D. L., Barnhart, B. J., Gaither, J. B., Adelson, P. D., Viscusi, C. D., Mullins, T., Humble, W. O., & Denninghoff, K. R. (2015, Spring). Association Between Lowest Prehospital Systolic Blood Pressure and Non-Mortality Outcomes in Major Traumatic Brain Injury: Is There a “Hypotension” Threshold?. Prehospital Emergency Care.