Pamela Carol Garcia-Filion
- Associate Research Scientist
- Research Associate Professor, Biomedical Informatics
- Research Associate Professor, Public Health
- Member of the Graduate Faculty
- AAMC mid-career leadership awardee
- AAMC, Winter 2019
- Best Paper in North America
- Hormone Research in Pediatrics, Summer 2018
No activities entered.
Informatics for Clinical RsrchCTS 503 (Spring 2020)
- Bromberg, C. E., Condon, A. M., Ridgway, S. W., Krishna, G., Garcia-Filion, P. C., Adelson, P. D., Rowe, R. K., & Thomas, T. C. (2020). Sex-Dependent Pathology in the HPA Axis at a Sub-acute Period After Experimental Traumatic Brain Injury. Frontiers in neurology, 11, 946.More infoOver 2.8 million traumatic brain injuries (TBIs) are reported in the United States annually, of which, over 75% are mild TBIs with diffuse axonal injury (DAI) as the primary pathology. TBI instigates a stress response that stimulates the hypothalamic-pituitary-adrenal (HPA) axis concurrently with DAI in brain regions responsible for feedback regulation. While the incidence of affective symptoms is high in both men and women, presentation is more prevalent and severe in women. Few studies have longitudinally evaluated the etiology underlying late-onset affective symptoms after mild TBI and even fewer have included females in the experimental design. In the experimental TBI model employed in this study, evidence of chronic HPA dysregulation has been reported at 2 months post-injury in male rats, with peak neuropathology in other regions of the brain at 7 days post-injury (DPI). We predicted that mechanisms leading to dysregulation of the HPA axis in male and female rats would be most evident at 7 DPI, the sub-acute time point. Young adult age-matched male and naturally cycling female Sprague Dawley rats were subjected to midline fluid percussion injury (mFPI) or sham surgery. Corticotropin releasing hormone, gliosis, and glucocorticoid receptor (GR) levels were evaluated in the hypothalamus and hippocampus, along with baseline plasma adrenocorticotropic hormone (ACTH) and adrenal gland weights. Microglial response in the paraventricular nucleus of the hypothalamus indicated mild neuroinflammation in males compared to sex-matched shams, but not females. Evidence of microglia activation in the dentate gyrus of the hippocampus was robust in both sexes compared with uninjured shams and there was evidence of a significant interaction between sex and injury regarding microglial cell count. GFAP intensity and astrocyte numbers increased as a function of injury, indicative of astrocytosis. GR protein levels were elevated 30% in the hippocampus of females in comparison to sex-matched shams. These data indicate sex-differences in sub-acute pathophysiology following DAI that precede late-onset HPA axis dysregulation. Further understanding of the etiology leading up to late-onset HPA axis dysregulation following DAI could identify targets to stabilize feedback, attenuate symptoms, and improve efficacy of rehabilitation and overall recovery.
- Kruglyakova, J., Garcia-Filion, P., Nelson, M., & Borchert, M. (2020). Orbital MRI versus fundus photography in the diagnosis of optic nerve hypoplasia and prediction of vision. The British journal of ophthalmology, 104(10), 1458-1461.More infoIn patients with optic nerve hypoplasia (ONH), the visualisation of the optic disc can be challenging and the definitive diagnosis difficult to ascertain without fundus photography. The use of MRI for diagnosis has been reported as a diagnostic alternative with conflicting results. We retrospectively analysed a disease registry to determine the reliability of orbital MRI measurements of the optic nerve diameter to diagnose ONH, and the correlation with vision outcomes.
- Bailly, D. K., Reeder, R. W., Winder, M., Barbaro, R. P., Pollack, M. M., Moler, F. W., Meert, K. L., Berg, R. A., Carcillo, J., Zuppa, A. F., Newth, C., Berger, J., Bell, M. J., Dean, M. J., Nicholson, C., Garcia-Filion, P., Wessel, D., Heidemann, S., Doctor, A., , Harrison, R., et al. (2019). Development of the Pediatric Extracorporeal Membrane Oxygenation Prediction Model for Risk-Adjusting Mortality. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 20(5), 426-434.More infoTo develop a prognostic model for predicting mortality at time of extracorporeal membrane oxygenation initiation for children which is important for determining center-specific risk-adjusted outcomes.
- Garcia, P. C., Kruglyakova, J., Borchert, M., & Marvin, N. (2019). Orbital MRI vs fundus photography in the diagnosis of optic nerve hypoplasia and prediction of vision. British Journal of Ophthalmology.
- Schwedt, T. J., Peplinski, J., Garcia-Filion, P., & Berisha, V. (2019). Altered speech with migraine attacks: A prospective, longitudinal study of episodic migraine without aura. Cephalalgia : an international journal of headache, 39(6), 722-731.More infoSome individuals with migraine report the presence of speech changes during their migraine attacks. The goal of this study was to compare objective features of speech during the migraine pre-attack, the migraine attack, and during the interictal period.
- Shahid, M., Shaibi, G. Q., Baines, H., Garcia-Filion, P., Gonzalez-Garcia, Z., & Olson, M. (2018). Risk of hypoglycemia in youth with type 2 diabetes on insulin. Journal of pediatric endocrinology & metabolism : JPEM, 31(6), 625-630.More infoThe objective of this study was to ascertain the risk of hypoglycemia among youth with type 2 diabetes (T2D) on insulin therapy.
- Balasuriya, L., Vyles, D., Bakerman, P., Holton, V., Vaidya, V., Garcia-Filion, P., Westdorp, J., Sanchez, C., & Kurz, R. (2017). Computerized Dose Range Checking Using Hard and Soft Stop Alerts Reduces Prescribing Errors in a Pediatric Intensive Care Unit. Journal of patient safety, 13(3), 144-148.More infoAn enhanced dose range checking (DRC) system was developed to evaluate prescription error rates in the pediatric intensive care unit and the pediatric cardiovascular intensive care unit.
- Berisha, V., Wang, S., LaCross, A., Liss, J., & Garcia-Filion, P. (2017). Longitudinal changes in linguistic complexity among professional football players. Brain and language, 169, 57-63.More infoReductions in spoken language complexity have been associated with the onset of various neurological disorders. The objective of this study is to analyze whether similar trends are found in professional football players who are at risk for chronic traumatic encephalopathy. We compare changes in linguistic complexity (as indexed by the type-to-token ratio and lexical density) measured from the interview transcripts of players in the National Football League (NFL) to those measured from interview transcripts of coaches and/or front-office NFL executives who have never played professional football. A multilevel mixed model analysis reveals that exposure to the high-impact sport (vs no exposure) was associated with an overall decline in language complexity scores over time. This trend persists even after controlling for age as a potential confound. The results set the stage for a prospective study to test the hypothesis that language complexity decline is a harbinger of chronic traumatic encephalopathy.
- Cook, A., Osler, T., Hosmer, D., Glance, L., Rogers, F., Gross, B., Garcia-Filion, P., & Malhotra, A. (2017). Gunshot wounds resulting in hospitalization in the United States: 2004-2013. INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 48(3), 621-627.
- Cook, A., Osler, T., Hosmer, D., Glance, L., Rogers, F., Gross, B., Garcia-Filion, P., & Malhotra, A. (2017). Gunshot wounds resulting in hospitalization in the United States: 2004-2013. Injury, 48(3), 621-627.More infoThe United States (US) leads all high income countries in gunshot wound (GSW) deaths. However, as a result of two decades of reduced federal support, study of GSW has been largely neglected. In this paper we describe the current state of GSW hospitalizations in the US using population-based data.
- Dalton, H. J., Reeder, R., Garcia-Filion, P., Holubkov, R., Berg, R. A., Zuppa, A., Moler, F. W., Shanley, T., Pollack, M. M., Newth, C., Berger, J., Wessel, D., Carcillo, J., Bell, M., Heidemann, S., Meert, K. L., Harrison, R., Doctor, A., Tamburro, R. F., , Dean, J. M., et al. (2017). Factors Associated with Bleeding and Thrombosis in Children Receiving Extracorporeal Membrane Oxygenation. American journal of respiratory and critical care medicine, 196(6), 762-771.More infoExtracorporeal membrane oxygenation (ECMO) is used for respiratory and cardiac failure in children but is complicated by bleeding and thrombosis.
- Garcia-Filion, P., Almarzouki, H., Fink, C., Geffner, M., Nelson, M., & Borchert, M. (2017). Brain Malformations Do Not Predict Hypopituitarism in Young Children with Optic Nerve Hypoplasia. Hormone research in paediatrics, 88(3-4), 251-257.More infoOptic nerve hypoplasia (ONH), a leading cause of pediatric blindness, is associated with brain malformations and hypopituitarism in the constellation known as septo-optic dysplasia. Neuroimaging is used to anticipate hypopituitarism, but with unconfirmed reliability. We report prospective findings on the association of hypopituitarism with brain malformations.
- Hammond, B. G., Garcia-Filion, P., Kang, P., Rao, M. Y., Willis, B. C., & Dalton, H. J. (2017). Identifying an Oxygenation Index Threshold for Increased Mortality in Acute Respiratory Failure. Respiratory care, 62(10), 1249-1254.More infoThe objective of this work was to examine current oxygenation index (OI) data and outcomes using electronic medical record data to identify a specific OI value associated with mortality.
- McCulloch, D., Garcia-Filion, P., Fink, C., Fisher, A. C., Eleuteri, A., & Borchert, M. S. (2017). Predictive value of N95 waveforms of pattern electroretinograms (PERGs) in children with optic nerve hypoplasia (ONH). Documenta ophthalmologica. Advances in ophthalmology, 135(2), 97-106.More infoAs part of a long-term, prospective study of prenatal and clinical risk factors for optic nerve hypoplasia (ONH) at Children's Hospital Los Angeles, pattern ERGs (PERGs) were evaluated for prognostic value using an automated objective and robust analytical method.
- Magoteaux, S., Gilbert, M., Langlais, C. S., Garcia-Filion, P., & Notrica, D. M. (2016). Should Children with Suspected Nonaccidental Injury Be Admitted to a Surgical Service?. Journal of the American College of Surgeons, 222(5), 838-43.More infoIn many hospitals, children with suspected nonaccidental trauma (sNAT) are admitted to nonsurgical services (NSS). Although the surgical service (SS) initially admitted sNAT patients at our American College of Surgeons (ACS)-verified level 1 pediatric trauma center (vPTC), a change in hospital policy allowed admission to NSS. The objective of this study was to determine if the rate of care-related indicators (CRIs) varies by admission to an SS vs an NSS in the sNAT patient population.
- Stewart, C., Garcia-Filion, P., Fink, C., Ryabets-Lienhard, A., Geffner, M. E., & Borchert, M. (2016). Efficacy of growth hormone replacement on anthropometric outcomes, obesity, and lipids in children with optic nerve hypoplasia and growth hormone deficiency. International journal of pediatric endocrinology, 2016, 5.More infoHypopituitarism and obesity are causes of major lifelong morbidity in patients with optic nerve hypoplasia (ONH). Growth hormone deficiency (GHD) affects the majority of children with ONH, though the degree of deficiency and variability of early growth patterns range from early severe retardation to normal initial growth. The utility of early GH replacement for improving anthropometric, body composition, and lipid outcomes in patients with ONH and GHD, especially those with normal initial height velocity, is unknown. This study examines the effects of GH replacement in a cohort of children with ONH and GHD.
- Buttram, S. D., Garcia-Filion, P., Miller, J., Youssfi, M., Brown, S. D., Dalton, H. J., & Adelson, P. D. (2015). Computed tomography vs magnetic resonance imaging for identifying acute lesions in pediatric traumatic brain injury. Hospital pediatrics, 5(2), 79-84.More infoPediatric traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Computed tomography (CT) is the modality of choice to screen for brain injuries. MRI may provide more clinically relevant information. The purpose of this study was to compare lesion detection between CT and MRI after TBI.
- Dalton, H. J., Garcia-Filion, P., Holubkov, R., Moler, F. W., Shanley, T., Heidemann, S., Meert, K., Berg, R. A., Berger, J., Carcillo, J., Newth, C., Harrison, R., Doctor, A., Rycus, P., Dean, J. M., Jenkins, T., Nicholson, C., & , E. K. (2015). Association of bleeding and thrombosis with outcome in extracorporeal life support. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 16(2), 167-74.More infoChanges in technology and increased reports of successful extracorporeal life support use in patient populations, such as influenza, cardiac arrest, and adults, are leading to expansion of extracorporeal life support. Major limitations to extracorporeal life support expansion remain bleeding and thrombosis. These complications are the most frequent causes of death and morbidity. As a pilot project to provide baseline data for a detailed evaluation of bleeding and thrombosis in the current era, extracorporeal life support patients were analyzed from eight centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network.
- Fisher, A. C., McCulloch, D. L., Borchert, M. S., Garcia-Filion, P., Fink, C., Eleuteri, A., & Simpson, D. M. (2015). Comparison of human expert and computer-automated systems using magnitude-squared coherence (MSC) and bootstrap distribution statistics for the interpretation of pattern electroretinograms (PERGs) in infants with optic nerve hypoplasia (ONH). Documenta ophthalmologica. Advances in ophthalmology, 131(1), 25-34.More infoPattern electroretinograms (PERGs) have inherently low signal-to-noise ratios and can be difficult to detect when degraded by pathology or noise. We compare an objective system for automated PERG analysis with expert human interpretation in children with optic nerve hypoplasia (ONH) with PERGs ranging from clear to undetectable.
- Notrica, D. M., Eubanks, J. W., Tuggle, D. W., Maxson, R. T., Letton, R. W., Garcia, N. M., Alder, A. C., Lawson, K. A., St Peter, S. D., Megison, S., & Garcia-Filion, P. (2015). Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE. The journal of trauma and acute care surgery, 79(4), 683-93.More infoNonoperative management of liver and spleen injury should be achievable for more than 95% of children. Large national studies continue to show that some regions fail to meet these benchmarks. Simultaneously, current guidelines recommend hospitalization for injury grade + 2 (in days). A new treatment algorithm, the ATOMAC guideline, is in clinical use at many centers but has not been prospectively validated.
- Oatman, O. J., McClellan, D. R., Olson, M. L., & Garcia-Filion, P. (2015). Endocrine and pubertal disturbances in optic nerve hypoplasia, from infancy to adolescence. International journal of pediatric endocrinology, 2015(1), 8.More infoEndocrinologic abnormalities are a common co-morbidity in patients with optic nerve hypoplasia (ONH), however the impact on puberty is unknown. The purpose of this study was to examine rates of endocrine dysfunction and pubertal disturbances in a pediatric population of ONH.
- Borchert, M., Garcia-Filion, P., Fink, C., Geffner, M., & Nelson, M. (2014). Re: Ramakrishnaiah et al.: Reliability of magnetic resonance imaging for the detection of hypopituitarism in children with optic nerve hypoplasia (Ophthalmology 2014;121:387-91). Ophthalmology, 121(5), e26-7.
- Johnson, J. J., Tuggle, D. W., Garcia, N. M., Eubanks, J. W., Notrica, D. M., Brahmamdam, P., Megison, S., Maxson, R. T., Piper, K., Lawson, K. A., Garcia-Filion, P., & Recicar, J. (2014). The use of a computer-based internal education program for pediatric trauma centers: a multicenter ATOMAC study. The American surgeon, 80(4), 419-21.
- Johnson, K. N., Harte, M., Garcia-Filion, P., & Notrica, D. M. (2014). Fate of the combined adult and pediatric trauma centers: impact of increased pediatric trauma requirements. The American surgeon, 80(12), 1280-2.
- Johnson, K. N., Raetz, A., Harte, M., McMahon, L. E., Grandsoult, V., Garcia-Filion, P., & Notrica, D. M. (2014). Pediatric trauma patient alcohol screening: a 3 year review of screening at a Level I pediatric trauma center using the CRAFFT tool. Journal of pediatric surgery, 49(2), 330-2.More infoAlcohol use is a risk factor for adult trauma. Alcohol may significantly influence pediatric trauma risk, but literature is sparse. The aim of this study was to examine the impact of alcohol use screening in pediatric trauma patients.
- Lettieri, C. K., Garcia-Filion, P., & Hingorani, P. (2014). Incidence and outcomes of desmoplastic small round cell tumor: results from the surveillance, epidemiology, and end results database. Journal of cancer epidemiology, 2014, 680126.More infoDesmoplastic small round cell tumor (DSRCT) is a rare but highly fatal malignancy. Due to the rarity of this neoplasm, no large population based studies exist. Procedure. This is a retrospective cohort analysis. Incidence rates were calculated based on sex and ethnicity and compared statistically. Gender-, ethnicity-, and treatment- based survival were calculated using the Kaplan-Meier method. Results. A total of 192 cases of DSRCT were identified. Peak incidence age was between 20 and 24 years. Age-adjusted incidence rate for blacks was 0.5 cases/million and for whites was 0.2 cases/million (P = 0.037). There was no statistically significant difference in survival based on gender or ethnicity. When adjusted for age, there was no statistically significant difference in survival amongst patients who received radiation therapy compared to those who did not (HRadj = 0.73; 95% CI 0.49, 1.11). There was a statistically significant survival advantage for patients who received radiation after surgery compared to those who did not (HR 0.49; 95% CI 0.30, 0.79). Conclusion. DSRCT is more common in males and in people of African-American descent. Although overall survival remains poor, radiation therapy following surgery seems to improve outcome in these patients.
- Sutedja, J., Garcia-Filion, P., Fink, C., & Borchert, M. (2014). Absence of age-related optic disk changes in young children with optic nerve hypoplasia. Eye (London, England), 28(5), 562-6.More infoTo determine whether the ratio of optic disk diameter to disk-to-macula distance (DD/DM) in children with optic nerve hypoplasia (ONH) changes over time.
- Azarakhsh, N., Grimes, S., Notrica, D. M., Raines, A., Garcia, N. M., Tuggle, D. W., Maxson, R. T., Alder, A. C., Recicar, J., Garcia-Filion, P., Greenwell, C., Lawson, K. A., Wan, J. Y., & Eubanks, J. W. (2013). Blunt cerebrovascular injury in children: underreported or underrecognized?: A multicenter ATOMAC study. The journal of trauma and acute care surgery, 75(6), 1006-11; discussion 1011-2.More infoBlunt cerebrovascular injury (BCVI) has been well described in the adult trauma literature. The risk factors, proper screening, and treatment options are well known. In pediatric trauma, there has been very little research performed regarding this injury. We hypothesize that the incidence of BCVI in children is lower than the 1% reported incidence in adult studies and that many children at risk are not being screened properly.
- Fink, C., Garcia-Filion, P., & Borchert, M. (2013). Failure of stem cell therapy to improve visual acuity in children with optic nerve hypoplasia. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus, 17(5), 490-3.More infoTo evaluate the effectiveness of stem cell therapy in improving visual acuity or optic nerve function in children with optic nerve hypoplasia (ONH).
- Garcia, P. C., Panchanathan, S., & Muth, A. (2019, November). Objective measures for medical education from the EHR. AMIA. Washington, DC.
- Garcia, P. C., Kruglyakova, J., & Borchert, M. (2019, May). Diagnosis of optic nerve hypoplasia and vision prognosis with orbital MRI vs fundus photography. ARVO. Vancouver, Canada.
- Garcia, P. C., McCulloch, D., & Borchert, M. (2019, May). Repeated measures comparison of chloral hydrate and propofol effects on full field electroretinograms (ERGs) and pattern ERGs (PERGS). ARVO. Vancouver, Canada.
- Garcia, P. C., Panchanathan, S., Hsiao, S., & Paredes, Y. (2020, April). Exploring Medical Education Learning Analytics from the Use of Electronic Health Record Systems. Learning Analytics. Tempe, Arizona.
- Martinez, G. F., Gallitano-Mendel, A. L., Nelson, L. R., Lucio, F., Hartmark-Hill, J. R., Garcia, P. C., Gulati, M., Mallin, E., Thomas, T., & Herbst-Kralovetz, M. (2019, November). Strategic initiative to create a Women in Medicine and Science (WIMS) program at a recently established and independently accredited College of Medicine. AAMC Learn Serve Lead. Phoenix, AZ: AAMC.