Samuel M Keim

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Scholarly Contributions

Chapters

• Mosier, J. M., & Keim, S. M. (2010). Complications of Cardiac Transplatation. In Rosen and Barkin's 5-Minute Emergency Medicine Consult. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins.

Journals/Publications

• Tyler, L., Bhakta, Y., Gottlieb, M., Kraus, C. K., Kowalenko, T., Calderon, Y., Keim, S. M., Gorgas, D. L., Diercks, D. B., & Nelson, L. S. (2026). Factors associated with corrective actions, remediation, and employment termination of emergency physicians. American Journal of Emergency Medicine, 99(Issue). doi:10.1016/j.ajem.2025.10.009
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  Objective: Medical professionalism is fundamental to the delivery of high-quality patient care. There is a paucity of data to describe behaviors associated with negative professional and employment outcomes. This study examines common factors leading to corrective actions, remediation, and termination of emergency physicians (EPs). Methods: This was a cross-sectional survey sent to academic chairs in emergency medicine to identify factors for corrective actions, remediation, or termination of EPs. Survey items were piloted and response process validity gathered prior to administration. Data are reported as descriptive statistics. Results: 60 of 167 (36 %) members of the Association of Academic Chairs in Emergency Medicine (AACEM) completed the survey. Most respondents were male (75 %), at least 45 years of age (93 %), had been in practice for at least 20 years (85 %), had 5 or more years' experience as an academic chair (63 %), and had served as chair for more than 60 EPs (70 %). Respondents reported providing corrective action for approximately 700 EPs, remediation for 371 EPs, and termination for 132 EPs. Corrective actions were most common for: disrespecting others (82 %), poor working relationships with nursing (77 %), and insufficient academic output (70 %). Remediation was most common for: disrespecting others (47 %), substandard patient care (43 %), and poor working relationships with nursing staff (42 %). Termination was most common for: substandard patient care (32 %), disrespecting others (23 %), and conviction for illegal activity (22 %). Conclusion: In this survey of academic chairs in emergency medicine, the most common factors of employment-related corrective actions, remediation, and termination among EPs were related to issues of professionalism. There may be opportunities to address these issues prior to employment termination. Future studies should be expanded to include survey respondents who are not academic chairs in emergency medicine.
• Finch, A. S., Keim, S. M., Bellamkonda, V. R., Carpenter, C. R., & Mattu, A. (2025). Coronary Computed Tomography Angiography for Assessment of Suspected Acute Coronary Syndrome in the Emergency Department. Journal of Emergency Medicine, 78(Issue). doi:10.1016/j.jemermed.2025.07.020
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  Background: Chest pain is a common chief symptom in the emergency department (ED). Acute coronary syndrome (ACS) is a critical diagnosis and, when missed, is associated with adverse patient outcomes and is frequently associated with malpractice claims. Coronary computed tomography angiography (cCTA) is increasingly available to ED patients and it may aid in diagnosis of ACS. Clinical Question: In adults presenting to the ED with suspected ACS, does cCTA during ED evaluation improve patient-centered outcomes compared with standard interventions, such as clinical gestalt, the HEART score/pathway, and nonimaging disposition strategies? Evidence Review: Three studies were reviewed, including a before-and-after retrospective study, a randomized controlled trial, and a systematic review, in addition to consensus recommendations from the Society of Cardiovascular Computed Tomography, American College of Radiology, and North American Society for Cardiovascular Imaging. Conclusions: Compared with current ED management strategies for suspected ACS, routinely ordering cCTA for patients with chest pain does not improve 1-year cardiac outcomes, reduce admissions, or return visits. However, among low-risk (< 10% baseline risk) patients with ACS, cCTA reduces hospital length of stay and lower costs while increasing revascularization rates. Ultimately, targeting cCTA for patients at higher short-term risk for major adverse cardiovascular events and limited access to invasive cardiac catheterization laboratories may prove to be more efficacious and cost-effective.
• Hamilton, R. J., Becker, L. B., Wolfe, R. E., Algren, D. A., Arnold, T., Baumann, M., Berkeley, R. P., Caffery, T. S., Cannon, C. M., Corbin, T. J., Chansky, M. E., Dhindsa, H. S., Emerman, C. L., Farcy, D. A., Fox, C., Gibbs, M. A., Goode, C. S., Godwin, S. A., Jehle, D., , Johnson, D., et al. (2025). Letter of Concern from the Association of Academic Chairs of Emergency Medicine Regarding ACGME Proposed Changes. The western journal of emergency medicine, 26(Issue 4). doi:10.5811/westjem.48840
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  This letter, signed by over 50 academic chairs of emergency medicine, urges the ACGME to reconsider a proposed mandate requiring all emergency medicine residency programs to adopt a four-year training model. The authors argue that current three-year programs are supported by data demonstrating equivalent educational and clinical outcomes compared to four-year formats. They criticize the flawed survey methodology underpinning the proposal, note the loss of milestone-based training flexibility, and highlight the lack of added scholarly or clinical value in the fourth year. The letter also outlines negative consequences for fellowship participation, workforce development, trainee debt, and diversity. The signatories advocate for maintaining the current flexible training model to preserve excellence, equity, and innovation in emergency medicine education.
• Long, B., Keim, S. M., Gottlieb, M., Schauer, S. G., & Schmitz, G. (2025). Is Intravenous Contrast Associated with Increased Risk of Acute Kidney Injury?. Journal of Emergency Medicine, 72(Issue). doi:10.1016/j.jemermed.2024.11.013
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  Background: Computed tomography (CT) is a common imaging modality used in the emergency department. Intravenous (i.v.) contrast can assist with visualization of pathology, particularly for inflammatory conditions and vascular structures. However, i.v. contrast has historically been associated with the risk of acute kidney injury (AKI). Clinical Question: Is i.v. contrast associated with an increased risk of AKI? Evidence Review: Studies retrieved included four systematic reviews and meta-analyses evaluating the use of i.v. contrast for CT and association with AKI, need for kidney replacement therapy, and mortality. These studies provide estimates of the potential association of AKI with use of i.v. contrast for CT. Conclusion: Based upon the available literature, the use of i.v. contrast for CT imaging does not seem to be associated with an increased risk of AKI.
• Reisdorff, E. J., Johnston, M. M., Bhakta, Y., Keim, S. M., Ankel, F. K., Singh, H., Abashkin, Y., Kraus, C. K., Barton, M. A., Ruff, K. C., & Santen, S. A. (2025). Association between American Board of Emergency Medicine certification performance and severe state medical licensure actions. American Journal of Emergency Medicine, 93(Issue). doi:10.1016/j.ajem.2025.04.013
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  Background: Maintaining ABEM certification is associated with fewer state medical board disciplinary actions. To become ABEM-certified, candidates must pass the Qualifying Examination (QE) and then pass the Oral Certification Examination (OCE). The purpose of this study was to examine the relationship between certification examination performance and severe state medical board licensure actions for emergency physicians. Methods: The sample was residency-trained emergency medicine physicians who graduated in 1973 or after and attempted to gain ABEM certification from 1979 to 2016. After excluding physicians who did not take the QE, graduated from non-categorical residency programs, or received a disciplinary action prior to graduation, 35,321 physicians remained. Severe actions were defined as actions that resulted in the denial, revocation, surrender, or suspension of a medical license. Severe actions data from 2021 and earlier were obtained from the NPDB. Analysis included descriptive statistics and Cox proportional hazard regression. Results: Physicians were divided into three groups based on their performance on the QE and OCE. Group 1 physicians (30,058; 85.1 %) passed both examinations on their first attempt; Group 2 (4694; 13.3 %) passed the QE and OCE after multiple attempts on either or both exams; and Group 3 (569; 1.6 %) never passed either the QE or OCE. There were 274 (0.9 %) physicians in Group 1 with severe actions; 96 (2.1 %) in Group 2; and 23 (4.0 %) in Group 3. Physicians in Group 1 had a lower rate of severe actions per 1000 person-years (0.52; 95 % CI, 0.46–0.59) than did physicians in Group 2 (1.02; 95 % CI, 0.81–1.22) or Group 3 (1.88; 95 % CI, 1.11–2.65). Compared to Group 1, Group 2 had a hazard ratio (HR) of 1.81 (95 % CI, 1.44–2.29); and Group 3 had an HR of 3.19 (95 % CI, 2.08–4.89). Compared to Group 2, Group 3 had a HR of 1.86 (95 % CI, 1.18–2.94). Additionally, female physicians were less likely to have severe actions than male physicians (Χ2(1) = 12.7, P < 0.01) when excluding physicians with no reported sex. Conclusion: Difficulty becoming ABEM-certified is associated with severe medical board licensure actions. Never achieving ABEM certification was associated with the highest risk of action.
• Reisdorff, E. J., Keim, S. M., Gorgas, D. L., White, S. R., Kendall, J. L., Ruff, K. C., Ankel, F. K., Farrell, S. E., Calderon, Y., Gottlieb, M., Bhakta, Y., Barton, M. A., & Joldersma, K. B. (2025). Declining Performance on American Board of Emergency Medicine Written Examinations. AEM Education and Training, 9(Issue 5). doi:10.1002/aet2.70105
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  Introduction: Emergency medicine (EM) is at a critical juncture with pervasive boarding and overcrowding, a rapid rise in new residency programs, and continuing recovery from the COVID-19 pandemic. These factors could all potentially impact trainees' learning experiences. To explore how this has influenced trainee knowledge acquisition, we analyzed the trends in the American Board of Emergency Medicine (ABEM) In-training Examination (ITE) and the written Qualifying Examination (QE). Methods: This was a retrospective study of multiyear performance trends for the ITE (2018–2024) and QE (2019–2024). Only ITE results from residents in categorical ACGME-accredited EM programs were included. ITE performance was the aggregate mean scaled (equated) scores of all EM training levels. The measures for QE performance were the mean scaled scores (equated) and the pass rates. For each test, descriptive statistics were reported and an omnibus analysis of variance (ANOVA) comparing scores across years was computed. When an ANOVA result was statistically significant (α < 0.01), Tukey's tests were performed. Results: For the ITE, there were 61,512 test results, of which 59,075 (96.0%) met inclusion criteria. The mean (SD) scaled ITE scores declined from 77.36 (8.85) in 2018 to 72.19 (9.44) in 2024. The ANOVA for the ITE scaled scores was statistically significant (p < 0.01). The QE had 17,040 test results, of which 15,651 (91.8%) met inclusion criteria. The mean (SD) scaled scores declined from 82.8 (4.6) in 2019 to 80.5 (4.5) in 2024, while the pass rate also declined from 92.3% in 2019 to 82.0% in 2024. The ANOVA for the QE scaled scores across years was significant (p < 0.01). Conclusions: Physician performance on the ABEM ITE has steadily declined since 2018; performance on the QE has declined since 2019. Future research is needed to understand and address the potential causes of these trends.
• 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, 159(Issue 4). doi:10.1001/jamasurg.2023.7155
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  Importance: 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. Objective: To evaluate the association of implementation of prehospital TBI evidence-based guidelines with survival among patients with prehospital PPV. Design, Setting, and Participants: The EPIC study was a multisystem, intention-to-treat study using a before/after controlled design. Evidence-based guidelines were implemented by emergency medical service agencies across Arizona. This subanalysis was planned a priori and included participants who received prehospital PPV. Outcomes were compared between the preimplementation and postimplementation cohorts using logistic regression, stratified by predetermined TBI severity categories (moderate, severe, or critical). Data were collected from January 2007 to June 2017, and data were analyzed from January to February 2023. Exposure: Implementation of the evidence-based guidelines for the prehospital care of patient with TBI. Main Outcomes and Measures: The primary outcome was survival to hospital discharge, and the secondary outcome was survival to admission. Results: Among the 21852 participants in the main study, 5022 received prehospital PPV (preimplementation, 3531 participants; postimplementation, 1491 participants). Of 5022 included participants, 3720 (74.1%) were male, and the median (IQR) age was 36 (22-54) years. Across all severities combined, survival to admission improved (adjusted odds ratio [aOR], 1.59; 95% CI, 1.28-1.97), while survival to discharge did not (aOR, 0.94; 95% CI, 0.78-1.13). Within the cohort with severe TBI but not in the moderate or critical subgroups, survival to hospital admission increased (aOR, 6.44; 95% CI, 2.39-22.00), as did survival to discharge (aOR, 3.52; 95% CI, 1.96-6.34). Conclusions and Relevance: Among patients with severe TBI who received active airway interventions in the field, guideline implementation was independently associated with improved survival to hospital admission and discharge. This was true whether they received basic airway interventions or advanced airways. These findings support the current guideline recommendations for aggressive prevention/correction of hypoxia and hyperventilation in patients with severe TBI, regardless of which airway type is used..
• Long, B., Keim, S., Gottlieb, M., & Rathlev, N. (2024). Is Phenobarbital an Effective Treatment for Alcohol Withdrawal Syndrome?. Journal of Emergency Medicine, 67(5). doi:10.1016/j.jemermed.2024.05.007
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  Background: Alcohol use disorder is associated with a variety of complications, including alcohol withdrawal syndrome (AWS), which may occur in those who decrease or stop alcohol consumption suddenly. AWS is associated with a range of signs and symptoms, which are most commonly treated with GABAergic medications. Clinical Question: Is phenobarbital an effective treatment for AWS? Evidence Review: Studies retrieved included two prospective, randomized, double-blind studies and three systematic reviews. These studies provided estimates of the effectiveness and safety of phenobarbital for treatment of AWS. Conclusions: Based on the available literature, phenobarbital is reasonable to consider for treatment of AWS. Clinicians must consider the individual patient, clinical situation, and comorbidities when selecting a medication for treatment of AWS.
• Long, B., Keim, S., Gottlieb, M., Carlson, J., Bedolla, J., & Reisdorff, E. (2024). Can I Discharge This Adult Patient with Abnormal Vital Signs From the Emergency Department?. Journal of Emergency Medicine, 67(5). doi:10.1016/j.jemermed.2024.05.009
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  Background: Vital signs are an essential component of the emergency department (ED) assessment. Vital sign abnormalities are associated with adverse events in the ED setting and may indicate a risk of poor outcomes after ED discharge. Clinical question: What is the risk of adverse events among adult patients with abnormal vital signs at the time of ED discharge? Evidence review: Studies retrieved included 6 retrospective studies with adult patients discharged from the ED. These studies evaluated adverse outcomes in adult patients discharged from the ED with abnormal vital signs. Hypotension at discharge was associated with the highest odds of adverse events after discharge. Tachycardia was also a key predictor of adverse events after discharge and may be easily missed by ED clinicians. Conclusion: Based on the available evidence, the specific vital sign abnormality and the number of total abnormalities influence the risk of adverse outcomes after discharge. Vital sign abnormalities at the time of discharge also increase the risk of ED revisit. The most common abnormal vital sign at the time of discharge is tachycardia.
• Reisdorff, E. J., Johnston, M. M., Kraus, C. K., Keim, S. M., & Santen, S. A. (2024). Association between the American Board of Emergency Medicine Oral Certifying Examination and Future State Medical Board Disciplinary Actions. Journal of the American College of Emergency Physicians Open, 5(1). doi:10.1002/emp2.13119
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  Objectives:: The American Board of Emergency Medicine (ABEM) requires a written examination (the Qualifying Examination) followed by the Oral Certifying Examination (OCE) to obtain ABEM certification. Maintaining ABEM certification is associated with fewer state medical board (SMB) disciplinary actions. We sought to determine the association between poor initial performance on the OCE and subsequent severe SMB disciplinary action. Methods: We included physicians who completed US categorical emergency medicine residencies in 2016 and earlier. We classified OCE performance as good (passed on first attempt) and poor (never passed or required > 1 attempt to pass). We obtained data on physician SMB disciplinary actions from the National Practitioner Data Bank that were limited to actions that denied licensure or altered the status of a medical license (eg, suspension). We determined the association between poor OCE performance and subsequent severe SMB disciplinary action. Results: Of 34,871, 93.5% passed the OCE on the first attempt, 6.1% required multiple attempts, and 0.3% never passed. Of the physicians (93.5%) with good OCE performance, 1.0% received a severe SMB action. Among physicians with poor OCE performance, 2.3% received a severe action; and of those who never passed, 1.7% received a severe action (Table 1). Poor OCE performance was associated with an increased odds of severe SMB disciplinary action (OR 2.21, 95% CI: 1.57–3.12). Conclusion: Physicians with poor OCE performance exhibited higher odds of experiencing a subsequent severe SMB disciplinary action. The OCE may have utility as a predictor of future professionalism or clinical performance.
• Barnhart, B. J., Spaite, D. W., Jorgenson, D. B., Burgett, K. S., Adam, S., Rice, A. D., Gaither, J. B., Keim, S. M., & Hu, C. (2023). Abstract 252: End-Tidal CO2 and Glasgow Coma Scale in Non-Intubated Traumatic Brain Injury Patients: Evaluation of Prehospital Nasal Capnography and Level of Consciousness. Circulation, 148(Suppl_1). doi:10.1161/circ.148.suppl_1.252
• Gettel, C. J., Courtney, D. M., Agrawal, P., Madsen, T. E., Rothenberg, C., Mills, A. M., Lall, M. D., Keim, S. M., Kraus, C. K., Ranney, M. L., & Venkatesh, A. K. (2023). Emergency medicine physician workforce attrition differences by age and gender. Academic Emergency Medicine, 30(11), 1092-1100. doi:10.1111/acem.14764
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  Background: Emergency care workforce concerns have gained national prominence given recent data suggesting higher than previously estimated attrition. With little known regarding characteristics of physicians leaving the workforce, we sought to investigate the age and number of years since residency graduation at which male and female emergency physicians (EPs) exhibited workforce attrition. Methods: We performed a repeated cross-sectional analysis of EPs reimbursed by Medicare linked to date of birth and residency graduation date data from the American Board of Emergency Medicine for the years 2013–2020. Stratified by gender, our primary outcomes were the median age and number of years since residency graduation at the time of attrition, defined as the last year during the study time frame that an EP provided clinical services. We constructed a multivariate logistic regression model to examine the association between gender and EP workforce attrition. Results: A total of 25,839 (70.2%) male and 10,954 (29.8%) female EPs were included. During the study years, 5905 male EPs exhibited attrition at a median (interquartile range [IQR]) age of 56.4 (44.5–65.4) years, and 2463 female EPs exhibited attrition at a median (IQR) age of 44.0 (38.0–53.9) years. Female gender (adjusted odds ratio 2.30, 95% confidence interval 1.82–2.91) was significantly associated with attrition from the workforce. Male and female EPs had respective median (IQR) post–residency graduation times in the workforce of 17.5 (9.5–25.5) years and 10.5 (5.5–18.5) years among those who exhibited attrition and one in 13 males and one in 10 females exited clinical practice within 5 years of residency graduation. Conclusions: Female physicians exhibited attrition from the EM workforce at an age approximately 12 years younger than male physicians. These data identify widespread disparities regarding EM workforce attrition that are critical to address to ensure stability, longevity, and diversity in the EP workforce.
• Gettel, C. J., Courtney, D. M., Bennett, C. L., Keim, S. M., Camargo, C. A., & Venkatesh, A. K. (2023). Attrition From the US Emergency Medicine Workforce During Early Stages of the COVID-19 Pandemic. Annals of Emergency Medicine, 82(Issue 2). doi:10.1016/j.annemergmed.2023.03.002
• 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. (2023). Correlation between prehospital and in-hospital hypotension and outcomes after traumatic brain injury. American Journal of Emergency Medicine, 65. doi:10.1016/j.ajem.2022.12.015
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  Background and objective: 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]. Methods: Subjects ≥10 years with major TBI were included. Standard statistics were used for unadjusted analyses. We used logistic regression, controlling for significant confounders, to determine the adjusted odds (aOR) for outcomes in each of the three cohorts. Results: Included were 12,582 subjects (69.8% male; median age 44 (IQR 26–61). Mortality by hypotension status: No hypotension: 9.2% (95%CI: 8.7–9.8%); EMS hypotension only: 27.8% (24.6–31.2%); hospital hypotension only: 45.6% (39.1–52.1%); combined EMS/hospital hypotension 57.6% (50.0–65.0%); (p < 0.0001). The aOR for death reflected the same progression: 1.0 (reference-no hypotension), 1.8 (1.39–2.33), 2.61 (1.73–3.94), and 4.36 (2.78–6.84), respectively. The proportion of subjects having hospital hypotension was 19.0% (16.5–21.7%) in those with EMS hypotension compared to 2.0% (1.8–2.3%) for those without (p < 0.0001). Additionally, the proportion of patients with TC hypotension was increased even with EMS “near hypotension” up to an SBP of 120 mmHg [(aOR 3.78 (2.97, 4.82)]. Conclusion: While patients with hypotension in the field or on arrival at the trauma center had markedly increased risk of death compared to those with no hypotension, those with prehospital hypotension that was not resolved before hospital arrival had, by far, the highest odds of death. Furthermore, TBI patients who had prehospital hypotension were five times more likely to arrive hypotensive at the trauma center than those who did not. Finally, even “near-hypotension” in the field was strongly and independently associated the risk of a hypotensive hospital arrival (
• Anderson, S. E., Andridge, R., Keim, S. A., Khalsa, A. S., Weber, Z. A., & Zvara, B. J. (2022). Factors associated with parenting stress in parents of 18-month-old children: Parenting stress in parents of toddlers.. Child: care, health and development. doi:10.1111/cch.12954
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  Parenting stress is associated with less optimal outcomes for children. Risk factors contributing to parenting stress in healthy toddlers have received little empirical attention. This study sought to determine the factors that are associated with parenting stress in parents of 18-month-old children..We analysed cross-sectional survey data from a prospective cohort study focused on parent-child mealtime interactions. Families with an 18-month-old child were recruited in Columbus, Ohio, USA, between December 2017 and May 2019. Adjusted stepwise linear regression models estimated associations between child factors (e.g., temperament), parental factors (e.g., depressive symptoms), quality of romantic relationship factors (e.g., adult attachment style) and home environment factors (e.g., household income) and parenting stress (Parental Distress subscale of the Parenting Stress Index-4 Short Form)..The 299 children included 129 (43%) females. Parents were on average 30.6 (SD 6.1) years old and included a diverse racial/ethnic cohort. Mean Parental Distress score was 24.3 (SD 6.8; score range 12-60). Higher Parental Distress scores were associated with greater parental depressive symptoms (B = 5.1 [95% CI: 2.4, 7.7]) and avoidant (B = 2.8 [95% CI: 0.9, 4.6]) attachment style. Other child, parental and home environment factors did not demonstrate statistically significant relationships with parental distress in the final model..Our findings align with recommendations for paediatric providers to screen for parenting stress and mental health.
• Barnhart, B. J., Spaite, D. W., Jorgenson, D. B., Seiver, A., Helfenbein, E. D., Gaither, J. B., Rice, A. D., Keim, S. M., & Hu, C. (2022). Abstract 167: Nasal Sensor Capnographic Differences In Major Traumatic Brain Injury Patients Receiving Non-rebreather Mask Versus Nasal Cannula Oxygen Delivery. Circulation, 146(Suppl_1). doi:10.1161/circ.146.suppl_1.167
• Cahir, T. M., Hughes, P. G., Hughes, K. E., Keim, S. M., & Nordlund, D. (2022). Fear Not: Utilizing Simulation for Medical Malpractice Education. Journal of Medical Education and Curricular Development, 9, 238212052210962. doi:10.1177/23821205221096269
• Long, B., Keim, S. M., Betz, M., & Gottlieb, M. (2022). Do All Adult Psychiatric Patients Need Routine Laboratory Evaluation and an Electrocardiogram?. Journal of Emergency Medicine, 63(Issue 5). doi:10.1016/j.jemermed.2022.09.038
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  Background: Acute psychiatric presentations account for a significant number of emergency department (ED) visits. These patients require assessment by the emergency physician and often need further evaluation by a psychiatrist, who may request routine laboratory evaluation and an electrocardiogram (ECG). Clinical Question: Do all adult psychiatric patients need routine laboratory evaluation and an ECG? Evidence Review: Studies retrieved included 2 prospective, observational studies and 7 retrospective studies. These studies evaluate the utility of laboratory analysis in all patients presenting a psychiatric complaint and its impact on patient management and disposition. Conclusion: Based upon the available literature, routine laboratory analysis and ECG for all patients presenting with a psychiatric complaint are not recommended. Clinicians should consider the individual patient, clinical situation, and comorbidities when deciding to obtain further studies such as laboratory analysis. © 2022 Elsevier Inc.
• Long, B., Keim, S. M., Gottlieb, M., & Mattu, A. (2022). Can I Send This Patient With Atrial Fibrillation Home From the Emergency Department?. Journal of Emergency Medicine, 63(Issue 4). doi:10.1016/j.jemermed.2022.07.016
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  Background: Atrial fibrillation (AF) is one of the most common dysrhythmias managed in the emergency department (ED) setting. Due to the variety of patient presentations and disease severity, most patients in the United States are admitted to the hospital. Clinical Question: In patients who present with AF, is there a reliable decision tool that clinicians can use to predict the risk of adverse outcome and determine who may be appropriate for discharge? Evidence Review: Studies retrieved included two prospective observational cohort studies and four retrospective observational studies. These studies evaluate the use of risk decision tools in predicting adverse outcomes in patients with AF. Conclusion: Based on the available literature, RED-AF, AFFORD, and the AFTER (complex, modified, and pragmatic) scores demonstrate modest predictive discrimination in predicting adverse events, but further validation is recommended.
• Nelson, L. S., Calderon, Y., Ankel, F. K., Barry, J. D., Beeson, M. S., Chudnofsky, C. R., Feldhaus, K. M., Gausche-Hill, M., Gaeta, T. J., Gorgas, D. L., Goyal, D. G., Keim, S. M., Clark-Roumpz, L. A., Purosky, R. G., & Johnston, M. M. (2022). American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2021-2022). Annals of Emergency Medicine, 80(Issue 1). doi:10.1016/j.annemergmed.2022.05.014
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  The American Board of Emergency Medicine gathers extensive background information on the Accreditation Council of Graduate Medical Education–accredited emergency medicine residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2022 annual report on the status of physicians training in Accreditation Council of Graduate Medical Education–accredited emergency medicine training programs in the United States.
• 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(Issue 1). doi:10.1016/j.annemergmed.2022.01.045
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  Study objective: 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. Methods: This was a preplanned secondary analysis from the Excellence in Prehospital Injury Care (EPIC) TBI study. Among patients (age ≥10 years) with major TBIs (Barell Matrix type 1 and/or Abbreviated Injury Scale-head severity ≥3) and lowest out-of-hospital SBPs of 40 to 299 mmHg, we utilized generalized additive models to summarize the distributions of various outcomes as smoothed functions of SBP, adjusting for important and significant confounders. The subjects who were enrolled in the study phase after the out-of-hospital TBI guideline implementation were used to validate the models developed from the preimplementation cohort. Results: Among 12,169 included cases, the mortality model revealed 3 distinct ranges: (1) a monotonically decreasing relationship between SBP and the adjusted probability of death from 40 to 130 mmHg, (2) lowest adjusted mortality from 130 to 180 mmHg, and (3) rapidly increasing mortality above 180 mmHg. A subanalysis of the cohorts with isolated TBIs and multisystem injuries with TBIs revealed SBP mortality patterns that were similar to each other and to that of the main analysis. While the specific SBP ranges varied somewhat for the nonmortality outcomes (hospital length of stay, ICU length of stay, discharge to skilled nursing/inpatient rehabilitation, and hospital charges), the patterns were very similar to that of mortality. In each model, validation was confirmed utilizing the postimplementation cohort. Conclusion: Optimal adjusted mortality was associated with a surprisingly high SBP range (130 to 180 mmHg). Below this level, there was no point or range of inflection that would indicate a physiologically meaningful threshold for defining hypotension. Nonmortality outcomes showed very similar patterns. These findings highlight how sensitive the injured brain is to compromised perfusion at SBP levels that, heretofore, have been considered adequate or even normal. While the study design does did not allow us to conclude that the currently recommended treatment threshold (
• Adelson, P. D., Barnhart, B. J., Bobrow, B. J., Chikani, V., Denninghoff, K. R., Gaither, J. B., Hu, C., Keim, S. M., Mullins, T., Rice, A. D., Sherrill, D. L., Spaite, D. W., & Viscusi, 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. doi:10.1016/j.annemergmed.2020.09.435
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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..The Excellence in Prehospital Injury Care for Children study is the preplanned secondary analysis of the Excellence in Prehospital Injury Care study, a multisystem, intention-to-treat study using a before-after controlled design. This subanalysis included children younger than 18 years who were transported to Level I trauma centers by participating out-of-hospital agencies between January 1, 2007, and June 30, 2015, throughout Arizona. The primary and secondary outcomes were survival to hospital discharge or admission for children with major traumatic brain injury and in 3 subgroups, defined a priori as those with moderate, severe, and critical traumatic brain injury. Outcomes in the preimplementation and postimplementation cohorts were compared with logistic regression, adjusting for risk factors and confounders..There were 2,801 subjects, 2,041 in preimplementation and 760 in postimplementation. The primary analysis (postimplementation versus preimplementation) yielded an adjusted odds ratio of 1.16 (95% confidence interval 0.70 to 1.92) for survival to hospital discharge and 2.41 (95% confidence interval 1.17 to 5.21) for survival to hospital admission. In the severe traumatic brain injury cohort (Regional Severity Score-Head 3 or 4), but not the moderate or critical subgroups, survival to discharge significantly improved after guideline implementation (adjusted odds ratio = 8.42; 95% confidence interval 1.01 to 100+). The improvement in survival to discharge among patients with severe traumatic brain injury who received positive-pressure ventilation did not reach significance (adjusted odds ratio = 9.13; 95% confidence interval 0.79 to 100+)..Implementation of the pediatric out-of-hospital traumatic brain injury guidelines was not associated with improved survival when the entire spectrum of severity was analyzed as a whole (moderate, severe, and critical). However, both adjusted survival to hospital admission and discharge improved in children with severe traumatic brain injury, indicating a potential severity-based interventional opportunity for guideline effectiveness. These findings support the widespread implementation of the out-of-hospital pediatric traumatic brain injury guidelines.
• Anderson, S. E., Andridge, R., Keim, S. A., Krupsky, K. L., Parrott, A., & Zvara, B. J. (2021). A mixed methods analysis of environmental and household chaos: considerations for early-childhood obesity research.. BMC public health, 21(1), 1867. doi:10.1186/s12889-021-11936-w
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  Chaos has implications for child health that may extend to childhood obesity. Yet, results from studies describing associations between chaos and childhood obesity are mixed. New approaches to studying the environments of young children may help to clarify chaos-obesity relationships..We conducted a concurrent mixed methods analysis of quantitative and qualitative data describing home and neighborhood chaos among a diverse cohort of 283 caregiver-toddlers dyads from Ohio. We examined the underlying structure of environmental and household chaos using exploratory factor analysis then sought to validate the structure using qualitative field notes. We generated total scores for factors of chaos and described their distributions overall and according to cohort characteristics. Additionally, we conducted a thematic content analysis of brief ethnographies to provide preliminary construct validity for our indicators of chaos..Dyads varied according to household composition, income, education, and race/ethnicity. We found evidence for a multi-factor structure for chaos, which included disorganization and neighborhood noise. Household disorganization scores ranged from 0 to 7.3 and were on average 2.1 (SD = 1.8). Neighborhood noise scores ranged from 0 to 4 and were on average 1.1 (SD = 1.1). Both disorganization and neighborhood noise were associated with indicators of socioeconomic disadvantage, such as lower educational attainment and household income. Qualitative data from households with high and low scores on the two identified factors were aligned in ways that were supportive of construct validity and further contextualized the social and material environments in which chaos occurred..Chaos represents a complex construct with implications spanning various disciplines, including childhood obesity research. Previous studies suggest challenges associated with measuring chaos may limit the conclusions that can be drawn about which aspect of chaos (if any) matter most of early childhood weight development. We advance the literature by demonstrating chaos may be comprised of conceptually distinct subdomains. Future childhood obesity prevention research may benefit from more contemporary measure of chaos, such as those relying on direct observations that account for a multifaceted underlying structure.
• April, M. D., Keim, S. M., Koyfman, A., Long, B., Mattu, A., & Tannenbaum, L. (2021). Can I Send This Syncope Patient Home From the Emergency Department?. The Journal of emergency medicine, 61(6), 801-809. doi:10.1016/j.jemermed.2021.07.060
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  Syncope is a common presentation to the emergency department (ED). A significant minority of these patients have potentially life-threatening pathology. Reliably identifying that patients require hospital admission for further workup and intervention is imperative..In patients who present with syncope, is there a reliable decision tool that clinicians can use to predict the risk of adverse outcome and determine who may be appropriate for discharge?.Four articles were reviewed. The first retrospective study found no difference in mortality or adverse events in patients admitted for further evaluation rather than discharged home with primary care follow-up. The next two articles examined the derivation and validation of the Canadian Syncope Risk Score (CSRS). After validation with an admission threshold score of -1, the sensitivity and specificity of the CSRS was 97.8% (95% confidence interval [CI] 93.8-99.6%) and 44.3% (95% CI 42.7-45.9%), respectively. The last article looked at the derivation of the FAINT score, a recently developed score to risk stratify syncope patients. A FAINT score of ≥ 1 (any score 1 or higher should be admitted) had a sensitivity of 96.7% (95% CI 92.9-98.8%) and specificity 22.2% (95% CI 20.7-23.8%)..Syncope remains a difficult chief symptom to disposition from the ED. The CSRS is modestly effective at establishing a low probability of actionable disease or need for intervention. However, CSRS might not reduce unnecessary hospitalizations. The FAINT score has yet to undergo validation; however, the initial derivation study offers less diagnostic accuracy compared with the CSRS.
• April, M. D., Keim, S. M., Koyfman, A., Long, B., Meurer, W. J., & Schmitzberger, F. (2021). Is a Lumbar Puncture Required to Rule Out Atraumatic Subarachnoid Hemorrhage in Emergency Department Patients With Headache and Normal Brain Computed Tomography More Than Six Hours After Symptom Onset?. The Journal of emergency medicine, 61(1), 97-104. doi:10.1016/j.jemermed.2021.01.039
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  Atraumatic subarachnoid hemorrhage (SAH) is a deadly condition that most commonly presents as acute, severe headache. Controversy exists concerning evaluation of SAH based on the time from onset of symptoms, specifically if the headache occurred > 6 h prior to patient presentation..Do patients undergoing evaluation for atraumatic SAH who have a negative computed tomography (CT) scan of the head obtained more than 6 h after symptom onset require a subsequent lumbar puncture to rule out the diagnosis?.Studies retrieved included a retrospective cohort study, two prospective cohort studies, and a case-control study. These studies provide estimates of the diagnostic accuracy of head CT imaging obtained > 6 h from symptom onset and diagnostic test characteristics of subsequent lumbar puncture..The probability of SAH above which emergency clinicians should perform a lumbar puncture is 1.0%. This threshold is essentially the same as the estimated probability of SAH in patients with a negative head CT obtained more than 6 h from symptom onset. Emergency physicians might reasonably decide to either perform or forego this procedure. Consequently, we contend that the decision whether to perform lumbar puncture in these instances is an excellent candidate for shared decision-making.
• Barnhart, B. J., Bradley, G., Gaither, J. B., Hu, C., Keim, S., McDannold, R., Rice, A. D., Spaite, D. W., & Wohlford, L. A. (2021). Abstract 13209: Law Enforcement-Initiated Cardiopulmonary Resuscitation in the Care of Out-of-Hospital Cardiac Arrest. Circulation, 144(Suppl_2). doi:10.1161/circ.144.suppl_2.13209
• Long, D. A., Keim, S. M., April, M. D., Koyfman, A., Long, B., & Ankel, F. (2021). Can D-Dimer in Low-Risk Patients Exclude Aortic Dissection in the Emergency Department?. Journal of Emergency Medicine, 61(Issue 5). doi:10.1016/j.jemermed.2021.07.028
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  Background: Aortic dissection (AD) is a challenging diagnosis associated with severe mortality. However, acute AD is a rare clinical entity and can be overevaluated in the emergency department. D-dimer, both alone and in combination with the Aortic Dissection Detection Risk Score (ADD-RS), has been studied as a tool to evaluate for AD. Clinical Question: Can a negative D-dimer in low-risk patients exclude AD in the emergency department? Evidence Review: Retrieved studies included three systematic review and meta-analyses and two prospective cohort studies. D-dimer was found to be highly sensitive for acute AD, with a sensitivity of 98.0%. The ADD-RS was also highly sensitive (95.7%) for AD. Two meta-analyses reported a combination of a negative D-dimer and ADD-RS < 1 to have a pooled sensitivity of 99.9% and 100% for acute aortic syndrome. Conclusions: Neither D-dimer nor the ADD-RS alone provides adequate sensitivity to exclude acute AD. However, a negative D-dimer combined with an ADD-RS < 1 is likely sufficient to rule out AD. Even with these findings, physicians must place clinical judgment above laboratory testing or scoring systems when deciding whether to pursue a diagnosis of acute AD.
• Ankel, F. K., Beeson, M. S., Calderon, Y., Chudnofsky, C. R., Clark-roumpz, L. A., Gausche-hill, M., Goyal, D. G., Johnston, M. M., Keim, S. M., Nelson, L. S., & Purosky, R. G. (2020). American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2019-2020).. Annals of emergency medicine, 75(5), 648-667. doi:10.1016/j.annemergmed.2020.03.012
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  The American Board of Emergency Medicine gathers extensive background information on Accreditation Council for Graduate Medical Education (ACGME)-accredited emergency medicine residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2020 annual report on the status of physicians training in ACGME-accredited emergency medicine training programs in the United States.
• Babaeizadeh, S., Barnhart, B. J., Bradley, G., Gaither, J. B., Helfenbein, E., Hu, C., Jorgenson, D., Keim, S. M., Rice, A. D., & Spaite, D. W. (2020). Abstract 200: Discordance Between Monitor-measured and EMS Documented Respiratory Rates in Major Traumatic Brain Injury: Implications for Injury Scoring Systems. Circulation, 142(Suppl_4). doi:10.1161/circ.142.suppl_4.200
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  Background: Respiratory rate (RR) is a key component in commonly-used trauma scoring systems [e.g., Revised Trauma Score (RTS), TRISS]. Imprecise documentation of RR introduces misclassification wh...
• Babaeizadeh, S., Barnhart, B. J., Bradley, G., Gaither, J. B., Helfenbein, E., Hu, C., Jorgenson, D., Keim, S. M., Rice, A. D., & Spaite, D. W. (2020). Abstract 277: Discrepancies Between Non-invasive Blood Pressure Monitor Data and Ems Provider Documentation in Major Traumatic Brain Injury: Are We Missing Hypotension?. Circulation, 142(Suppl_4). doi:10.1161/circ.142.suppl_4.277
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  Background: Recent studies have shown that prehospital systolic blood pressure (SBP) is strongly associated with mortality across a remarkably wide range (far above 90 mmHg) in traumatic brain inju...
• Barnhart, B. J., Bobrow, B. J., Bradley, G., Chikani, V., Denninghoff, K. R., Gaither, J. B., Hu, C., Keim, S. M., Mullins, T., Rice, A. D., & Spaite, D. W. (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...
• Barnhart, B. J., Bobrow, B. J., Bradley, G., Chikani, V., Gaither, J. B., Glenn, M., Hu, C., Keim, S. M., Mcdannold, R., Mullins, T., Mullins, M., Rice, A. D., Silver, A., & Spaite, D. W. (2020). Abstract 156: Capnographic Differences in Out-of-hospital Overdose-related, Respiratory, and Cardiac Arrests. Circulation, 142(Suppl_4). doi:10.1161/circ.142.suppl_4.156
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  Background: Little is known about the ventilatory aspects of overdose-related OHCA (OD-OHCA). We compared maximum ETCO2 (mETCO2; each patient’s highest CO2 level) and mean for each recorded minute ...
• Adelson, D., Barnhart, B. J., Bobrow, B. J., Chikani, V., Denninghoff, K. R., Gaither, J. B., Hu, C., Keim, S. M., Mullins, T., Rice, A. D., Spaite, D. W., & 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
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  Introduction: The EPIC Study implemented the national EMS TBI Guidelines in a massive, statewide initiative (>11,000 providers trained, 133 agencies). While implementation was not associated with i...
• Babaeizadeh, S., Barnhart, B. J., Gaither, J. B., Helfenbein, E., Hu, C., Jorgenson, D., Keim, S. M., Rice, A. D., & Spaite, D. W. (2019). Abstract 326: Prehospital Use of Nasal Cannula End-Tidal CO ₂ Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Circulation, 140(Suppl_2). doi:10.1161/circ.140.suppl_2.326
• Babaeizadeh, S., Barnhart, B. J., Gaither, J. B., Helfenbein, E., Hu, C., Jorgenson, D., Keim, S. M., Rice, A. D., & Spaite, D. W. (2019). Abstract 386: Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between End-Tidal CO2 and Level of Consciousness. Circulation, 140(Suppl_2). doi:10.1161/circ.140.suppl_2.386
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  Background: The EMS traumatic brain injury (TBI) guidelines encourage limiting prehospital intubation (ETI) to patients with profoundly depressed level of consciousness (LOC) and who cannot protect...
• Nelson, L. S., Keim, S. M., Beeson, M. S., Chudnofsky, C. R., Gausche-Hill, M., Gorgas, D. L., Goyal, D. G., Kowalenko, T., Muelleman, R. L., , R. C., Joldersma, K. B., Johnston, M. M., & , A. B. (2019). American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2018-2019). Annals of emergency medicine, 73(5), 524-541.
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  The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine-sponsored residency and fellowship programs, residents and fellows training in those programs, and all fellows for whom ABEM issues subspecialty certifications. We present the 2019 annual report on the status of US emergency medicine training programs.
• Panchal, A., Keim, S., Ewy, G., Kern, K., Hughes, K. E., & Beskind, D. (2019). Development of a Medical Student Cardiopulmonary Resuscitation Elective to Promote Education and Community Outreach. Cureus, 11(4), e4507.
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   One of the barriers to improving cardiac arrest survival is the low rate of cardiopulmonary resuscitation (CPR) provision. Identifying this as a public health issue, many medical students often assist in training the community in CPR. However, these experiences are often short and are not associated with structured resuscitation education, limiting the student's and the community's learning. In this assessment, we identified a need and developed a curriculum, including defined goals and objectives, for an undergraduate medical education (UME) elective in CPR.
• 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.
• Babaeizadeh, S., Barnhart, B. J., Gaither, J. B., Helfenbein, E., Hu, C., Jorgenson, D., Keim, S. M., Perez, O., Rice, A. D., & Spaite, D. W. (2018). Abstract 233: Prehospital End-Tidal CO2 Measurement in Non-Intubated Traumatic Brain Injury Patients: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Circulation, 138(Suppl_2). doi:10.1161/circ.138.suppl_2.233
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  Background: End-Tidal CO2 (ETCO2) monitoring is valuable in the management of traumatic brain injury (TBI). In intubated patients it helps prevent hyper/over-ventilation. In non-intubated patients,...
• Babaeizadeh, S., Barnhart, B. J., Helfenbein, E., Hu, C., Jorgenson, D., Keim, S. M., Perez, O., Rice, A. D., & Spaite, D. W. (2018). Abstract 235: End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury Patients Receiving O2 via Nasal Cannula vs. Non-Rebreather Mask. Circulation, 138(Suppl_2). doi:10.1161/circ.138.suppl_2.235
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  Background: The advent of highly sensitive End-Tidal CO2 (ETCO2) sensors allows effective monitoring of intubated patients in many emergency care settings, including EMS. Previous work has explored...
• Barnhart, B. J., Bobrow, B. J., Chikani, V., Denninghoff, K. R., Gaither, J. B., Hu, C., Keim, S. M., Rice, A. D., & Spaite, D. W. (2018). Abstract 232: Three-Dimensional Models of Complex Interactions Between Age, Prehospital Blood Pressure, and Mortality in Major Traumatic Brain Injury. Circulation, 138(Suppl_2). doi:10.1161/circ.138.suppl_2.232
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  Background: Traumatic brain injury (TBI) studies with extensive prehospital data linked to trauma center (TC) outcomes have been small. Thus, risk adjusters like age and systolic BP have been treated dichotomously (e.g. age ≥55, SBP
• Gausche-hill, M., Kowalenko, T., Baren, J. M., Beeson, M. S., Carius, M. L., Chudnofsky, C. R., Goyal, D. G., Johnston, M. M., Joldersma, K. B., Keim, S. M., Marco, C. A., Muelleman, R. L., & Nelson, L. S. (2018). American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2017-2018).. Annals of emergency medicine, 71(5), 636-648. doi:10.1016/j.annemergmed.2018.03.037
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  The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine-sponsored residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2018 annual report on the status of US emergency medicine training programs.
• Goyal, D. G., Harvey, A. L., House, H. R., Johnston, M. M., Joldersma, K. B., Keim, S. M., Ma, O. J., Marco, C. A., & Wahl, R. P. (2018). Physician Age and Performance on the American Board of Emergency Medicine ConCert Examination.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 25(8), 891-900. doi:10.1111/acem.13420
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  This study was undertaken to expand on results from a 2014 study on the association between physician age and performance on the American Board of Emergency Medicine (ABEM) ConCert examination..This was a retrospective, longitudinal growth study comparing performance on the ConCert examination and physicians' ages at the time of examination. All examination attempts from 1990 to 2016 made by residency-trained physicians were eligible for inclusion. Multilevel growth models were constructed to examine the relationship between age at time of examination and performance, controlling for physician characteristics..The study group included 15,533 examination attempts by 12,786 physicians. The mean (±SD) age of the physicians across all examination administrations was 45.02 (±5.18) years (range = 35 to 72 years). The mean (±SD) ConCert examination score across all administrations was 85.39 (±5.71; range = 51 to 100). Among first-time ConCert examination takers, older age was associated with lower examination scores (r = -0.25, p < 0.0001). Across all examination attempts, age was negatively correlated to examination scores (r = -0.24; p < 0.0001)..After physician characteristics were controlled for, there was an association between advancing age and declining performance on the ABEM ConCert examination. This information may be important to the individual physician to develop targeted competency assessment and professional development.
• Hunter, B. R., Keim, S. M., Kirschner, J. M., Lorenzo, R. A., & Schaffer, J. T. (2018). Do Orthostatic Vital Signs Have Utility in the Evaluation of Syncope?. The Journal of emergency medicine, 55(6), 780-787. doi:10.1016/j.jemermed.2018.09.011
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  Syncope is a common presentation in the emergency department (ED). The differential diagnosis is long and includes benign conditions as well as acute life threats, such as dysrhythmias or pulmonary embolism..The specific goals of this review are twofold: 1) to define the diagnostic utility of orthostatic vital signs (OVS) as a test for orthostatic syncope, and 2) to determine whether OVS help diagnose or exclude life-threatening causes of syncope in ED patients..Three prospective cohort studies plus 2017 national guidelines for syncope management were identified, reviewed, and critically appraised..This literature review found that orthostatic hypotension is common among ED patients with syncope and is often diagnosed as the cause of syncope..OVS measurements do not, in isolation, reliably diagnose or exclude orthostatic syncope, nor do they appear to have value in ruling out life-threatening causes of syncope.
• Keim, S. M., Sherrill, D. L., Viscusi, C. D., Rice, A. D., Denninghoff, K. R., Adelson, P. D., Barnhart, B., Gaither, J. B., Chikani, V., Bobrow, B. J., Hu, C., & Spaite, D. W. (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.
• Cohn, B. G., Keim, S. M., Kolinsky, D. C., Schwarz, E. S., & Yealy, D. M. (2017). Is a Prehospital Treat and Release Protocol for Opioid Overdose Safe?. The Journal of emergency medicine, 52(1), 52-58. doi:10.1016/j.jemermed.2016.09.015
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  The current standards for domestic emergency medical services suggest that all patients suspected of opioid overdose be transported to the emergency department for evaluation and treatment. This includes patients who improve after naloxone administration in the field because of concerns for rebound toxicity. However, various emergency medical services systems release such patients at the scene after a 15- to 20-min observation period as long as they return to their baseline..We sought to determine if a "treat and release" clinical pathway is safe in prehospital patients with suspected opioid overdose..Five studies were identified and critically appraised. From a pooled total of 3875 patients who refused transport to the emergency department after an opioid overdose, three patient deaths were attributed to rebound toxicity. These results imply that a "treat and release" policy might be safe with rare complications. A close review of these studies reveals several confounding factors that make extrapolation to our population limited..The existing literature suggests a "treat and release" policy for suspected prehospital opioid overdose might be safe, but additional research should be conducted in a prospective design.
• Gausche-hill, M., Kowalenko, T., Baren, J. M., Beeson, M. S., Carius, M. L., Chudnofsky, C. R., Goyal, D. G., Joldersma, K. B., Keim, S. M., Marco, C. A., Muelleman, R. L., & Nelson, L. S. (2017). American Board of Emergency Medicine Report on Residency and Fellowship Training Information (2016-2017).. Annals of emergency medicine, 69(5), 640-652. doi:10.1016/j.annemergmed.2017.03.025
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  The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents training in those programs. We present the 2017 annual report on the status of US emergency medicine training programs.
• Keim, S. M., Sherrill, D., Mullins, T., Rice, A. D., Denninghoff, K. R., Adelson, P. D., Barnhart, B. J., Gaither, J. B., Chikani, V., Bobrow, B. J., Hu, C., & Spaite, D. W. (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
• Nuno, T., Tormala, W., Bobrow, B. J., Estrada, A. L., Keim, S. M., Mullins, T., Panczyk, M., Rogge-miller, K. A., & Spaite, D. W. (2017). Disparities in telephone CPR access and timing during out-of-hospital cardiac arrest.. Resuscitation, 115, 11-16. doi:10.1016/j.resuscitation.2017.03.028
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  Spanish-only speaking residents in the United States face barriers to receiving potentially life-saving 911 interventions such as Telephone -cardiopulmonary resuscitation (TCPR) instructions. Since 2015, 911 dispatchers have placed an increased emphasis on rapid identification of potential cardiac arrest. The purpose of this study was to describe the utilization and timing of the 911 system during suspected out-of-hospital cardiac arrest (OHCA) by Spanish-speaking callers in Metropolitan Phoenix, Arizona..The dataset consisted of suspected OHCA from 911 centers from October 10, 2010 through December 31, 2013. Review of audio TCPR process data included whether the need for CPR was recognized by telecommunicators, whether CPR instructions were provided, and the time elements from call receipt to initiation of compressions..A total of 3398 calls were made to 911 for suspected OHCA where CPR was indicated. A total of 39 (1.2%) were determined to have a Spanish language barrier. This averages to 18 calls per year with a Spanish language barrier during the study period, compared with 286 OHCAs expected per year among this population. The average time until telecommunicators recognized CPR need was 87.4s for the no language barrier group compared to 160.6s for the Spanish-language barrier group (p
• Rice, A. D., Adelson, P. D., Barnhart, B. J., Bobrow, B. J., Chikani, V., Denninghoff, K. R., Gaither, J. B., Hu, C., Keim, S. M., Mullins, T., Sherrill, D. L., Spaite, D. W., & Viscusi, C. (2017). Association of Out-of-Hospital Hypotension Depth and Duration With Traumatic Brain Injury Mortality.. Annals of emergency medicine, 70(4), 522-530.e1. doi:10.1016/j.annemergmed.2017.03.027
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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..We evaluated adults and older children with moderate or severe traumatic brain injury in the preimplementation cohort of Arizona's statewide Excellence in Prehospital Injury Care study. We used logistic regression to determine the association between the depth-duration dose of hypotension (depth of systolic blood pressure
• Rice, A. D., Babaeizadeh, S., Barnhart, B. J., Bobrow, B. J., Chikani, V., Denninghoff, K. R., Gaither, J. B., Helfenbein, E., Hu, C., Keim, S. M., Perez, O., Sherrill, D. L., Spaite, D. W., & Viscusi, C. (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
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  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. Our goal was to compare the rate of hypoxia identified by EMS personnel and documented in EMS patient care records (PCR) versus the actual rate of hypoxia recorded by continuous, non-invasive monitoring in TBI.
• 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.
• Stolz, U., Rice, A. D., Barnhart, B. J., Bobrow, B. J., Chikani, V., Denninghoff, K. R., Gaither, J. B., Keim, S. M., Mhayamaguru, M., Mullins, T., Smith, J. J., Spaite, D. W., & Viscusi, C. (2017). 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. doi:10.1080/10903127.2017.1308609
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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..This retrospective observational study included all moderate/severe TBI cases (CDC Barell Matrix Type 1) in the pre-implementation cohort of the Excellence in Prehospital Injury Care (EPIC) TBI Study (NIH/NINDS: 1R01NS071049). Cases were compared across four cohorts of initial trauma center temperature (ITCT):
• Adelson, P. D., Barnhart, B. J., Bobrow, B. J., Chikani, V., Denninghoff, K. R., Gaither, J. B., Hu, C., Keim, S. M., Mullins, T., Sherrill, D. L., Spaite, D. W., & Viscusi, C. (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)
• Arif-tiwari, H., Chundru, S., Costello, J. R., Covington, M. F., Daye, Z. J., Duke, E., Gilbertson-dahdal, D., Gries, L., Kalb, B., Keim, S. M., Martin, D. R., Petkovska, I., Stolz, L. A., & Urbina, S. (2016). Accuracy of Unenhanced MR Imaging in the Detection of Acute Appendicitis: Single-Institution Clinical Performance Review.. Radiology, 279(2), 451-60. doi:10.1148/radiol.2015150468
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  To determine the accuracy of unenhanced magnetic resonance (MR) imaging in the detection of acute appendicitis in patients younger than 50 years who present to the emergency department with right lower quadrant (RLQ) pain..The institutional review board approved this retrospective study of 403 patients from August 1, 2012, to July 30, 2014, and waived the informed consent requirement. A cross-department strategy was instituted to use MR imaging as the primary diagnostic modality in patients aged 3-49 years who presented to the emergency department with RLQ pain. All MR examinations were performed with a 1.5- or 3.0-T system. Images were acquired without breath holding by using multiplanar half-Fourier single-shot T2-weighted imaging without and with spectral adiabatic inversion recovery fat suppression without oral or intravenous contrast material. MR imaging room time was measured for each patient. Prospective image interpretations from clinical records were reviewed to document acute appendicitis or other causes of abdominal pain. Final clinical outcomes were determined by using (a) surgical results (n = 77), (b) telephone follow-up combined with review of the patient's medical records (n = 291), or (c) consensus expert panel assessment if no follow-up data were available (n = 35). Logistic regression analysis was performed to evaluate the sensitivity and specificity of MR imaging in the detection of acute appendicitis, and corresponding 95% confidence intervals were determined..Of the 403 patients, 67 had MR imaging findings that were positive for acute appendicitis, and 336 had negative findings. MR imaging had a sensitivity of 97.0% (65 of 67) and a specificity of 99.4% (334 of 336). The mean total room time was 14 minutes (range, 8-62 minutes). An alternate diagnosis was offered in 173 (51.5%) of 336 patients..MR imaging is a highly sensitive and specific test in the evaluation of patients younger than 50 years with acute RLQ pain that uses a rapid imaging protocol performed without intravenous or oral contrast material.
• Arif-tiwari, H., Daye, Z. J., Duke, E., Gilbertson-dahdal, D., Kalb, B., Keim, S. M., & Martin, D. R. (2016). A Systematic Review and Meta-Analysis of Diagnostic Performance of MRI for Evaluation of Acute Appendicitis.. AJR. American journal of roentgenology, 206(3), 508-17. doi:10.2214/ajr.15.14544
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  A meta-analysis was performed to determine the accuracy of MRI in the diagnosis of acute appendicitis in the general population and in subsets of pregnant patients and children..A systematic search of the PubMed and EMBASE databases for articles published through the end of October 2014 was performed to identify studies that used MRI to evaluate patients suspected of having acute appendicitis. Pooled data for sensitivity, specificity, and positive and negative predictive values were calculated..A total of 30 studies that comprised 2665 patients were reviewed. The sensitivity and specificity of MRI for the diagnosis of acute appendicitis are 96% (95% CI, 95-97%) and 96% (95% CI, 95-97%), respectively. In a subgroup of studies that focused solely on pregnant patients, the sensitivity and specificity of MRI were 94% (95% CI, 87-98%) and 97% (95% CI, 96-98%), respectively, whereas in studies that focused on children, sensitivity and specificity were found to be 96% (95% CI, 95-97%) and 96% (95% CI, 94-98%), respectively..MRI has a high accuracy for the diagnosis of acute appendicitis, for a wide range of patients, and may be acceptable for use as a first-line diagnostic test.
• Babaeizadeh, S., Barnhart, B. J., Bobrow, B. J., Chikani, V., Denninghoff, K. R., Gaither, J. B., Helfenbein, E., Hu, C., Keim, S. M., Perez, O., Sherrill, D. L., Spaite, D. W., & Viscusi, C. (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...
• Duke, E., Kalb, B., Arif-Tiwari, H., Daye, Z., Gilbertson-Dahdal, D., Keim, S., & Martin, D. (2016). A systematic review and meta-Analysis of diagnostic performance of MRI for evaluation of acute appendicitis. American Journal of Roentgenology, 206(3). doi:10.2214/AJR.15.14544
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  OBJECTIVE. A meta-Analysis was performed to determine the accuracy of MRI in the diagnosis of acute appendicitis in the general population and in subsets of pregnant patients and children. MATERIALS AND METHODS. A systematic search of the PubMed and EMBASE databases for articles published through the end of October 2014 was performed to identify studies that used MRI to evaluate patients suspected of having acute appendicitis. Pooled data for sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS. A total of 30 studies that comprised 2665 patients were reviewed. The sensitivity and specificity of MRI for the diagnosis of acute appendicitis are 96% (95% CI, 95-97%) and 96% (95% CI, 95-97%), respectively. In a subgroup of studies that focused solely on pregnant patients, the sensitivity and specificity of MRI were 94% (95% CI, 87-98%) and 97% (95% CI, 96-98%), respectively, whereas in studies that focused on children, sensitivity and specificity were found to be 96% (95% CI, 95-97%) and 96% (95% CI, 94-98%), respectively. CONCLUSION. MRI has a high accuracy for the diagnosis of acute appendicitis, for a wide range of patients, and may be acceptable for use as a first-line diagnostic test.
• Sherrill, D. L., Babaeizadeh, S., Barnhart, B. J., Bobrow, B. J., Chikani, V., Denninghoff, K. R., Gaither, J. B., Helfenbein, E., Hu, C., Keim, S. M., Perez, O., Spaite, D. W., & Viscusi, C. (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
• Adhikari, S., Amini, R., Farrell, I., Kartchner, J., & Keim, S. M. (2015). 69 Quality of Research and Level of Evidence in Point-of-Care Ultrasound Literature: Where Are We Now?. Annals of Emergency Medicine, 66(4), S24-S25. doi:10.1016/j.annemergmed.2015.07.101
• Amini, R., Gordon, P. R., Hernandez, N. C., & Keim, S. M. (2015). 83 Using Standardized Patients to Evaluate Medical Students’ Evidence-Based Medicine Skills. Annals of Emergency Medicine, 66(4), S30. doi:10.1016/j.annemergmed.2015.07.115
• Bobrow, B. J., Curry, M., Gaither, J. B., Galson, S. W., Keim, S. M., Mhayamaguru, M., Spaite, D. W., & Williams, C. M. (2015). Environmental Hyperthermia in Prehospital Patients with Major Traumatic Brain Injury.. The Journal of emergency medicine, 49(3), 375-81. doi:10.1016/j.jemermed.2015.01.038
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  Traumatic brain injury (TBI) results in an estimated 1.7 million emergency department visits each year in the United States. These injuries frequently occur outside, leaving injured individuals exposed to environmental temperature extremes before they are transported to a hospital..Evaluate the existing literature for evidence that exposure to high temperatures immediately after TBI could result in elevated body temperatures (EBTs), and whether or not EBTs affect patient outcomes..It has been clear since the early 1980s that after brain injury, exposure to environmental temperatures can cause hypothermia, and that this represents a significant contributor to increased morbidity and mortality. Less is known about elevated body temperature. Early evidence from the Iraq and Afghanistan wars indicated that exposure to elevated environmental temperatures in the prehospital setting may result in significant EBTs, however, it is unclear what impact these EBTs might have on outcomes in TBI patients. In the hospital, EBT, or neurogenic fever, is thought to be due to the acute-phase reaction that follows critical injury, and these high body temperatures are associated with poor outcomes after TBI..Hospital data suggest that EBTs are associated with poor outcomes, and some preliminary reports suggest that early EBTs are common after TBI in the prehospital setting. However, it remains unclear whether patients with TBI have an increased risk of EBTs after exposure to high environmental temperatures, or if this very early "hyperthermia" might cause secondary injury after TBI.
• Camargo, C. A., Cohn, B. G., Keim, S. M., & Watkins, J. W. (2015). Does Management of Diabetic Ketoacidosis with Subcutaneous Rapid-acting Insulin Reduce the Need for Intensive Care Unit Admission?. The Journal of emergency medicine, 49(4), 530-8. doi:10.1016/j.jemermed.2015.05.016
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  In the last 20 years, rapid-acting insulin analogs have emerged on the market, including aspart and lispro, which may be efficacious in the management of diabetic ketoacidosis (DKA) when administered by non-intravenous (i.v.) routes..In patients with mild-to-moderate DKA without another reason for intensive care unit (ICU) admission, is the administration of a subcutaneous (s.c.) rapid-acting insulin analog a safe and effective alternative to a continuous infusion of i.v. regular insulin, and would such a strategy eliminate the need for ICU admission?.Five randomized controlled trials were identified and critically appraised..The outcomes suggest that there is no difference in the duration of therapy required to resolve DKA with either strategy..Current evidence supports DKA management with s.c. rapid-acting insulin analogs in a non-ICU setting in carefully selected patients.
• Adhikari, S., Amini, R., Stolz, L., O'Brien, K., Gross, A., Jones, T., Fiorello, A., & Keim, S. M. (2014). Implementation of a novel point-of-care ultrasound billing and reimbursement program: fiscal impact. The American journal of emergency medicine, 32(6), 592-5.
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  The aim of this study was to determine the fiscal impact of implementation of a novel emergency department (ED) point-of-care (POC) ultrasound billing and reimbursement program.
• Cohn, B., Keim, S. M., & Sanders, A. B. (2014). Can anticoagulated patients be discharged home safely from the emergency department after minor head injury?. The Journal of emergency medicine, 46(3), 410-7.
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  Anticoagulated patients have increased risk for bleeding, and serious outcomes could occur after head injury. Controversy exists regarding the utility of head computed tomography (CT) in allowing safe discharge dispositions for anticoagulated patients suffering minor head injury.
• Hunter, B. R., Keim, S. M., Seupaul, R. A., & Hern, G. (2014). Are plain radiographs sufficient to exclude cervical spine injuries in low-risk adults?. The Journal of emergency medicine, 46(2), 257-63.
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  The routine use of clinical decision rules and three-view plain radiography to clear the cervical spine in blunt trauma patients has been recently called into question.
• Panchal, A. R., Denninghoff, K. R., Munger, B., & Keim, S. M. (2014). Scholar quest: a residency research program aligned with faculty goals. The western journal of emergency medicine, 15(3), 299-305.
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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.
• Cohn, B. G., Keim, S. M., & Yealy, D. M. (2013). Is emergency department cardioversion of recent-onset atrial fibrillation safe and effective?. The Journal of emergency medicine, 45(1), 117-27.
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  Atrial fibrillation (AF) is a very common dysrhythmia presenting to Emergency Departments (EDs). Controversy exists regarding the optimal clinical therapy for these patients, which typically focuses on rhythm rate-control and admission or cardioversion and discharge home.
• Kalb, B., Keim, S. M., Lubarsky, M., Martin, D. R., & Sharma, P. (2013). MR imaging for acute nontraumatic abdominopelvic pain: rationale and practical considerations.. Radiographics : a review publication of the Radiological Society of North America, Inc, 33(2), 313-37. doi:10.1148/rg.332125116
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  Medical imaging is becoming an increasingly vital component of patient care in the emergency department. Computed tomography has been the diagnostic imaging method of choice for emergency department patients with acute abdominopelvic pain; however, the use of ionizing radiation and the potential need for exogenous contrast material adversely affect patient safety and work flow efficiency, respectively. Magnetic resonance (MR) imaging holds promise as an alternative for the evaluation of acute abdominopelvic pain. Critical causes of abdominopelvic pain may be detected with MR imaging without exogenous contrast material. MR imaging is sensitive for depicting tissue or fluid changes related to inflammation, a common process in causes of acute abdominopelvic pain. Fat suppression allows the detection of abnormal signal caused by inflamed tissue. MR imaging has proved sensitive in the detection of acute inflammatory diseases of the gallbladder and bile ducts, liver, pancreas, kidneys, collecting system, bowel, and pelvic soft tissues. Moreover, MR imaging without exogenous contrast material may be safely used in pregnant patients. Evolving roles for emergency department MR imaging include the assessment of vascular disease (including thromboembolic disease) and right upper quadrant pain. Emergency department MR imaging currently has limited availability, and its continued use will require further education regarding operation and image interpretation as well as further validation of cost-effectiveness. Nevertheless, current understanding of the diagnostic utility of this imaging method warrants continued study and the increased use of MR imaging in the evaluation of emergency department patients with acute abdominopelvic pain.
• Rosen, P., Carpenter, C. R., Keim, S. M., & Worster, A. (2012). Brain natriuretic peptide in the evaluation of emergency department dyspnea: is there a role?. The Journal of emergency medicine, 42(2), 197-205. doi:10.1016/j.jemermed.2011.07.014
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  Acute decompensated congestive heart failure (ADCHF) is a common etiology of dyspnea in emergency department (ED) patients. Delayed diagnosis of ADCHF increases morbidity and mortality. Two cardiac biomarkers, N-terminal-pro brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) have demonstrated excellent sensitivity in diagnostic accuracy studies, but the clinical impact on patient-oriented outcomes of these tests remains in question..Does emergency physician awareness of BNP or NT-proBNP level improve ADCHF patient-important outcomes including ED length of stay, hospital length of stay, cardiovascular mortality, or overall health care costs?.Five trials have randomized clinicians to either knowledge of or no knowledge of ADCHF biomarker levels in ED patients with dyspnea and some suspicion for heart failure. In assessing patient-oriented outcomes such as length-of-stay, return visits, and overall health care costs, the randomized controlled trials fail to provide evidence of unequivocal benefit to patients, clinicians, or society..Clinician awareness of BNP or NT-proBNP levels in ED dyspnea patients does not necessarily improve outcomes. Future ADCHF biomarker trials must assess patient-oriented outcomes in conjunction with validated risk-stratification instruments.
• Davis, D. P., Keim, S. M., & Sherbino, J. (2010). Clinical decision rules for termination of resuscitation in out-of-hospital cardiac arrest.. The Journal of emergency medicine, 38(1), 80-6. doi:10.1016/j.jemermed.2009.08.002
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  Out-of-hospital cardiac arrest (OHCA) has a low probability of survival to hospital discharge. Four clinical decision rules (CDRs) have been validated to identify patients with no probability of survival. Three of these rules focus on exclusive prehospital basic life support care for OHCA, and two of these rules focus on prehospital advanced life support care for OHCA..Can a CDR for the termination of resuscitation identify a patient with no probability of survival in the setting of OHCA?.Six validation studies were selected from a PubMed search. A structured review of each of the studies is presented..In OHCA receiving basic life support care, the BLS-TOR (basic life support termination of resuscitation) rule has a positive predictive value for death of 99.5% (95% confidence interval 98.9-99.8%), and decreases the transportation of all patients by 62.6%. This rule has been appropriately validated for widespread use. In OHCA receiving advanced life support care, no current rule has been appropriately validated for widespread use..The BLS-TOR rule is a simple rule that identifies patients who will not survive OHCA. Further research is required to identify similarly robust CDRs for patients receiving advanced life support care in the setting of OHCA.
• Erstad, B. L., Keim, S. M., & Patanwala, A. E. (2010). Intravenous opioids for severe acute pain in the emergency department.. The Annals of pharmacotherapy, 44(11), 1800-9. doi:10.1345/aph.1p438
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  To review clinical trials of intravenous opioids for severe acute pain in the emergency department (ED) and to provide an approach for optimization of therapy..Articles were identified through a search of Ovid/MEDLINE (1948-August 2010), PubMed (1950-August 2010), Cochrane Central Register of Controlled Trials (1991-August 2010), and Google Scholar (1900-August 2010). The search terms used were pain, opioid, and emergency department..The search was limited by age group to adults and by publication type to comparative studies. Studies comparing routes of administration other than intravenous or using non-opioid comparators were not included. Bibliographies of all retrieved articles were reviewed to obtain additional articles. The focus of the search was to identify original research that compared intravenous opioids used for treatment of severe acute pain for adults in the ED..At equipotent doses, randomized controlled trials have not shown clinically significant differences in analgesic response or adverse effects between opioids studied. Single opioid doses less than 0.1 mg/kg of intravenous morphine, 0.015 mg/kg of intravenous hydromorphone, or 1 μg/kg of intravenous fentanyl are likely to be inadequate for severe, acute pain and the need for additional doses should be anticipated. In none of the randomized controlled trials did patients develop respiratory depression requiring the use of naloxone. Future trials could investigate the safety and efficacy of higher doses of opioids. Implementation of nurse-initiated and patient-driven pain management protocols for opioids in the ED has shown improvements in timely provision of appropriate analgesics and has resulted in better pain reduction..Currently, intravenous administration of opioids for severe acute pain in the ED appears to be inadequate. Opioid doses in the ED should be high enough to provide adequate analgesia without additional risk to the patient. EDs could implement institution-specific protocols to standardize the management of pain.
• Keim, S. M., Pancioli, A. M., Sahsi, R., & Worster, A. (2010). Do either corticosteroids or antiviral agents reduce the risk of long-term facial paresis in patients with new-onset Bell's palsy?. The Journal of emergency medicine, 38(4), 518-23. doi:10.1016/j.jemermed.2009.08.016
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  The cause of Bell's palsy remains uncertain, although accumulating evidence suggests a viral etiology. To date, treatment to minimize long-term deficits from this disorder typically includes anti-inflammatory or antiviral medication..Do corticosteroids or antiviral agents, either alone or in combination, reduce the risk of long-term facial paresis in patients with new-onset Bell's palsy?.Three multicenter, randomized, controlled trials enrolled over 1,500 adult patients with paroxysmal, unilateral paresis of cranial nerve VII and treated them with varying regimens and combinations of prednisolone, antiviral agents, and placebo, and evaluated complete recovery up to 12 months later..The two larger, most recent trials incorporated similar factorial designs to allow for comparisons between steroids, antivirals, both combined, and placebo, and assessed recovery using validated measures of facial nerve function. In the larger, blinded trial, the numbers needed to treat to achieve complete recovery for patients in the prednisolone and acyclovir groups at 9 months were 7.8 (95% confidence interval [CI] 5.9-13.7) and 18.7 (95% CI 9.5-infinity), respectively. The number needed to treat to achieve complete recovery for patients in the valacyclovir plus prednisolone group vs. the prednisolone alone group in the second trial was 14.8 (95% CI 9.1-744.8)..Current evidence suggests that prednisolone, an inexpensive and readily available medication, is effective for this common condition, but there was no statistically significant difference observed with acyclovir. Valacyclovir provides minimal added benefit to prednisolone alone.
• Adeoye, O., Carpenter, C. R., Keim, S. M., & Worster, A. (2009). Does early intensive lowering of blood pressure reduce hematoma volume and improve clinical outcome after acute cerebral hemorrhage?. The Journal of emergency medicine, 37(4), 433-8. doi:10.1016/j.jemermed.2009.05.002
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  Intracerebral hemorrhage (ICH) is a poorly understood condition with devastating results. Despite the personal and social impact of ICH, modern medicine can offer little hope. Surgery is the longest-standing therapy, but with no demonstrated evidence of positive effect. Reduction of the early hypertension seen with ICH is believed to limit hematoma growth and improve clinical outcome. The effectiveness and safety of an early, aggressive blood-pressure-lowering strategy for ICH patients has only recently been examined in randomized controlled trials..Does early, intensive lowering of blood pressure reduce hematoma volume and improve clinical outcome after acute cerebral hemorrhage?.Two trials assessing the clinical impact of blood pressure lowering in intracerebral hemorrhage were acquired and appraised..The two randomized trials incorporated similar parallel designs and both trials measured clinical outcomes and short-term change in hematoma size. The smaller trial was only partially blinded and showed no difference in any of the outcomes; the large trial demonstrated marginal reduction in proportional hematoma growth, but no significant difference in clinical outcome..There is currently insufficient evidence to support the routine practice of lowering blood pressure of patients suffering an acute intracerebral hemorrhage.
• Carpenter, C. R., Crossley, J., Keim, S. M., & Perry, J. J. (2009). Post-transient ischemic attack early stroke stratification: the ABCD(2) prognostic aid.. The Journal of emergency medicine, 36(2), 194-8; discussion 198-200. doi:10.1016/j.jemermed.2008.04.034
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  In many patients, transient ischemic attack (TIA) precedes stroke. Prompt recognition of TIA patients who are at increased short-term risk for stroke may facilitate efficient resource utilization and improved patient outcomes. Three prognostic decision aids have been derived and validated to empower emergency physicians to stratify TIA patients for 2-day stroke risk based upon information readily available at the bedside..Can a TIA stratification tool predict short-term stroke risk?.Two relevant tool derivation studies and one validation study were selected from an evidence search and a structured review..The three tools reveal similar prognostic capabilities, although the ABCD(2) prognostic guide may be slightly superior. A proposal scoring system for TIA patients at low risk for stroke within 90 days is presented..Stroke risk stratification is possible with a simple prediction rule.
• Carpenter, C. R., Keim, S. M., Pines, J. M., & Seupaul, R. A. (2009). Differentiating low-risk and no-risk PE patients: the PERC score.. The Journal of emergency medicine, 36(3), 317-22. doi:10.1016/j.jemermed.2008.06.017
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  Pulmonary embolism (PE) remains one of the most challenging diagnoses in emergency medicine. The Pulmonary Embolism Rule-out Criteria (PERC) score, a decision aid to reliably distinguish low-risk from very low-risk PE patients, has been derived and validated..Can a subset of patients with sufficiently low risk for PE be identified who require no diagnostic testing?.The PERC score derivation and validation trials were located using PubMed and Web of Science. A critical appraisal of this research is presented..One single-center and another multi-center validation trial both confirmed that the eight-item PERC score identified a very low-risk subset of patients in whom PE was clinically contemplated with a negative likelihood ratio 0.17 (95% confidence interval 0.11-0.25) in the larger trial. If applied, the rule would have identified 20% of potential PE patients as very low risk..The PERC score provides clinicians with an easily remembered, validated clinical decision rule that allows physicians to forego diagnostic testing for pulmonary embolus in a very low-risk population.
• Bair, A. E., Deacon, J. M., Keim, S. M., Panacek, E. A., & Sakles, J. C. (2008). Delayed complications of emergency airway management: a study of 533 emergency department intubations.. The western journal of emergency medicine, 9(4), 190-4.
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  Airway management is a critical procedure performed frequently in emergency departments (EDs). Previous studies have evaluated the complications associated with this procedure but have focused only on the immediate complications. The purpose of this study is to determine the incidence and nature of delayed complications of tracheal intubation performed in the ED at an academic center where intubations are performed by emergency physicians (EPs)..All tracheal intubations performed in the ED over a one-year period were identified; 540 tracheal intubations were performed during the study period. Of these, 523 charts (96.9%) were available for review and were retrospectively examined. Using a structured datasheet, delayed complications occurring within seven days of intubation were abstracted from the medical record. Charts were scrutinized for the following complications: acute myocardial infarction (MI), stroke, airway trauma from the intubation, and new respiratory infections. An additional 30 consecutive intubations were examined for the same complications in a prospective arm over a 29-day period..The overall success rate for tracheal intubation in the entire study group was 99.3% (549/553). Three patients who could not be orally intubated underwent emergent cricothyrotomy. Thus, the airway was successfully secured in 99.8% (552/553) of the patients requiring intubation. One patient, a seven-month-old infant, had unanticipated subglottic stenosis and could not be intubated by the emergency medicine attending or the anesthesiology attending. The patient was mask ventilated and was transported to the operating room for an emergent tracheotomy. Thirty-four patients (6.2% [95% CI 4.3 - 8.5%]) developed a new respiratory infection within seven days of intubation. Only 18 patients (3.3% [95% CI 1.9 - 5.1%]) had evidence of a new respiratory infection within 48 hours, indicating possible aspiration pneumonia secondary to airway management. Three patients (0.5% [95% CI 0.1 - 1.6%]) suffered an acute MI, but none appeared to be related to the intubation. One patient was having an acute MI at the time of intubation and the other two patients had MIs more than 24 hours after the intubation. No patient suffered a stroke (0% [95% CI 0 - 0.6%]). No patients suffered any serious airway trauma such as a laryngeal or vocal cord injury..Emergency tracheal intubation in the ED is associated with an extremely high success rate and a very low rate of delayed complications. Complication rates identified in this study compare favorably to reports of emergency intubations in other hospital settings. Tracheal intubation can safely be performed by trained EPs.
• Barbee, R. A., Guerra, S., Keim, S., Sherrill, D. L., & Silva, G. E. (2008). Longitudinal decline of diffusing capacity of the lung for carbon monoxide in community subjects with the PiMZ alpha1-antitrypsin phenotype.. Chest, 133(5), 1095-100. doi:10.1378/chest.07-2405
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  It is well known that homozygous deficiency of alpha(1)-antitrypsin, PiZZ, is associated with an increased risk of emphysema. However, studies evaluating associations between the heterozygous form PiMZ with emphysema and impaired lung function have provided conflicting results..The goal of this study was to determine if the phenotype PiMZ is associated with an accelerated decline in diffusing capacity of the lung for carbon monoxide (Dlco)..The Tucson Epidemiologic Study of Airway Obstructive Disease is a prospective, population-based cohort study initiated in 1972. Participants completed standardized questionnaires in up to 12 periodic surveys and Dlco assessments in up to 4 surveys. Random-effects models were used to determine the effects of alpha(1)-antitrypsin phenotypes on percentage of predicted (% predicted) Dlco levels among 1,075 subjects > or = 18 years old..% predicted Dlco declined more rapidly in subjects who smoked compared to nonsmoking subjects. Additionally, in smokers, the PiMZ phenotype was associated with borderline % predicted Dlco deficits at age 40 years (8.6%; p = 0.075) and significant % predicted Dlco deficits at age 60 years (15.2%; p = 0.001) and 80 years (21.9%; p = 0.003), as compared with the PiMM phenotype..Dlco may be a more sensitive indicator of the long-term effects of intermediate levels of alpha(1)-antitrypsin on lung function especially in subjects who smoke.
• Bracke, P. J., Howse, D. K., & Keim, S. M. (2008). Evidence-based Medicine Search: a customizable federated search engine.. Journal of the Medical Library Association : JMLA, 96(2), 108-13. doi:10.3163/1536-5050.96.2.108
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  This paper reports on the development of a tool by the Arizona Health Sciences Library (AHSL) for searching clinical evidence that can be customized for different user groups..The AHSL provides services to the University of Arizona's (UA's) health sciences programs and to the University Medical Center. Librarians at AHSL collaborated with UA College of Medicine faculty to create an innovative search engine, Evidence-based Medicine (EBM) Search, that provides users with a simple search interface to EBM resources and presents results organized according to an evidence pyramid. EBM Search was developed with a web-based configuration component that allows the tool to be customized for different specialties..Informal and anecdotal feedback from physicians indicates that EBM Search is a useful tool with potential in teaching evidence-based decision making. While formal evaluation is still being planned, a tool such as EBM Search, which can be configured for specific user populations, may help lower barriers to information resources in an academic health sciences center.
• Keim, S. M., Rodgers, R. B., & Sakles, J. C. (2008). Optical and video laryngoscopes for emergency airway management.. Internal and emergency medicine, 3(2), 139-43. doi:10.1007/s11739-008-0101-y
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  Direct laryngoscopy for airway management was introduced into clinical medicine almost 70 years ago and is still the dominant modality. The recent development of video and optical laryngoscopy could be the most important change in this paradigm. This paper examines state of the art devices and makes recommendations regarding specific advantages they advance for the field of emergency medicine.
• Rosen, P., Keim, S. M., Vadera, R., & Worster, A. (2008). Do patients with acute myocardial infarction benefit from treatment with clopidogrel?. The Journal of emergency medicine, 34(4), 479-83; discussion 483. doi:10.1016/j.jemermed.2007.10.019
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  Clopidogrel (Plavix), a platelet aggregation inhibitor, has been shown to be effective in certain patients undergoing percutaneous coronary interventions, but its use in patients with acute myocardial infarction who receive a fibrinolytic strategy instead has been controversial. The aim of the Evidence-Based Medicine (EBM) Section is to bring the readership clinically relevant and practical evidence-based medicine principles and topic reviews. This EBM - Therapy review focuses on a relatively new therapy option for Emergency Department patients with acute myocardial infarction.
• Harris, R. M., Keim, S. M., Kent, M. A., Mays, M. Z., Parks, B. O., & Pytlak, E. (2007). Heat fatalities in Pima County, Arizona.. Health & place, 13(1), 288-92. doi:10.1016/j.healthplace.2005.08.004
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  The most common cause of heat fatalities is environmental exposure during heat waves. Deserts of the southwestern USA are known for temperatures that exceed 32 degrees C for 30 days or more; yet, heat-related fatalities are rare among residents of the region. We compiled data from the National Weather Service and the Office of the Medical Examiner in order to determine the relationship between temperature and occurrence of heat fatalities in Pima County, AZ. Logistic regression indicated that for each degree of increase in temperature (degrees C), there was a 35% increase in the odds of a heat fatality occurring (p
• Harris, R. B., Keim, S. M., Mays, M. Z., Serido, J., & Williams, J. M. (2006). Measuring wellness among resident physicians.. Medical teacher, 28(4), 370-4. doi:10.1080/01421590600625320
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  Requirements to include professionalism in residency curricula have generated a substantial body of literature concerning the environments that fail to nurture professionalism. Local and national surveys provide evidence that a high prevalence of depersonalization and emotional exhaustion exists among residents and that clinical practice is impaired as a result of these factors. A group of 34 residents from ten residency programmes participated in the psychometric testing of a resident wellness assessment instrument that can be rapidly administered, scored, and interpreted. The Brief Resident Wellness Profile is composed of a Mood faces graphical rating item and a six-question subscale. The six-item subscale had good reliability (alpha = 0.83; r = 0.84), convergent validity (r = 0.63), discriminant validity (r = -0.37), and concurrent validity ( p = 0.007). The Mood faces item had good convergent validity (r = 0.66), discriminant validity (r = -0.71), and concurrent validity ( p = 0.008). The Brief Resident Wellness Profile appears to be a reliable and valid instrument that measures residents' sense of professional accomplishment and mood and can be rapidly administered, scored, and interpreted.
• Harris, R. M., Keim, S. M., Kent, M. A., Mays, M. Z., Parks, B. O., & Pytlak, E. (2006). Estimating the incidence of heat-related deaths among immigrants in Pima County, Arizona.. Journal of immigrant and minority health, 8(2), 185-91. doi:10.1007/s10903-006-8527-z
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  Widespread media reports have described an increase in heat-related deaths among illegal immigrant border crossers in Southern Arizona in recent years. We conducted a retrospective case series review of heat-related deaths reported by a large border county medical examiner office in an attempt to estimate the occurrence and distribution of these deaths for the years 1998-2003. United States Border Patrol apprehension data were also collected and used in the analysis to estimate the size of the population of border crossers. An increase in the total heat-related deaths has occurred since 1999 in Pima County Arizona and has continued to date. Precise estimates of rates are not possible but appear to have increased as well. Implications for understanding the complexity of researching this public health issue including the definition of cases and population at risk are discussed.
• Cayten, C. G., Chew, J. L., Desmond, J. S., Garrison, H. G., Gregor, M. A., Keim, S. M., Mackenzie, E. J., Maio, R. F., Miller, D. R., O'malley, P. J., Spaite, D. W., & Stiell, I. G. (2004). Establishing the scope and methodological approach to out-of-hospital outcomes and effectiveness research.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 11(10), 1067-73. doi:10.1197/j.aem.2004.04.014
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  Outcomes research offers out-of-hospital medicine a valuable methodology for studying the effectiveness of services provided in the out-of hospital setting. A clear understanding of the history and constructs of outcomes research is necessary for its integration into emergency medical services research. This report describes the conceptual framework of outcomes research and key methodological considerations for the successful implementation of out-of-hospital outcomes research. Illustrations of the specific applications of outcomes research and implications to existing methodologies are given, as well as suggestions for improved interdisciplinary research.
• Grant, D. C., Keim, S. M., & Mays, M. Z. (2004). Interactions between emergency medicine programs and the pharmaceutical industry.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 11(1), 19-26. doi:10.1197/j.aem.2003.07.016
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  To examine the beliefs and practices of emergency medicine program directors regarding interactions with the pharmaceutical industry. The authors also sought to study the prevalence of program policies and the desire for organizational policies..The Board of the Council of Emergency Medicine Residency Directors (CORD) requested and approved a member survey. An institutional review board-approved, Web-based, 30-item survey was sent to all CORD members subscribed to the organization's listserv in May 2002 and was completed by June 2002. Program director respondents were surveyed as to their beliefs and practices regarding industry sponsorship of speakers, social events, drug samples, travel to conferences, and the educational value of marketing representatives. Subjects were queried about their awareness of existing guidelines and whether they desired policy development by CORD..Surveys were returned from 106 programs (85%). The majority of program directors (72%) "never" or "very rarely" allowed unrestricted interactions between pharmaceutical representatives and residents at work. However, only 52% of program directors said they "never" or "very rarely" allowed pharmaceutical representatives to give residents free drug samples at work. Only 46% said they "never" or "very rarely" allowed pharmaceutical representatives to teach residents. Two thirds of program directors desired CORD guidelines regarding interactions with the pharmaceutical industry. Program directors seeking guidelines were less likely to allow pharmaceutical representatives to teach residents (p = 0.001). They were also less likely to allow pharmaceutical representatives unrestricted interactions with residents (p = 0.05)..A wide range of practices exist among emergency medicine residency program directors, and most desire organizational guidelines regarding interactions with the pharmaceutical industry.
• Keim, S., & Perina, D. G. (2004). Council of Emergency Medicine Residency Directors Position on Interactions between Emergency Medicine Residencies and the Pharmaceutical Industry. Academic Emergency Medicine, 11(1), 78-78. doi:10.1111/j.1553-2712.2004.tb01376.x
• Keim, S., Keim, S. M., & Perina, D. G. (2004). Council of Emergency Medicine Residency Directors position on interactions between emergency medicine residencies and the pharmaceutical industry.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 11(1), 78. doi:10.1197/j.aem.2003.05.011
• Tolby, N. M., & Keim, S. M. (2004). Fluids and Electrolytes. Emergency Medicine- On Call.
• Davis, V., Erstad, B. L., Keim, S. M., & Sakles, J. C. (2002). Etomidate for procedural sedation in the emergency department.. Pharmacotherapy, 22(5), 586-92. doi:10.1592/phco.22.8.586.33204
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  To review our experience with etomidate in nonintubated patients in the emergency department..A 2-year retrospective chart review of consecutive patients receiving etomidate for sedation..Emergency department of a university-based teaching hospital..Forty-eight patients who underwent painful procedures in the emergency department..Demographics, dosing information, recovery times, and adverse events were abstracted using a standardized data collection form. Forty-eight nonintubated patients were sedated with etomidate. Mean age was 34 years (range 6-80 yrs); 38 were men and 10 women; two were children. The mean initial dose of etomidate was 13 mg. Adverse events occurred in 11 (21%) patients. None sustained any substantial morbidity as indicated by need for intubation, prolonged emergency department stay, or hospital admission..Although controversial, etomidate holds promise as a potent sedative agent for patients undergoing painful procedures in the emergency department. A large prospective evaluation is needed to document the performance and complications of this agent.
• Guisto, J. A., Keim, S. M., & Sullivan, J. B. (2002). Environmental thermal stress.. Annals of agricultural and environmental medicine : AAEM, 9(1), 1-15.
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  Thermal stress from cold and heat can affect health and productivity in a wide range of environmental and workload conditions. Health risks typically occur in the outer zones of heat and cold stress, but are also related to workload. Environmental factors related to thermal stress are reviewed. Individuals undergo thermoregulatory physiologic changes to adapt and these changes are reviewed. Heat and cold related illnesses are reviewed as well as their appropriate therapy. Published standards, thresholds and recommendations regarding work practices, personal protection and types of thermal loads are reviewed.
• Anderson, K., Anderson, K. A., Keim, S. M., Siegel, E. M., Spaite, D. W., & Valenzuela, T. D. (2001). Factors associated with CPR certification within an elderly community.. Resuscitation, 51(3), 269-74. doi:10.1016/s0300-9572(01)00418-x
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  To determine the frequency of CPR certification amongst residents living within a predominantly elderly community and examine the perceived barriers to learning basic CPR and factors associated with intent to become certified..A household survey was sent with a community newsletter to each home of a non-gated elderly community that requires one member of each household to be at least 55 years of age. The community consists of 2488 homes (approximately 4000 residents). Thirteen Yes/No questions were asked in a skip-pattern based upon the question: "Are you CPR certified?" Data analysis included univariate, bivariate, and logistic regression..947 participants with a mean age of 69 completed and returned the survey. Forty-eight percent of the participants had received prior training in CPR. Eighty-four percent were not currently certified in CPR, and top reasons cited were: 'don't know why' (36%), 'lack of interest' (20%), 'concerned about health risks' (17%). Forty-six percent of those not certified desired certification. Increasing age was inversely associated with CPR certification status and the desire to be certified..Almost half of the residents in this predominantly elderly community had received prior training in CPR, although most were not currently certified and cite significant specific and non-specific reasons and obstacles. Improved survival requires targeted interventions to achieve higher proportions of CPR-competent individuals in such high-risk communities.
• Kazzi, A., Chisholm, C., Hedges, J., Joseph, R., Keim, S., Martin, M., McNamara, R., & Wood, J. (2001). AAEM, CORD, and SAEM reach a landmark position: Consensus recommendations to the Federation of State Medical Boards (FSMB) for revisions to the FSMB May 1998 policy statement on physician licensure. Academic Emergency Medicine, 8(4). doi:10.1111/j.1553-2712.2001.tb02120.x
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  As a result of months of meetings and deliberations coordinated with the Medical Board of California and chaperoned by the California Chapter of the American Academy of Emergency Medicine (CAL/AAEM), the Society for Academic Medicine (SAEM), the Council of Emergency Medicine Residency Directors (CORD), and the American Academy of Emergency Medicine (AAEM) recently reached a landmark agreement on recommendations to the Federation of State Medical Boards (FSMB) pertaining to controversial May 1998 FSMB recommendations regarding physician licensure. Endorsed unanimously by the boards of all three emergency medicine (EM) organizations, the recommendations of this consensus have been forwarded to the FSMB and await its official response. The recommendations will also be forwarded to remaining EM organizations and to the medical community for comment and to enlist their support.
• Keim, S., Anderson, K., Siegel, E., Spaite, D., & Valenzuela, T. (2001). Factors associated with CPR certification within an elderly community. Resuscitation, 51(3). doi:10.1016/S0300-9572(01)00418-X
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  Objective: To determine the frequency of CPR certification amongst residents living within a predominantly elderly community and examine the perceived barriers to learning basic CPR and factors associated with intent to become certified. Methods: A household survey was sent with a community newsletter to each home of a non-gated elderly community that requires one member of each household to be at least 55 years of age. The community consists of 2488 homes (approximately 4000 residents). Thirteen Yes/No questions were asked in a skip-pattern based upon the question: "Are you CPR certified?" Data analysis included univariate, bivariate, and logistic regression. Results: 947 participants with a mean age of 69 completed and returned the survey. Forty-eight percent of the participants had received prior training in CPR. Eighty-four percent were not currently certified in CPR, and top reasons cited were: 'don't know why' (36%), 'lack of interest' (20%), 'concerned about health risks' (17%). Forty-six percent of those not certified desired certification. Increasing age was inversely associated with CPR certification status and the desire to be certified. Conclusion: Almost half of the residents in this predominantly elderly community had received prior training in CPR, although most were not currently certified and cite significant specific and non-specific reasons and obstacles. Improved survival requires targeted interventions to achieve higher proportions of CPR-competent individuals in such high-risk communities. © 2001 Elsevier Science Ireland Ltd. All rights reserved.
• McNamara, R., & Keim, S. (2001). EM moonlighting: The focus should be on patient safety. Journal of Emergency Medicine, 20(3). doi:10.1016/S0736-4679(01)00284-0
• Barletta, J. F., Erstad, B. L., Keim, S. M., & Loew, M. R. (2000). A prospective study of pain control in the emergency department.. American journal of therapeutics, 7(4), 251-5. doi:10.1097/00045391-200007040-00005
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  The most common complaint in the emergency department is pain. The management of acute pain, however, has not been well studied. This prospective study was designed to assess pain intensity and relief along with satisfaction in the emergency department. Adult patients with a primary complaint of acute pain were asked to complete a two-part questionnaire administered by a research assistant. The first part was completed on arrival and the second part on discharge from the emergency department. The respondents were not permitted to see the first part of the questionnaire while completing the second. The questionnaire used an unmarked, horizontal 10-cm visual analog scale along with short answer questions to measure pain, relief, and satisfaction. Choice of drug therapy was decided by the physician according to usual treatment methods. Fifty-seven people presented with the chief complaint of pain. Of those, 30 (53%) were treated with medications. The mean level of pain on admission for treated patients was 6.64 compared with a mean level of pain on discharge of 4.02 (P =.0001). Untreated patients had a mean admission visual analog scale score of 4.19. Compared with treated patients, this difference was statistically significant (P =.001). A mean visual analog scale score of 5.43, representing the mean amount of pain relief, was reported among treated patients. Treated patients also reported a visual analog scale score of 6.46 in overall satisfaction with pain management. The results of this study indicate that there is a significant and clinical difference in levels of pain and satisfaction between admission and discharge in these patients in the emergency department.
• Chisholm, C., & Keim, S. M. (2000). Moonlighting and emergency medicine: raising the standard.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 7(8), 927-8. doi:10.1111/j.1553-2712.2000.tb02074.x
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  Academic Emergency MedicineVolume 7, Issue 8 p. 927-928 Free Access Moonlighting and Emergency Medicine Raising the Standard Samuel Keim MD, Samuel Keim MD (sam@aemrc.arizona.edu), Section of Emergency Medicine, Arizona Health Sciences Center, Tucson, AZSearch for more papers by this authorCarey Chisholm MD, Carey Chisholm MD (cchisholm@clarian.com), Department of Emergency Medicine, Indiana University School of Medicine, Clarian-Methodist Hospital, Indianapolis, INSearch for more papers by this author Samuel Keim MD, Samuel Keim MD (sam@aemrc.arizona.edu), Section of Emergency Medicine, Arizona Health Sciences Center, Tucson, AZSearch for more papers by this authorCarey Chisholm MD, Carey Chisholm MD (cchisholm@clarian.com), Department of Emergency Medicine, Indiana University School of Medicine, Clarian-Methodist Hospital, Indianapolis, INSearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1111/j.1553-2712.2000.tb02074.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume7, Issue8August 2000Pages 927-928 ReferencesRelatedInformation
• Keim, S. M. (2000). CORD position statement on moonlighting. CORD Board of Directors. Council of Emergency Medicine Residency Directors.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 7(8), 929. doi:10.1111/j.1553-2712.2000.tb02076.x
• Keim, S. M. (2000). Can resident physicians be profiled?. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 7(1), 72-4. doi:10.1111/j.1553-2712.2000.tb01897.x
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  Academic Emergency MedicineVolume 7, Issue 1 p. 72-74 Free Access Can Resident Physicians Be Profiled? Samuel M. Keim MD, Samuel M. Keim MD ([email protected]), President of the Council of Emergency Medicine Residency Directors, and Section of Emergency Medicine Arizona Health Services Center, Tucson, AZSearch for more papers by this author Samuel M. Keim MD, Samuel M. Keim MD ([email protected]), President of the Council of Emergency Medicine Residency Directors, and Section of Emergency Medicine Arizona Health Services Center, Tucson, AZSearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1111/j.1553-2712.2000.tb01897.xCitations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Hofer TP, Hayward RA, Greenfield S, et al. The unreliability of individual physician “report cards” for assessing the costs and quality of care of a chronic disease. JAMA. 1999; 281: 2098– 105. 2 Bindman AB. Can physician profiles be trusted. JAMA. 1999; 281: 2142– 3. 3 Salem-Schatz S, Moore G, Rucker M, Pearson S. The case for case-mix adjustment in practice profiling. JAMA. 1994; 272: 871– 4. 4 Welch HG, Miller ME, Welch WP. An analysis of inpatient practice patterns in Florida and Oregon. N Engl J Med. 1994; 330: 607– 12. 5 DeBehnke D, O'Brien S, Leschke R. Emergency medicine resident work productivity in an academic emergency department [brief report]. Acad Emerg Med. 2000; 7: 90– 2. 6 Brook RH, Cleary PD. Quality of health care. N Engl J Med. 1996; 335: 966– 70. 7 Wennberg DE. Variation in the delivery of health care: the stakes are high. Ann Intern Med. 1998; 128: 866– 8. 8 Hayward RA, Manning WG, McMahon LF, Bernard AM. Do attending or resident physician practice styles account for variations in hospital resource use. Med Care. 1994; 32: 788– 94. 9 Epstein A. Performance reports on quality: prototypes, problems, and prospects. N Engl J Med. 1995; 333: 57– 61. 10 Accreditation Council for Graduate Medical Education. Essentials of Accredited Residencies in Graduate Medical Education. Chicago , IL : ACGME, 1998. Citing Literature Volume7, Issue1January 2000Pages 72-74 ReferencesRelatedInformation
• Bekkerman, A. G., Keim, S. M., Kendall, J. L., & Schwab, R. A. (1999). Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities: Zaroff JG, Rordorf GA, Newell JB, et al Neurosurgery 44:34–40 January 1999. Annals of Emergency Medicine, 33(6), 729. doi:10.1016/s0196-0644(99)80026-2
• Chisholm, C. D., Dyne, P. L., Hendey, G. W., Jouriles, N. J., Keim, S. M., King, R. W., Rein, J. A., Salomone, J. A., Schrading, W. A., Swart, G. L., & Wightman, J. M. (1999). A standardized letter of recommendation for residency application.. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 6(11), 1141-6. doi:10.1111/j.1553-2712.1999.tb00117.x
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  Emergency medicine (EM) program directors have expressed a desire for more evaluative data to be included in application materials. This is consistent with frustrations expressed by program directors of multiple specialties, but mostly by those in specialties with more competitive matches. Some of the concerns about traditional narrative letters of recommendation included lack of uniform information, lack of relative value given for interval grading, and a perception of ambiguity with regard to terminology. The Council of Emergency Medicine Residency Directors established a task force in 1995 that created a standardized letter of recommendation form. This form, to be completed by EM faculty, requests that objective, comparative, and narrative information be reported regarding the residency applicant.
• Beskind, D. L., & Keim, S. M. (1994). Choreoathetotic movement disorder in a boy with Mycoplasma pneumoniae encephalitis.. Annals of emergency medicine, 23(6), 1375-8. doi:10.1016/s0196-0644(94)70365-5
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  We present a case of a 10-year-old boy who presented to the emergency department with high fever, acute choreoathetosis, weakness, and dysarthria. An EEG showed generalized slowing, and serologies defined an acute case of Mycoplasma pneumoniae encephalitis. This report describes the most common presentations, therapy, and outcomes of M pneumoniae encephalitis.
• Beskind, D., & Keim, S. (1994). Choreoathetotic Movement Disorder in a Boy With Mycoplasma pneumoniae Encephalitis. Annals of Emergency Medicine, 23(6). doi:10.1016/S0196-0644(94)70365-5
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  We present a case of a 10-year-old boy who presented to the emergency department with high fever, acute choreoathetosis, weakness, and dysarthria. An EEG showed generalized slowing, and serologies defined an acute case of Mycoplasma pneumoniae encephalitis. This report describes the most common presentations, therapy, and outcomes of M pneumoniae encephalitis. [Beskind DL, Keim SM: Choreoathetotic movement disorder in a boy with Mycoplasma pneumoniae encephalitis. Ann Emerg Med June 1994;23:1375-1378.]. © 1994 Mosby, Inc. All rights reserved.
• Dyne, P. L., Fulginiti, J. W., Keim, S. M., Sanders, A. B., & Witzke, D. B. (1993). Beliefs and practices of emergency medicine faculty and residents regarding professional interactions with the biomedical industry.. Annals of emergency medicine, 22(10), 1576-81. doi:10.1016/s0196-0644(05)81262-4
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  To examine emergency medicine resident training and understanding of general bioethics and resident and faculty attitudes and behavior regarding professional interactions with the biomedical industry..Two companion questionnaire surveys..Annual resident in-service examination and written director survey with telephone follow-up..Emergency medicine residents and program directors..chi 2 analysis was used for questions involving relationships among variables with dichotomous or categorical response. An analysis of variance or Pearson Product Moment Correlation was calculated for questions with continuous variables..The surveys were completed by 1,385 of 1,836 (75%) residents and 80 of 81 (99%) residency directors. On average, residents receive eight hours of bioethical instruction per year but believe that they need 12 hours per year. Seventy-five percent of residents believe that company representatives sometimes cross ethical boundaries. The amount of resident understanding of bioethical concepts correlated with the number of hours of bioethics training they received. A sensitivity to bioethical conflicts index was correlated with the residents' behavior..There is wide variation in beliefs and practices regarding the interaction between emergency medicine residents and directors and the biomedical industry. Our results suggest that residents need training regarding conflicts of interest, accepted standards of practice, and dealing with potential conflicts with the biomedical industry.
• Keim, S., Sanders, A., Witzke, D., Dyne, P., & Fulginiti, J. (1993). Beliefs and practices of emergency medicine faculty and residents regarding professional interactions with the biomedical industry. Annals of Emergency Medicine, 22(10). doi:10.1016/S0196-0644(05)81262-4
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  Study objectives: To examine emergency medicine resident training and understanding of general bioethics and resident and faculty attitudes and behavior regarding professional interactions with the biomedical industry. Design: Two companion questionnaire surveys. Setting: Annual resident in-service examination and written director survey with telephone follow-up. Participants: Emergency medicine residents and program directors. Interventions: χ2 analysis was used for questions involving relationships among variables with dichotomous or categorical response. An analysis of variance or Pearson Product Moment Correlation was calculated for questions with continuous variables. Measurements and main results: The surveys were completed by 1,385 of 1,836 (75%) residents and 80 of 81 (99%) residency directors. On average, residents receive eight hours of bioethical instruction per year but believe that they need 12 hours per year. Seventy-five percent of residents believe that company representatives sometimes cross ethical boundaries. The amount of resident understanding of bioethical concepts correlated with the number of hours of bioethics training they received. A sensitivity to bioethical conflicts index was correlated with the residents' behavior. Conclusion: There is wide variation in beliefs and practices regarding the interaction between emergency medicine residents and directors and the biomedical industry. Our results suggest that residents need training regarding conflicts of interest, accepted standards of practice, and dealing with potential conflicts with the biomedical industry. © 1993 American College of Emergency Physicians.
• Adams, J. G., Keim, S. M., Sanders, A. B., & Sklar, D. P. (1992). Emergency physicians and the biomedical industry.. Annals of emergency medicine, 21(5), 556-8. doi:10.1016/s0196-0644(05)82524-7
• Sanders, A., Keim, S., Sklar, D., & Adams, J. (1992). Emergency physicians and the biomedical industry. Annals of Emergency Medicine, 21(5). doi:10.1016/S0196-0644(05)82524-7
• Carney, M. K., Keim, S. T., Mk, C., & St, K. (1978). Cost to the hospital of a clinical training program.. Journal of allied health, 7(3), 187-91.
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  Programs for the training of radiologic technologists involving clinical training at a host hospital are growing rapidly. The objective of the study reported in this paper was to determine the cost to the hospital of supporting such clinical training. Information was collected by means of interviews with hospital administrative officials, clinical instructors and current and recent students. The thrust of the inquiry was toward hospital activities in the production of patient radiologic services. Specifically, questions dealt with the diversion of professional care from the hospital workload and the substitutability of student effort in the performance of professional duties associated with the implementation of the clinical training program. It appears that hosting a clinical training program does not increase hospital costs. There may in fact be a net benefit to the hospital. There was widespread agreement that the production of a student-instructor team more than offset the loss of output resulting from the diversion of staff personnel to instructional duties. Other costs--capital, supplies, breakage--do not appear to be major, and are possibly offset by benefits such as improved recruitment of technologists.

Proceedings Publications

• Hu, C., Keim, S. M., Rice, A., Gaither, J. B., Babaeizadeh, S., Jorgenson, D. B., Helfenbein, E., Spaite, D. W., & Barnhardt, B. J. (2019, Fall). Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between Ent-Tidal CO2 and Level of Consciousness. In Annual Meeting of the American Heart Association, Resuscitation Science Symposium.
• Perez, O., Keim, S. M., Rice, A., Gaither, J. B., Hu, C., Jorgenson, D. B., Babaeizadeh, S., Helfenbein, E., Spaite, D. W., & Barnhardt, B. J. (2019, Jan). End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury: Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. In NAEMSP National Scientific Assembly.
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  Barnhart BJ, Spaite DW, Helfenbein E, Babaieizadeh S, Jorgenson D, Hu C, Gaither JB, Rice A, Keim SM, Perez O: End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury: Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask.
• Perez, O., Barnhardt, B. J., Keim, S. M., Spaite, D. W., Helfenbein, E., Rice, A., Babaeizadeh, S., Gaither, J. B., Hu, C., Jorgenson, D. B., Jorgenson, D. B., Hu, C., Babaeizadeh, S., Gaither, J. B., Helfenbein, E., Rice, A., Spaite, D. W., Keim, S. M., Barnhardt, B. J., & Perez, O. (2018, Nov). End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. In Resuscitation Science Symposium (ReSS) of the American Heart Association (AHA).
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  Barnhart B, Spaite DW, Helfenbein E, Babaeizadeh S, Jorgenson DB, Hu C, Gaither JB, Rice AD, Keim SM, Perez O: End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. Circulation 2018
• 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.
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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., Bobrow, B. J., Sherrill, D. L., Rice, A., Viscusi, C. D., Sherrill, D. L., Keim, S. M., Viscusi, C. D., Denninghoff, K. R., Keim, S. M., Gaither, J. B., Denninghoff, K. R., Chikani, V., Gaither, J. B., Chikani, V., Hu, C., Babaeizadeh, S., Hu, C., Babaeizadeh, S., , Barnhart, B. J., 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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  Barnhart BJ, Spaite DW, Helfenbein E, Perez O, 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 TBI Patients. Presented to the Mediterranean Emergency Medicine Congress, September 6-10, 2017, Lisbon, Portugal.
• 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.
• Keim, S. M., Grady, K., Rice, A. D., Adelson, P. D., Barnhart, B., Gaither, J. B., Chikani, V., Bobrow, B. J., Hu, C., Spaite, D. W., Keim, S. M., Grady, K., Rice, A. D., Adelson, P. D., Barnhart, B., Gaither, J. B., Chikani, V., Bobrow, B. J., Hu, C., & Spaite, D. W. (2017, Sept). Effect of Prehospital Hypoxia “Depth-Duration Dose” on Mortality in Major Traumatic Brain Injury. In Mediterranean Emergency Medicine Congress.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Gaither JB, Barnhart BJ, Adelson PD, Rice AD, Grady K, Keim SM: Effect of Prehospital Hypoxia “Depth-Duration Dose” on Mortality in Major Traumatic Brain Injury. Presented to the Mediterranean Emergency Medicine Congress, September 6-10, 2017, Lisbon, Portugal.
• Keim, S. M., Sherrill, D., Mullins, T., Rice, A. D., Denninghoff, K. R., Adelson, P. D., Barnhart, B. J., Gaither, J. B., Chikani, V., Bobrow, B. J., Hu, C., & Spaite, D. W. (2017, Nov). Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. In American Heart Association (AHA) Resuscitation Science Symposium (ReSS).
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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. Presented to the American Heart Association (AHA) Resuscitation Science Symposium (ReSS), November 11-13, 2017, Anaheim, California.
• 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.
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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.
• Sherrill, D. L., Mullins, T., Viscusi, C. D., Keim, S. M., Denninghoff, K. R., Grady, K., Rice, A. D., Adelson, P. D., Barnhart, B., 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. In National Association of EMS Physicians Annual Meeting.
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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. Presented at the Annual Meeting of the National Association of EMS Physicians, January 24-26, 2017, New Orleans, LA.
• 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, 21, 91.
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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.
• Spaite, D. W., Keim, S. M., Sherill, D., Gaither, J. B., Chikani, V., Hu, C., Jorgenson, D. B., Babaeizadeh, S., Perez, O., Helfenbein, E., & Barnhardt, B. J. (2017, Nov). Prehospital Oxygen Delivery Method and Nasal Cannula End-Tidal CO2 Patterns in Non-Intubated Major Traumatic Brain Injury Patients. In American Heart Association (AHA) Resuscitation Science Symposium (ReSS).
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  Barnhart BJ, Helfenbein E, Perez O, Babaeizadeh S, Jorgenson DB, Hu C, Chikani V, Gaither JB, Sherrill D, Keim SM, Spaite DW: Prehospital Oxygen Delivery Method and Nasal Cannula End-Tidal CO2 Patterns in Non-Intubated Major Traumatic Brain Injury Patients. Presented to the American Heart Association (AHA) Resuscitation Science Symposium (ReSS), November 11-13, 2017, Anaheim, California.
• Spaite, D. W., Sherill, D., Keim, S. M., Gaither, J. B., Chikani, V., Hu, C., Jorgenson, D. B., Babaeizadeh, S., Barnhardt, B. J., Helfenbein, E., Perez, O., Spaite, D. W., Sherill, D., Keim, S. M., Gaither, J. B., Chikani, V., Hu, C., Jorgenson, D. B., Babaeizadeh, S., , Barnhardt, B. J., et al. (2017, Nov). Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. In American Heart Association (AHA) Resuscitation Science Symposium (ReSS).
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  Perez O, Helfenbein E, Barnhart BJ, Babaeizadeh S, Jorgenson DB, Hu C, Chikani V, Gaither JB, Keim SM, Sherrill D, Spaite DW: Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Presented to the American Heart Association (AHA) Resuscitation Science Symposium (ReSS), November 11-13, 2017, Anaheim, California.
• 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., Barnhart, B. J., Spaite, D. W., Helfenbein, E., Perez, O., Babaeizadeh, S., Hu, C., Chikani, V., , Gaither, J. B., et al. (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
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhart, B. J., Babaeizadeh, S., Hu, C., Chikani, V., 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, 133, A13835.
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  Perez O, Spaite DW, Helfenbein E, Barnhart BJ, Babaeizadeh S, Hu C, Vatsal C, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Sherrill D, Bobrow BJ: Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Circulation 2016;133:A13835
• 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. L. (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, 133, A15910.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Adelson PD, Keim SM, Viscusi C, Mullins T, Sherrill D: Evaluation of Prehospital Hypotension Depth-Duration Dose and Mortality in Major Traumatic Brain Injury. Circulation 2016;A15910

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.
• Spaite, D. W., Hu, C., Bobrow, B. J., Chikani, V., Gaither, J. B., Barnhart, B., Adelson, P. D., Rice, A. D., Grady, K., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Mullins, T., & Sherrill, D. L. (2017, Jan). Evaluation Of Prehospital Hypoxia "Depth-Duration Dose'' and Mortality in Major Traumatic Brain Injury. National Association of EMS Physicians Annual Meeting. New Orleans, LA.
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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. 2017. Evaluation Of Prehospital Hypoxia "Depth-Duration Dose'' and Mortality in Major Traumatic Brain Injury. Prehospital Emerg Care, 2017;21(1):91.
• Perez, O. P., Spaite, D. W., Helfenbein, E., Barnhart, B., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Sherrill, D. L., & Bobrow, B. J. (2016, Nov). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
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  Perez O, Spaite D, Helfenbein E, Barnhart B, Babaeizadeh S, Hu C, Chikani V, Gaither JB, Denninghoff KR, Keim SM, Viscusi C, Sherrill D, Bobrow BJ. 2016. Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Circulation. 134 (Suppl 1): A13835.
• 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. L. (2016, November). Evaluation of Prehospital Hypotension Depth-Duration Dose and Mortality in Major Traumatic Brain Injury. American Heart Association (AHA) Resuscitation Science Symposium, Scientific Sessions. New Orleans, LA.
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  Spaite DW, Hu C, Bobrow BJ, Chikani V, Barnhart BJ, Gaither JB, Denninghoff KR, Adelson PD, Keim SM, Viscusi C, Mullins T, Sherrill D: Evaluation of Prehospital Hypotension Depth-Duration Dose and Mortality in Major Traumatic Brain Injury. Circulation 2016;A15910

Poster Presentations

• Keim, S. M., Tolby, N., Plitt, J., Min Simpkins, A. A., Ng, V., Berkman, M. R., Williams, C., Medina, T., Stea, N., Bradshaw, H. R., Situ-LaCasse, E. H., & Amini, R. (2023, November). Emergency Medicine Advising Program 2.0: An Innovative Approach to Medical Student Advising. Association of American Medical Colleges Learn Serve Lead. Seattle, WA: Association of American Medical Colleges.
• Bobrow, B. J., Rice, A. D., Viscusi, C. D., Keim, S. M., Denninghoff, K. R., Sherril, D., Gaither, J. B., Chikani, V., Hu, C., Babaeizadeh, S., Perez, O., Helfenbein, E., Spaite, D. W., & Barnhart, 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.
• Perez, O., Spaite, D. W., Helfenbein, E., Barnhart, B., Babaeizadeh, S., Hu, C., Chikani, V., Gaither, J. B., Denninghoff, K. R., Keim, S. M., Viscusi, C. D., Sherrill, D. L., Rice, A. D., & Bobrow, B. J. (2017, Jan). Prehospital Use of Nasal Cannula End-Tidal Co2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. National Association of EMS Physicians Annual Meeting. New Orleans, LA.
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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. 2017. Prehospital Use of Nasal Cannula End-Tidal Co2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Prehospital Emerg Care, 2017;21(1):97.
• 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.

Others

• Hu, C., Keim, S. M., Rice, A., Gaither, J. B., Babaeizadeh, S., Jorgenson, D. B., Helfenbein, E., Spaite, D. W., & Barnhardt, B. J. (2019, Fall). Prehospital Capnography in Non-Intubated Traumatic Brain Injury Patients: Association Between Ent-Tidal CO2 and Level of Consciousness. Circulation.
• Perez, O., Keim, S. M., Rice, A., Gaither, J. B., Hu, C., Jorgenson, D., Babaeizadeh, S., Helfenbein, E., Spaite, D. W., & Barnhart, B. J. (2019, Jan). End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury: Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. Prehospital Emergency Care, 23(1)..
• Keim, S. M., Keim, S. M., Sherrill, D. L., Sherrill, D. L., Viscusi, C. D., Viscusi, C. D., Rice, A. D., Rice, A. D., Denninghoff, K. R., Denninghoff, K. R., Adelson, P. D., Adelson, P. D., Barnhart, B., Barnhart, B., Gaither, J. B., Gaither, J. B., Chikani, V., Chikani, V., Bobrow, B. J., , Bobrow, B. J., et al. (2017, Sept). 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.
• Perez, O., Keim, S. M., Rice, A., Gaither, J. B., Hu, C., Jorgenson, D. B., Babaeizadeh, S., Helfenbein, E., Spaite, D. W., & Barnhardt, B. J. (2018, Nov). End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. Circulation.
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  Barnhart B, Spaite DW, Helfenbein E, Babaeizadeh S, Jorgenson DB, Hu C, Gaither JB, Rice AD, Keim SM, Perez O: End-Tidal CO2 Monitoring in Non-Intubated Traumatic Brain Injury Patients Receiving O2 Via Nasal Cannula Versus Non-Rebreather Mask. Circulation 2018
• Spaite, D. W., Sherril, D., Keim, S. M., Gaither, J. B., Chikani, V., Hu, C., Jorgenson, D., Babaeizadeh, S., Barnhart, B. J., Helfenbein, E., & Perez, O. (2017, Sept). Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Prehospital Emergency Care.
  More info

  Perez O, Helfenbein E, Barnhart BJ, Babaeizadeh S, Jorgenson D, Hu C, Chikani V, Gaither J, Keim S, Sherrill D, Spaite D: Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Prehospital Emerg Care 2018;22(1):123-124.
• Barnhart, B. J., Bobrow, B. J., Rice, A. D., Spaite, D. W., Helfenbein, E., Viscusi, C. D., Perez, O., Keim, S. M., Babaeizadeh, S., Denninghoff, K. R., Sherril, D., Hu, C., Chikani, V., Gaither, J. B., Chikani, V., Gaither, J. B., Hu, C., Sherril, D., Babaeizadeh, S., , Denninghoff, K. R., et al. (2017, Jan). Accuracy of Prehospital Documentation of Hypoxia Compared to Continuous Non-Invasive Monitor Data Tracking in Major Traumatic Brain Injury. Prehospital Emergency Care.
  More info

  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.
• Keim, S. M., Sherrill, D., Mullins, T., Rice, A. D., Denninghoff, K. R., Adelson, P. D., Barnhart, B. J., Gaither, J. B., Chikani, V., Bobrow, B. J., Hu, C., & Spaite, D. W. (2017, Nov). Evaluation of the Combined Prehospital Hypoxia-Hypotension “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Circulation.
  More info

  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
• Perez, O., Bobrow, B. J., Rice, A. D., Spaite, D. W., Helfenbein, E., Viscusi, C. D., Barnhardt, B. J., Keim, S. M., Babaeizadeh, S., Denninghoff, K. R., Sherill, D., Hu, C., Chikani, V., Gaither, J. B., Chikani, V., Gaither, J. B., Hu, C., Sherill, D., Babaeizadeh, S., , Denninghoff, K. R., et al. (2017, Jan). Prehospital Use of Nasal Cannula End-Tidal CO2 Monitoring in Non-Intubated Major Traumatic Brain Injury Patients. Prehospital Emergency Care.
  More info

  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., Spaite, D. W., Hu, C., Mullins, T., Viscusi, C. D., Bobrow, B. J., Chikani, V., Keim, S. M., Denninghoff, K. R., Gaither, J. B., Barnhart, B. J., Grady, K., Adelson, P. D., Rice, A. D., Rice, A. D., Adelson, P. D., Grady, K., Barnhart, B. J., Gaither, J. B., , Denninghoff, K. R., et al. (2017, Jan). Evaluation of Prehospital Hypoxia “Depth-Duration Dose” and Mortality in Major Traumatic Brain Injury. Prehospital Emergency Care.
  More info

  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.
• Spaite, D. W., Keim, S. M., Sherill, D., Gaither, J. B., Chikani, V., Hu, C., Jorgenson, D. B., Babaeizadeh, S., Perez, O., Helfenbein, E., & Barnhardt, B. J. (2017, Nov). Prehospital Oxygen Delivery Method and Nasal Cannula End-Tidal CO2 Patterns in Non-Intubated Major Traumatic Brain Injury Patients. Circulation.
  More info

  Barnhart BJ, Helfenbein E, Perez O, Babaeizadeh S, Jorgenson DB, Hu C, Chikani V, Gaither JB, Sherrill D, Keim SM, Spaite DW: Prehospital Oxygen Delivery Method and Nasal Cannula End-Tidal CO2 Patterns in Non-Intubated Major Traumatic Brain Injury Patients. Circulation 2017
• Spaite, D. W., Sherill, D., Keim, S. M., Gaither, J. B., Chikani, V., Hu, C., Jorgenson, D. B., Babaeizadeh, S., Barnhardt, B. J., Helfenbein, E., & Perez, O. (2017, Nov). Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Circulation.
  More info

  Perez O, Helfenbein E, Barnhart BJ, Babaeizadeh S, Jorgenson DB, Hu C, Chikani V, Gaither JB, Keim SM, Sherrill D, Spaite DW: Prehospital Blood Pressure Measurement in Major Traumatic Brain Injury: Concordance Between EMS Provider Documentation and Non-Invasive Monitor Data Tracking. Circulation 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. 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
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