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Article ; Online: Concerns About In-Hospital Complications, Transport Time, and Comorbidities in a Study of Emergency Department Pediatric Readiness-Reply.

Glass, Nina E / Newgard, Craig D

2023 Volume 159, Issue 3, Page(s) 352

MeSH term(s)	Child ; Humans ; Emergency Service, Hospital ; Surveys and Questionnaires ; Hospitals ; Disaster Planning
Language	English
Publishing date	2023-12-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2023.6527
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Article ; Online: The Effect of Trauma Center Verification on Outcomes of Traumatic Brain Injury Patients Undergoing Interfacility Transfer.

Jenkins, Peter C / Newgard, Craig D

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2020 Volume 28, Issue 3, Page(s) 375–376

MeSH term(s)	Brain Injuries, Traumatic/therapy ; Humans ; Injury Severity Score ; Patient Transfer ; Retrospective Studies ; Trauma Centers
Language	English
Publishing date	2020-12-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14185
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Article ; Online: Inclusion of All Patients Admitted for Trauma in Trauma Registries-Reply.

Newgard, Craig D / Bulger, Eileen M

JAMA surgery

2019 Volume 155, Issue 3, Page(s) 265–266

MeSH term(s)	Aged ; Follow-Up Studies ; Hospitalization ; Humans ; Registries ; Trauma Centers
Language	English
Publishing date	2019-12-03
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2019.4941
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Article ; Online: Cost-effectiveness of field trauma triage among injured children transported by emergency medical services.

Nishijima, Daniel K / Yang, Zhuo / Newgard, Craig D

The American journal of emergency medicine

2021 Volume 50, Page(s) 492–500

Abstract: Background: A pediatric field triage strategy that meets the national policy benchmark of ≥95% sensitivity would likely improve health outcomes but increase heath care costs. Our objective was to compare the cost-effectiveness of current pediatric field ...

Abstract	Background: A pediatric field triage strategy that meets the national policy benchmark of ≥95% sensitivity would likely improve health outcomes but increase heath care costs. Our objective was to compare the cost-effectiveness of current pediatric field triage practices to an alternative field triage strategy that meets the national policy benchmark of ≥95% sensitivity. Study design: We developed a decision-analysis Markov model to compare the outcomes and costs of the two strategies. We used a prospectively collected cohort of 3507 (probability weighted, unweighted n = 2832) injured children transported by 44 emergency medical services (EMS) agencies to 28 trauma and non-trauma centers in the Northwestern United States from 1/1/2011 to 12/31/2011 to derive the alternative field triage strategy and to populate model probability and cost inputs for both strategies. We compared the two strategies by calculating quality adjusted life years (QALYs) and health care costs over a time horizon from the time of injury until death. We set an incremental cost-effectiveness ratio threshold of less than $100,000 per QALY for the alternative field triage to be a cost-effective strategy. Results: Current pediatric field triage practices had a sensitivity of 87.4% (95% confidence interval [CI] 71.9 to 95.0%) and a specificity of 82.3% (95% CI 81.0 to 83.5%) and the alternative field triage strategy had a sensitivity of 97.3% (95% CI 82.6 to 99.6%) and a specificity of 46.1% (95% CI 43.8 to 48.4%). The alternative field triage strategy would cost $476,396 per QALY gained compared to current pediatric field triage practices and thus would not be a cost-effective strategy. Sensitivity analyses demonstrated similar findings. Conclusion: Current field triage practices do not meet national policy benchmarks for sensitivity. However, an alternative field triage strategy that meets the national policy benchmark of ≥95% sensitivity is not a cost-effective strategy.
MeSH term(s)	Adolescent ; Benchmarking ; Child ; Child, Preschool ; Cost-Benefit Analysis ; Emergency Medical Services/economics ; Health Care Costs ; Humans ; Infant ; Infant, Newborn ; Male ; Markov Chains ; Prospective Studies ; Quality-Adjusted Life Years ; Sensitivity and Specificity ; Triage/economics ; United States ; Wounds and Injuries/classification
Language	English
Publishing date	2021-08-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2021.08.037
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Article ; Online: Effect of the Coronavirus Disease 2019 (COVID-19) Pandemic on the U.S. Emergency Medical Services System: A Preliminary Report.

Lerner, E Brooke / Newgard, Craig D / Mann, N Clay

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2020 Volume 27, Issue 8, Page(s) 693–699

Abstract: Background: Our objective was to quantify trends in emergency medical services (EMS) incidents as the effects of the COVID-19 pandemic spread across the United States and to determine if there was an increase in EMS-attended deaths.: Methods: We ... ...

Abstract	Background: Our objective was to quantify trends in emergency medical services (EMS) incidents as the effects of the COVID-19 pandemic spread across the United States and to determine if there was an increase in EMS-attended deaths. Methods: We conducted a 3-year comparative retrospective cohort analysis of data from the National EMS Information System. Data were included if care was provided between the 40th and 21st weeks of the next year and compared over 3 years. We included incidents identified through 9-1-1 where patient contact was made. The total number of EMS incidents per week was used as the denominator to calculate the rate of patient deaths and possible injury. We assessed for temporal and seasonal trends. Results: Starting in the 10th week of 2020 there was a decrease in the number of EMS activations in the United States compared to the prior weeks and the same time period in previous years. The number of activations between week 10 and week 16 decreased by 140,292 or 26.1%. The portion of EMS activations reporting a patient disposition of death nearly doubled between the 11th and 15th weeks of 2020 (1.49%-2.77% of all activations). The number of EMS activations documenting a possible injury decreased from 18.43% to 15.27% between weeks 10 and 13. Conclusion: We found that early in the COVID-19 outbreak there was a significant decrease in the number of EMS responses across the United States. Simultaneously the rate of EMS-attended death doubled, while the rate of injuries decreased.
MeSH term(s)	COVID-19/diagnosis ; COVID-19/epidemiology ; Cohort Studies ; Emergencies/epidemiology ; Emergency Medical Services/statistics & numerical data ; Female ; Health Information Systems/statistics & numerical data ; Humans ; Male ; Outcome Assessment, Health Care/statistics & numerical data ; Pandemics/statistics & numerical data ; Retrospective Studies ; SARS-CoV-2 ; United States
Keywords	covid19
Language	English
Publishing date	2020-07-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14051
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Article ; Online: Development of a clinical decision rule for the early prediction of Shock-Refractory Out-of-Hospital cardiac arrest.

Lupton, Joshua R / Jui, Jonathan / Neth, Matthew R / Sahni, Ritu / Daya, Mohamud R / Newgard, Craig D

Resuscitation

2022 Volume 181, Page(s) 60–67

Abstract: Background: Nearly half of ventricular fibrillation or ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA) patients receive three or more shocks, often referred to as refractory VF/VT. Our objective was to derive a clinical decision ... ...

Abstract	Background: Nearly half of ventricular fibrillation or ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA) patients receive three or more shocks, often referred to as refractory VF/VT. Our objective was to derive a clinical decision rule (CDR) for the early stratification of patients into risk categories for refractory VF/VT. Methods: We included adults with non-traumatic OHCA in the Resuscitation Outcomes Consortium Epistry (2011-2015) with ≥ 1 EMS shock. We used Classification and Regression Tree analysis for CDR building using variables known at initial EMS rhythm analysis including age, sex, witness, location, bystander interventions, initial EMS rhythm, obvious non-cardiac etiology, and dispatch to arrival times. The outcome was refractory VF/VT (≥3 shocks). We calculated sensitivity, specificity, area under the receiver operating curve (AUROC), and odds ratios (OR). The rule was validated using the Portland Cardiac Arrest Epidemiologic Registry (2018-2020). Results: There were 17,140 eligible patients and 8,146 (47.5%) had refractory VF/VT. The optimal CDR (AUROC = 0.671) defined three groups: high-risk were any patients requiring an EMS shock after a bystander AED shock; moderate-risk were any non-EMS witnessed arrests with shockable initial EMS rhythms; and the remainder were low-risk. Refractory VF/VT increased across the low (30.7%), moderate (58.5%) and high-risk (84.8%) groups. Compared to low-risk, being moderate-risk or higher (OR [95% CI]:3.37 [3.16-3.59]; sensitivity 72.7%; specificity 55.9%) or high-risk (OR:12.63 [9.89-16.13]; sensitivity 5.4%; specificity 99.1%) had higher odds of refractory VF/VT. Results was similar in the validation cohort (n = 765, AUROC = 0.672). Conclusions: Patients at higher risk for refractory VF/VT can be identified early in EMS care.
MeSH term(s)	Adult ; Humans ; Out-of-Hospital Cardiac Arrest/therapy ; Cardiopulmonary Resuscitation/methods ; Clinical Decision Rules ; Ventricular Fibrillation ; Tachycardia, Ventricular/diagnosis ; Tachycardia, Ventricular/etiology ; Tachycardia, Ventricular/therapy ; Shock/diagnosis ; Shock/etiology ; Emergency Medical Services ; Electric Countershock/methods
Language	English
Publishing date	2022-10-22
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	189901-6
ISSN	1873-1570 ; 0300-9572
ISSN (online)	1873-1570
ISSN	0300-9572
DOI	10.1016/j.resuscitation.2022.10.010
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Article ; Online: Survival by time-to-administration of amiodarone, lidocaine, or placebo in shock-refractory out-of-hospital cardiac arrest.

Lupton, Joshua R / Neth, Matthew R / Sahni, Ritu / Jui, Jonathan / Wittwer, Lynn / Newgard, Craig D / Daya, Mohamud R

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2023 Volume 30, Issue 9, Page(s) 906–917

Abstract: Background: Amiodarone and lidocaine have not been shown to have a clear survival benefit compared to placebo for out-of-hospital cardiac arrest (OHCA). However, randomized trials may have been impacted by delayed administration of the study drugs. We ... ...

Abstract	Background: Amiodarone and lidocaine have not been shown to have a clear survival benefit compared to placebo for out-of-hospital cardiac arrest (OHCA). However, randomized trials may have been impacted by delayed administration of the study drugs. We sought to evaluate how timing from emergency medical services (EMS) arrival on scene to drug administration affects the efficacy of amiodarone and lidocaine compared to placebo. Method: This is a secondary analysis of the 10-site, 55-EMS-agency double-blind randomized controlled amiodarone, lidocaine, or placebo in OHCA study. We included patients with initial shockable rhythms who received the study drugs of amiodarone, lidocaine, or placebo before achieving return of spontaneous circulation. We performed logistic regression analyses evaluating survival to hospital discharge and secondary outcomes of survival to admission and functional survival (modified Rankin scale score ≤ 3). We evaluated the samples stratified by early (<8 min) and late administration groups (≥8 min). We compared outcomes for amiodarone and lidocaine compared to placebo and adjust for potential confounders. Results: There were 2802 patients meeting inclusion criteria, with 879 (31.4%) in the early (<8 min) and 1923 (68.6%) in the late (≥8 min) groups. In the early group, patients receiving amiodarone, compared to placebo, had significantly higher survival to admission (62.0% vs. 48.5%, p = 0.001; adjusted OR [95% CI] 1.76 [1.24-2.50]), survival to discharge (37.1% vs. 28.0%, p = 0.021; 1.56 [1.07-2.29]), and functional survival (31.6% vs. 23.3%, p = 0.029; 1.55 [1.04-2.32]). There were no significant differences with early lidocaine compared to early placebo (p > 0.05). Patients in the late group who received amiodarone or lidocaine had no significant differences in outcomes at discharge compared to placebo (p > 0.05). Conclusions: The early administration of amiodarone, particularly within 8 min, is associated with greater survival to admission, survival to discharge, and functional survival compared to placebo in patients with an initial shockable rhythm.
MeSH term(s)	Humans ; Amiodarone/therapeutic use ; Lidocaine/therapeutic use ; Anti-Arrhythmia Agents/therapeutic use ; Out-of-Hospital Cardiac Arrest/drug therapy ; Hospitalization ; Emergency Medical Services ; Cardiopulmonary Resuscitation
Chemical Substances	Amiodarone (N3RQ532IUT) ; Lidocaine (98PI200987) ; Anti-Arrhythmia Agents
Language	English
Publishing date	2023-04-05
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14716
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Article ; Online: Timing and causes of death to 1 year among children presenting to emergency departments.

Ames, Stefanie G / Salvi, Apoorva / Lin, Amber / Malveau, Susan / Mann, N Clay / Jenkins, Peter C / Hansen, Matthew / Papa, Linda / Schmitz, Sabrina / Sabogal, Cesar / Newgard, Craig D

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2024

Abstract: Background and objectives: A better characterization of deaths in children following emergency care is needed to inform timely interventions. This study aimed to describe the timing, location, and causes of death to 1 year among a cohort of injured and ... ...

Abstract	Background and objectives: A better characterization of deaths in children following emergency care is needed to inform timely interventions. This study aimed to describe the timing, location, and causes of death to 1 year among a cohort of injured and medically ill children. Methods: We conducted a retrospective cohort study of children <18 years requiring emergency care in six states from January 1, 2012, through December 31, 2017, with follow-up through December 31, 2018, for patients who were not discharged from the emergency department (ED). In this cohort, 1-year mortality, time to death within 1 year, and causes of death were assessed from ED, inpatient, and vital status records. Results: There were 546,044 children during the 6-year period. The 1-year mortality rate was 2.2% (n = 1356) for injured children and 1.4% (n = 6687) for medically ill children. Matched death certificates were available for 861 (63.5%) of 1356 deaths in the injury cohort and for 4712 (70.5%) of 6687 deaths in the medical cohort. Among deaths in the injury cohort, 1274 (94.0%) occurred in the ED or hospital. The most common causes of death were motor vehicle collisions, firearm injuries, and pedestrian injuries. Among the 6687 deaths in the medical cohort, 5081 (76.0%) children died in the ED or hospital (primarily in the ED) and 1606 (24.0%) occurred after hospital discharge. The most common causes of death were sudden infant death syndrome, suffocation and drowning, and congenital conditions. Conclusions: The 1-year mortality of children presenting to an ED is 2.2% for injured children and 1.4% for medically ill children with most deaths occurring in the ED. Future interventional trials, quality improvement efforts, and health policy focused in the ED could have the potential to improve outcomes of pediatric patients.
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14875
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Article ; Online: Accounting for Missing Data in Clinical Research--Reply.

Newgard, Craig D / Lewis, Roger J

JAMA

2016 Volume 315, Issue 5, Page(s) 518

MeSH term(s)	Albuminuria/drug therapy ; Diabetes Mellitus, Type 2/complications ; Diabetic Nephropathies/drug therapy ; Female ; Humans ; Male ; Naphthyridines/administration & dosage
Chemical Substances	Naphthyridines
Language	English
Publishing date	2016-02-02
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2015.16470
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Article ; Online: Cost Savings in Trauma Systems: The Devil's in the Details.

Newgard, Craig D / Lowe, Robert A

Annals of emergency medicine

2016 Volume 67, Issue 1, Page(s) 68–70

MeSH term(s)	Female ; Hospital Costs ; Hospital Mortality ; Humans ; Male ; Trauma Centers ; Wounds and Injuries/economics ; Wounds and Injuries/mortality ; Wounds and Injuries/therapy
Language	English
Publishing date	2016-01
Publishing country	United States
Document type	Comment ; Editorial ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2015.06.025
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