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Article ; Online: Euglycemic Diabetic Ketoacidosis: Experience with 44 Patients and Comparison to Hyperglycemic Diabetic Ketoacidosis.

Sell, Jordan / Haas, Nathan L / Korley, Frederick K / Cranford, James A / Bassin, Benjamin S

The western journal of emergency medicine

2024 Volume 24, Issue 6, Page(s) 1049–1055

Abstract: Introduction: Euglycemic diabetic ketoacidosis (DKA) (glucose <250 milligrams per deciliter (mg/dL) has increased in recognition since introduction of sodium-glucose co-transporter 2 (SGLT2) inhibitors but remains challenging to diagnose and manage ... ...

Abstract	Introduction: Euglycemic diabetic ketoacidosis (DKA) (glucose <250 milligrams per deciliter (mg/dL) has increased in recognition since introduction of sodium-glucose co-transporter 2 (SGLT2) inhibitors but remains challenging to diagnose and manage without the hyperglycemia that is otherwise central to diagnosing DKA, and with increased risk for hypoglycemia with insulin use. Our objective was to compare key resource utilization and safety outcomes between patients with euglycemic and hyperglycemic DKA from the same period. Methods: This is a retrospective review of adult emergency department patients in DKA at an academic medical center. Patients were included if they were >18 years old, met criteria for DKA on initial laboratories (pH ≤7.30, serum bicarbonate ≤18 millimoles per liter [mmol/L], anion gap ≥10), and were managed via a standardized DKA order set. Patients were divided into euglycemic (<250 milligrams per deciliter [mg/dL]) vs hyperglycemic (≥250 mg/dL) cohorts by presenting glucose. We extracted and analyzed patient demographics, resource utilization, and safety outcomes. Etiologies of euglycemia were obtained by manual chart review. For comparisons between groups we used independent-group Results: We identified 629 patients with DKA: 44 euglycemic and 585 hyperglycemic. Euglycemic patients had milder DKA on presentation (higher pH and bicarbonate, lower anion gap; Conclusion: Compared to hyperglycemic DKA patients managed in the same protocolized fashion, euglycemic DKA patients were on insulin infusions 5.9 hours less, yet experienced hypoglycemia over three times more frequently. Future work can investigate treatment strategies for euglycemic DKA to minimize adverse events, especially iatrogenic hypoglycemia.
MeSH term(s)	Adult ; Humans ; Adolescent ; Diabetic Ketoacidosis/drug therapy ; Diabetic Ketoacidosis/diagnosis ; Bicarbonates ; Insulin/adverse effects ; Hypoglycemia ; Glucose ; Diabetes Mellitus
Chemical Substances	Bicarbonates ; Insulin ; Glucose (IY9XDZ35W2)
Language	English
Publishing date	2024-01-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.60361
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The Wait for High-Sensitivity Troponin Is Over-Proceed Cautiously.

Korley, Frederick K

JAMA cardiology

2017 Volume 3, Issue 2, Page(s) 112–113

MeSH term(s)	Acute Coronary Syndrome ; Chest Pain ; Humans ; Myocardial Infarction ; Troponin I ; Troponin T
Chemical Substances	Troponin I ; Troponin T
Language	English
Publishing date	2017-12-14
Publishing country	United States
Document type	Journal Article ; Comment
ISSN	2380-6591
ISSN (online)	2380-6591
DOI	10.1001/jamacardio.2017.4626
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Convalescent Plasma for Outpatients with Covid-19. Reply.

Korley, Frederick K / Durkalski-Mauldin, Valerie / Callaway, Clifton W

The New England journal of medicine

2021 Volume 385, Issue 23, Page(s) 2206–2207

MeSH term(s)	COVID-19/therapy ; Humans ; Immunization, Passive ; Outpatients ; SARS-CoV-2 ; Treatment Outcome ; COVID-19 Serotherapy
Language	English
Publishing date	2021-10-13
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc2114591
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Article ; Online: The Two-Bag Method for Management of Adult Diabetic Ketoacidosis-Experience With 634 Patients.

Haas, Nathan L / Sell, Jordan / Cranford, James A / Korley, Frederick K / Bassin, Benjamin S

Journal of intensive care medicine

2023 Volume 38, Issue 7, Page(s) 668–674

Abstract: Purpose: To compare key resource utilization and safety outcomes of adult emergency department (ED) patients in diabetic ketoacidosis (DKA) managed via the Two-Bag or traditional One-Bag method.: Materials and methods: This is a retrospective review ... ...

Abstract	Purpose: To compare key resource utilization and safety outcomes of adult emergency department (ED) patients in diabetic ketoacidosis (DKA) managed via the Two-Bag or traditional One-Bag method. Materials and methods: This is a retrospective review at an academic medical center ED. Patients were included if >18 years, met diagnostic criteria for DKA (pH ≤ 7.30, bicarbonate ≤ 18 mmol/L, anion gap ≥ 10), and were managed via a standardized order set (either Two-Bag or One-Bag Method). Comparisons used independent-groups Results: We identified 634 patients with DKA managed via the Two-Bag method, and 107 managed via the One-Bag method. Cohorts were similar in demographics and presenting laboratories. The Two-Bag Method was associated with 8.1 h shorter to first bicarbonate >18 mmol/L (11.9 vs 20.0, Conclusions: For adult ED patients in DKA, the Two-Bag Method was associated with faster resolution of acidosis, fewer IV fluid bags charged, lower incidence of hypokalemia, and trend toward lower incidence of hypoglycemia compared to the One-Bag Method.
MeSH term(s)	Humans ; Adult ; Diabetic Ketoacidosis/therapy ; Diabetic Ketoacidosis/complications ; Hypokalemia ; Bicarbonates ; Insulin ; Hypoglycemia ; Retrospective Studies ; Diabetes Mellitus
Chemical Substances	Bicarbonates ; Insulin
Language	English
Publishing date	2023-05-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/08850666231175387
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Zs.A 2158: Show issues

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Article ; Online: The Current State of Traumatic Brain Injury Biomarker Measurement Methods.

Krausz, Alyse D / Korley, Frederick K / Burns, Mark A

Biosensors

2021 Volume 11, Issue 9

Abstract: Traumatic brain injury (TBI) is associated with high rates of morbidity and mortality partially due to the limited tools available for diagnosis and classification. Measuring panels of protein biomarkers released into the bloodstream after injury has ... ...

Abstract	Traumatic brain injury (TBI) is associated with high rates of morbidity and mortality partially due to the limited tools available for diagnosis and classification. Measuring panels of protein biomarkers released into the bloodstream after injury has been proposed to diagnose TBI, inform treatment decisions, and monitor the progression of the injury. Being able to measure these protein biomarkers at the point-of-care would enable assessment of TBIs from the point-of-injury to the patient's hospital bedside. In this review, we provide a detailed discussion of devices reported in the academic literature and available on the market that have been designed to measure TBI protein biomarkers in various biofluids and contexts. We also assess the challenges associated with TBI biomarker measurement devices and suggest future research directions to encourage translation of these devices to clinical use.
MeSH term(s)	Biomarkers ; Brain Injuries, Traumatic ; Humans
Chemical Substances	Biomarkers
Language	English
Publishing date	2021-09-07
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662125-3
ISSN	2079-6374 ; 2079-6374
ISSN (online)	2079-6374
ISSN	2079-6374
DOI	10.3390/bios11090319
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Article ; Online: A Variable Height Microfluidic Device for Multiplexed Immunoassay Analysis of Traumatic Brain Injury Biomarkers.

Krausz, Alyse D / Korley, Frederick K / Burns, Mark A

Biosensors

2021 Volume 11, Issue 9

Abstract: Traumatic brain injury (TBI) is a leading cause of global morbidity and mortality, partially due to the lack of sensitive diagnostic methods and efficacious therapies. Panels of protein biomarkers have been proposed as a way of diagnosing and monitoring ... ...

Abstract	Traumatic brain injury (TBI) is a leading cause of global morbidity and mortality, partially due to the lack of sensitive diagnostic methods and efficacious therapies. Panels of protein biomarkers have been proposed as a way of diagnosing and monitoring TBI. To measure multiple TBI biomarkers simultaneously, we present a variable height microfluidic device consisting of a single channel that varies in height between the inlet and outlet and can passively multiplex bead-based immunoassays by trapping assay beads at the point where their diameter matches the channel height. We developed bead-based quantum dot-linked immunosorbent assays (QLISAs) for interleukin-6 (IL-6), glial fibrillary acidic protein (GFAP), and interleukin-8 (IL-8) using Dynabeads
MeSH term(s)	Biomarkers/metabolism ; Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/immunology ; Glial Fibrillary Acidic Protein ; Humans ; Immunoassay ; Lab-On-A-Chip Devices ; Microfluidic Analytical Techniques
Chemical Substances	Biomarkers ; Glial Fibrillary Acidic Protein
Language	English
Publishing date	2021-09-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662125-3
ISSN	2079-6374 ; 2079-6374
ISSN (online)	2079-6374
ISSN	2079-6374
DOI	10.3390/bios11090320
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Article ; Online: Euglycemic Diabetic Ketoacidosis

Jordan Sell / Nathan L. Haas / Frederick K. Korley / James A. Cranford / Benjamin S. Bassin

Western Journal of Emergency Medicine, Vol 24, Iss 6, Pp 1049-

Experience with 44 Patients and Comparison to Hyperglycemic Diabetic Ketoacidosis

2023 Volume 1055

Abstract	Introduction: Euglycemic diabetic ketoacidosis (DKA) (glucose <250 milligrams per deciliter (mg/dL) has increased in recognition since introduction of sodium-glucose co-transporter 2 (SGLT2) inhibitors but remains challenging to diagnose and manage without the hyperglycemia that is otherwise central to diagnosing DKA, and with increased risk for hypoglycemia with insulin use. Our objective was to compare key resource utilization and safety outcomes between patients with euglycemic and hyperglycemic DKA from the same period. Methods: This is a retrospective review of adult emergency department patients in DKA at an academic medical center. Patients were included if they were >18 years old, met criteria for DKA on initial laboratories (pH ≤7.30, serum bicarbonate ≤18 millimoles per liter [mmol/L], anion gap ≥10), and were managed via a standardized DKA order set. Patients were divided into euglycemic (<250 milligrams per deciliter [mg/dL]) vs hyperglycemic (≥250 mg/dL) cohorts by presenting glucose. We extracted and analyzed patient demographics, resource utilization, and safety outcomes. Etiologies of euglycemia were obtained by manual chart review. For comparisons between groups we used independent-group t-tests for continuous variables and chi-squared tests for binary variables, with alpha 0.05. Results: We identified 629 patients with DKA: 44 euglycemic and 585 hyperglycemic. Euglycemic patients had milder DKA on presentation (higher pH and bicarbonate, lower anion gap; P < 0.05) and lower initial glucose (195 vs 561 mg/dL, P < 0.001) and potassium (4.3 vs 5.3 mmol/L, P < 0.001). Etiologies of euglycemia were insulin use prior to arrival (57%), poor oral intake with baseline insulin use (29%), and SGLT2 inhibitor use (14%). Mean time on insulin infusion was shorter for those with euglycemic DKA: 13.5 vs 19.4 hours, P = 0.003. Mean times to first bicarbonate >18 mmol/L and first long-acting insulin were similar. Incidence of hypoglycemia (<70 mg/dL) while on insulin infusion was ...
Keywords	Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
Subject code	610
Language	English
Publishing date	2023-09-01T00:00:00Z
Publisher	eScholarship Publishing, University of California
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Diagnostic Utility of Glial Fibrillary Acidic Protein Beyond 12 Hours After Traumatic Brain Injury: A TRACK-TBI Study.

Puccio, Ava M / Yue, John K / Korley, Frederick K / Okonkwo, David O / Diaz-Arrastia, Ramon / Yuh, Esther L / Ferguson, Adam R / Mukherjee, Pratik / Wang, Kevin K W / Taylor, Sabrina R / Deng, Hansen / Markowitz, Amy J / Sun, Xiaoying / Jain, Sonia / Manley, Geoffrey T

Journal of neurotrauma

2024

Abstract: Blood levels of glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1) within 12h of suspected traumatic brain injury (TBI) have been approved by the Food and Drug administration to aid in determining the need for a ... ...

Abstract	Blood levels of glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1) within 12h of suspected traumatic brain injury (TBI) have been approved by the Food and Drug administration to aid in determining the need for a brain computed tomography (CT) scan. The current study aimed to determine whether this context of use can be expanded beyond 12h post-TBI in patients presenting with Glasgow Coma Scale (GCS) 13-15. The prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study enrolled TBI participants aged ≥17 years who presented to a United States Level 1 trauma center and received a clinically indicated brain CT scan within 24h post-injury, a blood draw within 24h and at 14 days for biomarker analysis. Data from participants with emergency department arrival GCS 13-15 and biomarker values at days 1 and 14 were extracted for the primary analysis. A subgroup of hospitalized participants with serial biomarkers at days 1, 3, 5, and 14 were analyzed, including plasma GFAP and UCH-L1, and serum neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B). The primary analysis compared biomarker values dichotomized by head CT results (CT+/CT-). Area under receiver-operating characteristic curve (AUC) was used to determine diagnostic accuracy. The overall cohort included 1142 participants with initial GCS 13-15, with mean age 39.8 years, 65% male, and 73% Caucasian. The GFAP provided good discrimination in the overall cohort at days 1 (AUC = 0.82) and 14 (AUC = 0.72), and in the hospitalized subgroup at days 1 (AUC = 0.84), 3 (AUC = 0.88), 5 (AUC = 0.82), and 14 (AUC = 0.74). The UCH-L1, NSE, and S100B did not perform well (AUC = 0.51-0.57 across time points). This study demonstrates the utility of GFAP to aid in decision-making for diagnostic brain CT imaging beyond the 12h time frame in patients with TBI who have a GCS 13-15.
Language	English
Publishing date	2024-03-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2023.0186
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Zs.A 2016: Show issues

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Article: High Sensitivity Cardiac Troponin Assays - How to Implement them Successfully.

Korley, Frederick K / Jaffe, Allan S

EJIFCC

2016 Volume 27, Issue 3, Page(s) 217–223

Abstract: High sensitivity troponin (hsTn) assays provide an unprecedented opportunity to improve the detection and treatment of cardiac injury from coronary and non-coronary causes. They may also play a role in guiding the primary and secondary prevention of ... ...

Abstract	High sensitivity troponin (hsTn) assays provide an unprecedented opportunity to improve the detection and treatment of cardiac injury from coronary and non-coronary causes. They may also play a role in guiding the primary and secondary prevention of cardiovascular disease. However, to derive maximal benefit from their use, careful planning for the implementation of these new assays is required. In this manuscript, we will discuss actions that can be taken during hsTn pre-implementation, implementation and post-implementation phases. Key concepts for consideration in the pre-implementation phase include: the establishment of a multi-disciplinary implementation team; development of quality control procedures; education of clinical staff; modification of existing clinical workflow and provision of computerized decision support. Strategies for ensuring successful implementation and post-implementation phases will also be discussed.
Language	English
Publishing date	2016-08-01
Publishing country	Italy
Document type	Journal Article
ISSN	1650-3414
ISSN	1650-3414
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Longitudinal Trajectories of Post-Concussive Symptoms Following Mild Traumatic Brain Injury.

Keatley, Eva / Bechtold, Kathleen / Psoter, Kevin / Peters, Matthew E / Everett, Allen / Rao, Vani / Van Meter, Timothy E / Falk, Hayley / Korley, Frederick K / Roy, Durga

Brain injury

2023 Volume 37, Issue 8, Page(s) 737–745

Abstract: Background: Individuals recovering from mild traumatic brain injury (TBI) represent a heterogenous population that requires distinct treatment approaches. Identification of recovery trajectories improves our ability to understand the natural history of ... ...

Abstract	Background: Individuals recovering from mild traumatic brain injury (TBI) represent a heterogenous population that requires distinct treatment approaches. Identification of recovery trajectories improves our ability to understand the natural history of mild TBI recovery and develop targeted interventions. Objective: To utilize group-based trajectory modeling (GBTM) to identify distinct patterns of symptom recovery following mild TBI in the first 6 months after mild TBI. Methods: This study is comprised of 253 adults who presented to the emergency department with mild TBI and completed assessments for six-months post-injury. Patients were recruited for the prospective observational cohort study, HeadSMART. The primary outcome measure was the Rivermead Postconcussion Symptom Questionnaire. GBTM was used to identify longitudinal trajectories of recovery following mild TBI using Rivermead scores at baseline, one, three, and six months following diagnosis. Results: Findings identified four distinct trajectories of symptom recovery follwing mild TBI including 9% of participants who were categorized with minimal acute symptoms that decreased over time, 45% with mild acute symptoms that decreased over time, 33% with relatively higher acute symptoms that decreased over time, and 13% with relatively higher acute symptoms that increased over time. Conclusions: GBTM identified four distinct trajectories of recovery following mild TBI and GBTM may be useful for research interventions that can alter recovery trajectories.
MeSH term(s)	Adult ; Humans ; Brain Concussion/complications ; Post-Concussion Syndrome/etiology ; Post-Concussion Syndrome/diagnosis ; Prospective Studies ; Surveys and Questionnaires ; Brain Injuries, Traumatic/complications ; Longitudinal Studies
Language	English
Publishing date	2023-02-05
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639115-1
ISSN	1362-301X ; 0269-9052
ISSN (online)	1362-301X
ISSN	0269-9052
DOI	10.1080/02699052.2023.2172612
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Zs.A 2242: Show issues

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