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Article ; Online: Association between ABO blood type and coronavirus disease 2019 severe outcomes across dominant variant strains.

Mielke, Nicholas / Gorz, Rebecca / Bahl, Amit / Zhao, Lili / Berger, David A

Journal of the American College of Emergency Physicians open

2024 Volume 5, Issue 1, Page(s) e13115

Abstract: Objectives: Existing evidence suggests a link between ABO blood type and severe outcomes in coronavirus disease 2019 (COVID-19). We aimed to assess the relationship between blood type and severe outcomes across variant strains throughout the pandemic.!## ...

Abstract	Objectives: Existing evidence suggests a link between ABO blood type and severe outcomes in coronavirus disease 2019 (COVID-19). We aimed to assess the relationship between blood type and severe outcomes across variant strains throughout the pandemic. Methods: This was a multicenter retrospective observational cohort analysis from a large health system in southeastern Michigan using electronic medical records to evaluate emergency encounters, hospitalization, and severe outcomes in COVID-19 based on ABO blood type. Consecutive adult patients presenting to the emergency department with a primary diagnosis of COVID-19 (U07.1) from March 1, 2020 through December 31, 2022 were assessed. Patients who presented during three distinct time intervals that coincided with Alpha, Delta, and Omicron variant predominance were included in the analysis. Exclusions included no record of ABO blood type, positive PCR COVID-19 test within the preceding 28 days, and if transferred from out of the health system. Severe outcomes were inclusive of intensive care unit admission, mechanical ventilation, or death, which, as a composite, represented our primary outcome. Secondary outcomes were hospital admission and length of stay. A logistic regression model was employed to test the association between ABO blood type and severe outcome, adjusting for age, sex, race, vaccination status, Elixhauser comorbidity indices, and the dominant variant time period in which the encounter occurred. Results: Of the 33,796 COVID-19 encounters, 9416 met inclusion criteria; 4071 (43.2%) were type O, 3417 (36.3%) were type A, 459 (4.9%) were type AB, and 1469 (15.6%) were type B blood. Note that 66.4% of the cohort was female ( Conclusions: ABO blood type was not associated with COVID-19 severe outcomes across the Delta, Alpha, and Omicron dominant COVID waves across a large health system in southeastern Michigan. Further research is needed to better understand if ABO blood type is a risk factor for severe disease among evolving COVID-19 variants and other viral upper respiratory infections.
Language	English
Publishing date	2024-02-05
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.13115
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Article: ECG to Activation: Not an Appropriate Physician Metric, but a Worthy Process Metric.

Berger, David A / Yiadom, Maame Yaa A B

The Journal of emergency medicine

2022 Volume 62, Issue 1, Page(s) 129–130

MeSH term(s)	Electrocardiography ; Humans ; Physicians
Language	English
Publishing date	2022-02-04
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	605559-x
ISSN	0736-4679
ISSN	0736-4679
DOI	10.1016/j.jemermed.2021.07.019
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Article ; Online: Identifying acute myocardial infarction in ventricular-paced patients: The effectiveness of modified Sgarbossa criteria.

Newson, Joshua M / Sefa, Nana / Berger, David A

The American journal of emergency medicine

2020 Volume 45, Page(s) 680.e1–680.e4

Abstract: Screening for acute myocardial infarction (AMI) in patients with ventricular pacemakers (VP) is a diagnostic challenge. We report a case where application of the Modified Sgarbossa criteria (mSC) would have immediately identified AMI in a patient with a ... ...

Abstract	Screening for acute myocardial infarction (AMI) in patients with ventricular pacemakers (VP) is a diagnostic challenge. We report a case where application of the Modified Sgarbossa criteria (mSC) would have immediately identified AMI in a patient with a VP and merited strong advocacy for emergent cardiac catheterization. A 94-year-old male with VP presented to the emergency department (ED) after he had burning sensation in his chest. Initial ECG demonstrated >5 mm of discordant ST elevation in leads III and aVF which gave him 2 points per original Sgarbossa Criteria (oSC) and not meeting criteria for activation for cardiac catheterization. An ECG at three and a half hours after arrival demonstrated a dynamic change with new V2 concordant depression. At this point, the concordant depression (3 points) and excessive discordance (2 points) gave him a total of 5 points, which then met the oSC for activation of cardiac catheterization (≥ 3 points). Troponin I value (ng/mL) at 0/2/4 h after ED arrival are 0.02, 0.08 and 4.33 respectively. Pain never recurred after single nitroglycerine (NTG) tablet upon arrival. He was urgently taken for catheterization and had acute right coronary artery (RCA) culprit lesion and discharged on hospital day 4. This case report highlighted the benefits of applying mSC to patients with VP, which to authors knowledge remains unvalidated. A significant benefit of mSC is that they are unweighted, thus any positive criteria is suggestive of AMI. While the first EKG yielded an oSC score <3, applying the unweighted mSC to the EKG revealed ≤-0.25 ST/S ratio discordant changes in leads III, aVF, I and aVL would have merited strong advocacy for emergent cardiac catherization.
MeSH term(s)	Aged, 80 and over ; Cardiac Catheterization ; Decision Support Techniques ; Delayed Diagnosis ; Electrocardiography ; Humans ; Male ; Myocardial Infarction/diagnosis ; Myocardial Infarction/therapy ; Pacemaker, Artificial/adverse effects
Language	English
Publishing date	2020-12-05
Publishing country	United States
Document type	Case Reports
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2020.11.068
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Article: The Effect of Resuscitation Residents on the Duration of Pre-induction of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest.

Wloszczynski, Patrick / Berger, David A / Lee, David M / Chen, Nai-Wei / Burla, Michael J

Cureus

2022 Volume 14, Issue 11, Page(s) e32050

Abstract: Background The Resuscitation Rotation is a novel second-year emergency medicine rotation focusing on the highest acuity patients, including out-of-hospital cardiac arrest (OHCA). The resuscitation resident (RR) functions as an extra physician during ... ...

Abstract	Background The Resuscitation Rotation is a novel second-year emergency medicine rotation focusing on the highest acuity patients, including out-of-hospital cardiac arrest (OHCA). The resuscitation resident (RR) functions as an extra physician during resuscitation and post return of spontaneous circulation (ROSC). The objective of this study is to examine if the presence of a RR decreases the pre-induction interval of targeted temperature management (TTM) for patients following OHCA. Methods A retrospective study was conducted at a tertiary care level 1 trauma center with an annual ED census of 127,323 visits in 2019. We retrospectively reviewed consecutive OHCA patients from September 1, 2014, to July 20, 2020, who underwent TTM. Patients were identified as cases with or without a RR. Clinical characteristics were summarized by the status of RR involvement and compared by using t-test and χ
Language	English
Publishing date	2022-11-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.32050
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Article ; Online: The Effect of Missing Data on the Measurement of Cardiac Arrest Outcomes According to Race.

Rykulski, Nicholas S / Berger, David A / Paxton, James H / Klausner, Howard / Smith, Graham / Swor, Robert A

Prehospital emergency care

2022 Volume 27, Issue 8, Page(s) 1054–1057

Abstract: Introduction: High-quality data are important to understanding racial differences in outcome following out of hospital cardiac arrest (OHCA). Previous studies have shown differences in OHCA outcomes according to both race and socioeconomic status. EMS ... ...

Abstract	Introduction: High-quality data are important to understanding racial differences in outcome following out of hospital cardiac arrest (OHCA). Previous studies have shown differences in OHCA outcomes according to both race and socioeconomic status. EMS reporting of data on race is often incomplete. We aim to determine the effect of missing data on the determination of racial differences in outcomes for OHCA patients. Methods: We performed a secondary analysis of a data set developed by probabilistically linking the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) and the Michigan Inpatient Database (MIDB). Adult OHCA patients (age >18) who survived to hospital admission between 2014 and 2017 were included. Both datasets recorded patient race and ethnicity with CARES using a single race/ethnicity variable. Patients were categorized as White, Black, other, or missing and only a single choice was allowed. Due to the small number of Hispanic patients and the combined race/ethnicity variable, these patients were excluded. The outcomes of interest were survival to hospital discharge and survival to discharge with Cerebral Performance Category 1 or 2 (good outcome). Outcomes were stratified according to EMS- or hospital-documented race. Results: We included 3,756 matched patients, after excluding 34 Hispanic patients from analysis. Documentation of patient race was missing in 892 (22.1%) of CARES and 212 (5.6%) of MIDB patients. When both datasets documented Black or White race, agreement in race documentation was excellent (κ=0.83). White patients were more likely to have good outcomes than Black in both the CARES (27.3% vs 14.8%) and MIDB (26.9% vs 16.1%) databases (both p < 0.001), but were not more likely to survive (30.8% vs 27.3% p = 0.22; 30.3% vs 28.1%, p = 0.07). Moreover, we found no significant difference in outcome measures based on race documentation for White vs Black patients (good outcome [27.3 vs 26.9% (MIDB)] and [16.1% vs 14.8% (CARES)] respectively and survival [30.8% vs 30.3% (MIDB)] and [27.3 vs 28.1% (CARES)] respectively). Conclusion: Despite higher rates of missing EMS documentation, we identified statistically similar rates in OHCA outcome measures between databases. Further work is needed to determine the true effect of missing documentation of race on OHCA outcome measures.
MeSH term(s)	Adult ; Humans ; Cardiopulmonary Resuscitation ; Emergency Medical Services ; Out-of-Hospital Cardiac Arrest ; Hospitals ; Ethnicity
Language	English
Publishing date	2022-11-16
Publishing country	England
Document type	Journal Article
ZDB-ID	1461751-1
ISSN	1545-0066 ; 1090-3127
ISSN (online)	1545-0066
ISSN	1090-3127
DOI	10.1080/10903127.2022.2137862
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Article ; Online: Systemic thrombolysis for refractory cardiac arrest due to presumed myocardial infarction.

Hamera, Joseph A / Bryant, Noah B / Shievitz, Mark S / Berger, David A

The American journal of emergency medicine

2020 Volume 40, Page(s) 226.e3–226.e5

Abstract: The empiric usage of systemic thrombolysis for refractory out of hospital cardiac arrest (OHCA) is considered for pulmonary embolism (PE), but not for undifferentiated cardiac etiology [1, 2]. We report a case of successful resuscitation after protracted ...

Abstract	The empiric usage of systemic thrombolysis for refractory out of hospital cardiac arrest (OHCA) is considered for pulmonary embolism (PE), but not for undifferentiated cardiac etiology [1, 2]. We report a case of successful resuscitation after protracted OHCA with suspected non-PE cardiac etiology, with favorable neurological outcome after empiric administration of systemic thrombolysis. A 47-year-old male presented to the emergency department (ED) after a witnessed OHCA with no bystander cardiopulmonary resuscitation (CPR). His initial rhythm was ventricular fibrillation (VF) which had degenerated into pulseless electrical activity (PEA) by ED arrival. Fifty-seven minutes into his arrest, we gave systemic thrombolysis which obtained return of spontaneous circulation (ROSC). He was transferred to the coronary care unit (CCU) and underwent therapeutic hypothermia. On hospital day (HD) 4 he began following commands and was extubated on HD 5. Subsequent percutaneous coronary intervention (PCI) revealed non-obstructive stenosis in distal LAD. He was discharged home directly from the hospital, with one-month cerebral performance category (CPC) score of one. He was back to work three months post-arrest. Emergency physicians (EP) should be aware of this topic since we are front-line health care professionals for OHCA. Thrombolytics have the advantage of being widely available in ED and therefore offer an option on a case-by-case basis when intra-arrest PCI and ECPR are not available. This case report adds to the existing literature on systemic thrombolysis as salvage therapy for cardiac arrest from an undifferentiated cardiac etiology. The time is now for this treatment to be reevaluated.
MeSH term(s)	Combined Modality Therapy ; Fibrinolytic Agents/therapeutic use ; Humans ; Hypothermia, Induced ; Male ; Middle Aged ; Myocardial Infarction/complications ; Out-of-Hospital Cardiac Arrest/etiology ; Out-of-Hospital Cardiac Arrest/therapy ; Percutaneous Coronary Intervention
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2020-07-24
Publishing country	United States
Document type	Case Reports
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2020.07.053
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Article ; Online: Elderly Woman With Chest Pain.

Rose, Jessilynn / Berger, David A

Annals of emergency medicine

2016 Volume 68, Issue 3, Page(s) e67–8

Language	English
Publishing date	2016-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2016.02.011
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Article: Emergency Department Urosepsis and Abdominal Imaging.

Siddiqui, Mansoor / Abuelroos, Dena / Qu, Lihua / Jackson, Raymond E / Berger, David A

Cureus

2021 Volume 13, Issue 4, Page(s) e14752

Abstract: Introduction Insufficient attention has been directed towards urosepsis. Notably, no protocols or clinical decision rules currently exist outlining the appropriate use of imaging in uroseptic patients. The primary objective of our study was to ... ...

Abstract	Introduction Insufficient attention has been directed towards urosepsis. Notably, no protocols or clinical decision rules currently exist outlining the appropriate use of imaging in uroseptic patients. The primary objective of our study was to retrospectively evaluate uroseptic emergency department (ED) patients who underwent abdominal imaging, to report the proportion of patients with imaging findings necessitating emergent surgical consultation. Methods We retrospectively identified 1142 patients ≥ 18 years of age that presented to the ED from January 2009 to December 2012 with ICD9 code indicative of urosepsis. All included patients underwent ED-ordered abdominal computerized tomography (CT) or retroperitoneal ultrasound (US). Imaging and urinalysis (UA) results were categorized. We report proportions with odds ratios and 95% confidence intervals. Results Of 1142 patients, we excluded 80 for neg UA, 167 for < 2 SIRS (systemic inflammatory response syndrome), 320 for positive blood cultures, and 37 for incomplete data. This yielded 538 patients which the authors reviewed the results of the CT or US to determine the proportion who required emergent surgical consultation and who underwent surgical or interventional procedure. There were 243 (45%) that had CT or US results that necessitated emergency surgical consultation, of those 180 (33%) underwent surgical or interventional procedure. Similar rates of emergency surgical consultation occurred when sub-divided by positive versus equivocal UA, with 43% and 47%, respectively. Conclusions Forty-five percent of our abdominally imaged urosepsis cohort had imaging findings that necessitated emergent surgical consultation, with a similar proportion in the subset with positive versus equivocal UA. The utility of abdominal imaging in this population should be studied prospectively.
Language	English
Publishing date	2021-04-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.14752
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Article ; Online: Operative Hysteroscopy Intravascular Absorption Syndrome Causing Hyponatremia with Associated Cerebral and Pulmonary Edema.

Elegante, Marco F / Hamera, Joseph A / Xiao, Jane / Berger, David A

Clinical practice and cases in emergency medicine

2019 Volume 3, Issue 3, Page(s) 252–255

Abstract: Operative hysteroscopy intravascular absorption syndrome is an iatrogenic syndrome caused by absorption of hypo-osmolar distension medium during hysteroscopy, which can lead to rapid hyponatremia with resulting cerebral and pulmonary edema. We present a ... ...

Abstract	Operative hysteroscopy intravascular absorption syndrome is an iatrogenic syndrome caused by absorption of hypo-osmolar distension medium during hysteroscopy, which can lead to rapid hyponatremia with resulting cerebral and pulmonary edema. We present a case of a 47-year-old female who underwent hysteroscopic myomectomy at an outpatient ambulatory surgical center who was brought to the emergency department with dyspnea, hypoxia, and altered mental status. Workup showed hyponatremia with cerebral edema on computed tomography of the head and pulmonary edema on chest radiograph. The patient improved after resuscitation with intravenous saline and supplemental oxygen, and she was discharged home the next day.
Language	English
Publishing date	2019-06-04
Publishing country	United States
Document type	Case Reports
ISSN	2474-252X
ISSN (online)	2474-252X
DOI	10.5811/cpcem.2019.4.41878
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Article ; Online: Short-Stay Units vs Routine Admission From the Emergency Department in Patients With Acute Heart Failure: The SSU-AHF Randomized Clinical Trial.

Pang, Peter S / Berger, David A / Mahler, Simon A / Li, Xiaochun / Pressler, Susan J / Lane, Kathleen A / Bischof, Jason J / Char, Douglas / Diercks, Deborah / Jones, Alan E / Hess, Erik P / Levy, Phillip / Miller, Joseph B / Venkat, Arvind / Harrison, Nicholas E / Collins, Sean P

JAMA network open

2024 Volume 7, Issue 1, Page(s) e2350511

Abstract: Importance: More than 80% of patients who present to the emergency department (ED) with acute heart failure (AHF) are hospitalized. With more than 1 million annual hospitalizations for AHF in the US, safe and effective alternatives are needed. Care for ... ...

Abstract	Importance: More than 80% of patients who present to the emergency department (ED) with acute heart failure (AHF) are hospitalized. With more than 1 million annual hospitalizations for AHF in the US, safe and effective alternatives are needed. Care for AHF in short-stay units (SSUs) may be safe and more efficient than hospitalization, especially for lower-risk patients, but randomized clinical trial data are lacking. Objective: To compare the effectiveness of SSU care vs hospitalization in lower-risk patients with AHF. Design, setting, and participants: This multicenter randomized clinical trial randomly assigned low-risk patients with AHF 1:1 to SSU or hospital admission from the ED. Patients received follow-up at 30 and 90 days post discharge. The study began December 6, 2017, and was completed on July 22, 2021. The data were analyzed between March 27, 2020, and November 11, 2023. Intervention: Randomized post-ED disposition to less than 24 hours of SSU care vs hospitalization. Main outcomes and measures: The study was designed to detect at least 1-day superiority for a primary outcome of days alive and out of hospital (DAOOH) at 30-day follow-up for 534 participants, with an allowance of 10% participant attrition. Due to the COVID-19 pandemic, enrollment was truncated at 194 participants. Before unmasking, the primary outcome was changed from DAOOH to an outcome with adequate statistical power: quality of life as measured by the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). The KCCQ-12 scores range from 0 to 100, with higher scores indicating better quality of life. Results: Of the 193 patients enrolled (1 was found ineligible after randomization), the mean (SD) age was 64.8 (14.8) years, 79 (40.9%) were women, and 114 (59.1%) were men. Baseline characteristics were balanced between arms. The mean (SD) KCCQ-12 summary score between the SSU and hospitalization arms at 30 days was 51.3 (25.7) vs 45.8 (23.8) points, respectively (P = .19). Participants in the SSU arm had 1.6 more DAOOH at 30-day follow-up than those in the hospitalization arm (median [IQR], 26.9 [24.4-28.8] vs 25.4 [22.0-27.7] days; P = .02). Adverse events were uncommon and similar in both arms. Conclusions and relevance: The findings show that the SSU strategy was no different than hospitalization with regard to KCCQ-12 score, superior for more DAOOH, and safe for lower-risk patients with AHF. These findings of lower health care utilization with the SSU strategy need to be definitively tested in an adequately powered study. Trial registration: ClinicalTrials.gov Identifier: NCT03302910.
MeSH term(s)	Female ; Humans ; Male ; Middle Aged ; Aftercare ; Emergency Service, Hospital ; Heart Failure/therapy ; Hospitalization ; Pandemics ; Patient Discharge ; Quality of Life ; Aged
Language	English
Publishing date	2024-01-02
Publishing country	United States
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.50511
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