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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 156 Research Studies Displayed
Newgard CD, Lin A, Caughey AB
The cost of a fall among older adults requiring emergency services.
Researchers evaluated medical expenditures to 1 year among community-dwelling older adults who fell and required ambulance transport, including acute versus post-acute periods, the primary drivers of cost, and comparison to baseline expenditures. They found that older adults who fall and require emergency services have increased healthcare expenditures compared with baseline, particularly during the post-acute period. Comorbidities, noninjury medical conditions, fracture type, and surgical interventions were independently associated with increased costs.
AHRQ-funded; HS023796.
Citation:
Newgard CD, Lin A, Caughey AB .
The cost of a fall among older adults requiring emergency services.
J Am Geriatr Soc 2021 Feb;69(2):389-98. doi: 10.1111/jgs.16863..
Keywords:
Elderly, Falls, Emergency Department, Healthcare Costs, Emergency Medical Services (EMS)
Govindarajan P, Shiboski S, Grimes B
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Investigators sought to determine whether increasing access to primary stroke centers (regionalization) led to an increase in intravenous alteplase use in acute ischemic stroke patients. Studying two urban counties in the western region of US that regionalized acute stroke care, they found that in Santa Clara County, intravenous alteplase was administered to 1.7% of patients in the pre-regionalization period and 2.1% in the post-regionalization period, while in San Mateo County, the numbers were 1.3% and 3.2%, respectively. In the post-regionalization phase, San Mateo County had greater change in paramedic stroke detection, higher number of transports to primary stroke centers, and more frequent use of intravenous alteplase at stroke centers. They concluded that greater post-regionalization improvements in San Mateo County contributed to significantly improved county-level thrombolysis use than Santa Clara County.
AHRQ-funded; HS026207; HS017965.
Citation:
Govindarajan P, Shiboski S, Grimes B .
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Prehosp Emerg Care 2020 Jul-Aug;24(4):505-14. doi: 10.1080/10903127.2019.1679303..
Keywords:
Stroke, Cardiovascular Conditions, Urban Health, Access to Care, Emergency Medical Services (EMS), Critical Care
Panchal AR, Finnegan G, Way DP
Assessment of paramedic performance on difficult airway simulation.
The purpose of this study was to assess paramedic comprehensive airway management practices during a difficult airway simulation through which paramedics were obligated to consider alternatives to endotracheal intubation (ETI). The investigators concluded that in a difficult airway management scenario designed for low ETI success rates, even experienced paramedics were challenged with comprehensive airway management. This was exemplified by difficulties with the use of backup airway devices.
AHRQ-funded; HS021456.
Citation:
Panchal AR, Finnegan G, Way DP .
Assessment of paramedic performance on difficult airway simulation.
Prehosp Emerg Care 2020 May-Jun;24(3):411-20. doi: 10.3109/10903127.2015.1102993..
Keywords:
Simulation, Emergency Medical Services (EMS), Training, Quality of Care, Care Management, Provider Performance
Stangenes SR, Painter IS, Rea TD
Delays in recognition of the need for telephone-assisted CPR due to caller descriptions of chief complaint.
The objective of this study was to test if caller descriptions of chief complaint delays emergency medical dispatchers' (EMDs) recognition of the need for telephone-assisted CPR (T-CPR). The investigators conducted an analysis of N = 433 cardiac arrest calls from six large call centers in the United States. They concluded that caller chief complaint description affected the time to recognition of the need for T-CPR.
AHRQ-funded; HS021658.
Citation:
Stangenes SR, Painter IS, Rea TD .
Delays in recognition of the need for telephone-assisted CPR due to caller descriptions of chief complaint.
Resuscitation 2020 Apr;149:82-86. doi: 10.1016/j.resuscitation.2020.02.013..
Keywords:
Emergency Medical Services (EMS), Cardiovascular Conditions, Patient Safety, Quality of Care, Telehealth, Health Information Technology (HIT), Communications
Zive D, Newgard CD, Lin A
Injured older adults transported by emergency medical services: one year outcomes by POLST status.
Advance care planning documents, including Physician Orders for Life-Sustaining Treatment (POLST), are intended to guide care near end of life, particularly in emergency situations. Yet, research on POLST during emergency care is sparse. This study examined one year outcomes, by Physician Orders for Life-Sustaining Treatment status, of injured adults transported by EMS. The investigators concluded that among injured older adults transported by ambulance in Oregon, one in 5 had an active POLST form at the time of 9-1-1 contact, the prevalence of which increased over the following year.
AHRQ-funded; HS023796.
Citation:
Zive D, Newgard CD, Lin A .
Injured older adults transported by emergency medical services: one year outcomes by POLST status.
Prehosp Emerg Care 2020 Mar-Apr;24(2):257-64. doi: 10.1080/10903127.2019.1615154..
Keywords:
Elderly, Injuries and Wounds, Emergency Medical Services (EMS), Emergency Department
Sobieraj DM, Martinez BK, Miao B
Comparative effectiveness of analgesics to reduce acute pain in the prehospital setting.
The objectives of this study were to assess comparative effectiveness and harms of opioid and nonopioid analgesics for the treatment of moderate to severe acute pain in the prehospital setting. Among the investigators’ conclusions were that as initial analgesia, opioids were no different than ketamine, APAP, and NSAIDs in reducing acute pain in the prehospital setting. Opioids may cause fewer total side effects than ketamine, but more than APAP or NSAIDs.
AHRQ-funded; 290201500012I.
Citation:
Sobieraj DM, Martinez BK, Miao B .
Comparative effectiveness of analgesics to reduce acute pain in the prehospital setting.
Prehosp Emerg Care 2020 Mar-Apr;24(2):163-74. doi: 10.1080/10903127.2019.1657213..
Keywords:
Opioids, Medication, Pain, Emergency Medical Services (EMS), Comparative Effectiveness, Patient-Centered Outcomes Research
Hanchate AD, Paasche-Orlow MK, Baker WE
Association of race/ethnicity with emergency department destination of emergency medical services transport.
The authors examined the patterns of emergency department (ED) destination of emergency medical services (EMS) transport according to patient race/ethnicity and compared the patterns between those transported by EMS and those who did not draw on EMS. Using Medicare claims data, they found race/ethnicity variation in ED destination for patients using EMS transport, with black and Hispanic patients more likely to be transported to a safety-net hospital ED compared with white patients living in the same zip code.
AHRQ-funded; HS022242.
Citation:
Hanchate AD, Paasche-Orlow MK, Baker WE .
Association of race/ethnicity with emergency department destination of emergency medical services transport.
JAMA Netw Open 2019 Sep 4;2(9):e1910816. doi: 10.1001/jamanetworkopen.2019.10816..
Keywords:
Emergency Medical Services (EMS), Emergency Department, Racial / Ethnic Minorities, Safety Net, Medicare, Disparities
Hsuan C, Hsia RY, Horwitz JR
Ambulance diversions following public hospital emergency department closures.
The purpose of this study was to examine whether hospitals are more likely to temporarily close their emergency departments to ambulances, through ambulance diversions, if neighboring diverting hospitals are public vs private. Results showed that sample hospitals respond differently to diversions by neighboring public (vs private) hospitals. The authors conclude that these findings suggest that these hospitals might be strategically declaring ambulance diversions to avoid treating low-paying patients served by public hospitals.
AHRQ-funded; HS024247.
Citation:
Hsuan C, Hsia RY, Horwitz JR .
Ambulance diversions following public hospital emergency department closures.
Health Serv Res 2019 Aug;54(4):870-79. doi: 10.1111/1475-6773.13147..
Keywords:
Access to Care, Emergency Department, Emergency Medical Services (EMS), Health Services Research (HSR), Hospitals
Newgard CD, Lin A, Yanez ND
Long-term outcomes among injured older adults transported by emergency medical services.
This study examined the outcomes of injured older adults who were transported by emergency medical services (EMS) to the hospital. Older adults 65 years and older who were transported by 44 EMS agencies to 51 hospitals in 2011 were included and then had a 12-month follow-up through December 31, 2012. The majority of older adults were transported after a fall (84.5%). Serious injuries occurred in 3.5% with a serious extremity injury being the most common (17.8%). Mortality rates for older adults with severe injuries ranged from 1.6% in the hospital to 20.3% at 1 year. The most common causes of death was cardiovascular diseases and dementia.
AHRQ-funded; HS023796.
Citation:
Newgard CD, Lin A, Yanez ND .
Long-term outcomes among injured older adults transported by emergency medical services.
Injury 2019 Jun;50(6):1175-85. doi: 10.1016/j.injury.2019.04.028..
Keywords:
Elderly, Emergency Medical Services (EMS), Falls, Injuries and Wounds, Outcomes, Trauma
Cicero MX, Whitfill T, Walsh B
Correlation between paramedic disaster triage accuracy in screen-based simulations and immersive simulations.
This study examined the effectiveness of adding a screen-based simulation (SBS) to immersive simulation of a disaster for triage education of paramedics and emergency medical technicians (EMTs). A randomized controlled trial (RCT) was conducted with emergency medical personnel who had completed an immersive simulation of a school shooting, interacted with an SBS for 13 weeks, and completed the immersive simulation again. The participants were divided into groups: one who had gone through the Seconds to Survival (60S) disaster triage SBS and the other who had not. There was a significant increase in triage accuracy with immersive simulation, but SBS did not correlate with performance in the immersive simlation.
AHRQ-funded; HS022837.
Citation:
Cicero MX, Whitfill T, Walsh B .
Correlation between paramedic disaster triage accuracy in screen-based simulations and immersive simulations.
Prehosp Emerg Care 2019 Jan-Feb;23(1):83-89. doi: 10.1080/10903127.2018.1475530..
Keywords:
Emergency Preparedness, Emergency Medical Services (EMS), Simulation, Training, Education: Continuing Medical Education
Rhee C, Kalil AC
Toward a more nuanced approach to the early administration of intravenous fluids in patients with sepsis.
In this paper the authors discuss an article by Lane et al., published in 2018 in JAMA Network Open, related to the early administration of intravenous fluids in patients with sepsis.
AHRQ-funded; HS025008.
Citation:
Rhee C, Kalil AC .
Toward a more nuanced approach to the early administration of intravenous fluids in patients with sepsis.
JAMA Netw Open 2018 Dec 7;1(8):e185844. doi: 10.1001/jamanetworkopen.2018.5844..
Keywords:
Emergency Medical Services (EMS), Mortality, Sepsis
Adelgais KM, Hansen M, Lerner EB
Establishing the key outcomes for pediatric emergency medical services research.
The evidence supporting best practices when treating children in the prehospital setting or even the effect emergency medical services (EMS) has on patient outcomes is limited. This article describes a consensus process among stakeholders in the pediatric emergency medicine and EMS community that identified the critical outcomes for EMS care in five clinical areas (traumatic brain injury, general injury, respiratory disease/failure, sepsis, and seizures).
AHRQ-funded; HS026101.
Citation:
Adelgais KM, Hansen M, Lerner EB .
Establishing the key outcomes for pediatric emergency medical services research.
Acad Emerg Med 2018 Dec;25(12):1345-54. doi: 10.1111/acem.13637..
Keywords:
Children/Adolescents, Emergency Medical Services (EMS), Evidence-Based Practice, Health Services Research (HSR), Outcomes, Patient-Centered Outcomes Research
Ali A, Zachrison KS, Eschenfeldt PC
Optimization of prehospital triage of patients with suspected ischemic stroke.
Prehospital routing algorithms for patients with suspected stroke because of large vessel occlusions should account for likelihood of benefit from endovascular therapy (EVT), risk of alteplase delays, and transport times. In this study, the investigators present a mathematical decision model that determines ideal prehospital routing recommendations for patients with suspected stroke because of large vessel occlusions, with consideration of patient characteristics and location at onset.
AHRQ-funded; HS024561.
Citation:
Ali A, Zachrison KS, Eschenfeldt PC .
Optimization of prehospital triage of patients with suspected ischemic stroke.
Stroke 2018 Oct;49(10):2532-35. doi: 10.1161/strokeaha.118.022041..
Keywords:
Emergency Medical Services (EMS), Stroke
Gyftopoulos S, Smith SW, Simon E
Qualitative study to understand ordering of CT angiography to diagnose pulmonary embolism in the emergency room setting.
The purpose of the study was to better understand, using semi-structured interviews, the decision making behind the ordering of CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism (PE) in the emergency department. The authors found that EM providers were the main drivers of CTPA ordering, and there was a marginalized role for the radiologist. Experience- and gestalt-based heuristics were the main influencers of CTPA ordering.
AHRQ-funded; HS024376.
Citation:
Gyftopoulos S, Smith SW, Simon E .
Qualitative study to understand ordering of CT angiography to diagnose pulmonary embolism in the emergency room setting.
J Am Coll Radiol 2018 Sep;15(9):1276-84. doi: 10.1016/j.jacr.2017.08.022..
Keywords:
Diagnosis, Emergency Department, Emergency Medical Services (EMS), Imaging
Fong A, Kim TC, Ratwani RM
Task2Heart: exploring heart rate differences with time-motion workflow observations of emergency medicine physicians.
This paper presents Task2Heart, a system developed to integrate near real-time heart rate with in-situ time motion observations. The authors describe and validate the system and discuss its use in the exploration of emergency physician heart rate in-situ.
AHRQ-funded; HS024801.
Citation:
Fong A, Kim TC, Ratwani RM .
Task2Heart: exploring heart rate differences with time-motion workflow observations of emergency medicine physicians.
J Med Syst 2018 Aug 7;42(9):170. doi: 10.1007/s10916-018-1024-4..
Keywords:
Cardiovascular Conditions, Emergency Department, Workflow, Emergency Medical Services (EMS)
Le Parc JM, Bischof JJ, King AM JM, Bischof JJ, King AM
A randomized comparison of in-hospital rescuer positions for endotracheal intubation in a difficult airway.
The objective of the study was to compare in-hospital emergency medicine (EM) trainees' performance on endotracheal intubation (ETI) delivered from both the seated and standing positions. The study concluded that the position of the in-hospital provider, whether seated or standing, had no effect on the provider's ETI performance. Since environmental circumstances sometimes necessitate alternative positioning for effective ETI administration, the findings suggest that there may be value in training residents to perform ETI from both positions.
AHRQ-funded; HS021456.
Citation:
Le Parc JM, Bischof JJ, King AM JM, Bischof JJ, King AM .
A randomized comparison of in-hospital rescuer positions for endotracheal intubation in a difficult airway.
West J Emerg Med 2018 Jul;19(4):660-67. doi: 10.5811/westjem.2018.4.37227..
Keywords:
Education: Continuing Medical Education, Emergency Medical Services (EMS), Patient Safety, Provider Performance
Joseph D, Vogel JA, Smith CS
Alcohol as a factor in 911 calls in Denver.
This study analyzed data from 911 calls in Denver, Colorado to determine the impact of excessive alcohol consumption on those calls. The number of calls made from July 1, 2012 to June 30, 2014 was 169,642 and of those calls 30% had alcohol consumption has a main factor, and 29% as a contribution factor. These calls were more likely associated with male sex, traumatic injuries, advanced monitoring, airway adjuncts, and medications for sedation.
AHRQ-funded; HS023901.
Citation:
Joseph D, Vogel JA, Smith CS .
Alcohol as a factor in 911 calls in Denver.
Prehosp Emerg Care 2018 Jul-Aug;22(4):427-35. doi: 10.1080/10903127.2017.1413467..
Keywords:
Alcohol Use, Emergency Department, Emergency Medical Services (EMS), Healthcare Utilization
Richards CT, Huebinger R, Tataris KL
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
This study explores the hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), an assessment tool currently used by emergency medical services (EMS) providers, can be used to identify large vessel occlusion (LVO). Patients with acute ischemic stroke arriving via EMS at a high-volume stroke center in a large city were identified in a prospective, single-center registry. LVO was confirmed via head and neck vessel imaging and CPSS scores were abstracted from pre-hospital EMS records. The researchers conclude that a CPSS score of 3 identifies LVO in AIS patients reliably, and that EMS providers may be able to use the CPSS with a cut-off score to screen for patients with suspected LVO.
AHRQ-funded; HS000078.
Citation:
Richards CT, Huebinger R, Tataris KL .
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
Prehosp Emerg Care 2018 May-Jun;22(3):312-18. doi: 10.1080/10903127.2017.1387629..
Keywords:
Diagnosis, Emergency Department, Emergency Medical Services (EMS), Stroke
Mbachu SN, Pieribone VA, Bechtel KA
Optimizing recruitment and retention of adolescents in ED research: findings from concussion biomarker pilot study.
The authors conducted a pilot study to optimize screening, recruitment, and enrollment strategies for a larger, fully-powered study that seeks to identify proteins in the blood of adolescent athletes following a concussion that are significantly and consistently altered compared with age- and gender-matched controls with isolated extremity injuries. They found that EHR-based notifications and financial incentives for participation in ED research on prolonged recovery in adolescents with concussion increased participant identification and enrollment and retention rates to inform and optimize the enrollment and recruitment strategies for a larger study. There was a clear trend for participants to present to the ED on nights or weekends, likely reflecting the time of sport play.
AHRQ-funded; HS021271.
Citation:
Mbachu SN, Pieribone VA, Bechtel KA .
Optimizing recruitment and retention of adolescents in ED research: findings from concussion biomarker pilot study.
Am J Emerg Med 2018 May;36(5):884-87. doi: 10.1016/j.ajem.2017.09.014.
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Keywords:
Children/Adolescents, Emergency Department, Emergency Medical Services (EMS), Health Services Research (HSR), Research Methodologies
Mistry B, Stewart De Ramirez S, Kelen G
Accuracy and reliability of emergency department triage using the emergency severity index: an international multicenter assessment.
This study assessed the accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. It found that the concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, its findings point to a need for more reliable ED triage tools.
AHRQ-funded; HS023641.
Citation:
Mistry B, Stewart De Ramirez S, Kelen G .
Accuracy and reliability of emergency department triage using the emergency severity index: an international multicenter assessment.
Ann Emerg Med 2018 May;71(5):581-87.e3. doi: 10.1016/j.annemergmed.2017.09.036.
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Keywords:
Decision Making, Emergency Department, Emergency Medical Services (EMS), Health Information Technology (HIT), Nursing
Velopulos CG, Shihab HM, Lottenberg L
Prehospital spine immobilization/spinal motion restriction in penetrating trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma (EAST).
This study reviewed the published evidence on prehospital spine immobilization or spinal motion restriction in adult patients with penetrating trauma in order to structure a practice management guideline. Using a Cochrane-style systematic review, 24 studies met inclusion criteria; five studies were used for the quantitative review. No study showed benefit to spine immobilization with regard to mortality and neurologic injury, even for patients with direct neck injuries. Increased mortality was associated with spine immobilization. The authors recommend that spine immobilization not be routinely used for adult patients with penetrating trauma.
AHRQ-funded; HS024547.
Citation:
Velopulos CG, Shihab HM, Lottenberg L .
Prehospital spine immobilization/spinal motion restriction in penetrating trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma (EAST).
J Trauma Acute Care Surg 2018 May;84(5):736-44. doi: 10.1097/ta.0000000000001764..
Keywords:
Care Management, Emergency Medical Services (EMS), Evidence-Based Practice, Guidelines, Trauma
Mullen MT, Pajerowski W, Messe SR
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
The purpose of this study was to evaluate the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and to use geographic modeling in order to evaluate expected changes for a comprehensive stroke center policy. Suspected stroke emergency medical services encounters in Philadelphia, PA, were identified, and transport times before and after the initiation of a PSC destination policy in October 2011 were compared. Geographic modeling was used to estimate the impact of bypassing the closest hospital for the closest PSC or comprehensive stroke centers, which was common before the official policy and increased steadily over time. The researchers conclude that the time taken to route patients to PSCs or comprehensive stroke centers is low.
AHRQ-funded; HS018362.
Citation:
Mullen MT, Pajerowski W, Messe SR .
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
Stroke 2018 Apr;49(4):1021-23. doi: 10.1161/strokeaha.118.020691.
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Keywords:
Emergency Department, Emergency Medical Services (EMS), Hospitals, Policy, Stroke
Newgard CD, Uribe-Leitz T, Haider AH
Undertriage remains a vexing problem for even the most highly developed trauma systems: The need for innovations in field triage.
This paper is a commentary on an article by Voskens FJ, et al., published in 2017 in JAMA Surgery, entitled “Accuracy of prehospital triage in selecting severely injured trauma patients.”
AHRQ-funded; HS023796.
Citation:
Newgard CD, Uribe-Leitz T, Haider AH .
Undertriage remains a vexing problem for even the most highly developed trauma systems: The need for innovations in field triage.
AHRQ-funded; HS023796..
Keywords:
Emergency Medical Services (EMS), Health Services Research (HSR), Trauma
Ray KN, Olson LM, Edgerton EA
Access to high pediatric-readiness emergency care in the United States.
The researchers determined the geographic accessibility of emergency departments (EDs) with high pediatric readiness by assessing the percentage of US children living within a 30-minute drive time of an ED with high pediatric readiness, as defined by collaboratively developed published guidelines. They concluded that a significant proportion of US children do not have timely access to EDs with high pediatric readiness.
AHRQ-funded; HS022989.
Citation:
Ray KN, Olson LM, Edgerton EA .
Access to high pediatric-readiness emergency care in the United States.
J Pediatr 2018 Mar;194:225-32.e1. doi: 10.1016/j.jpeds.2017.10.074.
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Keywords:
Access to Care, Children/Adolescents, Emergency Department, Emergency Medical Services (EMS), Children/Adolescents
Khubchandani JA, Shen C, Ayturk D
Disparities in access to emergency general surgery care in the United States.
This study examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. The study concluded that gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities and policy initiatives need to increase emergency general surgery capacity nationwide.
AHRQ-funded; HS022694.
Citation:
Khubchandani JA, Shen C, Ayturk D .
Disparities in access to emergency general surgery care in the United States.
Surgery 2018 Feb;163(2):243-50. doi: 10.1016/j.surg.2017.07.026..
Keywords:
Access to Care, Disparities, Emergency Medical Services (EMS), Surgery, Vulnerable Populations
