Research Division Overview
Compliments of:
News and Updates:
Congratulations to all our faculty who had abstracts accepted for the ACEP Scientific Assembly in October 2008!
Click here for a list of the accepted abstracts:
ACEP 2008 Department of Emergency Medicine Event Schedule
Active Research Projects
Diagnosing DKA: Sanjay Arora, MD
Genetics of Pulmonary Embolism or Deep Vein Thrombosis: Sean O. Henderson, MD
Asthma and Genetics: Sean O. Henderson, MD
National Emergency Airway Registry III: Sean O. Henderson, MD
Geriatric Trauma: Christian McClung, MD
Trauma Study: Biomarkers and Non-Invasive Measures: Christian McClung, MD
Diagnosing DKA
HS-07-00289
Principal Investigator : Sanjay Arora, MD
Study Summary
Diabetic ketoacidosis (DKA) is a life threatening complication of diabetes and the rapid and accurate identification of this condition is an important function of triage in the emergency department. Currently, when a patient arrives to the emergency department here at LAC+USC with an elevated glucose level, the urine of the patient is dipped and sent to the lab to check for the presence of ketones as a proxy for the presence of DKA while we wait for the results of the chemistry panel. However, the American diabetes association does not advocate this method of triage as urine ketones have been shown to have poor sensitivity and specificity. Recently a new capillary finger stick test has been developed which can rapidly (less than 30 seconds) evaluate for the presence of beta-hydroxybutyrate, which is the main contributor to the academia seen in DKA. It is our hypothesis that when compared to urine ketones, this new finger stick test will provide a more rapid and accurate diagnosis of DKA from triage using the universally accepted levels of bicarbonate and anion gap from the chemistry panel as the gold standard. To test this hypothesis, patients who consent to be in the study will have a beta-hydroxybutyrate finger stick test done in addition to their routine ED care if they are found to be hyperglycemic. No other part of their workup or management will be affected and all laboratory tests will be done at the discretion of the treating physician.
Inclusion Criteria: Age ≥ 18 years, Blood Glucose levels greater than or equal to 250, Ability to give Informed Consent
Exclusion Criteria: Has ALREADY received insulin treatment, Incarcerated/Jail patient, pregnant, mentally altered
Genetics of Pulmonary Embolism or Deep Vein Thrombosis
HS-06-00163
Principal Investigator: Sean O. Henderson, MD
Study Summary
This proposed study would evaluate how frequently certain genetic mutations occur in patients who have been diagnosed with deep vein thrombosis or pulmonary embolism. We are working within a Los Angeles Emergency Medicine patient population. Deep vein thrombosis and pulmonary embolism are diseases, which arise because of abnormal blood clotting in a patient's veins. Deep vein thrombosis is when a clot blocks off a "deep," or major vein. This usually happens in a patient's extremities. Pulmonary embolism is a specific type of deep vein thrombosis, occurring when a clot lodges in the blood vessels of the lungs. These are both serious conditions and without prompt medical treatment, up to 30% of patients die. We are interested in studying the genes, which influence the development of deep vein thrombosis and pulmonary embolism in order to ultimately improve the ability of doctors to accurately diagnose these diseases. For those patients for whom a diagnosis of deep vein thrombosis or pulmonary embolism is certain or highly probable, a small amount of blood will be collected. Beyond a standard blood draw, participation in this study will not require any additional procedures, tests, or treatments. The blood will be analyzed for the following genetic variations: Factor V Leiden, Prothrombin G20210A, MTHFR C677T, and ACE I/D. Previous studies have suggested an association between carrying these genetic mutations and an increased risk of developing deep vein thrombosis and pulmonary embolism.
Inclusion Criteria: Age ≥18 years, Ultrasound of the deep veins OR Computer Tomography Pulmonary Angiogram has been performed on patient
Exclusion Criteria: Not able to give informed consent, Incarcerated/Jail patient, mentally altered, pregnant
Asthma and Genetics
HS-05-00235
Principal Investigator: Sean O. Henderson, MD
Study Summary
Background: Bronchial asthma has been established as being the result of both genetic and environmental factors. Genetic variation also appears to play a role in response to therapy for asthmatics. One such therapeutic target, the β2-adenoreceptor (β2AR), has two such variants (β2AR A(46)G and β2AR C(79)G) which have been described to effect response to therapy.
Objective: In the emergency department (ED), we wished to examine the effect of these polymorphisms in asthmatics with regards to their response to standard therapy measured by change in Forced Expiratory Volume (one second) (FEV1). Our hypothesis was that polymorphisms in the β2AR gene would predict clinical response to therapy.
Methods: After consent, baseline data was obtained which included FEV1. Patients received standard care (albuterol and steroids). FEV1 was measured after each treatment. Blood was taken and processed to obtain the buffy coat, which was used in DNA extraction. Genotyping was done using the Taqman assay.
Inclusion Criteria: 18 - 54 years old, History of Asthma, Pulse Oximetry on arrival to ED ≥ 92%, Signs and symptoms consistent with acute asthma exacerbation including but not limited to dyspnea, hypoxia, wheezing, etc
Exclusion Criteria: Allergy to Albuterol, Has CHF, TB or pneumonia, Presence of fever > 100o F, Not able to give informed consent, Pregnant, Jail Patient
National Emergency Airway Registry III (NEAR III)
HS-07-00024
Principal Investigator: Sean O. Henderson, MD
Study Summary
This study, National Emergency Airway Registry, is intended to create a permanent international data repository of emergency airway management. This study is therefore an observational data collection study that will not affect the choice or timing of airway management. Rather, data recorded will only be comprised of clinical parameters associated with emergency department airway management. All ranges of patients who were intubated will be included into the database in the hope that this large-scale data registry will allow the medical community at large to be informed regarding the standard of care in emergency airway management and that future studies on airway will be based on this large-scale database. ED physicians will complete a paper collection form shortly after emergency department intubation or surgical airways are completed. This data will remain anonymous in such a manner that subjects cannot be identified, directly or through identifies linked to the subjects. Data collection will be retrospective and observational. It will not interfere with the routine care of emergency patients. NEAR III is only a registry of clinical parameters associated with emergency department airway management.
Geriatric Trauma
HS-06-00440
Principal Investigator: Christian McClung, MD
Study Summary
This study will evaluate whether pre-existing medical conditions affect the severity of injury that occurs during a motor vehicle accident. The study will also evaluate if position within the vehicle (driver vs. passenger) also affects the type of injury observed. The purpose of this study is to determine the prevalence of co-existing acute medical illness in elderly victims of motor vehicle collisions presenting at a Level I trauma center. Furthermore, through prospective means, we aim to estimate the frequency with which acute medical illness is a contributing cause of such collisions.
Inclusion Criteria: Patient age ≥ 65, Involved in a motor vehicle collision as a driver or a passenger
Trauma Study: Biomarkers and Non-Invasive Measures
HS-08-00194
Principal Investigator: Christian McClung, MD
Study Summary
This is a study of proteins that reside in the cell whose actions on DNA play an important role in tolerating shock. Animal studies demonstrate that modifying the movement of these proteins allow for survival from bleeding for several hours beyond when they would otherwise die. There are few human studies of this protein and none of them include patients with stabbing nor gun shot wounds. Our medical center would provide us access to these types of patients to investigate if the activity of these proteins correlates with survival. This initial study is to determine if collecting a teaspoon of blood (5 ml) on arrival and one hour later is feasible to measure this protein. Previous studies involved collecting 6 times this amount. Furthermore it is unknown what the activity of this protein is in children who seemingly tolerate bleeding better than adults. By collecting dramatically smaller amounts of blood we can justify attempting to measure this activity in injured children who are the most difficult to know if your resuscitation efforts are adequate.
Patients older than 5 years who are transported to USC Medical Center for trauma care and that are placed in the critical booth (C-booth) would have blood drawn on arrival and one hour afterwards. The blood draw would correspond with routine blood draws and therefore would not involve additional needlesticks. The white blood cells would be separated from the remaining blood and these cells would be processed to separate their nuclear material. The nuclear samples would be frozen and then processed at the same time in bulk. We plan to report the activity of these proteins and use clinical data to determine if they predict survival. We also plan to use two devices that provide information about cardiovascular status. An infrared-device that measures the amount of oxygen in the tissue would be applied to the hand. Another device using ultrasound would be positioned over the rib cage to evaluate the flow of blood through the aorta and pumonary artery. These devices would provide information that may correlate with the activity of the studied proteins.
Inclusion Criteria:Patients over the age of 5 years old (> 20kg estimated weight) brought in by ambulance for trauma center criteria. Only patients that are then triaged to the Critical Booth (C-Booth) would be included. Only patients who have intravenous lines or intraossseous or central lines placed for assessment and resuscitation efforts will be included.
Exclusion Criteria: Patients under 5 years of age. Or estimated weight <20kg, Patients triaged to 1060, 1050, or 1350 side booths, Patients whom do not have intravenous catheters routinely placed, Patients whose routine blood collection is too limited to allow for research use (e.g. unable to obtain further sampling after immediate type and screen/match, complete blood count, chemistry, and prothrombin time), Patients who arrive pulseless and apneic