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Mannix R, Borglund E, Monashefsky A, Master C, Corwin D, Badawy M, Thomas DG, Reisner A. Age-Dependent Differences in Blood Levels of Glial Fibrillary Acidic Protein but Not Ubiquitin Carboxy-Terminal Hydrolase L1 in Children. Neurology 2024; 103:e209651. [PMID: 38986044 PMCID: PMC11238939 DOI: 10.1212/wnl.0000000000209651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/22/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVES Despite the growing evidence of the clinical utility of blood-brain biomarkers in adults with traumatic brain injury (TBI), less is known about the performance of these biomarkers in children. We characterize age-dependent differences in levels of ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) in children without TBI. METHODS Plasma biobank specimens from children and adolescents aged 0-<19 years without TBI were obtained, and UCH-L1 and GFAP levels were quantified. The relationship between age and biomarker expression was determined using previously defined aged epochs (<3.5 years, 3.5 years to <11 years, 11 years and older), then biomarker levels were compared with established thresholds for ruling out the need for a head CT in adults with a mild TBI (mTBI) (UCH-L1 400 pg/mL, GFAP 35 pg/mL). RESULTS The age range of the 366 control patients was 3 months-18 years. There was a significant negative association between age and GFAP but not UCH-L1. Only 1.4% of samples exceeded the UCH-L1 cutoff; however, 20% of samples exceeded the GFAP cutoff and 100% children younger than 3.5 years had values that exceeded the cutoff. DISCUSSION Age seems to modify physiologic plasma GFAP levels. Diagnostic cutoffs for TBI based on GFAP but not UCH-L1 and may need to be adjusted in children younger than 11 years.
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Affiliation(s)
- Rebekah Mannix
- From the Division of Emergency Medicine, Boston Children's Hospital (R.M.), Harvard Medical School, MA; Computational Health Informatics Program (CHIP) (E.B., A.M.), Boston Children's Hospital, MA; Division of Sports Medicine (C.M.), Hospital of Philadelphia; Division of Emergency Medicine (D.C.), Children's Hospital of Philadelphia, PA; Division of Emergency Medicine (M.B.), UT Southwestern Medical Center, Dallas, TX; Division of Emergency Medicine (D.G.T.), Medical College of Wisconsin, Milwaukee; and Children's Hospital of Atlanta (A.R.), GA
| | - Erin Borglund
- From the Division of Emergency Medicine, Boston Children's Hospital (R.M.), Harvard Medical School, MA; Computational Health Informatics Program (CHIP) (E.B., A.M.), Boston Children's Hospital, MA; Division of Sports Medicine (C.M.), Hospital of Philadelphia; Division of Emergency Medicine (D.C.), Children's Hospital of Philadelphia, PA; Division of Emergency Medicine (M.B.), UT Southwestern Medical Center, Dallas, TX; Division of Emergency Medicine (D.G.T.), Medical College of Wisconsin, Milwaukee; and Children's Hospital of Atlanta (A.R.), GA
| | - Alexandra Monashefsky
- From the Division of Emergency Medicine, Boston Children's Hospital (R.M.), Harvard Medical School, MA; Computational Health Informatics Program (CHIP) (E.B., A.M.), Boston Children's Hospital, MA; Division of Sports Medicine (C.M.), Hospital of Philadelphia; Division of Emergency Medicine (D.C.), Children's Hospital of Philadelphia, PA; Division of Emergency Medicine (M.B.), UT Southwestern Medical Center, Dallas, TX; Division of Emergency Medicine (D.G.T.), Medical College of Wisconsin, Milwaukee; and Children's Hospital of Atlanta (A.R.), GA
| | - Christina Master
- From the Division of Emergency Medicine, Boston Children's Hospital (R.M.), Harvard Medical School, MA; Computational Health Informatics Program (CHIP) (E.B., A.M.), Boston Children's Hospital, MA; Division of Sports Medicine (C.M.), Hospital of Philadelphia; Division of Emergency Medicine (D.C.), Children's Hospital of Philadelphia, PA; Division of Emergency Medicine (M.B.), UT Southwestern Medical Center, Dallas, TX; Division of Emergency Medicine (D.G.T.), Medical College of Wisconsin, Milwaukee; and Children's Hospital of Atlanta (A.R.), GA
| | - Daniel Corwin
- From the Division of Emergency Medicine, Boston Children's Hospital (R.M.), Harvard Medical School, MA; Computational Health Informatics Program (CHIP) (E.B., A.M.), Boston Children's Hospital, MA; Division of Sports Medicine (C.M.), Hospital of Philadelphia; Division of Emergency Medicine (D.C.), Children's Hospital of Philadelphia, PA; Division of Emergency Medicine (M.B.), UT Southwestern Medical Center, Dallas, TX; Division of Emergency Medicine (D.G.T.), Medical College of Wisconsin, Milwaukee; and Children's Hospital of Atlanta (A.R.), GA
| | - Mohamed Badawy
- From the Division of Emergency Medicine, Boston Children's Hospital (R.M.), Harvard Medical School, MA; Computational Health Informatics Program (CHIP) (E.B., A.M.), Boston Children's Hospital, MA; Division of Sports Medicine (C.M.), Hospital of Philadelphia; Division of Emergency Medicine (D.C.), Children's Hospital of Philadelphia, PA; Division of Emergency Medicine (M.B.), UT Southwestern Medical Center, Dallas, TX; Division of Emergency Medicine (D.G.T.), Medical College of Wisconsin, Milwaukee; and Children's Hospital of Atlanta (A.R.), GA
| | - Danny G Thomas
- From the Division of Emergency Medicine, Boston Children's Hospital (R.M.), Harvard Medical School, MA; Computational Health Informatics Program (CHIP) (E.B., A.M.), Boston Children's Hospital, MA; Division of Sports Medicine (C.M.), Hospital of Philadelphia; Division of Emergency Medicine (D.C.), Children's Hospital of Philadelphia, PA; Division of Emergency Medicine (M.B.), UT Southwestern Medical Center, Dallas, TX; Division of Emergency Medicine (D.G.T.), Medical College of Wisconsin, Milwaukee; and Children's Hospital of Atlanta (A.R.), GA
| | - Andrew Reisner
- From the Division of Emergency Medicine, Boston Children's Hospital (R.M.), Harvard Medical School, MA; Computational Health Informatics Program (CHIP) (E.B., A.M.), Boston Children's Hospital, MA; Division of Sports Medicine (C.M.), Hospital of Philadelphia; Division of Emergency Medicine (D.C.), Children's Hospital of Philadelphia, PA; Division of Emergency Medicine (M.B.), UT Southwestern Medical Center, Dallas, TX; Division of Emergency Medicine (D.G.T.), Medical College of Wisconsin, Milwaukee; and Children's Hospital of Atlanta (A.R.), GA
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Ali AZ, Wright B, Curran JA, Fawcett-Arsenault J, Newton AS. Co-designing discharge communication interventions for mental health visits to the pediatric emergency department: a mixed-methods study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:64. [PMID: 38907328 PMCID: PMC11191193 DOI: 10.1186/s40900-024-00594-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/31/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Discharge communication is essential to convey information regarding the care provided and follow-up plans after a visit to a hospital emergency department (ED), but it can be lacking for visits for pediatric mental health crises. Our objective was to co-design and conduct usability testing of new discharge communication interventions to improve pediatric mental health discharge communication. METHODS The study was conducted in two phases using experience-based co-design (EBCD). In phase 1 (Sep 2021 to Jan 2022), five meetings were conducted with a team of six parents and two clinicians to co-design new ED discharge communication interventions for pediatric mental health care. Thematic analysis was used to identify patterns in team discussions and participant feedback related to discharge communication improvement and the Capability, Opportunity, Motivation, Behavior (COM-B) model was used to identify strategies to support the delivery of the new interventions. After meeting five, team members completed the Public and Patient Engagement Evaluation Tool (PPEET) to evaluate the co-design experience. In phase 2 (Apr to Jul 2022), intervention usability and satisfaction were evaluated by a new group of parents, youth aged 16-24 years, ED physicians, and nurses (n = 2 of each). Thematic analysis was used to identify usability issues and a validated 5-point Likert survey was used to evaluate user satisfaction. Evaluation results were used by the co-design team to finalize the interventions and delivery strategies. RESULTS Two discharge communication interventions were created: a brochure for families and clinicians to use during the ED visit, and a text-messaging system for families after the visit. There was high satisfaction with engagement in phase 1 (overall mean PPEET score, 4.5/5). In phase 2, user satisfaction was high (mean clinician score, 4.4/5; mean caregiver/youth score, 4.1/5) with both interventions. Usability feedback included in the final intervention versions included instructions on intervention use and ensuring the text-messaging system activates within 12-24 h of discharge. CONCLUSIONS The interventions produced by this co-design initiative have the potential to address gaps in current discharge practices. Future testing is required to evaluate the impact on patients, caregivers, and health care system use after the ED visit.
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Affiliation(s)
- Amber Z Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Bruce Wright
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
- Women and Children's Health Research Institute, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | | | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
- Women and Children's Health Research Institute, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Lopez-Rippe J, Schwartz ES, Davis JC, Dennis RA, Francavilla ML, Jalloul M, Kaplan SL. Imaging Stewardship: Triage for Neuroradiology MR During Limited-Resource Hours. J Am Coll Radiol 2024; 21:70-80. [PMID: 37863151 DOI: 10.1016/j.jacr.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES To decrease call burden on pediatric neuroradiologists, we developed guidelines for appropriate use of MR overnight. These guidelines were implemented using triage by in-house generalist pediatric radiologists. Process measures and balancing measures were assessed during implementation. METHODS For this improvement project, interdepartmental consensus guidelines were developed using exploratory mixed-methods design. Implementation of triage used plan-do-study-act cycles. Process measures included reduction in the number of telephone calls, frequency of calls, triage decisions, and number and type of examinations ordered. Balancing measures included burden of time and effort to the generalist radiologists. Differences in examination orders between implementation intervals was assessed using Kruskal-Wallis, with significance at P < .05. RESULTS Consensus defined MR requests as "do," "defer," or "divert" (to CT). Guidelines decreased neuroradiologist calls 74% while adding minimal burden to the generalist radiologists. Most nights had zero or one triage request and the most common triage decision was "do," and the most common examination was routine brain MR. Number of MR ordered and completed overnight did not significantly change with triage. DISCUSSION Multidisciplinary consensus for use of pediatric neurological MR during limited resource hours overnight is an example of imaging stewardship that decreased the burden of calls and burnout for neuroradiologists while maintaining a comparable level of service to the ordering clinicians.
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Affiliation(s)
- Julian Lopez-Rippe
- Research Scholar, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Erin S Schwartz
- Division Chief Neuroradiology and Associate Chair for Diversity, Equity, and Inclusion, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Professor of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J Christopher Davis
- Section Director for Emergency Radiology, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Assistant Professor of Clinical Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca A Dennis
- Director of Fellowship, Residency and Observership Program, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Assistant Professor of Clinical Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael L Francavilla
- Associate Professor and Chief Medical Information Officer for Radiology, Department of Radiology, University of South Alabama, Mobile, Alabama
| | - Mohammad Jalloul
- Research Scholar, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Summer L Kaplan
- Associate Chair for Quality and Medical Director of Point-of-Care Ultrasound, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Assistant Professor of Clinical Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Vu MT, Schwartz H, Straube S, Pondicherry N, Emanuels D, Dhanoa J, Bains J, Singh M, Stark N, Peabody C. Compass for antibiotic stewardship: using a digital tool to improve guideline adherence and drive clinician behaviour for appendicitis treatment in the emergency department. Emerg Med J 2023; 40:847-853. [PMID: 37907325 DOI: 10.1136/emermed-2022-213015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Antibiotic stewardship in the ED is important given the increasing prevalence of multidrug resistance associated with poorer patient outcomes. The use of broad-spectrum antibiotics in the ED for infections like appendicitis is common. At baseline, 75% of appendicitis cases at our institution received broad-spectrum ertapenem rather than the recommended narrower-spectrum ceftriaxone/metronidazole combination. We aimed to improve antibiotic stewardship by identifying barriers to guideline adherence and redesigning our appendicitis antibiotic guideline. METHODS Using the 'Fit between Individuals, Task and Technology (FITT)' framework, we identified barriers that preventclinicians from adhering to guidelines. We reformatted a clinical guideline and disseminated it using our ED's clinical decision support system (CDSS), E*Drive. Next, we examined E*Drive's user data and clinician surveys to assess utilisation and satisfaction. Finally, we conducted a retrospective chart review to measure clinician behaviour change in antibiotic prescription for appendicitis treatment. RESULTS Data demonstrated an upward trend in the number of monthly users of E*Drive from 1 April 2021 to 30 April 2022, with an average increase of 46 users per month. Our clinician survey results demonstrated that >95% of users strongly agree/agree that E*Drive improves access to clinical information, makes their job more efficient and that E*Drive is easy to access and navigate, with a Net Promoter Score increase from 26.0 to 78.3. 69.4% of patients treated for appendicitis in the post-intervention group received antibiotics concordant with our institutional guideline compared with 20.0% in the pre-intervention group (OR=9.07, 95% CI (3.84 to 21.41)). CONCLUSION Antibiotic stewardship can be improved by ensuring clinicians have access to convenient and up-to-date guidelines through clinical decision support systems. The FITT model can help guide projects by identifying individual, task and technology barriers. Sustained adherence to clinical guidelines through simplification of guideline content is a potentially powerful tool to influence clinician behaviour in the ED.
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Affiliation(s)
- Mai Trang Vu
- UCSF School of Medicine, San Francisco, California, USA
| | - Hope Schwartz
- UCSF School of Medicine, San Francisco, California, USA
| | - Steven Straube
- Department of Emergency Medicine, UCSF, San Francisco, California, USA
| | | | | | - Jaskirat Dhanoa
- Department of Emergency Medicine, UCSF, San Francisco, California, USA
| | - Jaskaran Bains
- Department of Emergency Medicine, UCSF, San Francisco, California, USA
| | - Malini Singh
- Department of Emergency Medicine, UCSF, San Francisco, California, USA
| | - Nicholas Stark
- Department of Emergency Medicine, UCSF, San Francisco, California, USA
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Gyedu A, Stewart BT, Nakua E, Donkor P. Standardized trauma intake form with clinical decision support prompts improves care and reduces mortality for seriously injured patients in non-tertiary hospitals in Ghana: stepped-wedge cluster randomized trial. Br J Surg 2023; 110:1473-1481. [PMID: 37612450 PMCID: PMC10564400 DOI: 10.1093/bjs/znad253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/22/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND The WHO Trauma Care Checklist improved key performance indicators (KPIs) of trauma care at tertiary hospitals. A standardized trauma intake form (TIF) with real-time clinical decision support prompts was developed by adapting the WHO Trauma Care Checklist for use in smaller low- and middle-income country hospitals, where care is delivered by non-specialized providers and without trauma teams. This study aimed to determine the effectiveness of the TIF for improving KPIs in initial trauma care and reducing mortality at non-tertiary hospitals in Ghana. METHODS A stepped-wedge cluster randomized trial was conducted by stationing research assistants at emergency units of eight non-tertiary hospitals for 17.5 months to observe management of injured patients before and after introduction of the TIF. Differences in performance of KPIs in trauma care (primary outcomes) and mortality (secondary outcome) were estimated using generalized linear mixed regression models. RESULTS Management of 4077 injured patients was observed (2067 before TIF introduction, 2010 after). There was improvement in 14 of 16 primary survey and initial care KPIs after TIF introduction. Airway assessment increased from 72.9 to 98.4 per cent (adjusted OR 25.27, 95 per cent c.i. 2.47 to 258.94; P = 0.006) and breathing assessment from 62.1 to 96.8 per cent (adjusted OR 38.38, 4.84 to 304.69; P = 0.001). Documentation of important clinical data improved from 52.4 to 76.7 per cent (adjusted OR 2.14, 1.17 to 3.89; P = 0.013). The mortality rate decreased from 17.7 to 12.1 per cent among 302 patients (186 before, 116 after) with impaired physiology on arrival (hypotension or decreased level of consciousness) (adjusted OR 0.10, 0.02 to 0.56; P = 0.009). CONCLUSION The TIF improved overall initial trauma care and reduced mortality for more seriously injured patients. REGISTRATION NUMBER NCT04547192 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Surgery Unit, University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Emmanuel Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Waltzman D, Miller GF, Patel N, Sarmiento K, Breiding M, Lumba-Brown A. Neuroimaging for mild traumatic brain injury in children: cross-sectional study using national claims data. Pediatr Radiol 2023; 53:1163-1170. [PMID: 36859687 PMCID: PMC10416194 DOI: 10.1007/s00247-023-05633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Current guidelines recommend healthcare professionals avoid routine use of neuroimaging for diagnosing mild traumatic brain injury (mTBI). OBJECTIVE This study aimed to examine current use of CT and MRI among children and young adult patients with mTBI and factors that increase likelihood of neuroimaging in this population. MATERIALS AND METHODS Data were analyzed using the 2019 MarketScan commercial claims and encounters database for the commercially insured population for both inpatient and outpatient claims. Descriptive statistics and logistic regression models for patients ≤24 years of age who received an ICD-10-CM code indicative of a possible mTBI were analyzed. RESULTS Neuroimaging was performed in 16.9% (CT; 95% CI=16.7-17.1) and 0.9% (MRI; 95% CI=0.8-0.9) of mTBI outpatient visits (including emergency department visits) among children (≤18 years old). Neuroimaging was performed in a higher percentage of outpatient visits for patients 19-24 years old (CT=47.1% [95% CI=46.5-47.6] and MRI=1.7% [95% CI=1.5-1.8]), and children aged 15-18 years old (CT=20.9% [95% CI=20.5-21.2] and MRI=1.4% [95% CI=1.3-1.5]). Outpatient visits for males were 1.22 (95% CI=1.10-1.25) times more likely to include CT compared to females, while there were no differences by sex for MRI or among inpatient stays. Urban residents, as compared to rural, were less likely to get CT in outpatient settings (adjusted odds ratio [aOR]=0.55, 95% CI=0.53-0.57). Rural residents demonstrated a larger proportion of inpatient admissions that had a CT. CONCLUSIONS Despite recommendations to avoid routine use of neuroimaging for mTBI, neuroimaging remained common practice in 2019.
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Affiliation(s)
- Dana Waltzman
- Division of Injury Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, Atlanta, GA, 30341, USA.
| | - Gabrielle F Miller
- Division of Injury Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Nimesh Patel
- Division of Injury Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Kelly Sarmiento
- Division of Injury Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Matthew Breiding
- Division of Injury Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Angela Lumba-Brown
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Dayan PS, Ballard DW, Shelton RC, Kuppermann N. Implementation Trials That Change Practice: Evidence Alone Is Never Enough. Ann Emerg Med 2022; 80:344-346. [PMID: 35965161 DOI: 10.1016/j.annemergmed.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Peter S Dayan
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY.
| | - Dustin W Ballard
- Department of Emergency Medicine, Kaiser Permanente Northern California, Oakland, CA; Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, and Columbia's Irving Institute for Clinical and Translational Research, New York City, NY
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA
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