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Lewis NM, Zhu Y, Peltan ID, Gaglani M, McNeal T, Ghamande S, Steingrub JS, Shapiro NI, Duggal A, Bender WS, Taghizadeh L, Brown SM, Hager DN, Gong MN, Mohamed A, Exline MC, Khan A, Wilson JG, Qadir N, Chang SY, Ginde AA, Mohr NM, Mallow C, Lauring AS, Johnson NJ, Gibbs KW, Kwon JH, Columbus C, Gottlieb RL, Raver C, Vaughn IA, Ramesh M, Johnson C, Lamerato L, Safdar B, Casey JD, Rice TW, Halasa N, Chappell JD, Grijalva CG, Talbot HK, Baughman A, Womack KN, Swan SA, Harker E, Price A, DeCuir J, Surie D, Ellington S, Self WH. Vaccine Effectiveness Against Influenza A-Associated Hospitalization, Organ Failure, and Death: United States, 2022-2023. Clin Infect Dis 2024; 78:1056-1064. [PMID: 38051664 DOI: 10.1093/cid/ciad677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Influenza circulation during the 2022-2023 season in the United States largely returned to pre-coronavirus disease 2019 (COVID-19)-pandemic patterns and levels. Influenza A(H3N2) viruses were detected most frequently this season, predominately clade 3C.2a1b.2a, a close antigenic match to the vaccine strain. METHODS To understand effectiveness of the 2022-2023 influenza vaccine against influenza-associated hospitalization, organ failure, and death, a multicenter sentinel surveillance network in the United States prospectively enrolled adults hospitalized with acute respiratory illness between 1 October 2022, and 28 February 2023. Using the test-negative design, vaccine effectiveness (VE) estimates against influenza-associated hospitalization, organ failures, and death were measured by comparing the odds of current-season influenza vaccination in influenza-positive case-patients and influenza-negative, SARS-CoV-2-negative control-patients. RESULTS A total of 3707 patients, including 714 influenza cases (33% vaccinated) and 2993 influenza- and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative controls (49% vaccinated) were analyzed. VE against influenza-associated hospitalization was 37% (95% confidence interval [CI]: 27%-46%) and varied by age (18-64 years: 47% [30%-60%]; ≥65 years: 28% [10%-43%]), and virus (A[H3N2]: 29% [6%-46%], A[H1N1]: 47% [23%-64%]). VE against more severe influenza-associated outcomes included: 41% (29%-50%) against influenza with hypoxemia treated with supplemental oxygen; 65% (56%-72%) against influenza with respiratory, cardiovascular, or renal failure treated with organ support; and 66% (40%-81%) against influenza with respiratory failure treated with invasive mechanical ventilation. CONCLUSIONS During an early 2022-2023 influenza season with a well-matched influenza vaccine, vaccination was associated with reduced risk of influenza-associated hospitalization and organ failure.
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Affiliation(s)
- Nathaniel M Lewis
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah, and University of Utah, Salt Lake City, Utah, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple and Dallas, Texas, and Texas A&M University College of Medicine, Temple, Texas, USA
| | - Tresa McNeal
- Baylor Scott and White Health, and Baylor College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Leyla Taghizadeh
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah, and University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St.Louis, Missouri, USA
| | | | - Robert L Gottlieb
- Baylor University Medical Center Dallas, Baylor, Scott & White Heart and Vascular Hospital, Baylor, Scott and White Research Institute, Dallas, Texas, USA
| | | | - Ivana A Vaughn
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Mayur Ramesh
- Division of Infectious Diseases, Henry Ford Health, Detroit, Michigan, USA
| | - Cassandra Johnson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA
| | - Basmah Safdar
- Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - H Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth Harker
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Ashley Price
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Jennifer DeCuir
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Diya Surie
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sascha Ellington
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt Institute for Clinical and Translational Research, and Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Surie D, Yuengling KA, DeCuir J, Zhu Y, Lauring AS, Gaglani M, Ghamande S, Peltan ID, Brown SM, Ginde AA, Martinez A, Mohr NM, Gibbs KW, Hager DN, Ali H, Prekker ME, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Leis AM, Khan A, Hough CL, Bender WS, Duggal A, Bendall EE, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Shapiro NI, Columbus C, Vaughn IA, Ramesh M, Mosier JM, Safdar B, Casey JD, Talbot HK, Rice TW, Halasa N, Chappell JD, Grijalva CG, Baughman A, Womack KN, Swan SA, Johnson CA, Lwin CT, Lewis NM, Ellington S, McMorrow ML, Martin ET, Self WH. Severity of Respiratory Syncytial Virus vs COVID-19 and Influenza Among Hospitalized US Adults. JAMA Netw Open 2024; 7:e244954. [PMID: 38573635 DOI: 10.1001/jamanetworkopen.2024.4954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Importance On June 21, 2023, the Centers for Disease Control and Prevention recommended the first respiratory syncytial virus (RSV) vaccines for adults aged 60 years and older using shared clinical decision-making. Understanding the severity of RSV disease in adults can help guide this clinical decision-making. Objective To describe disease severity among adults hospitalized with RSV and compare it with the severity of COVID-19 and influenza disease by vaccination status. Design, Setting, and Participants In this cohort study, adults aged 18 years and older admitted to the hospital with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 US states from February 1, 2022, to May 31, 2023. Clinical data during each patient's hospitalization were collected using standardized forms. Data were analyzed from August to October 2023. Exposures RSV, SARS-CoV-2, or influenza infection. Main Outcomes and Measures Using multivariable logistic regression, severity of RSV disease was compared with COVID-19 and influenza severity, by COVID-19 and influenza vaccination status, for a range of clinical outcomes, including the composite of invasive mechanical ventilation (IMV) and in-hospital death. Results Of 7998 adults (median [IQR] age, 67 [54-78] years; 4047 [50.6%] female) included, 484 (6.1%) were hospitalized with RSV, 6422 (80.3%) were hospitalized with COVID-19, and 1092 (13.7%) were hospitalized with influenza. Among patients with RSV, 58 (12.0%) experienced IMV or death, compared with 201 of 1422 unvaccinated patients with COVID-19 (14.1%) and 458 of 5000 vaccinated patients with COVID-19 (9.2%), as well as 72 of 699 unvaccinated patients with influenza (10.3%) and 20 of 393 vaccinated patients with influenza (5.1%). In adjusted analyses, the odds of IMV or in-hospital death were not significantly different among patients hospitalized with RSV and unvaccinated patients hospitalized with COVID-19 (adjusted odds ratio [aOR], 0.82; 95% CI, 0.59-1.13; P = .22) or influenza (aOR, 1.20; 95% CI, 0.82-1.76; P = .35); however, the odds of IMV or death were significantly higher among patients hospitalized with RSV compared with vaccinated patients hospitalized with COVID-19 (aOR, 1.38; 95% CI, 1.02-1.86; P = .03) or influenza disease (aOR, 2.81; 95% CI, 1.62-4.86; P < .001). Conclusions and Relevance Among adults hospitalized in this US cohort during the 16 months before the first RSV vaccine recommendations, RSV disease was less common but similar in severity compared with COVID-19 or influenza disease among unvaccinated patients and more severe than COVID-19 or influenza disease among vaccinated patients for the most serious outcomes of IMV or death.
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Affiliation(s)
- Diya Surie
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katharine A Yuengling
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer DeCuir
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam S Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
- Baylor College of Medicine, Temple, Texas
| | - Shekhar Ghamande
- Baylor Scott & White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
- Baylor College of Medicine, Temple, Texas
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Amanda Martinez
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | | | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harith Ali
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nicholas J Johnson
- Department of Emergency Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
| | | | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Aleda M Leis
- School of Public Health, University of Michigan, Ann Arbor
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland
| | - Catherine L Hough
- Department of Medicine, Oregon Health and Sciences University, Portland
| | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Emily E Bendall
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Nida Qadir
- Department of Medicine, University of California, Los Angeles
| | - Steven Y Chang
- Department of Medicine, University of California, Los Angeles
| | | | - Jennie H Kwon
- Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | | | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Cristie Columbus
- Baylor Scott &White Health, Dallas, Texas
- Texas A&M University College of Medicine, Dallas
| | - Ivana A Vaughn
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan
| | - Mayur Ramesh
- Division of Infectious Diseases, Henry Ford Health, Detroit, Michigan
| | - Jarrod M Mosier
- Department of Emergency Medicine, University of Arizona, Tucson
| | - Basmah Safdar
- Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cassandra A Johnson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cara T Lwin
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nathaniel M Lewis
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sascha Ellington
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith L McMorrow
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
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DeMerle KM, Kennedy JN, Chang CCH, Delucchi K, Huang DT, Kravitz MS, Shapiro NI, Yealy DM, Angus DC, Calfee CS, Seymour CW. Identification of a hyperinflammatory sepsis phenotype using protein biomarker and clinical data in the ProCESS randomized trial. Sci Rep 2024; 14:6234. [PMID: 38485953 PMCID: PMC10940677 DOI: 10.1038/s41598-024-55667-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/26/2024] [Indexed: 03/18/2024] Open
Abstract
Sepsis is a heterogeneous syndrome and phenotypes have been proposed using clinical data. Less is known about the contribution of protein biomarkers to clinical sepsis phenotypes and their importance for treatment effects in randomized trials of resuscitation. The objective is to use both clinical and biomarker data in the Protocol-Based Care for Early Septic Shock (ProCESS) randomized trial to determine sepsis phenotypes and to test for heterogeneity of treatment effect by phenotype comparing usual care to protocolized early, goal-directed therapy(EGDT). In this secondary analysis of a subset of patients with biomarker sampling in the ProCESS trial (n = 543), we identified sepsis phenotypes prior to randomization using latent class analysis of 20 clinical and biomarker variables. Logistic regression was used to test for interaction between phenotype and treatment arm for 60-day inpatient mortality. Among 543 patients with severe sepsis or septic shock in the ProCESS trial, a 2-class model best fit the data (p = 0.01). Phenotype 1 (n = 66, 12%) had increased IL-6, ICAM, and total bilirubin and decreased platelets compared to phenotype 2 (n = 477, 88%, p < 0.01 for all). Phenotype 1 had greater 60-day inpatient mortality compared to Phenotype 2 (41% vs 16%; p < 0.01). Treatment with EGDT was associated with worse 60-day inpatient mortality compared to usual care (58% vs. 23%) in Phenotype 1 only (p-value for interaction = 0.05). The 60-day inpatient mortality was similar comparing EGDT to usual care in Phenotype 2 (16% vs. 17%). We identified 2 sepsis phenotypes using latent class analysis of clinical and protein biomarker data at randomization in the ProCESS trial. Phenotype 1 had increased inflammation, organ dysfunction and worse clinical outcomes compared to phenotype 2. Response to EGDT versus usual care differed by phenotype.
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Affiliation(s)
- Kimberley M DeMerle
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason N Kennedy
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chung-Chou H Chang
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin Delucchi
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - David T Huang
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Multidisciplinary Acute Care Research Organization (MACRO), Pittsburgh, PA, USA
| | - Max S Kravitz
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Donald M Yealy
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Derek C Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carolyn S Calfee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Christopher W Seymour
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Pittsburgh, PA, USA.
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, 3459 Fifth Avenue, NW628, Pittsburgh, PA, 15213, USA.
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Khader A, Zelnick LR, Sathe NA, Kestenbaum BR, Himmelfarb J, Johnson NJ, Shapiro NI, Douglas IS, Hough CL, Bhatraju PK. The Interaction of Acute Kidney Injury with Resuscitation Strategy in Sepsis: A Secondary Analysis of a Multicenter, Phase 3, Randomized Clinical Trial (CLOVERS). Am J Respir Crit Care Med 2023; 208:1335-1338. [PMID: 37870416 PMCID: PMC10765399 DOI: 10.1164/rccm.202308-1448le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/20/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- Ayesha Khader
- Division of Pulmonary, Critical Care and Sleep Medicine
| | - Leila R. Zelnick
- Kidney Research Institute, Division of Nephrology, Department of Medicine
| | - Neha A. Sathe
- Division of Pulmonary, Critical Care and Sleep Medicine
| | | | | | - Nicholas J. Johnson
- Division of Pulmonary, Critical Care and Sleep Medicine
- Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ivor S. Douglas
- Pulmonary Science and Critical Care Medicine, Denver Health Medical Center and University of Colorado, Anschutz Medical Campus, Denver, Colorado; and
| | - Catherine L. Hough
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon
| | - Pavan K. Bhatraju
- Division of Pulmonary, Critical Care and Sleep Medicine
- Kidney Research Institute, Division of Nephrology, Department of Medicine
- Sepsis Center of Research Excellence, and
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Antkowiak PS, Lai SY, Burke RC, Janes M, Zawi T, Shapiro NI, Rosen CL. Characterizing malpractice cases involving emergency department advanced practice providers, physicians in training, and attending physicians. Acad Emerg Med 2023; 30:1237-1245. [PMID: 37682564 DOI: 10.1111/acem.14800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE The objective was to evaluate available characteristics and financial costs of malpractice cases among advanced practice providers (APPs; nurse practitioners [NPs] and physician assistants [PAs]), trainees (medical students, residents, fellows), and attending physicians. METHODS This study was a retrospective analysis of claims occurring in the emergency department (ED) from January 1, 2010, to December 31, 2019, contained in the Candello database. Cases were classified according to the provider type(s) involved: NP, PA, trainee, or cases that did not identify an extender as being substantially involved in the adverse event that resulted in the case ("no extender"). RESULTS There were 5854 cases identified with a total gross indemnity paid of $1,007,879,346. Of these cases, 193 (3.3%) involved an NP, 513 (8.8%) involved a PA, 535 (9.1%) involved a trainee, and 4568 (78.0%) were no extender. Cases where a trainee was involved account for the highest average gross indemnity paid whereas no-extender cases are the lowest. NP and PA cases differed by contributing factors compared to no-extender cases: clinical judgment (NP 89.1% vs. no extender 76.8%, p < 0.0001; PA 84.6% vs. no extender, p < 0.0001), documentation (NP 23.3% vs. no extender 17.8%, p = 0.0489; PA 25.9% vs. no extender, p < 0.0001), and supervision (NP 22.3% vs. no extender 1.8%, p < 0.0001; PA 25.7% vs. no extender p < 0.0001). Cases involving NPs and PAs had a lower percentage of high-severity cases such as loss of limb or death (NP 45.6% vs. no extender 50.2%, p = 0.0004; PA 48.3% vs. no extender, p < 0.0001). CONCLUSIONS APPs and trainees comprise approximately 21% of malpractice cases and 33% of total gross indemnity paid in this large national ED data set. Understanding differences in characteristics of malpractice claims that occur in emergency care settings can be used to help to mitigate provider risk.
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Affiliation(s)
- Peter S Antkowiak
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Shin-Yi Lai
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan C Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret Janes
- CRICO/Risk Management Foundation, Boston, Massachusetts, USA
| | - Tarek Zawi
- CRICO/Risk Management Foundation, Boston, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Carlo L Rosen
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
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Surie D, Yuengling KA, DeCuir J, Zhu Y, Gaglani M, Ginde AA, Talbot HK, Casey JD, Mohr NM, Ghamande S, Gibbs KW, Files DC, Hager DN, Ali H, Prekker ME, Gong MN, Mohamed A, Johnson NJ, Steingrub JS, Peltan ID, Brown SM, Leis AM, Khan A, Hough CL, Bender WS, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Lauring AS, Shapiro NI, Columbus C, Vaughn IA, Ramesh M, Safdar B, Halasa N, Chappell JD, Grijalva CG, Baughman A, Rice TW, Womack KN, Han JH, Swan SA, Mukherjee I, Lewis NM, Ellington S, McMorrow ML, Martin ET, Self WH. Disease Severity of Respiratory Syncytial Virus Compared with COVID-19 and Influenza Among Hospitalized Adults Aged ≥60 Years - IVY Network, 20 U.S. States, February 2022-May 2023. MMWR Morb Mortal Wkly Rep 2023; 72:1083-1088. [PMID: 37796753 PMCID: PMC10564326 DOI: 10.15585/mmwr.mm7240a2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
On June 21, 2023, CDC's Advisory Committee on Immunization Practices recommended respiratory syncytial virus (RSV) vaccination for adults aged ≥60 years, offered to individual adults using shared clinical decision-making. Informed use of these vaccines requires an understanding of RSV disease severity. To characterize RSV-associated severity, 5,784 adults aged ≥60 years hospitalized with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 U.S. states during February 1, 2022-May 31, 2023. Multivariable logistic regression was used to compare RSV disease severity with COVID-19 and influenza severity on the basis of the following outcomes: 1) standard flow (<30 L/minute) oxygen therapy, 2) high-flow nasal cannula (HFNC) or noninvasive ventilation (NIV), 3) intensive care unit (ICU) admission, and 4) invasive mechanical ventilation (IMV) or death. Overall, 304 (5.3%) enrolled adults were hospitalized with RSV, 4,734 (81.8%) with COVID-19 and 746 (12.9%) with influenza. Patients hospitalized with RSV were more likely to receive standard flow oxygen, HFNC or NIV, and ICU admission than were those hospitalized with COVID-19 or influenza. Patients hospitalized with RSV were more likely to receive IMV or die compared with patients hospitalized with influenza (adjusted odds ratio = 2.08; 95% CI = 1.33-3.26). Among hospitalized older adults, RSV was less common, but was associated with more severe disease than COVID-19 or influenza. High disease severity in older adults hospitalized with RSV is important to consider in shared clinical decision-making regarding RSV vaccination.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - IVY Network
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; Vanderbilt University Medical Center, Nashville, Tennessee; Baylor Scott & White Health, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; Baylor, Scott & White Health, Dallas, Texas; University of Colorado School of Medicine, Aurora, Colorado; University of Iowa, Iowa City, Iowa; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; Johns Hopkins Hospital, Baltimore, Maryland; Hennepin County Medical Center, Minneapolis, Minnesota; Montefiore Healthcare Center, Albert Einstein College of Medicine, New York, New York; University of Washington School of Medicine, Seattle, Washington; Baystate Medical Center, Springfield, Massachusetts; Intermountain Medical Center and University of Utah, Salt Lake City, Utah; University of Michigan School of Public Health, Ann Arbor, Michigan; Oregon Health & Science University Hospital, Portland, Oregon; Emory University School of Medicine, Atlanta, Georgia; Cleveland Clinic, Cleveland, Ohio; Stanford University School of Medicine, Stanford, California; Ronald Reagan-UCLA Medical Center, Los Angeles, California; University of Miami, Miami, Florida; Washington University, St. Louis, Missouri; The Ohio State University Wexner Medical Center, Columbus, Ohio; University of Michigan School of Medicine, Ann Arbor, Michigan; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Henry Ford Health, Detroit, Michigan; Yale University School of Medicine, New Haven, Connecticut; Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
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7
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Kojima N, Adams K, Self WH, Gaglani M, McNeal T, Ghamande S, Steingrub JS, Shapiro NI, Duggal A, Busse LW, Prekker ME, Peltan ID, Brown SM, Hager DN, Ali H, Gong MN, Mohamed A, Exline MC, Khan A, Wilson JG, Qadir N, Chang SY, Ginde AA, Withers CA, Mohr NM, Mallow C, Martin ET, Lauring AS, Johnson NJ, Casey JD, Stubblefield WB, Gibbs KW, Kwon JH, Baughman A, Chappell JD, Hart KW, Jones ID, Rhoads JP, Swan SA, Womack KN, Zhu Y, Surie D, McMorrow ML, Patel MM, Tenforde MW. Changing Severity and Epidemiology of Adults Hospitalized With Coronavirus Disease 2019 (COVID-19) in the United States After Introduction of COVID-19 Vaccines, March 2021-August 2022. Clin Infect Dis 2023; 77:547-557. [PMID: 37255285 PMCID: PMC10526883 DOI: 10.1093/cid/ciad276] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies. METHODS Among adults (≥18 years) hospitalized with laboratory-confirmed, acute COVID-19 between 11 March 2021, and 31 August 2022 at 21 hospitals in 18 states, those hospitalized during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron-predominant period (BA.1, BA.2, BA.4/BA.5) were compared to those from earlier Alpha- and Delta-predominant periods. Demographic characteristics, biomarkers within 24 hours of admission, and outcomes, including oxygen support and death, were assessed. RESULTS Among 9825 patients, median (interquartile range [IQR]) age was 60 years (47-72), 47% were women, and 21% non-Hispanic Black. From the Alpha-predominant period (Mar-Jul 2021; N = 1312) to the Omicron BA.4/BA.5 sublineage-predominant period (Jun-Aug 2022; N = 1307): the percentage of patients who had ≥4 categories of underlying medical conditions increased from 11% to 21%; those vaccinated with at least a primary COVID-19 vaccine series increased from 7% to 67%; those ≥75 years old increased from 11% to 33%; those who did not receive any supplemental oxygen increased from 18% to 42%. Median (IQR) highest C-reactive protein and D-dimer concentration decreased from 42.0 mg/L (9.9-122.0) to 11.5 mg/L (2.7-42.8) and 3.1 mcg/mL (0.8-640.0) to 1.0 mcg/mL (0.5-2.2), respectively. In-hospital death peaked at 12% in the Delta-predominant period and declined to 4% during the BA.4/BA.5-predominant period. CONCLUSIONS Compared to adults hospitalized during early COVID-19 variant periods, those hospitalized during Omicron-variant COVID-19 were older, had multiple co-morbidities, were more likely to be vaccinated, and less likely to experience severe respiratory disease, systemic inflammation, coagulopathy, and death.
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Affiliation(s)
- Noah Kojima
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Adams
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wesley H Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manjusha Gaglani
- Department of Pediatrics, Baylor Scott & White Health and Texas A&M University College of Medicine, Temple and Dallas, Texas, USA
| | - Tresa McNeal
- Department of Medical Education, Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Department of Medical Education, Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Matthew E Prekker
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harith Ali
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cori A Withers
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam S Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ian D Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jillian P Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diya Surie
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith L McMorrow
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish M Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Dimcheff DE, Blair CN, Zhu Y, Chappell JD, Gaglani M, McNeal T, Ghamande S, Steingrub JS, Shapiro NI, Duggal A, Busse LW, Frosch AEP, Peltan ID, Hager DN, Gong MN, Exline MC, Khan A, Wilson JG, Qadir N, Ginde AA, Douin DJ, Mohr NM, Mallow C, Martin ET, Johnson NJ, Casey JD, Stubblefield WB, Gibbs KW, Kwon JH, Talbot HK, Halasa N, Grijalva CG, Baughman A, Womack KN, Hart KW, Swan SA, Surie D, Thornburg NJ, McMorrow ML, Self WH, Lauring AS. Total and Subgenomic RNA Viral Load in Patients Infected With SARS-CoV-2 Alpha, Delta, and Omicron Variants. J Infect Dis 2023; 228:235-244. [PMID: 36883903 PMCID: PMC10420395 DOI: 10.1093/infdis/jiad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomic and subgenomic RNA levels are frequently used as a correlate of infectiousness. The impact of host factors and SARS-CoV-2 lineage on RNA viral load is unclear. METHODS Total nucleocapsid (N) and subgenomic N (sgN) RNA levels were measured by quantitative reverse transcription polymerase chain reaction (RT-qPCR) in specimens from 3204 individuals hospitalized with coronavirus disease 2019 (COVID-19) at 21 hospitals. RT-qPCR cycle threshold (Ct) values were used to estimate RNA viral load. The impact of time of sampling, SARS-CoV-2 variant, age, comorbidities, vaccination, and immune status on N and sgN Ct values were evaluated using multiple linear regression. RESULTS Mean Ct values at presentation for N were 24.14 (SD 4.53) for non-variants of concern, 25.15 (SD 4.33) for Alpha, 25.31 (SD 4.50) for Delta, and 26.26 (SD 4.42) for Omicron. N and sgN RNA levels varied with time since symptom onset and infecting variant but not with age, comorbidity, immune status, or vaccination. When normalized to total N RNA, sgN levels were similar across all variants. CONCLUSIONS RNA viral loads were similar among hospitalized adults, irrespective of infecting variant and known risk factors for severe COVID-19. Total N and subgenomic RNA N viral loads were highly correlated, suggesting that subgenomic RNA measurements add little information for the purposes of estimating infectivity.
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Affiliation(s)
- Derek E Dimcheff
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher N Blair
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Anne E P Frosch
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah, USA
- Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nida Qadir
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St Louis, Missouri, USA
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diya Surie
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Natalie J Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Meredith L McMorrow
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam S Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
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9
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Prekker ME, Driver BE, Trent SA, Resnick-Ault D, Seitz KP, Russell DW, Gaillard JP, Latimer AJ, Ghamande SA, Gibbs KW, Vonderhaar DJ, Whitson MR, Barnes CR, Walco JP, Douglas IS, Krishnamoorthy V, Dagan A, Bastman JJ, Lloyd BD, Gandotra S, Goranson JK, Mitchell SH, White HD, Palakshappa JA, Espinera A, Page DB, Joffe A, Hansen SJ, Hughes CG, George T, Herbert JT, Shapiro NI, Schauer SG, Long BJ, Imhoff B, Wang L, Rhoads JP, Womack KN, Janz DR, Self WH, Rice TW, Ginde AA, Casey JD, Semler MW. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N Engl J Med 2023; 389:418-429. [PMID: 37326325 PMCID: PMC11075576 DOI: 10.1056/nejmoa2301601] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Whether video laryngoscopy as compared with direct laryngoscopy increases the likelihood of successful tracheal intubation on the first attempt among critically ill adults is uncertain. METHODS In a multicenter, randomized trial conducted at 17 emergency departments and intensive care units (ICUs), we randomly assigned critically ill adults undergoing tracheal intubation to the video-laryngoscope group or the direct-laryngoscope group. The primary outcome was successful intubation on the first attempt. The secondary outcome was the occurrence of severe complications during intubation; severe complications were defined as severe hypoxemia, severe hypotension, new or increased vasopressor use, cardiac arrest, or death. RESULTS The trial was stopped for efficacy at the time of the single preplanned interim analysis. Among 1417 patients who were included in the final analysis (91.5% of whom underwent intubation that was performed by an emergency medicine resident or a critical care fellow), successful intubation on the first attempt occurred in 600 of the 705 patients (85.1%) in the video-laryngoscope group and in 504 of the 712 patients (70.8%) in the direct-laryngoscope group (absolute risk difference, 14.3 percentage points; 95% confidence interval [CI], 9.9 to 18.7; P<0.001). A total of 151 patients (21.4%) in the video-laryngoscope group and 149 patients (20.9%) in the direct-laryngoscope group had a severe complication during intubation (absolute risk difference, 0.5 percentage points; 95% CI, -3.9 to 4.9). Safety outcomes, including esophageal intubation, injury to the teeth, and aspiration, were similar in the two groups. CONCLUSIONS Among critically ill adults undergoing tracheal intubation in an emergency department or ICU, the use of a video laryngoscope resulted in a higher incidence of successful intubation on the first attempt than the use of a direct laryngoscope. (Funded by the U.S. Department of Defense; DEVICE ClinicalTrials.gov number, NCT05239195.).
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Affiliation(s)
- Matthew E Prekker
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Brian E Driver
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Stacy A Trent
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Daniel Resnick-Ault
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Kevin P Seitz
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Derek W Russell
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - John P Gaillard
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Andrew J Latimer
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Shekhar A Ghamande
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Kevin W Gibbs
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Derek J Vonderhaar
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Micah R Whitson
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Christopher R Barnes
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jeremy P Walco
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Ivor S Douglas
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Vijay Krishnamoorthy
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Alon Dagan
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jill J Bastman
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Bradley D Lloyd
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Sheetal Gandotra
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jordan K Goranson
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Steven H Mitchell
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Heath D White
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jessica A Palakshappa
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Alyssa Espinera
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - David B Page
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Aaron Joffe
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Sydney J Hansen
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Christopher G Hughes
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Tobias George
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - J Taylor Herbert
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Nathan I Shapiro
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Steven G Schauer
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Brit J Long
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Brant Imhoff
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Li Wang
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jillian P Rhoads
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Kelsey N Womack
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - David R Janz
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Wesley H Self
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Todd W Rice
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Adit A Ginde
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Jonathan D Casey
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
| | - Matthew W Semler
- From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.)
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10
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Duranteau J, De Backer D, Donadello K, Shapiro NI, Hutchings SD, Rovas A, Legrand M, Harrois A, Ince C. The future of intensive care: the study of the microcirculation will help to guide our therapies. Crit Care 2023; 27:190. [PMID: 37193993 PMCID: PMC10186296 DOI: 10.1186/s13054-023-04474-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023] Open
Abstract
The goal of hemodynamic resuscitation is to optimize the microcirculation of organs to meet their oxygen and metabolic needs. Clinicians are currently blind to what is happening in the microcirculation of organs, which prevents them from achieving an additional degree of individualization of the hemodynamic resuscitation at tissue level. Indeed, clinicians never know whether optimization of the microcirculation and tissue oxygenation is actually achieved after macrovascular hemodynamic optimization. The challenge for the future is to have noninvasive, easy-to-use equipment that allows reliable assessment and immediate quantitative analysis of the microcirculation at the bedside. There are different methods for assessing the microcirculation at the bedside; all have strengths and challenges. The use of automated analysis and the future possibility of introducing artificial intelligence into analysis software could eliminate observer bias and provide guidance on microvascular-targeted treatment options. In addition, to gain caregiver confidence and support for the need to monitor the microcirculation, it is necessary to demonstrate that incorporating microcirculation analysis into the reasoning guiding hemodynamic resuscitation prevents organ dysfunction and improves the outcome of critically ill patients.
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Affiliation(s)
- J Duranteau
- Department of Anesthesiology and Intensive Care, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), INSERM UMR-S 999, Paris-Saclay University, Le Kremlin-Bicêtre, France.
| | - D De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Boulevard du Triomphe 201, 1160, Brussels, Belgium
| | - K Donadello
- Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
| | - N I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School, Boston, MA, USA
| | - S D Hutchings
- King's College Hospital NHS Foundation Trust, London, UK
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | - A Rovas
- Division of General Internal and Emergency Medicine, Nephrology, and Rheumatology, Department of Medicine D, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - M Legrand
- Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care, UCSF, San Francisco, USA
| | - A Harrois
- Department of Anesthesiology and Intensive Care, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), INSERM UMR-S 999, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - C Ince
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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11
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Surie D, Bonnell LN, DeCuir J, Gaglani M, McNeal T, Ghamande S, Steingrub JS, Shapiro NI, Busse LW, Prekker ME, Peltan ID, Brown SM, Hager DN, Ali H, Gong MN, Mohamed A, Khan A, Wilson JG, Qadir N, Chang SY, Ginde AA, Huynh D, Mohr NM, Mallow C, Martin ET, Lauring AS, Johnson NJ, Casey JD, Gibbs KW, Kwon JH, Baughman A, Chappell JD, Hart KW, Grijalva CG, Rhoads JP, Swan SA, Keipp Talbot H, Womack KN, Zhu Y, Tenforde MW, Adams K, Self WH, McMorrow ML. Comparison of mRNA vaccine effectiveness against COVID-19-associated hospitalization by vaccination source: Immunization information systems, electronic medical records, and self-report-IVY Network, February 1-August 31, 2022. Vaccine 2023:S0264-410X(23)00567-4. [PMID: 37301704 DOI: 10.1016/j.vaccine.2023.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Accurate determination of COVID-19 vaccination status is necessary to produce reliable COVID-19 vaccine effectiveness (VE) estimates. Data comparing differences in COVID-19 VE by vaccination sources (i.e., immunization information systems [IIS], electronic medical records [EMR], and self-report) are limited. We compared the number of mRNA COVID-19 vaccine doses identified by each of these sources to assess agreement as well as differences in VE estimates using vaccination data from each individual source and vaccination data adjudicated from all sources combined. METHODS Adults aged ≥18 years who were hospitalized with COVID-like illness at 21 hospitals in 18 U.S. states participating in the IVY Network during February 1-August 31, 2022, were enrolled. Numbers of COVID-19 vaccine doses identified by IIS, EMR, and self-report were compared in kappa agreement analyses. Effectiveness of mRNA COVID-19 vaccines against COVID-19-associated hospitalization was estimated using multivariable logistic regression models to compare the odds of COVID-19 vaccination between SARS-CoV-2-positive case-patients and SARS-CoV-2-negative control-patients. VE was estimated using each source of vaccination data separately and all sources combined. RESULTS A total of 4499 patients were included. Patients with ≥1 mRNA COVID-19 vaccine dose were identified most frequently by self-report (n = 3570, 79 %), followed by IIS (n = 3272, 73 %) and EMR (n = 3057, 68 %). Agreement was highest between IIS and self-report for 4 doses with a kappa of 0.77 (95 % CI = 0.73-0.81). VE point estimates of 3 doses against COVID-19 hospitalization were substantially lower when using vaccination data from EMR only (VE = 31 %, 95 % CI = 16 %-43 %) than when using all sources combined (VE = 53 %, 95 % CI = 41 %-62%). CONCLUSION Vaccination data from EMR only may substantially underestimate COVID-19 VE.
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Affiliation(s)
- Diya Surie
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Levi N Bonnell
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States; General Dynamics Information Technology, Falls Church, VA, United States
| | - Jennifer DeCuir
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Manjusha Gaglani
- Baylor Scott & White Health and Texas A&M University College of Medicine, Temple, TX, United States
| | - Tresa McNeal
- Baylor Scott & White Health and Texas A&M University College of Medicine, Temple, TX, United States
| | - Shekhar Ghamande
- Baylor Scott & White Health and Texas A&M University College of Medicine, Temple, TX, United States
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, MA, United States
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Laurence W Busse
- Department of Medicine, Emory University, Atlanta, GA, United States
| | - Matthew E Prekker
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, MN, United States
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, UT and University of Utah, Salt Lake City, UT, United States
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, UT and University of Utah, Salt Lake City, UT, United States
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Harith Ali
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Amira Mohamed
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, United States
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, CA, United States
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, CA, United States
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - David Huynh
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, United States
| | | | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, United States
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, MO, United States
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jillian P Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Meredith L McMorrow
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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12
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DeCuir J, Surie D, Zhu Y, Gaglani M, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Phan M, Prekker ME, Gong MN, Mohamed A, Johnson NJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Bender WS, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Lauring AS, Shapiro NI, Columbus C, Gottlieb R, Vaughn IA, Ramesh M, Lamerato LE, Safdar B, Halasa N, Chappell JD, Grijalva CG, Baughman A, Womack KN, Rhoads JP, Hart KW, Swan SA, Lewis N, McMorrow ML, Self WH. Effectiveness of Monovalent mRNA COVID-19 Vaccination in Preventing COVID-19-Associated Invasive Mechanical Ventilation and Death Among Immunocompetent Adults During the Omicron Variant Period - IVY Network, 19 U.S. States, February 1, 2022-January 31, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:463-468. [PMID: 37104244 DOI: 10.15585/mmwr.mm7217a3] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
As of April 2023, the COVID-19 pandemic has resulted in 1.1 million deaths in the United States, with approximately 75% of deaths occurring among adults aged ≥65 years (1). Data on the durability of protection provided by monovalent mRNA COVID-19 vaccination against critical outcomes of COVID-19 are limited beyond the Omicron BA.1 lineage period (December 26, 2021-March 26, 2022). In this case-control analysis, the effectiveness of 2-4 monovalent mRNA COVID-19 vaccine doses was evaluated against COVID-19-associated invasive mechanical ventilation (IMV) and in-hospital death among immunocompetent adults aged ≥18 years during February 1, 2022-January 31, 2023. Vaccine effectiveness (VE) against IMV and in-hospital death was 62% among adults aged ≥18 years and 69% among those aged ≥65 years. When stratified by time since last dose, VE was 76% at 7-179 days, 54% at 180-364 days, and 56% at ≥365 days. Monovalent mRNA COVID-19 vaccination provided substantial, durable protection against IMV and in-hospital death among adults during the Omicron variant period. All adults should remain up to date with recommended COVID-19 vaccination to prevent critical COVID-19-associated outcomes.
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13
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Macdonald S, Bosio E, Keijzers G, Burrows S, Hibbs M, O'Donoghue H, Taylor D, Mukherjee A, Kinnear F, Smart L, Ascencio-Lane JC, Litton E, Fraser J, Shapiro NI, Arendts G, Fatovich D. Effect of intravenous fluid volume on biomarkers of endothelial glycocalyx shedding and inflammation during initial resuscitation of sepsis. Intensive Care Med Exp 2023; 11:21. [PMID: 37062769 PMCID: PMC10106534 DOI: 10.1186/s40635-023-00508-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/10/2023] [Indexed: 04/18/2023] Open
Abstract
PURPOSE To investigate the effect of IV fluid resuscitation on endothelial glycocalyx (EG) shedding and activation of the vascular endothelium and inflammation. MATERIALS AND METHODS A planned biomarker sub-study of the REFRESH trial in which emergency department (ED) patients) with suspected sepsis and hypotension were randomised to a restricted fluid/early vasopressor regimen or IV fluid resuscitation with later vasopressors if required (usual care). Blood samples were collected at randomisation (T0) and at 3 h (T3), 6 h (T6)- and 24 h (T24) for measurement of a range of biomarkers if EG shedding, endothelial cell activation and inflammation. RESULTS Blood samples were obtained in 95 of 99 enrolled patients (46 usual care, 49 restricted fluid). Differences in the change in biomarker over time between the groups were observed for Hyaluronan (2.2-fold from T3 to T24, p = 0.03), SYN-4 (1.5-fold from T3 to T24, P = 0.01) and IL-6 (2.5-fold from T0 to T3, p = 0.03). No difference over time was observed between groups for the other biomarkers. CONCLUSIONS A consistent signal across a range of biomarkers of EG shedding or of endothelial activation or inflammation was not demonstrated. This could be explained by pre-existing EG shedding or overlap between the fluid volumes administered in the two groups in this clinical trial. Trial registration Australia New Zealand Clinical Trials Registry ACTRN126160000006448 Registered 12 January 2016.
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Affiliation(s)
- Stephen Macdonald
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, WA, Australia.
- Medical School, University of Western Australia, Perth, WA, Australia.
- Emergency Department, Royal Perth Hospital, Perth, WA, Australia.
| | - Erika Bosio
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Gerben Keijzers
- Emergency Department, Gold Coast University Hospital, Gold Coast, QLD, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Sally Burrows
- Medical School, University of Western Australia, Perth, WA, Australia
- Research Foundation, Royal Perth Hospital, Perth, WA, Australia
| | - Moira Hibbs
- Research Centre, Royal Perth Hospital, Perth, WA, Australia
| | | | - David Taylor
- Emergency Department, Austin Health, Melbourne, Australia
| | - Ashes Mukherjee
- Emergency Department, Armadale Health Service, Perth, WA, Australia
| | - Frances Kinnear
- Department of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Lisa Smart
- School of Science, Health Engineering and Education, Murdoch University, Perth, WA, Australia
| | | | - Edward Litton
- Intensive Care, Fiona Stanley Hospital, Perth, WA, Australia
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Glenn Arendts
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- Emergency Department, Fiona Stanley Hospital, Perth, WA, Australia
| | - Daniel Fatovich
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- Emergency Department, Royal Perth Hospital, Perth, WA, Australia
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14
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Tenforde MW, Patel MM, Lewis NM, Adams K, Gaglani M, Steingrub JS, Shapiro NI, Duggal A, Prekker ME, Peltan ID, Hager DN, Gong MN, Exline MC, Ginde AA, Mohr NM, Mallow C, Martin ET, Talbot HK, Gibbs KW, Kwon JH, Chappell JD, Halasa N, Lauring AS, Lindsell CJ, Swan SA, Hart KW, Womack KN, Baughman A, Grijalva CG, Self WH. Vaccine Effectiveness Against Influenza A(H3N2)-Associated Hospitalized Illness: United States, 2022. Clin Infect Dis 2023; 76:1030-1037. [PMID: 36327388 PMCID: PMC10226741 DOI: 10.1093/cid/ciac869] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic was associated with historically low influenza circulation during the 2020-2021 season, followed by an increase in influenza circulation during the 2021-2022 US season. The 2a.2 subgroup of the influenza A(H3N2) 3C.2a1b subclade that predominated was antigenically different from the vaccine strain. METHODS To understand the effectiveness of the 2021-2022 vaccine against hospitalized influenza illness, a multistate sentinel surveillance network enrolled adults aged ≥18 years hospitalized with acute respiratory illness and tested for influenza by a molecular assay. Using the test-negative design, vaccine effectiveness (VE) was measured by comparing the odds of current-season influenza vaccination in influenza-positive case-patients and influenza-negative, SARS-CoV-2-negative controls, adjusting for confounders. A separate analysis was performed to illustrate bias introduced by including SARS-CoV-2-positive controls. RESULTS A total of 2334 patients, including 295 influenza cases (47% vaccinated), 1175 influenza- and SARS-CoV-2-negative controls (53% vaccinated), and 864 influenza-negative and SARS-CoV-2-positive controls (49% vaccinated), were analyzed. Influenza VE was 26% (95% CI: -14% to 52%) among adults aged 18-64 years, -3% (-54% to 31%) among adults aged ≥65 years, and 50% (15-71%) among adults aged 18-64 years without immunocompromising conditions. Estimated VE decreased with inclusion of SARS-CoV-2-positive controls. CONCLUSIONS During a season where influenza A(H3N2) was antigenically different from the vaccine virus, vaccination was associated with a reduced risk of influenza hospitalization in younger immunocompetent adults. However, vaccination did not provide protection in adults ≥65 years of age. Improvements in vaccines, antivirals, and prevention strategies are warranted.
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Affiliation(s)
- Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish M Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nathaniel M Lewis
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Adams
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew E Prekker
- Departments of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - H Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St Louis, Missouri, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sydney A Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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15
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Kaizer AM, Shapiro NI, Wild J, Brown SM, Cwik BJ, Hart KW, Jones AE, Pulia MS, Self WH, Smith C, Smith SA, Ng PC, Thompson BT, Rice TW, Lindsell CJ, Ginde AA. Lopinavir/ritonavir for treatment of non-hospitalized patients with COVID-19: a randomized clinical trial. Int J Infect Dis 2023; 128:223-229. [PMID: 36581186 PMCID: PMC9792182 DOI: 10.1016/j.ijid.2022.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Effective and widely available therapies are still needed for outpatients with COVID-19. We aimed to evaluate the efficacy and safety of lopinavir/ritonavir (LPV/r) for early treatment of non-hospitalized individuals diagnosed with COVID-19. METHODS This randomized, placebo (Plb)-controlled, double-blind, multi-site decentralized clinical trial enrolled non-hospitalized adults with confirmed SARS-CoV-2 infection and six or fewer days of acute respiratory infection symptoms who were randomized to either twice-daily oral LPV/r (400 mg/100 mg) or Plb for 14 days. Daily surveys on study days 1 through 16 and again on study day 28 evaluated symptoms, daily activities, and hospitalization status. The primary outcome was longitudinal change in an ordinal scale based on a combination of symptoms, activity, and hospitalization status through day 15 and was analyzed by use of a Bayesian longitudinal proportional odds logistic regression model for estimating the probability of a superior recovery for LPV/r over Plb (odds ratio >1). RESULTS Between June 2020 and December 2021, 448 participants were randomized to receive either LPV/r (n = 216) or Plb (n = 221). The mean symptom duration before randomization was 4.3 days (SD 1.3). There were no differences between treatment groups through the first 15 days for the ordinal primary outcome (odds ratio 0.96; 95% credible interval: 0.66 to 1.41). There were 3.2% (n = 7) of LPV/r and 2.7% (n = 6) of Plb participants hospitalized by day 28. Serious adverse events did not differ between groups. CONCLUSION LPV/r did not significantly improve symptom resolution or reduce hospitalization in non-hospitalized participants with COVID-19. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04372628.
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Affiliation(s)
- Alexander M Kaizer
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jessica Wild
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samuel M Brown
- Department of Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, Utah, USA
| | - B Jessica Cwik
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alan E Jones
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Missouri, USA
| | - Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Clay Smith
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephanie A Smith
- Vanderbilt Coordinating Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patrick C Ng
- San Antonio Military Medical Center, En route Care Research Center, 59th Medical Wing/Office of Science and Technology, US Air Force 59th Medical Wing, Joint Base San Antonio-Lackland, Texas, USA
| | - B Taylor Thompson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
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16
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Shapiro NI, Douglas IS, Brower RG, Brown SM, Exline MC, Ginde AA, Gong MN, Grissom CK, Hayden D, Hough CL, Huang W, Iwashyna TJ, Jones AE, Khan A, Lai P, Liu KD, Miller CD, Oldmixon K, Park PK, Rice TW, Ringwood N, Semler MW, Steingrub JS, Talmor D, Thompson BT, Yealy DM, Self WH. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med 2023; 388:499-510. [PMID: 36688507 PMCID: PMC10685906 DOI: 10.1056/nejmoa2212663] [Citation(s) in RCA: 86] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Intravenous fluids and vasopressor agents are commonly used in early resuscitation of patients with sepsis, but comparative data for prioritizing their delivery are limited. METHODS In an unblinded superiority trial conducted at 60 U.S. centers, we randomly assigned patients to either a restrictive fluid strategy (prioritizing vasopressors and lower intravenous fluid volumes) or a liberal fluid strategy (prioritizing higher volumes of intravenous fluids before vasopressor use) for a 24-hour period. Randomization occurred within 4 hours after a patient met the criteria for sepsis-induced hypotension refractory to initial treatment with 1 to 3 liters of intravenous fluid. We hypothesized that all-cause mortality before discharge home by day 90 (primary outcome) would be lower with a restrictive fluid strategy than with a liberal fluid strategy. Safety was also assessed. RESULTS A total of 1563 patients were enrolled, with 782 assigned to the restrictive fluid group and 781 to the liberal fluid group. Resuscitation therapies that were administered during the 24-hour protocol period differed between the two groups; less intravenous fluid was administered in the restrictive fluid group than in the liberal fluid group (difference of medians, -2134 ml; 95% confidence interval [CI], -2318 to -1949), whereas the restrictive fluid group had earlier, more prevalent, and longer duration of vasopressor use. Death from any cause before discharge home by day 90 occurred in 109 patients (14.0%) in the restrictive fluid group and in 116 patients (14.9%) in the liberal fluid group (estimated difference, -0.9 percentage points; 95% CI, -4.4 to 2.6; P = 0.61); 5 patients in the restrictive fluid group and 4 patients in the liberal fluid group had their data censored (lost to follow-up). The number of reported serious adverse events was similar in the two groups. CONCLUSIONS Among patients with sepsis-induced hypotension, the restrictive fluid strategy that was used in this trial did not result in significantly lower (or higher) mortality before discharge home by day 90 than the liberal fluid strategy. (Funded by the National Heart, Lung, and Blood Institute; CLOVERS ClinicalTrials.gov number, NCT03434028.).
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Affiliation(s)
- Nathan I Shapiro
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Ivor S Douglas
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Roy G Brower
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Samuel M Brown
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Matthew C Exline
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Adit A Ginde
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Michelle N Gong
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Colin K Grissom
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Douglas Hayden
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Catherine L Hough
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Weixing Huang
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Theodore J Iwashyna
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Alan E Jones
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Akram Khan
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Poying Lai
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Kathleen D Liu
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Chadwick D Miller
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Katherine Oldmixon
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Pauline K Park
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Todd W Rice
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Nancy Ringwood
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Matthew W Semler
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Jay S Steingrub
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Daniel Talmor
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - B Taylor Thompson
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Donald M Yealy
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
| | - Wesley H Self
- From the Department of Emergency Medicine, Beth Israel Deaconess Medical Center-Harvard Medical School (N.I.S.), the Biostatistics Center (D.H., W.H., P.L.) and the Department of Medicine (K.O., N.R., B.T.T.), Massachusetts General Hospital, and the Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center (D.T.), Boston, and the Department of Medicine, Baystate Medical Center, Springfield (J.S.S.) - all in Massachusetts; the Department of Medicine, Denver Health Medical Center, Denver (I.S.D.), and the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (A.A.G.) - both in Colorado; the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (R.G.B., T.J.I.); the Department of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, and the Department of Medicine, University of Utah, Salt Lake City - both in Utah (S.M.B., C.K.G.); the Ohio State University Wexner Medical Center, Columbus (M.C.E.); the Department of Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); the Department of Medicine, Oregon Health and Science University, Portland (C.L.H., A.K.); the Department of Emergency Medicine, University of Mississippi Medical Center, Jackson (A.E.J.); the Department of Medicine, University of California, San Francisco, Medical Center, San Francisco (K.D.L.); the Department of Emergency Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.M.); the Department of Surgery, University of Michigan Medical School, Ann Arbor (P.K.P.); the Departments of Medicine (T.W.R., M.W.S.) and Emergency Medicine (W.H.S.), Vanderbilt University Medical Center, Nashville; and the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh (D.M.Y.)
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17
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Tenforde MW, Self WH, Zhu Y, Naioti EA, Gaglani M, Ginde AA, Jensen K, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, Lohuis CT, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Botros MM, Lauring AS, Shapiro NI, Halasa N, Chappell JD, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Lindsell CJ, Hart KW, Turbyfill C, Olson S, Murray N, Adams K, Patel MM. Protection of Messenger RNA Vaccines Against Hospitalized Coronavirus Disease 2019 in Adults Over the First Year Following Authorization in the United States. Clin Infect Dis 2023; 76:e460-e468. [PMID: 35580849 PMCID: PMC9129194 DOI: 10.1093/cid/ciac381] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/29/2022] [Accepted: 05/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines were authorized in the United States in December 2020. Although vaccine effectiveness (VE) against mild infection declines markedly after several months, limited understanding exists on the long-term durability of protection against COVID-19-associated hospitalization. METHODS Case-control analysis of adults (≥18 years) hospitalized at 21 hospitals in 18 states 11 March-15 December 2021, including COVID-19 case patients and reverse transcriptase-polymerase chain reaction-negative controls. We included adults who were unvaccinated or vaccinated with 2 doses of a mRNA vaccine before the date of illness onset. VE over time was assessed using logistic regression comparing odds of vaccination in cases versus controls, adjusting for confounders. Models included dichotomous time (<180 vs ≥180 days since dose 2) and continuous time modeled using restricted cubic splines. RESULTS A total of 10 078 patients were included, 4906 cases (23% vaccinated) and 5172 controls (62% vaccinated). Median age was 60 years (interquartile range, 46-70), 56% were non-Hispanic White, and 81% had ≥1 medical condition. Among immunocompetent adults, VE <180 days was 90% (95% confidence interval [CI], 88-91) versus 82% (95% CI, 79-85) at ≥180 days (P < .001). VE declined for Pfizer-BioNTech (88% to 79%, P < .001) and Moderna (93% to 87%, P < .001) products, for younger adults (18-64 years) (91% to 87%, P = .005), and for adults ≥65 years of age (87% to 78%, P < .001). In models using restricted cubic splines, similar changes were observed. CONCLUSIONS In a period largely predating Omicron variant circulation, effectiveness of 2 mRNA doses against COVID-19-associated hospitalization was largely sustained through 9 months.
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Affiliation(s)
| | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuwei Zhu
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas, USA.,Texas A&M University College of Medicine, Temple, Texas, USA
| | - Adit A Ginde
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kelly Jensen
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | - Tresa McNeal
- Baylor Scott & White Health, Temple, Texas, USA.,Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott & White Health, Temple, Texas, USA.,Texas A&M University College of Medicine, Temple, Texas, USA
| | - Kevin W Gibbs
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - D Clark Files
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | | | - Arber Shehu
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | - Michelle N Gong
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | - Ithan D Peltan
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M Brown
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Akram Khan
- Oregon Health & Science University Hospital, Portland, Oregon, USA
| | | | | | | | | | | | - Nida Qadir
- Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | - Steven Y Chang
- Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | | | | | | | | | - Matthew C Exline
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mena M Botros
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Adam S Lauring
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Nathan I Shapiro
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Todd W Rice
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ian D Jones
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Kelsey N Womack
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Kimberly W Hart
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Nancy Murray
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
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18
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Eshel R, Bellolio F, Boggust A, Shapiro NI, Mullan AF, Heaton HA, Madsen BE, Homme JL, Iliff BW, Sunga KL, Wangsgard CR, Vanmeter D, Cabrera D. Comparison of clinical note quality between an automated digital intake tool and the standard note in the emergency department. Am J Emerg Med 2023; 63:79-85. [PMID: 36327754 DOI: 10.1016/j.ajem.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/05/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Medical encounters require an efficient and focused history of present illness (HPI) to create differential diagnoses and guide diagnostic testing and treatment. Our aim was to compare the HPI of notes created by an automated digital intake tool versus standard medical notes created by clinicians. METHODS Prospective trial in a quaternary academic Emergency Department (ED). Notes were compared using the 5-point Physician Documentation Quality Instrument (PDQI-9) scale and the Centers for Medicare & Medicaid Services (CMS) level of complexity index. Reviewers were board certified emergency medicine physicians blinded to note origin. Reviewers received training and calibration prior to note assessments. A difference of 1 point was considered clinically significant. Analysis included McNemar's (binary), Wilcoxon-rank (Likert), and agreement with Cohen's Kappa. RESULTS A total of 148 ED medical encounters were charted by both digital note and standard clinical note. The ability to capture patient information was assessed through comparison of note content across paired charts (digital-standard note on the same patient), as well as scores given by the reviewers. Reviewer agreement was kappa 0.56 (CI 0.49-0.64), indicating moderate level of agreement between reviewers scoring the same patient chart. Considering all 18 questions across PDQI-9 and CMS scales, the average agreement between standard clinical note and digital note was 54.3% (IQR 44.4-66.7%). There was a moderate level of agreement between content of standard and digital notes (kappa 0.54, 95%CI 0.49-0.60). The quality of the digital note was within the 1 point clinically significant difference for all of the attributes, except for conciseness. Digital notes had a higher frequency of CMS severity elements identified. CONCLUSION Digitally generated clinical notes had moderate agreement compared to standard clinical notes and within the one point clinically significant difference except for the conciseness attribute. Digital notes more reliably documented billing components of severity. The use of automated notes should be further explored to evaluate its utility in facilitating documentation of patient encounters.
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Affiliation(s)
- Ron Eshel
- Department of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Andy Boggust
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States; Diagnostics Robotics. Tel Aviv, Israel
| | - Aidan F Mullan
- Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States
| | - Heather A Heaton
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Bo E Madsen
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - James L Homme
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Benjamin W Iliff
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kharmene L Sunga
- Department of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Derek Vanmeter
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Daniel Cabrera
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States.
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19
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Lewis NM, Murray N, Adams K, Surie D, Gaglani M, Ginde AA, McNeal T, Ghamande S, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, Shapiro NI, Gibbs KW, Files DC, Hager DN, Ali H, Prekker ME, Frosch AE, Exline MC, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Lauring AS, Khan A, Hough CL, Busse LW, Bender W, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Chappell JD, Halasa N, Grijalva CG, Rice TW, Stubblefield WB, Baughman A, Lindsell CJ, Hart KW, Rhoads JP, McMorrow ML, Tenforde MW, Self WH, Patel MM. Absolute and Relative Vaccine Effectiveness of Primary and Booster Series of COVID-19 Vaccines (mRNA and Adenovirus Vector) Against COVID-19 Hospitalizations in the United States, December 2021-April 2022. Open Forum Infect Dis 2023; 10:ofac698. [PMID: 36695662 PMCID: PMC9868348 DOI: 10.1093/ofid/ofac698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) vaccine effectiveness (VE) studies are increasingly reporting relative VE (rVE) comparing a primary series plus booster doses with a primary series only. Interpretation of rVE differs from traditional studies measuring absolute VE (aVE) of a vaccine regimen against an unvaccinated referent group. We estimated aVE and rVE against COVID-19 hospitalization in primary-series plus first-booster recipients of COVID-19 vaccines. Methods Booster-eligible immunocompetent adults hospitalized at 21 medical centers in the United States during December 25, 2021-April 4, 2022 were included. In a test-negative design, logistic regression with case status as the outcome and completion of primary vaccine series or primary series plus 1 booster dose as the predictors, adjusted for potential confounders, were used to estimate aVE and rVE. Results A total of 2060 patients were analyzed, including 1104 COVID-19 cases and 956 controls. Relative VE against COVID-19 hospitalization in boosted mRNA vaccine recipients versus primary series only was 66% (95% confidence interval [CI], 55%-74%); aVE was 81% (95% CI, 75%-86%) for boosted versus 46% (95% CI, 30%-58%) for primary. For boosted Janssen vaccine recipients versus primary series, rVE was 49% (95% CI, -9% to 76%); aVE was 62% (95% CI, 33%-79%) for boosted versus 36% (95% CI, -4% to 60%) for primary. Conclusions Vaccine booster doses increased protection against COVID-19 hospitalization compared with a primary series. Comparing rVE measures across studies can lead to flawed interpretations of the added value of a new vaccination regimen, whereas difference in aVE, when available, may be a more useful metric.
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Affiliation(s)
| | - Nancy Murray
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
| | | | - Diya Surie
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - H Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - D Clark Files
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harith Ali
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew E Prekker
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Anne E Frosch
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Vasisht Srinivasan
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Arnold S Monto
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Catherine L Hough
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | | | - William Bender
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alexandra June Gordon
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | | | - Carolina Rivas
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Hilary M Babcock
- Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jillian P Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Wesley H Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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20
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Surie D, DeCuir J, Zhu Y, Gaglani M, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Ali H, Taghizadeh L, Gong MN, Mohamed A, Johnson NJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Khan A, Bender WS, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Lauring AS, Shapiro NI, Columbus C, Halasa N, Chappell JD, Grijalva CG, Rice TW, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Hart KW, Swan SA, Lewis NM, McMorrow ML, Self WH. Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19-Associated Hospitalization Among Immunocompetent Adults Aged ≥65 Years - IVY Network, 18 States, September 8-November 30, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1625-1630. [PMID: 36580424 PMCID: PMC9812444 DOI: 10.15585/mmwr.mm715152e2] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Monovalent COVID-19 mRNA vaccines, designed against the ancestral strain of SARS-CoV-2, successfully reduced COVID-19-related morbidity and mortality in the United States and globally (1,2). However, vaccine effectiveness (VE) against COVID-19-associated hospitalization has declined over time, likely related to a combination of factors, including waning immunity and, with the emergence of the Omicron variant and its sublineages, immune evasion (3). To address these factors, on September 1, 2022, the Advisory Committee on Immunization Practices recommended a bivalent COVID-19 mRNA booster (bivalent booster) dose, developed against the spike protein from ancestral SARS-CoV-2 and Omicron BA.4/BA.5 sublineages, for persons who had completed at least a primary COVID-19 vaccination series (with or without monovalent booster doses) ≥2 months earlier (4). Data on the effectiveness of a bivalent booster dose against COVID-19 hospitalization in the United States are lacking, including among older adults, who are at highest risk for severe COVID-19-associated illness. During September 8-November 30, 2022, the Investigating Respiratory Viruses in the Acutely Ill (IVY) Network§ assessed effectiveness of a bivalent booster dose received after ≥2 doses of monovalent mRNA vaccine against COVID-19-associated hospitalization among immunocompetent adults aged ≥65 years. When compared with unvaccinated persons, VE of a bivalent booster dose received ≥7 days before illness onset (median = 29 days) against COVID-19-associated hospitalization was 84%. Compared with persons who received ≥2 monovalent-only mRNA vaccine doses, relative VE of a bivalent booster dose was 73%. These early findings show that a bivalent booster dose provided strong protection against COVID-19-associated hospitalization in older adults and additional protection among persons with previous monovalent-only mRNA vaccination. All eligible persons, especially adults aged ≥65 years, should receive a bivalent booster dose to maximize protection against COVID-19 hospitalization this winter season. Additional strategies to prevent respiratory illness, such as masking in indoor public spaces, should also be considered, especially in areas where COVID-19 community levels are high (4,5).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - IVY Network
- National Center for Immunization and Respiratory Diseases, CDC; Vanderbilt University Medical Center, Nashville, Tennessee; Baylor Scott & White Health – Baylor Scott & White Medical Center, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; University of Colorado School of Medicine, Aurora, Colorado; University of Iowa, Iowa City, Iowa; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; Johns Hopkins Hospital, Baltimore, Maryland; Hennepin County Medical Center, Minneapolis, Minnesota; Montefiore Healthcare Center, Albert Einstein College of Medicine, New York, New York; University of Washington School of Medicine, Seattle, Washington; Baystate Medical Center, Springfield, Massachusetts; Intermountain Medical Center and University of Utah, Salt Lake City, Utah; University of Michigan School of Public Health, Ann Arbor, Michigan; Oregon Health & Science University Hospital, Portland, Oregon; Emory University School of Medicine, Atlanta, Georgia; Cleveland Clinic, Cleveland, Ohio; Stanford University School of Medicine, Stanford, California; Ronald Reagan-UCLA Medical Center, Los Angeles, California; University of Miami, Miami, Florida; Washington University, St. Louis, Missouri; The Ohio State University Wexner Medical Center, Columbus, Ohio; University of Michigan School of Medicine, Ann Arbor, Michigan; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Baylor Scott & White Health – Baylor University Medical Center, Dallas, Texas
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21
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Linderman SL, Lai L, Bocangel Gamarra EL, Lau MS, Edupuganti S, Surie D, Tenforde MW, Chappell JD, Mohr NM, Gibbs KW, Steingrub JS, Exline MC, Shapiro NI, Frosch AE, Qadir N, Davis-Gardner ME, McElrath MJ, Lauring AS, Suthar MS, Patel MM, Self WH, Ahmed R. Neutralizing antibody responses in patients hospitalized with SARS-CoV-2 Delta or Omicron infection. J Clin Invest 2022; 132:164303. [PMID: 36256473 PMCID: PMC9711871 DOI: 10.1172/jci164303] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Lilin Lai
- Emory Vaccine Center,,Department of Pediatrics
| | | | - Max S.Y. Lau
- Department of Biostatistics and Bioinformatics, and
| | | | | | | | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicholas M. Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Kevin W. Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jay S. Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Matthew C. Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anne E. Frosch
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Nida Qadir
- Department of Medicine, UCLA, Los Angeles, California, USA
| | | | - M. Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Adam S. Lauring
- Departments of Medicine and of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mehul S. Suthar
- Emory Vaccine Center,,Department of Microbiology and Immunology,,Department of Pediatrics
| | | | - Wesley H. Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rafi Ahmed
- Emory Vaccine Center,,Department of Microbiology and Immunology
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22
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Abouzeid M, Alam HB, Arif H, Ballman K, Bennion R, Bernardi K, Burris D, Carter D, Chee P, Chen F, Chung B, Clark S, Cooper R, Cuschieri J, Deeney K, Dhanani N, Diflo T, Drake FT, Fairfield C, Farjah F, Ferrigno L, Fischkoff K, Fleischman R, Foster C, Gerry T, Gibbons M, Guiden M, Haas N, Hayes LA, Hayward A, Hennessey L, Hernandez M, Horvath KF, Howell EC, Hsu C, Johnson J, Johnsson B, Kim D, Kim D, Ko TC, Lavallee DC, Lew D, Mack J, MacKenzie D, Maggi J, Marquez S, Martinez R, McGrane K, Melis M, Miller K, Mireles D, Moran GJ, Morgan D, Morris A, Moser KM, Mount L, O'Connor K, Odom SR, Olavarria O, Olbrich N, Osborn S, Owens O, Park P, Parr Z, Parsons CS, Pathmarajah K, Patki D, Patton JH, Peacock RK, Pierce K, Pullar K, Putnam B, Rushing A, Sabbatini A, Saltzman D, Salzberg M, Schaetzel S, Schmidt PJ, Shah P, Shapiro NI, Sinha P, Skeete D, Skopin E, Sohn V, Spence LH, Steinberg S, Tichter A, Tschirhart J, Tudor B, Uribe L, VanDusen H, Wallick J, Weiss M, Wells S, Wiebusch A, Williams EJ, Winchell RJ, Wisler J, Wolfe B, Wolff E, Yealy DM, Yu J, Zhang IY, Voldal EC, Davidson GH, Liao JM, Thompson CM, Self WH, Kao LS, Cherry-Bukowiec J, Raghavendran K, Kaji AH, DeUgarte DA, Gonzalez E, Mandell KA, Ohe K, Siparsky N, Price TP, Evans DC, Victory J, Chiang W, Jones A, Kutcher ME, Ciomperlik H, Liang MK, Evans HL, Faine BA, Neufeld M, Sanchez SE, Krishnadasan A, Comstock BA, Heagerty PJ, Lawrence SO, Monsell SE, Fannon EEC, Kessler LG, Talan DA, Flum DR. Association of Patient Belief About Success of Antibiotics for Appendicitis and Outcomes: A Secondary Analysis of the CODA Randomized Clinical Trial. JAMA Surg 2022; 157:1080-1087. [PMID: 36197656 PMCID: PMC9535504 DOI: 10.1001/jamasurg.2022.4765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance A patient's belief in the likely success of a treatment may influence outcomes, but this has been understudied in surgical trials. Objective To examine the association between patients' baseline beliefs about the likelihood of treatment success with outcomes of antibiotics for appendicitis in the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial. Design, Setting, and Participants This was a secondary analysis of the CODA randomized clinical trial. Participants from 25 US medical centers were enrolled between May 3, 2016, and February 5, 2020. Included in the analysis were participants with appendicitis who were randomly assigned to receive antibiotics in the CODA trial. After informed consent but before randomization, participants who were assigned to receive antibiotics responded to a baseline survey including a question about how successful they believed antibiotics could be in treating their appendicitis. Interventions Participants were categorized based on baseline survey responses into 1 of 3 belief groups: unsuccessful/unsure, intermediate, and completely successful. Main Outcomes and Measures Three outcomes were assigned at 30 days: (1) appendectomy, (2) high decisional regret or dissatisfaction with treatment, and (3) persistent signs and symptoms (abdominal pain, tenderness, fever, or chills). Outcomes were compared across groups using adjusted risk differences (aRDs), with propensity score adjustment for sociodemographic and clinical factors. Results Of the 776 study participants who were assigned antibiotic treatment in CODA, a total of 425 (mean [SD] age, 38.5 [13.6] years; 277 male [65%]) completed the baseline belief survey before knowing their treatment assignment. Baseline beliefs were as follows: 22% of participants (92 of 415) had an unsuccessful/unsure response, 51% (212 of 415) had an intermediate response, and 27% (111 of 415) had a completely successful response. Compared with the unsuccessful/unsure group, those who believed antibiotics could be completely successful had a 13-percentage point lower risk of appendectomy (aRD, -13.49; 95% CI, -24.57 to -2.40). The aRD between those with intermediate vs unsuccessful/unsure beliefs was -5.68 (95% CI, -16.57 to 5.20). Compared with the unsuccessful/unsure group, those with intermediate beliefs had a lower risk of persistent signs and symptoms (aRD, -15.72; 95% CI, -29.71 to -1.72), with directionally similar results for the completely successful group (aRD, -15.14; 95% CI, -30.56 to 0.28). Conclusions and Relevance Positive patient beliefs about the likely success of antibiotics for appendicitis were associated with a lower risk of appendectomy and with resolution of signs and symptoms by 30 days. Pathways relating beliefs to outcomes and the potential modifiability of beliefs to improve outcomes merit further investigation. Trial Registration ClinicalTrials.gov Identifier: NCT02800785.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cindy Hsu
- Writing Group for the CODA Collaborative
| | | | | | - Dennis Kim
- Writing Group for the CODA Collaborative
| | - Daniel Kim
- Writing Group for the CODA Collaborative
| | - Tien C. Ko
- Writing Group for the CODA Collaborative
| | | | - Debbie Lew
- Writing Group for the CODA Collaborative
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Olga Owens
- Writing Group for the CODA Collaborative
| | | | - Zoe Parr
- Writing Group for the CODA Collaborative
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Vance Sohn
- Writing Group for the CODA Collaborative
| | | | | | | | | | | | | | | | | | | | - Sean Wells
- Writing Group for the CODA Collaborative
| | | | | | | | - Jon Wisler
- Writing Group for the CODA Collaborative
| | | | | | | | | | - Irene Y. Zhang
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Emily C. Voldal
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Giana H. Davidson
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Joshua M. Liao
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Callie M. Thompson
- Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Surgery, University of Utah, Salt Lake City
| | - Wesley H. Self
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lillian S. Kao
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston
| | | | | | - Amy H. Kaji
- Harbor–UCLA Medical Center, West Carson, California
| | | | - Eva Gonzalez
- Harbor–UCLA Medical Center, West Carson, California
| | | | - Kristen Ohe
- The Swedish Medical Center, Seattle, Washington
| | | | | | - David C. Evans
- The Ohio State University Wexner Medical Center, Columbus
| | - Jesse Victory
- Bellevue Hospital Center, NYU School of Medicine, New York, New York
| | - William Chiang
- Tisch Hospital, NYU Langone Medical Center, New York, New York
| | - Alan Jones
- The University of Mississippi Medical Center, Jackson
| | | | | | - Mike K. Liang
- Lyndon B. Johnson General Hospital, University of Texas, Houston
- HCA Healthcare, University of Houston, Kingwood, Kingwood, Texas
| | - Heather L. Evans
- Harborview Medical Center, UW Medicine, Seattle, Washington
- The Medical University of South Carolina, Charleston
| | | | | | | | | | - Bryan A. Comstock
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Patrick J. Heagerty
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Sarah O. Lawrence
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Sarah E. Monsell
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Erin E. C. Fannon
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - Larry G. Kessler
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
| | - David A. Talan
- Olive View–UCLA Medical Center, Los Angeles, California
- Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - David R. Flum
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle
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23
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Stephenson M, Olson SM, Self WH, Ginde AA, Mohr NM, Gaglani M, Shapiro NI, Gibbs KW, Hager DN, Prekker ME, Gong MN, Steingrub JS, Peltan ID, Martin ET, Reddy R, Busse LW, Duggal A, Wilson JG, Qadir N, Mallow C, Kwon JH, Exline MC, Chappell JD, Lauring AS, Baughman A, Lindsell CJ, Hart KW, Lewis NM, Patel MM, Tenforde MW. Ascertainment of vaccination status by self-report versus source documentation: Impact on measuring COVID-19 vaccine effectiveness. Influenza Other Respir Viruses 2022; 16:1101-1111. [PMID: 35818721 PMCID: PMC9350035 DOI: 10.1111/irv.13023] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, self-reported COVID-19 vaccination might facilitate rapid evaluations of vaccine effectiveness (VE) when source documentation (e.g., immunization information systems [IIS]) is not readily available. We evaluated the concordance of COVID-19 vaccination status ascertained by self-report versus source documentation and its impact on VE estimates. METHODS Hospitalized adults (≥18 years) admitted to 18 U.S. medical centers March-June 2021 were enrolled, including COVID-19 cases and SARS-CoV-2 negative controls. Patients were interviewed about COVID-19 vaccination. Abstractors simultaneously searched IIS, medical records, and other sources for vaccination information. To compare vaccination status by self-report and documentation, we estimated percent agreement and unweighted kappa with 95% confidence intervals (CIs). We then calculated VE in preventing COVID-19 hospitalization of full vaccination (2 doses of mRNA product ≥14 days prior to illness onset) independently using data from self-report or source documentation. RESULTS Of 2520 patients, 594 (24%) did not have self-reported vaccination information to assign vaccination group; these patients tended to be more severely ill. Among 1924 patients with both self-report and source documentation information, 95.0% (95% CI: 93.9-95.9%) agreement was observed, with a kappa of 0.9127 (95% CI: 0.9109-0.9145). VE was 86% (95% CI: 81-90%) by self-report data only and 85% (95% CI: 81-89%) by source documentation data only. CONCLUSIONS Approximately one-quarter of hospitalized patients could not provide self-report COVID-19 vaccination status. Among patients with self-report information, there was high concordance with source documented status. Self-report may be a reasonable source of COVID-19 vaccination information for timely VE assessment for public health action.
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Affiliation(s)
| | | | - Wesley H. Self
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Adit A. Ginde
- University of Colorado School of MedicineAuroraColoradoUSA
| | | | - Manjusha Gaglani
- Baylor Scott & White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | | | - Kevin W. Gibbs
- Wake Forest University Baptist Medical CenterWinston‐SalemNorth CarolinaUSA
| | | | | | - Michelle N. Gong
- Montefiore Healthcare CenterAlbert Einstein College of MedicineBronxNew YorkUSA
| | | | - Ithan D. Peltan
- Intermountain Medical Center and University of UtahSalt Lake CityUtahUSA
| | - Emily T. Martin
- University of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Raju Reddy
- Oregon Health & Science University HospitalPortlandOregonUSA
| | | | | | | | - Nida Qadir
- Ronald Reagan‐UCLA Medical CenterLos AngelesCaliforniaUSA
| | | | | | | | | | - Adam S. Lauring
- University of Michigan School of MedicineAnn ArborMichiganUSA
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24
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Self WH, Wheeler AP, Stewart TG, Schrager H, Mallada J, Thomas CB, Cataldo VD, O'Neal HR, Shapiro NI, Higgins C, Ginde AA, Chauhan L, Johnson NJ, Henning DJ, Jaiswal SJ, Mammen MJ, Harris ES, Pannu SR, Laguio-Vila M, El Atrouni W, de Wit M, Hoda D, Cohn CS, McWilliams C, Shanholtz C, Jones AE, Raval JS, Mucha S, Ipe TS, Qiao X, Schrantz SJ, Shenoy A, Fremont RD, Brady EJ, Carnahan RH, Chappell JD, Crowe JE, Denison MR, Gilchuk P, Stevens LJ, Sutton RE, Thomsen I, Yoder SM, Bistran-Hall AJ, Casey JD, Lindsell CJ, Wang L, Pulley JM, Rhoads JP, Bernard GR, Rice TW. Neutralizing COVID-19 Convalescent Plasma in Adults Hospitalized With COVID-19: A Blinded, Randomized, Placebo-Controlled Trial. Chest 2022; 162:982-994. [PMID: 35780813 PMCID: PMC9247217 DOI: 10.1016/j.chest.2022.06.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/21/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Convalescent plasma has been one of the most common treatments for COVID-19, but most clinical trial data to date have not supported its efficacy. RESEARCH QUESTION Is rigorously selected COVID-19 convalescent plasma with neutralizing anti-SARS-CoV-2 antibodies an efficacious treatment for adults hospitalized with COVID-19? STUDY DESIGN AND METHODS This was a multicenter, blinded, placebo-controlled randomized clinical trial among adults hospitalized with SARS-CoV-2 infection and acute respiratory symptoms for < 14 days. Enrolled patients were randomly assigned to receive one unit of COVID-19 convalescent plasma (n = 487) or placebo (n = 473). The primary outcome was clinical status (disease severity) 14 days following study infusion measured with a seven-category ordinal scale ranging from discharged from the hospital with resumption of normal activities (lowest score) to death (highest score). The primary outcome was analyzed with a multivariable ordinal regression model, with an adjusted odds ratio (aOR) < 1.0 indicating more favorable outcomes with convalescent plasma than with placebo. In secondary analyses, trial participants were stratified according to the presence of endogenous anti-SARS-CoV-2 antibodies ("serostatus") at randomization. The trial included 13 secondary efficacy outcomes, including 28-day mortality. RESULTS Among 974 randomized patients, 960 were included in the primary analysis. Clinical status on the ordinal outcome scale at 14 days did not differ between the convalescent plasma and placebo groups in the overall population (aOR, 1.04; one-seventh support interval [1/7 SI], 0.82-1.33), in patients without endogenous antibodies (aOR, 1.15; 1/7 SI, 0.74-1.80), or in patients with endogenous antibodies (aOR, 0.96; 1/7 SI, 0.72-1.30). None of the 13 secondary efficacy outcomes were different between groups. At 28 days, 89 of 482 (18.5%) patients in the convalescent plasma group and 80 of 465 (17.2%) patients in the placebo group had died (aOR, 1.04; 1/7 SI, 0.69-1.58). INTERPRETATION Among adults hospitalized with COVID-19, including those seronegative for anti-SARS-CoV-2 antibodies, treatment with convalescent plasma did not improve clinical outcomes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT04362176; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research and Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.
| | - Allison P Wheeler
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas G Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Harry Schrager
- Department of Medicine, Tufts School of Medicine, Newton-Wellesley Hospital, Newton, MA
| | - Jason Mallada
- Department of Pharmacy, Newton-Wellesley Hospital, Massachusetts College of Pharmacy and Health Sciences, Newton, MA
| | - Christopher B Thomas
- Division of Pulmonary and Critical Care, Louisiana State University Health-Sciences Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
| | - Vince D Cataldo
- Division of Hematology and Oncology, Louisiana State University Health-Sciences Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
| | - Hollis R O'Neal
- Division of Pulmonary and Critical Care, Louisiana State University Health-Sciences Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Conor Higgins
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Lakshmi Chauhan
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Stuti J Jaiswal
- Division of Hospital Medicine, Scripps Clinic, Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, CA
| | - Manoj J Mammen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Estelle S Harris
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah, Salt Lake City, UT
| | - Sonal R Pannu
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University, Columbus, OH
| | - Maryrose Laguio-Vila
- Department of Internal Medicine, Division of Infectious Disease, Rochester General Hospital, Rochester, NY
| | - Wissam El Atrouni
- Division of Infectious Diseases, Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - Marjolein de Wit
- Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Daanish Hoda
- Oncology Clinical Program, Intermountain Healthcare, Murray, UT
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Carla McWilliams
- Department of Infectious Disease, Cleveland Clinic Florida Weston, Weston, FL
| | - Carl Shanholtz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Alan E Jones
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Jay S Raval
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM
| | - Simon Mucha
- Department of Critical Care, Respiratory Institute, Cleveland Clinical Health System, Cleveland, OH
| | - Tina S Ipe
- Department of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Xian Qiao
- Sentara Pulmonary, Critical Care, and Sleep Specialists, Sentara Health, Sentara Norfolk General Hospital, Eastern Virginia Medical School, Norfolk, VA
| | | | - Aarthi Shenoy
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC
| | | | - Eric J Brady
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN
| | - Robert H Carnahan
- Department of Pediatrics, Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN; Department of Radiology, Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN
| | - James D Chappell
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - James E Crowe
- Department of Pediatrics, Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN; Department of Pediatrics, and Department of Pathology, Microbiology, and Immunology, Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN
| | - Mark R Denison
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Pavlo Gilchuk
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN
| | - Laura J Stevens
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Rachel E Sutton
- Immunology and Molecular Pathogeneisis Program, Emory University, Atlanta, GA
| | - Isaac Thomsen
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sandra M Yoder
- Vanderbilt Vaccine Center, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda J Bistran-Hall
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan D Casey
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | | | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Jill M Pulley
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Jillian P Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Gordon R Bernard
- Vanderbilt Institute for Clinical and Translational Research and Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Todd W Rice
- Vanderbilt Institute for Clinical and Translational Research and Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
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Surie D, Bonnell L, Adams K, Gaglani M, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Shehu A, Frosch AP, Erickson HL, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Khan A, Bender WS, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Rivas C, Kwon JH, Exline MC, Lauring AS, Shapiro NI, Halasa N, Chappell JD, Grijalva CG, Rice TW, Stubblefield WB, Baughman A, Womack KN, Hart KW, Swan SA, Zhu Y, DeCuir J, Tenforde MW, Patel MM, McMorrow ML, Self WH. Effectiveness of Monovalent mRNA Vaccines Against COVID-19-Associated Hospitalization Among Immunocompetent Adults During BA.1/BA.2 and BA.4/BA.5 Predominant Periods of SARS-CoV-2 Omicron Variant in the United States - IVY Network, 18 States, December 26, 2021-August 31, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1327-1334. [PMID: 36264830 PMCID: PMC9590291 DOI: 10.15585/mmwr.mm7142a3] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Adams K, Rhoads JP, Surie D, Gaglani M, Ginde AA, McNeal T, Talbot HK, Casey JD, Zepeski A, Shapiro NI, Gibbs KW, Files DC, Hager DN, Frosch AE, Exline MC, Mohamed A, Johnson NJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Lauring AS, Khan A, Busse LW, Duggal A, Wilson JG, Chang SY, Mallow C, Kwon JH, Chappell JD, Halasa N, Grijalva CG, Lindsell CJ, Lester SN, Thornburg NJ, Park S, McMorrow ML, Patel MM, Tenforde MW, Self WH. Vaccine effectiveness of primary series and booster doses against covid-19 associated hospital admissions in the United States: living test negative design study. BMJ 2022; 379:e072065. [PMID: 36220174 PMCID: PMC9551237 DOI: 10.1136/bmj-2022-072065] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the effectiveness of a primary covid-19 vaccine series plus booster doses with a primary series alone for the prevention of hospital admission with omicron related covid-19 in the United States. DESIGN Multicenter observational case-control study with a test negative design. SETTING Hospitals in 18 US states. PARTICIPANTS 4760 adults admitted to one of 21 hospitals with acute respiratory symptoms between 26 December 2021 and 30 June 2022, a period when the omicron variant was dominant. Participants included 2385 (50.1%) patients with laboratory confirmed covid-19 (cases) and 2375 (49.9%) patients who tested negative for SARS-CoV-2 (controls). MAIN OUTCOME MEASURES The main outcome was vaccine effectiveness against hospital admission with covid-19 for a primary series plus booster doses and a primary series alone by comparing the odds of being vaccinated with each of these regimens versus being unvaccinated among cases versus controls. Vaccine effectiveness analyses were stratified by immunosuppression status (immunocompetent, immunocompromised). The primary analysis evaluated all covid-19 vaccine types combined, and secondary analyses evaluated specific vaccine products. RESULTS Overall, median age of participants was 64 years (interquartile range 52-75 years), 994 (20.8%) were immunocompromised, 85 (1.8%) were vaccinated with a primary series plus two boosters, 1367 (28.7%) with a primary series plus one booster, and 1875 (39.3%) with a primary series alone, and 1433 (30.1%) were unvaccinated. Among immunocompetent participants, vaccine effectiveness for prevention of hospital admission with omicron related covid-19 for a primary series plus two boosters was 63% (95% confidence interval 37% to 78%), a primary series plus one booster was 65% (58% to 71%), and for a primary series alone was 37% (25% to 47%) (P<0.001 for the pooled boosted regimens compared with a primary series alone). Vaccine effectiveness was higher for a boosted regimen than for a primary series alone for both mRNA vaccines (BNT162b2 (Pfizer-BioNTech): 73% (44% to 87%) for primary series plus two boosters, 64% (55% to 72%) for primary series plus one booster, and 36% (21% to 48%) for primary series alone (P<0.001); mRNA-1273 (Moderna): 68% (17% to 88%) for primary series plus two boosters, 65% (55% to 73%) for primary series plus one booster, and 41% (25% to 54%) for primary series alone (P=0.001)). Among immunocompromised patients, vaccine effectiveness for a primary series plus one booster was 69% (31% to 86%) and for a primary series alone was 49% (30% to 63%) (P=0.04). CONCLUSION During the first six months of 2022 in the US, booster doses of a covid-19 vaccine provided additional benefit beyond a primary vaccine series alone for preventing hospital admissions with omicron related covid-19. READERS' NOTE This article is a living test negative design study that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.
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Affiliation(s)
| | - Jillian P Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Diya Surie
- CDC COVID-19 Response Team, Atlanta, GA, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, USA
| | - H Keipp Talbot
- Department of Medicine¸ Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan D Casey
- Department of Medicine¸ Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - D Clark Files
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anne E Frosch
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | | | - Jennie H Kwon
- Department of Medicine, Washington University, St Louis, MI, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - SoHee Park
- CDC COVID-19 Response Team, Atlanta, GA, USA
| | | | | | | | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Shapiro NI, Filbin MR, Hou PC, Kurz MC, Han JH, Aufderheide TP, Ward MA, Pulia MS, Birkhahn RH, Diaz JL, Hughes TL, Harsch MR, Bell A, Suarez-Cuervo C, Sambursky R. Diagnostic Accuracy of a Bacterial and Viral Biomarker Point-of-Care Test in the Outpatient Setting. JAMA Netw Open 2022; 5:e2234588. [PMID: 36255727 PMCID: PMC9579916 DOI: 10.1001/jamanetworkopen.2022.34588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Acute respiratory infections (ARIs) account for most outpatient visits. Discriminating bacterial vs viral etiology is a diagnostic challenge with therapeutic implications. OBJECTIVE To investigate whether FebriDx, a rapid, point-of-care immunoassay, can differentiate bacterial- from viral-associated host immune response in ARI through measurement of myxovirus resistance protein A (MxA) and C-reactive protein (CRP) from finger-stick blood. DESIGN, SETTING, AND PARTICIPANTS This diagnostic study enrolled adults and children who were symptomatic for ARI and individuals in a control group who were asymptomatic between October 2019 and April 2021. Included participants were a convenience sample of patients in outpatient settings (ie, emergency department, urgent care, and primary care) who were symptomatic, aged 1 year or older, and had suspected ARI and fever within 72 hours. Individuals with immunocompromised state and recent vaccine, antibiotics, stroke, surgery, major burn, or myocardial infarction were excluded. Of 1685 individuals assessed for eligibility, 259 individuals declined participation, 718 individuals were excluded, and 708 individuals were enrolled (520 patients with ARI, 170 patients without ARI, and 18 individuals who dropped out). EXPOSURES Bacterial and viral immunoassay testing was performed using finger-stick blood. Results were read at 10 minutes, and treating clinicians and adjudicators were blinded to results. MAIN OUTCOMES AND MEASURES Bacterial- or viral-associated systemic host response to an ARI as determined by a predefined comparator algorithm with adjudication classified infection etiology. RESULTS Among 520 participants with ARI (230 male patients [44.2%] and 290 female patients [55.8%]; mean [SD] age, 35.3 [17.7] years), 24 participants with missing laboratory information were classified as unknown (4.6%). Among 496 participants with a final diagnosis, 73 individuals (14.7%) were classified as having a bacterial-associated response, 296 individuals (59.7%) as having a viral-associated response, and 127 individuals (25.6%) as negative by the reference standard. The bacterial and viral test correctly classified 68 of 73 bacterial infections, demonstrating a sensitivity of 93.2% (95% CI, 84.9%-97.0%), specificity of 374 of 423 participants (88.4% [95% CI, 85.0%-91.1%]), positive predictive value (PPV) of 68 of 117 participants (58.1% [95% CI, 49.1%-66.7%), and negative predictive value (NPV) of 374 of 379 participants (98.7% [95% CI, 96.9%-99.4%]).The test correctly classified 208 of 296 viral infections, for a sensitivity of 70.3% (95% CI, 64.8%-75.2%), a specificity of 176 of 200 participants (88.0% [95% CI, 82.8%-91.8%]), a PPV of 208 of 232 participants (89.7% [95% CI, 85.1%-92.9%]), and an NPV of 176 of 264 participants (66.7% [95% CI, 60.8%-72.1%]). CONCLUSIONS AND RELEVANCE In this study, a rapid diagnostic test demonstrated diagnostic performance that may inform clinicians when assessing for bacterial or viral etiology of ARI symptoms.
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Affiliation(s)
- Nathan I. Shapiro
- Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Michael R. Filbin
- Emergency Medicine, Massachusetts General Hospital Institute for Patient Care, Boston, Massachusetts
| | - Peter C. Hou
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael C. Kurz
- Emergency Medicine, University of Alabama School of Medicine, Birmingham
| | - Jin H. Han
- Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare Center, Nashville
| | - Tom P. Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Michael A. Ward
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Michael S. Pulia
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Robert H. Birkhahn
- Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Jorge L. Diaz
- Internal Medicine, Doral Medical Research, Miami, Florida
| | | | - Manya R. Harsch
- Statistical Analysis, Technomics Research, Long Lake, Minnesota
| | - Annie Bell
- Medical Affairs, Lumos Diagnostics, Sarasota, Florida
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28
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Kwon JH, Tenforde MW, Gaglani M, Talbot HK, Ginde AA, McNeal T, Ghamande S, Douin DJ, Casey JD, Mohr NM, Zepeski A, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Caspers SD, Exline MC, Botros M, Gong MN, Li A, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Khan A, Hough CL, Busse LW, Duggal A, Wilson JG, Perez C, Chang SY, Mallow C, Rovinski R, Babcock HM, Lauring AS, Felley L, Halasa N, Chappell JD, Grijalva CG, Rice TW, Womack KN, Lindsell CJ, Hart KW, Baughman A, Olson SM, Schrag S, Kobayashi M, Verani JR, Patel MM, Self WH. mRNA Vaccine Effectiveness Against Coronavirus Disease 2019 Hospitalization Among Solid Organ Transplant Recipients. J Infect Dis 2022; 226:797-807. [PMID: 35385875 PMCID: PMC9047160 DOI: 10.1093/infdis/jiac118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/31/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The study objective was to evaluate 2- and 3-dose coronavirus disease 2019 (COVID-19) mRNA vaccine effectiveness (VE) in preventing COVID-19 hospitalization among adult solid organ transplant (SOT) recipients. METHODS We conducted a 21-site case-control analysis of 10 425 adults hospitalized in March to December 2021. Cases were hospitalized with COVID-19; controls were hospitalized for an alternative diagnosis (severe acute respiratory syndrome coronavirus 2-negative). Participants were classified as follows: SOT recipient (n = 440), other immunocompromising condition (n = 1684), or immunocompetent (n = 8301). The VE against COVID-19-associated hospitalization was calculated as 1-adjusted odds ratio of prior vaccination among cases compared with controls. RESULTS Among SOT recipients, VE was 29% (95% confidence interval [CI], -19% to 58%) for 2 doses and 77% (95% CI, 48% to 90%) for 3 doses. Among patients with other immunocompromising conditions, VE was 72% (95% CI, 64% to 79%) for 2 doses and 92% (95% CI, 85% to 95%) for 3 doses. Among immunocompetent patients, VE was 88% (95% CI, 87% to 90%) for 2 doses and 96% (95% CI, 83% to 99%) for 3 doses. CONCLUSIONS Effectiveness of COVID-19 mRNA vaccines was lower for SOT recipients than immunocompetent adults and those with other immunocompromising conditions. Among SOT recipients, vaccination with 3 doses of an mRNA vaccine led to substantially greater protection than 2 doses.
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Affiliation(s)
- Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, Missouri, USA
| | | | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - H Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - D Clark Files
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arber Shehu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Matthew E Prekker
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Sean D Caspers
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mena Botros
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alex Li
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine and Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Vasisht Srinivasan
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Catherine L Hough
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA
| | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Cynthia Perez
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Christopher Mallow
- Department of Medicine, University of Miami and Jackson Memorial Health System, Miami, Florida, USA
| | - Randal Rovinski
- Department of Medicine, University of Miami and Jackson Memorial Health System, Miami, Florida, USA
| | - Hilary M Babcock
- Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura Felley
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | | | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Bischof JJ, Elsaid MI, Bridges JFP, Rosko AE, Presley CJ, Abar B, Adler D, Bastani A, Baugh CW, Bernstein SL, Coyne CJ, Durham DD, Grudzen CR, Henning DJ, Hudson MF, Klotz A, Lyman GH, Madsen TE, Reyes-Gibby CC, Rico JF, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Yeung SCJ, Yilmaz S, Caterino JM. Characterization of older adults with cancer seeking acute emergency department care: A prospective observational study. J Geriatr Oncol 2022; 13:943-951. [PMID: 35718667 DOI: 10.1016/j.jgo.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/05/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Disparities in care of older adults in cancer treatment trials and emergency department (ED) use exist. This report provides a baseline description of older adults ≥65 years old who present to the ED with active cancer. MATERIALS AND METHODS Planned secondary analysis of the Comprehensive Oncologic Emergencies Research Network observational ED cohort study sponsored by the National Cancer Institute. Of 1564 eligible adults with active cancer, 1075 patients were prospectively enrolled, of which 505 were ≥ 65 years old. We recruited this convenience sample from eighteen participating sites across the United States between February 1, 2016 and January 30, 2017. RESULTS Compared to cancer patients younger than 65 years of age, older adults were more likely to be transported to the ED by emergency medical services, have a higher Charlson Comorbidity Index score, and be admitted despite no significant difference in acuity as measured by the Emergency Severity Index. Despite the higher admission rate, no significant difference was noted in hospitalization length of stay, 30-day mortality, ED revisit or hospital admission within 30 days after the index visit. Three of the top five ED diagnoses for older adults were symptom-related (fever of other and unknown origin, abdominal and pelvic pain, and pain in throat and chest). Despite this, older adults were less likely to report symptoms and less likely to receive symptomatic treatment for pain and nausea than the younger comparison group. Both younger and older adults reported a higher symptom burden on the patient reported Condensed Memorial Symptom Assessment Scale than to ED providers. When treating suspected infection, no differences were noted in regard to administration of antibiotics in the ED, admissions, or length of stay ≤2 days for those receiving ED antibiotics. DISCUSSION We identified several differences between older (≥65 years old) and younger adults with active cancer seeking emergency care. Older adults frequently presented for symptom-related diagnoses but received fewer symptomatic interventions in the ED suggesting that important opportunities to improve the care of older adults with cancer in the ED exist.
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Affiliation(s)
- Jason J Bischof
- Departments of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Mohamed I Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - John F P Bridges
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Ashley E Rosko
- Department of Internal Medicine, Division of Hematology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Carolyn J Presley
- Department of Internal Medicine, Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA.
| | - David Adler
- Department of Emergency Medicine, University of Rochester, Rochester, NY, USA.
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital - Troy Campus, Troy, MI, USA.
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Christopher J Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, CA, USA.
| | - Danielle D Durham
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
| | | | - Adam Klotz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Troy E Madsen
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Cielito C Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Juan Felipe Rico
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Richard J Ryan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
| | - Charles R Thomas
- Department of Radiation Oncology, Geisel School of Medicine @ Dartmouth, Lebanon, NH, USA.
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Jason Wilson
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Sule Yilmaz
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jeffrey M Caterino
- Departments of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Talan DA, Moran GJ, Krishnadasan A, Monsell SE, Faine BA, Uribe L, Kaji AH, DeUgarte DA, Self WH, Shapiro NI, Cuschieri J, Glaser J, Park PK, Price TP, Siparsky N, Sanchez SE, Machado-Aranda DA, Victory J, Ayoung-Chee P, Chiang W, Corsa J, Evans HL, Ferrigno L, Garcia L, Hatch Q, Horton MD, Johnson J, Jones A, Kao LS, Kelly A, Kim D, Kutcher ME, Liang MK, Maghami N, McGrane K, Minko E, Mohr C, Neufeld M, Patton JH, Rog C, Rushing A, Sabbatini AK, Salzberg M, Thompson CM, Tichter A, Wisler J, Bizzell B, Fannon E, Lawrence SO, Voldal EC, Lavallee DC, Comstock BA, Heagerty PJ, Davidson GH, Flum DR, Kessler LG. Analysis of Outcomes Associated With Outpatient Management of Nonoperatively Treated Patients With Appendicitis. JAMA Netw Open 2022; 5:e2220039. [PMID: 35796152 PMCID: PMC9250049 DOI: 10.1001/jamanetworkopen.2022.20039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE In the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial, which found antibiotics to be noninferior, approximately half of participants randomized to receive antibiotics had outpatient management with hospital discharge within 24 hours. If outpatient management is safe, it could increase convenience and decrease health care use and costs. OBJECTIVE To assess the use and safety of outpatient management of acute appendicitis. DESIGN, SETTING, AND PARTICIPANTS This cohort study, which is a secondary analysis of the CODA trial, included 776 adults with imaging-confirmed appendicitis who received antibiotics at 25 US hospitals from May 1, 2016, to February 28, 2020. EXPOSURES Participants randomized to antibiotics (intravenous then oral) could be discharged from the emergency department based on clinician judgment and prespecified criteria (hemodynamically stable, afebrile, oral intake tolerated, pain controlled, and follow-up confirmed). Outpatient management and hospitalization were defined as discharge within or after 24 hours, respectively. MAIN OUTCOMES AND MEASURES Outcomes compared among patients receiving outpatient vs inpatient care included serious adverse events (SAEs), appendectomies, health care encounters, satisfaction, missed workdays at 7 days, and EuroQol 5-dimension (EQ-5D) score at 30 days. In addition, appendectomy incidence among outpatients and inpatients, unadjusted and adjusted for illness severity, was compared. RESULTS Among 776 antibiotic-randomized participants, 42 (5.4%) underwent appendectomy within 24 hours and 8 (1.0%) did not receive their first antibiotic dose within 24 hours, leaving 726 (93.6%) comprising the study population (median age, 36 years; range, 18-86 years; 462 [63.6%] male; 437 [60.2%] White). Of these participants, 335 (46.1%; site range, 0-89.2%) were discharged within 24 hours, and 391 (53.9%) were discharged after 24 hours. Over 7 days, SAEs occurred in 0.9 (95% CI, 0.2-2.6) per 100 outpatients and 1.3 (95% CI, 0.4-2.9) per 100 inpatients; in the appendicolith subgroup, SAEs occurred in 2.3 (95% CI, 0.3-8.2) per 100 outpatients vs 2.8 (95% CI, 0.6-7.9) per 100 inpatients. During this period, appendectomy occurred in 9.9% (95% CI, 6.9%-13.7%) of outpatients and 14.1% (95% CI, 10.8%-18.0%) of inpatients; adjusted analysis demonstrated a similar difference in incidence (-4.0 percentage points; 95% CI, -8.7 to 0.6). At 30 days, appendectomies occurred in 12.6% (95% CI, 9.1%-16.7%) of outpatients and 19.0% (95% CI, 15.1%-23.4%) of inpatients. Outpatients missed fewer workdays (2.6 days; 95% CI, 2.3-2.9 days) than did inpatients (3.8 days; 95% CI, 3.4-4.3 days) and had similar frequency of return health care visits and high satisfaction and EQ-5D scores. CONCLUSIONS AND RELEVANCE These findings support that outpatient antibiotic management is safe for selected adults with acute appendicitis, with no greater risk of complications or appendectomy than hospital care, and should be included in shared decision-making discussions of patient preferences for outcomes associated with nonoperative and operative care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02800785.
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Affiliation(s)
| | - David A Talan
- Department of Emergency Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | - Gregory J Moran
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | - Anusha Krishnadasan
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | | | - Brett A Faine
- College of Pharmacy, University of Iowa Hospitals and Clinics, Iowa City
| | - Lisandra Uribe
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, California
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-UCLA Medical Center, West Carson, California
| | - Daniel A DeUgarte
- Department of Pediatric General Surgery, Harbor-UCLA Medical Center, West Carson, California
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nathan I Shapiro
- Department of Emergency Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Joseph Cuschieri
- Department of Surgery, Harborview Medical Center, UW Medicine, Seattle, Washington
- Department of Surgery, University of California, San Francisco
| | - Jacob Glaser
- Department of Surgery, Providence Regional Medical Center Everett, Everett, Washington
| | | | - Thea P Price
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nicole Siparsky
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Sabrina E Sanchez
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts
| | | | - Jesse Victory
- Department of Surgery, Bellevue Hospital Center, NYU School of Medicine, New York, New York
| | - Patricia Ayoung-Chee
- Department of Surgery, Tisch Hospital, NYU Langone Medical Center, New York, New York
- Department of Surgery Morehouse School of Medicine, Atlanta, Georgia
| | - William Chiang
- Department of Surgery, University of California, San Francisco
| | - Joshua Corsa
- Department of Surgery, Providence Regional Medical Center Everett, Everett, Washington
| | - Heather L Evans
- Department of Surgery, Harborview Medical Center, UW Medicine, Seattle, Washington
- Department of Surgery, The Medical University of South Carolina, Charleston
| | - Lisa Ferrigno
- Department of Surgery, UCHealth University of Colorado Hospital, Denver
| | - Luis Garcia
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City
| | - Quinton Hatch
- Department of Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Marc D Horton
- Department of Surgery, The Swedish Medical Center, Seattle, Washington
| | - Jeffrey Johnson
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Alan Jones
- Department of Emergency Medicine, The University of Mississippi Medical Center, Jackson
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Anton Kelly
- Department of Surgery, Weill Cornell Medical Center, New York, New York
| | - Daniel Kim
- Department of Surgery, University of Washington, Seattle
| | - Matthew E Kutcher
- Department of Surgery, The University of Mississippi Medical Center, Jackson
| | - Mike K Liang
- Department of Surgery, Lyndon B. Johnson General Hospital, University of Texas, Houston
- Department of Surgery, University of Houston, HCA Healthcare, Kingwood, Kingwood, Texas
| | - Nima Maghami
- Department of Surgery, Weill Cornell Medical Center, New York, New York
| | - Karen McGrane
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Elizaveta Minko
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Cassandra Mohr
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Miriam Neufeld
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Joe H Patton
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Colin Rog
- Department of Surgery, UCHealth University of Colorado Hospital, Denver
- Department of Surgery, The Swedish Medical Center, Seattle, Washington
| | - Amy Rushing
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
- Department of Surgery, UH Cleveland Medical Center, Cleveland, Ohio
| | | | - Matthew Salzberg
- Department of Emergency Medicine, UCHealth University of Colorado Hospital, Denver
| | - Callie M Thompson
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Surgery, University of Utah, Salt Lake City
| | - Aleksandr Tichter
- Department of Emergency Medicine, Columbia University Medical Center, New York, New York
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | - Jon Wisler
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Bonnie Bizzell
- Department of Surgery, University of Washington, Seattle
| | - Erin Fannon
- Department of Surgery, University of Washington, Seattle
| | | | - Emily C Voldal
- Center for Biostatistics, University of Washington, Seattle
| | - Danielle C Lavallee
- Department of Surgery, University of Washington, Seattle
- BC Support Unit, BC Academic Health Science Network, Vancouver, British Columbia, Canada
| | | | | | | | - David R Flum
- Department of Surgery, University of Washington, Seattle
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Yilmaz S, Grudzen CR, Durham DD, McNaughton C, Marcelin I, Abar B, Adler D, Bastani A, Baugh CW, Bernstein SL, Bischof JJ, Coyne CJ, Henning DJ, Hudson MF, Klotz A, Lyman GH, Madsen TE, Pallin DJ, Reyes-Gibby C, Rico JF, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Yeung SCJ, Caterino JM. Palliative Care Needs and Clinical Outcomes of Patients with Advanced Cancer in the Emergency Department. J Palliat Med 2022; 25:1115-1121. [PMID: 35559758 PMCID: PMC9467631 DOI: 10.1089/jpm.2021.0567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Older adults with cancer use the emergency department (ED) for acute concerns. Objectives: Characterize the palliative care needs and clinical outcomes of advanced cancer patients in the ED. Design: A planned secondary data analysis of the Comprehensive Oncologic Emergencies Research Network (CONCERN) data. Settings/Subjects: Cancer patients who presented to the 18 CONCERN affiliated EDs in the United States. Measurements: Survey included demographics, cancer type, functional status, symptom burden, palliative and hospice care enrollment, and advance directive code status. Results: Of the total (674/1075, 62.3%) patients had advanced cancer and most were White (78.6%) and female (50.3%); median age was 64 (interquartile range 54-71) years. A small proportion of them were receiving palliative (6.5% [95% confidence interval; CI 3.0-7.6]; p = 0.005) and hospice (1.3% [95% CI 1.0-3.2]; p = 0.52) care and had a higher 30-day mortality rate (8.3%, [95% CI 6.2-10.4]). Conclusions: Patients with advanced cancer continue to present to the ED despite recommendations for early delivery of palliative care.
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Affiliation(s)
- Sule Yilmaz
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
- Address correspondence to: Sule Yilmaz, PhD, Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, 265 Crittenden Boulevard, Rochester, NY 14642, USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Danielle D. Durham
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Isabelle Marcelin
- Ronald O. Perelman Department of Emergency Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, New York, USA
| | - David Adler
- Department of Emergency Medicine, University of Rochester, Rochester, New York, USA
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital—Troy Campus, Troy, Michigan, USA
| | - Christopher W. Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven L. Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason J. Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher J. Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
| | - Daniel J. Henning
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | | | - Adam Klotz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Troy E. Madsen
- Division of Emergency Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Daniel J. Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Cielito Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan Felipe Rico
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Richard J. Ryan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconness Medical Center, Boston, Massachusetts, USA
| | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Charles R. Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Jason Wilson
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Sai-Ching Jim Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine and Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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32
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Adams K, Rhoads JP, Surie D, Gaglani M, Ginde AA, McNeal T, Ghamande S, Huynh D, Talbot HK, Casey JD, Mohr NM, Zepeski A, Shapiro NI, Gibbs KW, Files DC, Hicks M, Hager DN, Ali H, Prekker ME, Frosch AE, Exline MC, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Lauring AS, Khan A, Hough CL, Busse LW, Ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Chappell JD, Halasa N, Grijalva CG, Rice TW, Stubblefield WB, Baughman A, Lindsell CJ, Hart KW, Lester SN, Thornburg NJ, Park S, McMorrow ML, Patel MM, Tenforde MW, Self WH. Vaccine Effectiveness of Primary Series and Booster Doses against Omicron Variant COVID-19-Associated Hospitalization in the United States. medRxiv 2022. [PMID: 35734090 DOI: 10.1101/2022.06.09.22276228] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: To compare the effectiveness of a primary COVID-19 vaccine series plus a booster dose with a primary series alone for the prevention of Omicron variant COVID-19 hospitalization. Design: Multicenter observational case-control study using the test-negative design to evaluate vaccine effectiveness (VE). Setting: Twenty-one hospitals in the United States (US). Participants: 3,181 adults hospitalized with an acute respiratory illness between December 26, 2021 and April 30, 2022, a period of SARS-CoV-2 Omicron variant (BA.1, BA.2) predominance. Participants included 1,572 (49%) case-patients with laboratory confirmed COVID-19 and 1,609 (51%) control patients who tested negative for SARS-CoV-2. Median age was 64 years, 48% were female, and 21% were immunocompromised; 798 (25%) were vaccinated with a primary series plus booster, 1,326 (42%) were vaccinated with a primary series alone, and 1,057 (33%) were unvaccinated. Main Outcome Measures: VE against COVID-19 hospitalization was calculated for a primary series plus a booster and a primary series alone by comparing the odds of being vaccinated with each of these regimens versus being unvaccinated among cases versus controls. VE analyses were stratified by immune status (immunocompetent; immunocompromised) because the recommended vaccine schedules are different for these groups. The primary analysis evaluated all COVID-19 vaccine types combined and secondary analyses evaluated specific vaccine products. Results: Among immunocompetent patients, VE against Omicron COVID-19 hospitalization for a primary series plus one booster of any vaccine product dose was 77% (95% CI: 71-82%), and for a primary series alone was 44% (95% CI: 31-54%) (p<0.001). VE was higher for a boosted regimen than a primary series alone for both mRNA vaccines used in the US (BNT162b2: primary series plus booster VE 80% (95% CI: 73-85%), primary series alone VE 46% (95% CI: 30-58%) [p<0.001]; mRNA-1273: primary series plus booster VE 77% (95% CI: 67-83%), primary series alone VE 47% (95% CI: 30-60%) [p<0.001]). Among immunocompromised patients, VE for a primary series of any vaccine product against Omicron COVID-19 hospitalization was 60% (95% CI: 41-73%). Insufficient sample size has accumulated to calculate effectiveness of boosted regimens for immunocompromised patients. Conclusions: Among immunocompetent people, a booster dose of COVID-19 vaccine provided additional benefit beyond a primary vaccine series alone for preventing COVID-19 hospitalization due to the Omicron variant.
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33
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Lewis NM, Self WH, Gaglani M, Ginde AA, Douin DJ, Keipp Talbot H, Casey JD, Mohr NM, Zepeski A, Ghamande SA, McNeal TA, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Busse LW, ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Lauring AS, Halasa N, Chappell JD, Grijalva CG, Rice TW, Rhoads JP, Jones ID, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Adams K, Patel MM, Tenforde MW. Effectiveness of the Ad26.COV2.S (Johnson & Johnson) Coronavirus Disease 2019 (COVID-19) Vaccine for Preventing COVID-19 Hospitalizations and Progression to High Disease Severity in the United States. Clin Infect Dis 2022; 75:S159-S166. [PMID: 35675695 PMCID: PMC9214149 DOI: 10.1093/cid/ciac439] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Indexed: 01/19/2023] Open
Abstract
Background . Adults in the United States (US) began receiving the adenovirus vector coronavirus disease 2019 (COVID-19) vaccine, Ad26.COV2.S (Johnson & Johnson [Janssen]), in February 2021. We evaluated Ad26.COV2.S vaccine effectiveness (VE) against COVID-19 hospitalization and high disease severity during the first 10 months of its use. Methods . In a multicenter case-control analysis of US adults (≥18 years) hospitalized 11 March to 15 December 2021, we estimated VE against susceptibility to COVID-19 hospitalization (VEs), comparing odds of prior vaccination with a single dose Ad26.COV2.S vaccine between hospitalized cases with COVID-19 and controls without COVID-19. Among hospitalized patients with COVID-19, we estimated VE against disease progression (VEp) to death or invasive mechanical ventilation (IMV), comparing odds of prior vaccination between patients with and without progression. Results . After excluding patients receiving mRNA vaccines, among 3979 COVID-19 case-patients (5% vaccinated with Ad26.COV2.S) and 2229 controls (13% vaccinated with Ad26.COV2.S), VEs of Ad26.COV2.S against COVID-19 hospitalization was 70% (95% confidence interval [CI]: 63-75%) overall, including 55% (29-72%) among immunocompromised patients, and 72% (64-77%) among immunocompetent patients, for whom VEs was similar at 14-90 days (73% [59-82%]), 91-180 days (71% [60-80%]), and 181-274 days (70% [54-81%]) postvaccination. Among hospitalized COVID-19 case-patients, VEp was 46% (18-65%) among immunocompetent patients. Conclusions . The Ad26.COV2.S COVID-19 vaccine reduced the risk of COVID-19 hospitalization by 72% among immunocompetent adults without waning through 6 months postvaccination. After hospitalization for COVID-19, vaccinated immunocompetent patients were less likely to require IMV or die compared to unvaccinated immunocompetent patients.
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Affiliation(s)
- Nathaniel M. Lewis
- Corresponding Author Nathaniel M. Lewis, Influenza Prevention and Control Team, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop 46 24/7, Atlanta, Georgia, 30329 ()
| | - Wesley H. Self
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas, USA,Texas A&M University College of Medicine, Temple, Texas, USA
| | - Adit A. Ginde
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David J. Douin
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - H. Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | | | | | - Kevin W. Gibbs
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - D. Clark Files
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | | | - Arber Shehu
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | - Michelle N. Gong
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | - Ithan D. Peltan
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M. Brown
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Emily T. Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Arnold S. Monto
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Akram Khan
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | | | | | | | | | - Nida Qadir
- David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | - Steven Y. Chang
- David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | | | | | | | | | | | - Adam S. Lauring
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Todd W. Rice
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ian D. Jones
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | | | | | - Yuwei Zhu
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Lewis NM, Naioti EA, Self WH, Ginde AA, Douin DJ, Keipp Talbot H, Casey JD, Mohr NM, Zepeski A, Gaglani M, Ghamande SA, McNeal T, Shapiro NI, Gibbs KW, Clark Files D, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Henning DJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Hubel K, Hough CL, Busse LW, ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Rhoads JP, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Schrag SJ, Kobayashi M, Verani JR, Patel MM, Tenforde MW. Effectiveness of mRNA Vaccines Against COVID-19 Hospitalization by Age and Chronic Medical Conditions Burden Among Immunocompetent US Adults, March-August 2021. J Infect Dis 2022; 225:1694-1700. [PMID: 34932114 PMCID: PMC9113447 DOI: 10.1093/infdis/jiab619] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/16/2021] [Indexed: 11/15/2022] Open
Abstract
Vaccine effectiveness (VE) against COVID-19 hospitalization was evaluated among immunocompetent adults (≥18 years) during March-August 2021 using a case-control design. Among 1669 hospitalized COVID-19 cases (11% fully vaccinated) and 1950 RT-PCR-negative controls (54% fully vaccinated), VE was 96% (95% confidence interval [CI], 93%-98%) among patients with no chronic medical conditions and 83% (95% CI, 76%-88%) among patients with ≥ 3 categories of conditions. VE was similar between those aged 18-64 years versus ≥65 years (P > .05). VE against severe COVID-19 was very high among adults without chronic conditions and lessened with increasing comorbidity burden.
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Affiliation(s)
- Nathaniel M Lewis
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Eric A Naioti
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adit A Ginde
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David J Douin
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas, USA
- Texas A&M University College of Medicine, Temple, Texas, USA
| | | | | | - Nathan I Shapiro
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin W Gibbs
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - D Clark Files
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | | | - Arber Shehu
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | - Michelle N Gong
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amira Mohamed
- Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel J Henning
- University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Ithan D Peltan
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Samuel M Brown
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kinsley Hubel
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Catherine L Hough
- Oregon Health and Science University Hospital, Portland, Oregon, USA
| | | | | | | | | | | | - Nida Qadir
- David Geffen School of Medicine at University of California Los Angeles, Ronald Reagan-University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Steven Y Chang
- David Geffen School of Medicine at University of California Los Angeles, Ronald Reagan-University of California Los Angeles Medical Center, Los Angeles, California, USA
| | | | | | | | | | - Matthew C Exline
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Adam S Lauring
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | | | - Todd W Rice
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | - Kelsey N Womack
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Kimberly W Hart
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuwei Zhu
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephanie J Schrag
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Miwako Kobayashi
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Jennifer R Verani
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Manish M Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
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Tenforde MW, Patel MM, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, Gaglani M, McNeal T, Ghamande S, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Exline MC, Gong MN, Mohamed A, Henning DJ, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CT, Busse L, ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Gershengorn HB, Babcock HM, Kwon JH, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Olson SM, Stephenson M, Schrag SJ, Kobayashi M, Verani JR, Self WH. Effectiveness of Severe Acute Respiratory Syndrome Coronavirus 2 Messenger RNA Vaccines for Preventing Coronavirus Disease 2019 Hospitalizations in the United States. Clin Infect Dis 2022; 74:1515-1524. [PMID: 34358310 PMCID: PMC8436392 DOI: 10.1093/cid/ciab687] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination coverage increases in the United States, there is a need to understand the real-world effectiveness against severe coronavirus disease 2019 (COVID-19) and among people at increased risk for poor outcomes. METHODS In a multicenter case-control analysis of US adults hospitalized March 11-May 5, 2021, we evaluated vaccine effectiveness to prevent COVID-19 hospitalizations by comparing odds of prior vaccination with a messenger RNA (mRNA) vaccine (Pfizer-BioNTech or Moderna) between cases hospitalized with COVID-19 and hospital-based controls who tested negative for SARS-CoV-2. RESULTS Among 1212 participants, including 593 cases and 619 controls, median age was 58 years, 22.8% were Black, 13.9% were Hispanic, and 21.0% had immunosuppression. SARS-CoV-2 lineage B0.1.1.7 (Alpha) was the most common variant (67.9% of viruses with lineage determined). Full vaccination (receipt of 2 vaccine doses ≥14 days before illness onset) had been received by 8.2% of cases and 36.4% of controls. Overall vaccine effectiveness was 87.1% (95% confidence interval [CI], 80.7-91.3). Vaccine effectiveness was similar for Pfizer-BioNTech and Moderna vaccines, and highest in adults aged 18-49 years (97.4%; 95% CI, 79.3-9.7). Among 45 patients with vaccine-breakthrough COVID hospitalizations, 44 (97.8%) were ≥50 years old and 20 (44.4%) had immunosuppression. Vaccine effectiveness was lower among patients with immunosuppression (62.9%; 95% CI,20.8-82.6) than without immunosuppression (91.3%; 95% CI, 85.6-94.8). CONCLUSION During March-May 2021, SARS-CoV-2 mRNA vaccines were highly effective for preventing COVID-19 hospitalizations among US adults. SARS-CoV-2 vaccination was beneficial for patients with immunosuppression, but effectiveness was lower in the immunosuppressed population.
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Affiliation(s)
| | | | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado
| | - H Keipp Talbot
- Department of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa
| | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - D Clark Files
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arber Shehu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E Prekker
- Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Heidi L Erickson
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Daniel J Henning
- Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Ithan D Peltan
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Arnold S Monto
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - C Terri Hough
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - Laurence Busse
- Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Alexandra June Gordon
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, California
| | | | | | - Hilary M Babcock
- Department of Medicine, Washington University, St. Louis, Missouri
| | - Jennie H Kwon
- Department of Medicine, Washington University, St. Louis, Missouri
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam S Lauring
- Department of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W Rice
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ian D Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | | | - Wesley H Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
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Kaizer AM, Wild J, Lindsell CJ, Rice TW, Self WH, Brown S, Thompson BT, Hart KW, Smith C, Pulia MS, Shapiro NI, Ginde AA. Trial of Early Antiviral Therapies during Non-hospitalized Outpatient Window (TREAT NOW) for COVID-19: a summary of the protocol and analysis plan for a decentralized randomized controlled trial. Trials 2022; 23:273. [PMID: 35395957 PMCID: PMC8990452 DOI: 10.1186/s13063-022-06213-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has a heterogeneous outcome in individuals from remaining asymptomatic to death. In a majority of cases, mild symptoms are present that do not require hospitalization and can be successfully treated in the outpatient setting, though symptoms may persist for a long duration. We hypothesize that drugs suitable for decentralized study in outpatients will have efficacy among infected outpatients Methods The TREAT NOW platform is designed to accommodate testing multiple agents with the ability to incorporate new agents in the future. TREAT NOW is an adaptive, blinded, multi-center, placebo-controlled superiority randomized clinical trial which started with two active therapies (hydroxychloroquine and lopinavir/ritonavir) and placebo, with the hydroxychloroquine arm dropped shortly after enrollment began due to external evidence. Each arm has a target enrollment of 300 participants who will be randomly assigned in an equal allocation to receive either an active therapy or placebo twice daily for 14 days with daily electronic surveys collected over days 1 through 16 and on day 29 to evaluate symptoms and a modified COVID-19 ordinal outcome scale. Participants are enrolled remotely by telephone and consented with a digital interface, study drug is overnight mailed to study participants, and data collection occurs electronically without in-person interactions. Discussion If effective treatments for COVID-19 can be identified for individuals in the outpatient setting before they advance to severe disease, it will prevent progression to more severe disease, reduce the need for hospitalization, and shorten the duration of symptoms. The novel decentralized, “no touch” approach used by the TREAT NOW platform has distinction advantages over traditional in-person trials to reach broader populations and perform study procedures in a pragmatic yet rigorous manner. Trial registration ClinicalTrials.gov NCT04372628. Registered on April 30, 2020. First posted on May 4, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06213-z.
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Affiliation(s)
- Alexander M Kaizer
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, USA.
| | - Jessica Wild
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, USA
| | | | - Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Wesley H Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, USA
| | - Samuel Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Salt Lake City, USA.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - B Taylor Thompson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University, Nashville, USA
| | - Clay Smith
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Michael S Pulia
- Departments of Emergency Medicine and Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USA
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Han JH, Womack KN, Tenforde MW, Files DC, Gibbs KW, Shapiro NI, Prekker ME, Erickson HL, Steingrub JS, Qadir N, Khan A, Hough CL, Johnson NJ, Ely EW, Rice TW, Casey JD, Lindsell CJ, Gong MN, Srinivasan V, Lewis NM, Patel MM, Self WH. Associations between persistent symptoms after mild COVID‐19 and long‐term health status, quality of life, and psychological distress. Influenza Other Respir Viruses 2022; 16:680-689. [PMID: 35347854 PMCID: PMC9111447 DOI: 10.1111/irv.12980] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
Background We sought to assess whether persistent COVID‐19 symptoms beyond 6 months (Long‐COVID) among patients with mild COVID‐19 is associated with poorer health status, quality of life, and psychological distress. Methods This was a multicenter prospective cohort study that included adult outpatients with acute COVID‐19 from eight sites during 2‐week sampling periods from April 1 and July 28, 2020. Participants were contacted 6–11 months after their first positive SARS‐CoV‐2 to complete a survey, which collected information on the severity of eight COVID‐19 symptoms using a 4‐point scale ranging from 0 (not present) to 3 (severe) at 1 month before COVID‐19 (pre‐illness) and at follow‐up; the difference for each was calculated as an attributable persistent symptom severity score. A total attributable persistent COVID‐19 symptom burden score was calculated by summing the attributable persistent severity scores for all eight symptoms. Outcomes measured at long‐term follow‐up comprised overall health status (EuroQol visual analogue scale), quality of life (EQ‐5D‐5L), and psychological distress (Patient Health Questionnaire‐4). The association between the total attributable persistent COVID‐19 burden score and each outcome was analyzed using multivariable proportional odds regression. Results Of the 2092 outpatients with COVID‐19, 436 (21%) responded to the survey. The median (IQR) attributable persistent COVID‐19 symptom burden score was 2 (0, 4); higher scores were associated with lower overall health status (aOR 0.63; 95% CI: 0.57–0.69), lower quality of life (aOR: 0.65; 95%CI: 0.59–0.72), and higher psychological distress (aOR: 1.40; 95%CI, 1.28–1.54) after adjusting for age, race, ethnicity, education, and income. Conclusions In participants with mild acute COVID‐19, the burden of persistent symptoms was significantly associated with poorer long‐term health status, poorer quality of life, and psychological distress.
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Affiliation(s)
- Jin H. Han
- Vanderbilt University Medical Center Nashville Tennessee USA
- Geriatric Research, Education, and Clinical Center Tennessee Valley Healthcare System Nashville Tennessee USA
| | | | - Mark W. Tenforde
- CDC COVID‐19 Response Team Centers for Disease Control and Prevention Atlanta Georgia USA
| | - D. Clark Files
- Wake Forest University Baptist Medical Center Winston‐Salem North Carolina USA
| | - Kevin W. Gibbs
- Wake Forest University Baptist Medical Center Winston‐Salem North Carolina USA
| | | | | | | | | | - Nida Qadir
- UCLA Medical Center Los Angeles California USA
| | - Akram Khan
- Oregon Health & Sciences University Portland Oregon USA
| | | | | | - E. Wesley Ely
- Vanderbilt University Medical Center Nashville Tennessee USA
- Geriatric Research, Education, and Clinical Center Tennessee Valley Healthcare System Nashville Tennessee USA
| | - Todd W. Rice
- Vanderbilt University Medical Center Nashville Tennessee USA
| | | | | | | | | | - Nathaniel M. Lewis
- CDC COVID‐19 Response Team Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Manish M. Patel
- CDC COVID‐19 Response Team Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Wesley H. Self
- Vanderbilt University Medical Center Nashville Tennessee USA
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Tenforde MW, Self WH, Gaglani M, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Frosch AE, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Botros M, Lauring AS, Shapiro NI, Halasa N, Chappell JD, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Lindsell CJ, Hart KW, Zhu Y, Adams K, Surie D, McMorrow ML, Patel MM. Effectiveness of mRNA Vaccination in Preventing COVID-19-Associated Invasive Mechanical Ventilation and Death - United States, March 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:459-465. [PMID: 35324878 PMCID: PMC8956334 DOI: 10.15585/mmwr.mm7112e1] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Lauring AS, Tenforde MW, Chappell JD, Gaglani M, Ginde AA, McNeal T, Ghamande S, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Exline MC, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, Ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Halasa N, Grijalva CG, Rice TW, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Lindsell CJ, Hart KW, Zhu Y, Adams K, Schrag SJ, Olson SM, Kobayashi M, Verani JR, Patel MM, Self WH. Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study. BMJ 2022; 376:e069761. [PMID: 35264324 PMCID: PMC8905308 DOI: 10.1136/bmj-2021-069761] [Citation(s) in RCA: 290] [Impact Index Per Article: 145.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To characterize the clinical severity of covid-19 associated with the alpha, delta, and omicron SARS-CoV-2 variants among adults admitted to hospital and to compare the effectiveness of mRNA vaccines to prevent hospital admissions related to each variant. DESIGN Case-control study. SETTING 21 hospitals across the United States. PARTICIPANTS 11 690 adults (≥18 years) admitted to hospital: 5728 with covid-19 (cases) and 5962 without covid-19 (controls). Patients were classified into SARS-CoV-2 variant groups based on viral whole genome sequencing, and, if sequencing did not reveal a lineage, by the predominant circulating variant at the time of hospital admission: alpha (11 March to 3 July 2021), delta (4 July to 25 December 2021), and omicron (26 December 2021 to 14 January 2022). MAIN OUTCOME MEASURES Vaccine effectiveness calculated using a test negative design for mRNA vaccines to prevent covid-19 related hospital admissions by each variant (alpha, delta, omicron). Among patients admitted to hospital with covid-19, disease severity on the World Health Organization's clinical progression scale was compared among variants using proportional odds regression. RESULTS Effectiveness of the mRNA vaccines to prevent covid-19 associated hospital admissions was 85% (95% confidence interval 82% to 88%) for two vaccine doses against the alpha variant, 85% (83% to 87%) for two doses against the delta variant, 94% (92% to 95%) for three doses against the delta variant, 65% (51% to 75%) for two doses against the omicron variant; and 86% (77% to 91%) for three doses against the omicron variant. In-hospital mortality was 7.6% (81/1060) for alpha, 12.2% (461/3788) for delta, and 7.1% (40/565) for omicron. Among unvaccinated patients with covid-19 admitted to hospital, severity on the WHO clinical progression scale was higher for the delta versus alpha variant (adjusted proportional odds ratio 1.28, 95% confidence interval 1.11 to 1.46), and lower for the omicron versus delta variant (0.61, 0.49 to 0.77). Compared with unvaccinated patients, severity was lower for vaccinated patients for each variant, including alpha (adjusted proportional odds ratio 0.33, 0.23 to 0.49), delta (0.44, 0.37 to 0.51), and omicron (0.61, 0.44 to 0.85). CONCLUSIONS mRNA vaccines were found to be highly effective in preventing covid-19 associated hospital admissions related to the alpha, delta, and omicron variants, but three vaccine doses were required to achieve protection against omicron similar to the protection that two doses provided against the delta and alpha variants. Among adults admitted to hospital with covid-19, the omicron variant was associated with less severe disease than the delta variant but still resulted in substantial morbidity and mortality. Vaccinated patients admitted to hospital with covid-19 had significantly lower disease severity than unvaccinated patients for all the variants.
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Affiliation(s)
- Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | | | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tresa McNeal
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, USA
| | - Shekhar Ghamande
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, USA
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - H Keipp Talbot
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan D Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA
| | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, USA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - D Clark Files
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David N Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arber Shehu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Heidi L Erickson
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Matthew C Exline
- Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Amira Mohamed
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Nicholas J Johnson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Vasisht Srinivasan
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA
| | - Jay S Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, MA, USA
| | - Ithan D Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA
| | - Emily T Martin
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Arnold S Monto
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - Catherine L Hough
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | | | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Jennifer G Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexandra June Gordon
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nida Qadir
- Department of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Steven Y Chang
- Department of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | | | - Carolina Rivas
- Department of Medicine, University of Miami, Miami, FL, USA
| | - Hilary M Babcock
- Department of Medicine, Washington University, St Louis, MI, USA
| | - Jennie H Kwon
- Department of Medicine, Washington University, St Louis, MI, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd W Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelsey N Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jillian P Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | | | | | | | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
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Hudson MF, Strassels SA, Durham DD, Siddique S, Adler D, Yeung SJ, Bernstein SL, Baugh CW, Coyne CJ, Grudzen CR, Henning DJ, Klotz A, Madsen TE, Pallin DJ, Rico JF, Ryan RJ, Shapiro NI, Swor R, Venkat A, Wilson J, Thomas CR, Bischof JJ, Lyman GH, Caterino JM. Examining pain among non-Hispanic Black and non-Hispanic White patients with cancer visiting emergency departments: CONCERN (Comprehensive Oncologic Emergencies Research Network). Acad Emerg Med 2022; 29:364-368. [PMID: 34606137 DOI: 10.1111/acem.14395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Scott A. Strassels
- Division of Pharmacy Atrium Health Charlotte North Carolina USA
- Department of Surgery The Ohio State University Columbus Ohio USA
| | - Danielle D. Durham
- Department of Radiology School of Medicine University of North Carolina Chapel Hill North Carolina USA
| | - Sunny Siddique
- Healthcare Delivery Research Program Division of Cancer Control and Population Sciences National Cancer Institute Rockville Maryland USA
| | - David Adler
- Department of Emergency Medicine University of Rochester Rochester New York USA
| | - Sai‐Ching J. Yeung
- Department of Emergency Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Steven L. Bernstein
- Department of Emergency Medicine Dartmouth Hitchcock Medical Center Hanover New Hampshire USA
| | - Christopher W. Baugh
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
| | - Christopher J. Coyne
- Department of Emergency Medicine University of California San Diego San Diego California USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health New York University School of Medicine New York New York USA
| | - Daniel J. Henning
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | - Adam Klotz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Troy E. Madsen
- Division of Emergency Medicine University of Utah Salt Lake City, Utah USA
| | - Daniel J. Pallin
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
| | - Juan F. Rico
- Department of Pediatrics University of South Florida Morsani College of Medicine Tampa Florida USA
| | - Richard J. Ryan
- Department of Emergency Medicine University of Cincinnati Cincinnati Ohio USA
| | - Nathan I. Shapiro
- Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Robert Swor
- Department of Emergency Medicine William Beaumont Hospital Royal Oak Michigan USA
| | - Arvind Venkat
- Department of Emergency Medicine Allegheny Health Network Pittsburgh Pennsylvania USA
| | - Jason Wilson
- Department of Emergency Medicine University of South Florida Morsani College of Medicine Tampa Florida USA
| | - Charles R. Thomas
- Department of Radiation Medicine Knight Cancer Institute Oregon Health & Sciences University Portland Oregon USA
| | - Jason J. Bischof
- Department of Emergency Medicine The Ohio State University, Wexner Medical Center Columbus Ohio USA
| | - Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center and the Department of Medicine University of Washington School of Medicine Seattle Washington USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine The Ohio State University, Wexner Medical Center Columbus Ohio USA
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Yealy DM, Mohr NM, Shapiro NI, Self WH. In reply. Ann Emerg Med 2022; 79:319-320. [DOI: 10.1016/j.annemergmed.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 11/25/2022]
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Tenforde MW, Patel MM, Gaglani M, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, McNeal T, Ghamande S, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Botros M, Lauring AS, Shapiro NI, Halasa N, Chappell JD, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Lindsell CJ, Hart KW, Zhu Y, Naioti EA, Adams K, Lewis NM, Surie D, McMorrow ML, Self WH. Effectiveness of a Third Dose of Pfizer-BioNTech and Moderna Vaccines in Preventing COVID-19 Hospitalization Among Immunocompetent and Immunocompromised Adults - United States, August-December 2021. MMWR Morb Mortal Wkly Rep 2022; 71:118-124. [PMID: 35085218 PMCID: PMC9351530 DOI: 10.15585/mmwr.mm7104a2] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
COVID-19 mRNA vaccines (BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna]) provide protection against infection with SARS-CoV-2, the virus that causes COVID-19, and are highly effective against COVID-19-associated hospitalization among eligible persons who receive 2 doses (1,2). However, vaccine effectiveness (VE) among persons with immunocompromising conditions* is lower than that among immunocompetent persons (2), and VE declines after several months among all persons (3). On August 12, 2021, the Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for a third mRNA vaccine dose as part of a primary series ≥28 days after dose 2 for persons aged ≥12 years with immunocompromising conditions, and, on November 19, 2021, as a booster dose for all adults aged ≥18 years at least 6 months after dose 2, changed to ≥5 months after dose 2 on January 3, 2022 (4,5,6). Among 2,952 adults (including 1,385 COVID-19 case-patients and 1,567 COVID-19-negative controls) hospitalized at 21 U.S. hospitals during August 19-December 15, 2021, effectiveness of mRNA vaccines against COVID-19-associated hospitalization was compared between adults eligible for but who had not received a third vaccine dose (1,251) and vaccine-eligible adults who received a third dose ≥7 days before illness onset (312). Among 1,875 adults without immunocompromising conditions (including 1,065 [57%] unvaccinated, 679 [36%] 2-dose recipients, and 131 [7%] 3-dose [booster] recipients), VE against COVID-19 hospitalization was higher among those who received a booster dose (97%; 95% CI = 95%-99%) compared with that among 2-dose recipients (82%; 95% CI = 77%-86%) (p <0.001). Among 1,077 adults with immunocompromising conditions (including 324 [30%] unvaccinated, 572 [53%] 2-dose recipients, and 181 [17%] 3-dose recipients), VE was higher among those who received a third dose to complete a primary series (88%; 95% CI = 81%-93%) compared with 2-dose recipients (69%; 95% CI = 57%-78%) (p <0.001). Administration of a third COVID-19 mRNA vaccine dose as part of a primary series among immunocompromised adults, or as a booster dose among immunocompetent adults, provides improved protection against COVID-19-associated hospitalization.
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Tenforde MW, Self WH, Adams K, Gaglani M, Ginde AA, McNeal T, Ghamande S, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Exline MC, Gong MN, Mohamed A, Henning DJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Rhoads JP, Lindsell CJ, Hart KW, Zhu Y, Olson SM, Kobayashi M, Verani JR, Patel MM. Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity. JAMA 2021; 326:2043-2054. [PMID: 34734975 PMCID: PMC8569602 DOI: 10.1001/jama.2021.19499] [Citation(s) in RCA: 389] [Impact Index Per Article: 129.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022]
Abstract
Importance A comprehensive understanding of the benefits of COVID-19 vaccination requires consideration of disease attenuation, determined as whether people who develop COVID-19 despite vaccination have lower disease severity than unvaccinated people. Objective To evaluate the association between vaccination with mRNA COVID-19 vaccines-mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech)-and COVID-19 hospitalization, and, among patients hospitalized with COVID-19, the association with progression to critical disease. Design, Setting, and Participants A US 21-site case-control analysis of 4513 adults hospitalized between March 11 and August 15, 2021, with 28-day outcome data on death and mechanical ventilation available for patients enrolled through July 14, 2021. Date of final follow-up was August 8, 2021. Exposures COVID-19 vaccination. Main Outcomes and Measures Associations were evaluated between prior vaccination and (1) hospitalization for COVID-19, in which case patients were those hospitalized for COVID-19 and control patients were those hospitalized for an alternative diagnosis; and (2) disease progression among patients hospitalized for COVID-19, in which cases and controls were COVID-19 patients with and without progression to death or mechanical ventilation, respectively. Associations were measured with multivariable logistic regression. Results Among 4513 patients (median age, 59 years [IQR, 45-69]; 2202 [48.8%] women; 23.0% non-Hispanic Black individuals, 15.9% Hispanic individuals, and 20.1% with an immunocompromising condition), 1983 were case patients with COVID-19 and 2530 were controls without COVID-19. Unvaccinated patients accounted for 84.2% (1669/1983) of COVID-19 hospitalizations. Hospitalization for COVID-19 was significantly associated with decreased likelihood of vaccination (cases, 15.8%; controls, 54.8%; adjusted OR, 0.15; 95% CI, 0.13-0.18), including for sequenced SARS-CoV-2 Alpha (8.7% vs 51.7%; aOR, 0.10; 95% CI, 0.06-0.16) and Delta variants (21.9% vs 61.8%; aOR, 0.14; 95% CI, 0.10-0.21). This association was stronger for immunocompetent patients (11.2% vs 53.5%; aOR, 0.10; 95% CI, 0.09-0.13) than immunocompromised patients (40.1% vs 58.8%; aOR, 0.49; 95% CI, 0.35-0.69) (P < .001) and weaker at more than 120 days since vaccination with BNT162b2 (5.8% vs 11.5%; aOR, 0.36; 95% CI, 0.27-0.49) than with mRNA-1273 (1.9% vs 8.3%; aOR, 0.15; 95% CI, 0.09-0.23) (P < .001). Among 1197 patients hospitalized with COVID-19, death or invasive mechanical ventilation by day 28 was associated with decreased likelihood of vaccination (12.0% vs 24.7%; aOR, 0.33; 95% CI, 0.19-0.58). Conclusions and Relevance Vaccination with an mRNA COVID-19 vaccine was significantly less likely among patients with COVID-19 hospitalization and disease progression to death or mechanical ventilation. These findings are consistent with risk reduction among vaccine breakthrough infections compared with absence of vaccination.
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Affiliation(s)
| | - Wesley H. Self
- Vanderbilt Institute for Clinical and Translational Research, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple
| | - Adit A. Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Tresa McNeal
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple
| | - Shekhar Ghamande
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple
| | - David J. Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora
| | - H. Keipp Talbot
- Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan D. Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Anne Zepeski
- Department of Emergency Medicine, University of Iowa, Iowa City
| | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kevin W. Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - D. Clark Files
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David N. Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arber Shehu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E. Prekker
- Departments of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Heidi L. Erickson
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | - Michelle N. Gong
- Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Jay S. Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Ithan D. Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah; and University of Utah, Salt Lake City
| | - Samuel M. Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah; and University of Utah, Salt Lake City
| | | | | | - Akram Khan
- Department of Medicine, Oregon Health & Science University, Portland
| | | | | | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer G. Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Alexandra June Gordon
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Nida Qadir
- Department of Medicine, University of California–Los Angeles, Los Angeles
| | - Steven Y. Chang
- Department of Medicine, University of California–Los Angeles, Los Angeles
| | | | - Carolina Rivas
- Department of Medicine, University of Miami, Miami, Florida
| | | | - Jennie H. Kwon
- Department of Medicine, Washington University, St Louis, Missouri
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam S. Lauring
- Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W. Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ian D. Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William B. Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelsey N. Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jillian P. Rhoads
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kimberly W. Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
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Klotz AD, Caterino JM, Durham D, Felipe Rico J, Pallin DJ, Grudzen CR, McNaughton C, Marcelin I, Abar B, Adler D, Bastani A, Bernstein SL, Bischof JJ, Coyne CJ, Henning DJ, Hudson MF, Lyman GH, Madsen TE, Reyes‐Gibby CC, Ryan RJ, Shapiro NI, Swor R, Thomas CR, Venkat A, Wilson J, Jim Yeung S, Yilmaz S, Stutman R, Baugh CW. Observation unit use among patients with cancer following emergency department visits: Results of a multicenter prospective cohort from CONCERN. Acad Emerg Med 2021; 29:174-183. [PMID: 34811858 PMCID: PMC10359998 DOI: 10.1111/acem.14392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/08/2021] [Accepted: 09/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Emergency department (ED) visits by patients with cancer frequently end in hospitalization. As concerns about ED and hospital crowding increase, observation unit care may be an important strategy to deliver safe and efficient treatment for eligible patients. In this investigation, we compared the prevalence and clinical characteristics of cancer patients who received observation unit care with those who were admitted to the hospital from the ED. METHODS We performed a multicenter prospective cohort study of patients with cancer presenting to an ED affiliated with one of 18 hospitals of the Comprehensive Oncologic Emergency Research Network (CONCERN) between March 1, 2016 and January 30, 2017. We compared patient characteristics with the prevalence of observation unit care usage, hospital admission, and length of stay. RESULTS Of 1051 enrolled patients, 596 (56.7%) were admitted as inpatients, and 72 (6.9%) were placed in an observation unit. For patients admitted as inpatients, 23.7% had a length of stay ≤2 days. The conversion rate from observation to inpatient was 17.1% (95% CI 14.6-19.4) among those receiving care in an observation unit. The average observation unit length of stay was 14.7 h. Patient factors associated ED disposition to observation unit care were female gender and low Charlson Comorbidity Index. CONCLUSION In this multicenter prospective cohort study, the discrepancy between observation unit care use and short inpatient hospitalization may represent underutilization of this resource and a target for process change.
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Affiliation(s)
- Adam D. Klotz
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Jeffrey M. Caterino
- Departments of Emergency Medicine and Internal Medicine Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Danielle Durham
- Department of Radiology School of Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
| | - Juan Felipe Rico
- Department of Pediatrics Morsani College of Medicine University of South Florida Tampa Florida USA
| | - Daniel J. Pallin
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health School of Medicine New York University New York New York USA
| | | | - Isabelle Marcelin
- Ronald O. Perelman Department of Emergency Medicine and Population Health School of Medicine New York University New York New York USA
| | - Beau Abar
- Department of Emergency Medicine University of Rochester Rochester New York USA
| | - David Adler
- Department of Emergency Medicine University of Rochester Rochester New York USA
| | - Aveh Bastani
- Department of Emergency Medicine William Beaumont Hospital Troy Michigan USA
| | - Steven L. Bernstein
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
| | - Jason J. Bischof
- Department of Emergency Medicine Wexner Medical Center The Ohio State University Columbus Ohio USA
| | - Christopher J. Coyne
- Department of Emergency Medicine University of California San Diego San Diego California USA
| | - Daniel J. Henning
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center and the Department of Medicine Hutchinson Institute for Cancer Outcomes Research University of Washington School of Medicine Seattle Washington USA
| | - Troy E. Madsen
- Division of Emergency Medicine University of Utah Salt Lake City Utah USA
| | - Cielito C. Reyes‐Gibby
- Department of Emergency Medicine and Biostatistics The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Richard J. Ryan
- Department of Emergency Medicine University of Cincinnati Cincinnati Ohio USA
| | - Nathan I. Shapiro
- Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Robert Swor
- Department of Emergency Medicine William Beaumont Hospital Royal Oak Michigan USA
| | - Charles R. Thomas
- Department of Radiation Medicine Knight Cancer Institute Oregon Health & Sciences University Portland Oregon USA
| | - Arvind Venkat
- Department of Emergency Medicine Allegheny Health Network Pittsburgh Pennsylvania USA
| | - Jason Wilson
- Department of Emergency Medicine Morsani College of Medicine University of South Florida Tampa Florida USA
| | - Sai‐Ching Jim Yeung
- Department of Emergency Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Sule Yilmaz
- Department of Geriatric Oncology University of Rochester Medical center Rochester New York USA
| | - Robin Stutman
- Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Christopher W. Baugh
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
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45
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Schmaier AA, Pajares Hurtado GM, Manickas-Hill ZJ, Sack KD, Chen SM, Bhambhani V, Quadir J, Nath AK, Collier ARY, Ngo D, Barouch DH, Shapiro NI, Gerszten RE, Yu XG, Peters KG, Flaumenhaft R, Parikh SM. Tie2 activation protects against prothrombotic endothelial dysfunction in COVID-19. JCI Insight 2021; 6:e151527. [PMID: 34506304 PMCID: PMC8564889 DOI: 10.1172/jci.insight.151527] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/09/2021] [Indexed: 12/27/2022] Open
Abstract
Endothelial dysfunction accompanies the microvascular thrombosis commonly observed in severe COVID-19. Constitutively, the endothelial surface is anticoagulant, a property maintained at least in part via signaling through the Tie2 receptor. During inflammation, the Tie2 antagonist angiopoietin-2 (Angpt-2) is released from endothelial cells and inhibits Tie2, promoting a prothrombotic phenotypic shift. We sought to assess whether severe COVID-19 is associated with procoagulant endothelial dysfunction and alterations in the Tie2/angiopoietin axis. Primary HUVECs treated with plasma from patients with severe COVID-19 upregulated the expression of thromboinflammatory genes, inhibited the expression of antithrombotic genes, and promoted coagulation on the endothelial surface. Pharmacologic activation of Tie2 with the small molecule AKB-9778 reversed the prothrombotic state induced by COVID-19 plasma in primary endothelial cells. Lung autopsies from patients with COVID-19 demonstrated a prothrombotic endothelial signature. Assessment of circulating endothelial markers in a cohort of 98 patients with mild, moderate, or severe COVID-19 revealed endothelial dysfunction indicative of a prothrombotic state. Angpt-2 concentrations rose with increasing disease severity, and the highest levels were associated with worse survival. These data highlight the disruption of Tie2/angiopoietin signaling and procoagulant changes in endothelial cells in severe COVID-19. Our findings provide rationale for current trials of Tie2-activating therapy with AKB-9778 in COVID-19.
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Affiliation(s)
- Alec A. Schmaier
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Kelsey D. Sack
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Siyu M. Chen
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Victoria Bhambhani
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Juweria Quadir
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anjali K. Nath
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Debby Ngo
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Dan H. Barouch
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Center for Virology and Vaccine Research, and
| | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert E. Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Xu G. Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Diseases Division, Brigham and Women’s Hospital and Harvard Medical School, Massachusetts, Boston USA
| | - MGH COVID-19 Collection and Processing Team
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- The MGH COVID-19 Collection and Processing Team is detailed in Supplemental Acknowledgments
| | | | | | - Samir M. Parikh
- Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
- Division of Nephrology, University of Texas Southwestern, Dallas, Texas, USA
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Yealy DM, Mohr NM, Shapiro NI, Self WH. In Reply to Ivor Douglas Letter to the Editor 2021-1053. Ann Emerg Med 2021; 78:573. [PMID: 34563305 DOI: 10.1016/j.annemergmed.2021.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Donald M Yealy
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Nathan I Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN
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47
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Tenforde MW, Self WH, Naioti EA, Ginde AA, Douin DJ, Olson SM, Talbot HK, Casey JD, Mohr NM, Zepeski A, Gaglani M, McNeal T, Ghamande S, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Gong MN, Mohamed A, Henning DJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CL, Busse LW, ten Lohuis CC, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Rivas C, Babcock HM, Kwon JH, Exline MC, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Stephenson M, Schrag SJ, Kobayashi M, Verani JR, Patel MM. Sustained Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Associated Hospitalizations Among Adults - United States, March-July 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1156-1162. [PMID: 34437524 PMCID: PMC8389395 DOI: 10.15585/mmwr.mm7034e2] [Citation(s) in RCA: 155] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Real-world evaluations have demonstrated high effectiveness of vaccines against COVID-19-associated hospitalizations (1-4) measured shortly after vaccination; longer follow-up is needed to assess durability of protection. In an evaluation at 21 hospitals in 18 states, the duration of mRNA vaccine (Pfizer-BioNTech or Moderna) effectiveness (VE) against COVID-19-associated hospitalizations was assessed among adults aged ≥18 years. Among 3,089 hospitalized adults (including 1,194 COVID-19 case-patients and 1,895 non-COVID-19 control-patients), the median age was 59 years, 48.7% were female, and 21.1% had an immunocompromising condition. Overall, 141 (11.8%) case-patients and 988 (52.1%) controls were fully vaccinated (defined as receipt of the second dose of Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines ≥14 days before illness onset), with a median interval of 65 days (range = 14-166 days) after receipt of second dose. VE against COVID-19-associated hospitalization during the full surveillance period was 86% (95% confidence interval [CI] = 82%-88%) overall and 90% (95% CI = 87%-92%) among adults without immunocompromising conditions. VE against COVID-19- associated hospitalization was 86% (95% CI = 82%-90%) 2-12 weeks and 84% (95% CI = 77%-90%) 13-24 weeks from receipt of the second vaccine dose, with no significant change between these periods (p = 0.854). Whole genome sequencing of 454 case-patient specimens found that 242 (53.3%) belonged to the B.1.1.7 (Alpha) lineage and 74 (16.3%) to the B.1.617.2 (Delta) lineage. Effectiveness of mRNA vaccines against COVID-19-associated hospitalization was sustained over a 24-week period, including among groups at higher risk for severe COVID-19; ongoing monitoring is needed as new SARS-CoV-2 variants emerge. To reduce their risk for hospitalization, all eligible persons should be offered COVID-19 vaccination.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - IVY Network Investigators
- CDC COVID-19 Response Team; Vanderbilt University Medical Center, Nashville, Tennessee; University of Colorado School of Medicine, Aurora, Colorado; University of Iowa, Iowa City, Iowa; Baylor Scott & White Health, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; Johns Hopkins Hospital, Baltimore, Maryland; Hennepin County Medical Center, Minneapolis, Minnesota; Montefiore Healthcare Center, Albert Einstein College of Medicine, Bronx, New York; University of Washington School of Medicine, Seattle, Washington; Baystate Medical Center, Springfield, Massachusetts; Intermountain Medical Center and University of Utah, Salt Lake City, Utah; University of Michigan School of Public Health, Ann Arbor, Michigan; Oregon Health & Science University Hospital, Portland, Oregon; Emory University School of Medicine, Atlanta, Georgia; Cleveland Clinic, Cleveland, Ohio; Stanford University School of Medicine, Palo Alto, California; Ronald Reagan-UCLA Medical Center, Los Angeles, California; University of Miami, Miami, Florida; Washington University, St. Louis, Missouri; Ohio State University Wexner Medical Center, Columbus, Ohio; University of Michigan School of Medicine, Ann Arbor, Michigan
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Lytle KL, Collins SP, Feldstein LR, Baughman AH, Brown SM, Casey JD, Erickson HL, Exline MC, Files DC, Gibbs KW, Ginde AA, Gong MN, Grijalva CG, Khan A, Lindsell CJ, Peltan ID, Prekker ME, Rice TW, Shapiro NI, Steingrub JS, Stubblefield WB, Tenforde MW, Womack KN, Patel MM, Self WH. Influenza vaccine acceptance and hesitancy among adults hospitalized with severe acute respiratory illnesses, United States 2019-2020. Vaccine 2021; 39:5271-5276. [PMID: 34376307 DOI: 10.1016/j.vaccine.2021.07.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/24/2021] [Accepted: 07/20/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Understanding patient factors associated with not being vaccinated is essential for successful implementation of influenza vaccination programs. METHODS We enrolled adults hospitalized with severe acute respiratory illness at 10 United States (US) hospitals during the 2019-2020 influenza season. We interviewed patients to collect data about influenza vaccination, sociodemographic characteristics, and vaccine perceptions. RESULTS Among 679 participants, 264 (38.9%) reported not receiving influenza vaccination. Among those not vaccinated, 135 (51.1%) reported choosing not to receive a vaccine because of perceived ineffectiveness (36.7%) or risk (14.4%) of influenza vaccination. Sociodemographic factors associated with not being vaccinated included no medical insurance (aOR = 6.42; 95% CI: 2.52-16.38) and being non-White or Hispanic (aOR = 1.54, 95% CI: 1.02-2.32). CONCLUSIONS Optimizing uptake of influenza vaccination in the US may be improved by educational programs regarding vaccine safety and effectiveness and enhancing vaccine access, particularly among non-White and Hispanic Americans and those without medical insurance.
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Affiliation(s)
- Kelsey L Lytle
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sean P Collins
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Samuel M Brown
- Intermountain Medical Center and University of Utah, Salt Lake City, UT, USA
| | | | - Heidi L Erickson
- Hennepin County Medical Center and the University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - D Clark Files
- Wake Forest School of Medicine, Winston Salem North Carolina, USA
| | - Kevin W Gibbs
- Wake Forest School of Medicine, Winston Salem North Carolina, USA
| | - Adit A Ginde
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Michelle N Gong
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Akram Khan
- Oregon Health & Sciences University, Portland, OR, USA
| | | | - Ithan D Peltan
- Intermountain Medical Center and University of Utah, Salt Lake City, UT, USA
| | - Matthew E Prekker
- Hennepin County Medical Center and the University of Minnesota Medical School, Minneapolis, MN, USA
| | - Todd W Rice
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Mark W Tenforde
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Manish M Patel
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, TN, USA.
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Gootenberg DB, Kurtzman N, O'Mara T, Ge JY, Chiu D, Shapiro NI, Mechanic OJ, Dagan A. Developing a pulse oximetry home monitoring protocol for patients suspected with COVID-19 after emergency department discharge. BMJ Health Care Inform 2021; 28:bmjhci-2021-100330. [PMID: 34301725 PMCID: PMC8313308 DOI: 10.1136/bmjhci-2021-100330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/17/2021] [Indexed: 01/10/2023] Open
Abstract
Objectives Patients with COVID-19 can present to the emergency department (ED) without immediate indication for admission, but with concern for decompensation. Clinical experience has demonstrated that critical illness may present later in the disease course and hypoxia is often the first indication of disease progression. The objectives of this study are to (a) assess feasibility and describe a protocol for ED-based outpatient pulse-oximetry monitoring with structured follow-up and (b) determine rates of ED return, hospitalisation and hypoxia among participants. Methods Prospective observational study of patients presenting to a single academic ED in Boston with suspected COVID-19. Eligible patients were adults being discharged from the ED with presumed COVID-19. Exclusion criteria included resting oxygen saturation <92%, ambulatory oxygen saturation <90%, heart rate >110 beats per minute or inability to use the device. Study personnel made scripted phone calls on postdischarge days 1, 3 and 7 to review the pulse-oximetry readings and to evaluate for decompensation. Return visit and admission information were collected via medical record and 28-day follow-up calls. Results 81 patients were enrolled of which 10 (12%) developed hypoxia after their initial discharge from the ED. Overall, 23 (28%) of the 81 patients returned to the ED at least once and 10 of those who returned (43%) were admitted. We successfully contacted 76/81 (94%) of subjects via phone at least once for follow-up assessment. Discussion Patients are eager and willing to participate in home monitoring systems and are comfortable with using technology, which will allow providers and health systems to extend our hospitals capabilities for tracking patient populations in times of crisis. Conclusions It is feasible to implement an outpatient pulse-oximetry monitoring protocol to monitor patients discharged from the ED with confirmed or suspected COVID-19.
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Affiliation(s)
| | - Nicholas Kurtzman
- Harvard Medical School, Boston, Massachusetts, USA .,Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Thomas O'Mara
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Y Ge
- Harvard Medical School, Boston, Massachusetts, USA.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA
| | - David Chiu
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nathan I Shapiro
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Oren J Mechanic
- Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alon Dagan
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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50
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Sami S, Tenforde MW, Talbot HK, Lindsell CJ, Steingrub JS, Shapiro NI, Ginde AA, Douin DJ, Prekker ME, Erickson HL, Brown SM, Peltan ID, Gong MN, Khan A, Exline MC, Files DC, Gibbs KW, Rice TW, Casey JD, Grijalva CG, Stubblefield WB, Womack KN, Hager DN, Qadir N, Chang SY, Henning DJ, Wilson JG, Self WH, Patel MM. Adults Hospitalized With Coronavirus Disease 2019 (COVID-19)-United States, March-June and October-December 2020: Implications for the Potential Effects of COVID-19 Tier-1 Vaccination on Future Hospitalizations and Outcomes. Clin Infect Dis 2021; 73:S32-S37. [PMID: 33977301 PMCID: PMC8136001 DOI: 10.1093/cid/ciab319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Because of the increased risk for severe coronavirus disease 2019 (COVID-19), the Advisory Committee on Immunization Practices (ACIP) initially prioritized COVID-19 vaccination for persons in long-term care facilities (LTCF), persons aged ≥65 years, and persons aged 16-64 years with high-risk medical conditions when there is limited vaccine supply. We compared characteristics and severe outcomes of hospitalized patients with COVID-19 in the United States between early and later in the pandemic categorized by groups at higher risk of severe COVID-19. METHODS Observational study of sampled patients aged ≥18 years who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and admitted to one of 14 academic hospitals in the United States during March-June and October-December 2020. Demographic and clinical information were gathered from electronic health record data. RESULTS Among 647 patients, 91% met ≥1 of the following risk factors for severe COVID-19 [91% March-June (n = 434); 90% October-December (n = 213)]; 19% were LTCF residents, 45% were aged ≥65-years, and 84% had ≥1 high-risk condition. The proportion of patients who resided in a LTCF declined significantly (25% vs 6%) from early to later pandemic periods. Compared with patients at lower risk for severe COVID-19, in-hospital mortality was higher among patients at high risk for severe COVID-19 (20% vs 7%); these differences were consistently observed between March-June and October-December. CONCLUSIONS Most adults hospitalized with COVID-19 were those recommended to be prioritized for vaccination based on risk for developing severe COVID-19. These findings highlight the continued urgency to vaccinate patients at high risk for severe COVID-19 and monitor vaccination impact on hospitalizations and outcomes.
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Affiliation(s)
- Samira Sami
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Atlanta, Georgia, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Nathan I Shapiro
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Adit A Ginde
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David J Douin
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | | | - Michelle N Gong
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Akram Khan
- Oregon Health and Sciences University Hospital, Portland, Oregon, USA
| | - Matthew C Exline
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - D Clark Files
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Kevin W Gibbs
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Todd W Rice
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | | | - Kelsey N Womack
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Nida Qadir
- Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | - Steven Y Chang
- Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
| | | | | | - Wesley H Self
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manish M Patel
- CDC COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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