Alexandra Gordon

All Publications

• Vaccine Effectiveness Against Influenza A-Associated Hospitalization, Organ Failure, and Death: United States, 2022-2023. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Lewis, N. M., Zhu, Y., Peltan, I. D., Gaglani, M., McNeal, T., Ghamande, S., Steingrub, J. S., Shapiro, N. I., Duggal, A., Bender, W. S., Taghizadeh, L., Brown, S. M., Hager, D. N., Gong, M. N., Mohamed, A., Exline, M. C., Khan, A., Wilson, J. G., Qadir, N., Chang, S. Y., Ginde, A. A., Mohr, N. M., Mallow, C., Lauring, A. S., Johnson, N. J., Gibbs, K. W., Kwon, J. H., Columbus, C., Gottlieb, R. L., Raver, C., Vaughn, I. A., Ramesh, M., Johnson, C., Lamerato, L., Safdar, B., Casey, J. D., Rice, T. W., Halasa, N., Chappell, J. D., Grijalva, C. G., Talbot, H. K., Baughman, A., Womack, K. N., Swan, S. A., Harker, E., Price, A., DeCuir, J., Surie, D., Ellington, S., Self, W. H. 2023

  Abstract

  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.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.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.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.

  View details for DOI 10.1093/cid/ciad677

  View details for PubMedID 38051664

• Further advancing emergency department triage prediction. Resuscitation Levin, N. M., Gordon, A. J., Htet, N., Wilson, J. G. 2023; 191: 109930

  View details for DOI 10.1016/j.resuscitation.2023.109930

  View details for PubMedID 37748821

• 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. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Kojima, N., Adams, K., Self, W. H., Gaglani, M., McNeal, T., Ghamande, S., Steingrub, J. S., Shapiro, N. I., Duggal, A., Busse, L. W., Prekker, M. E., Peltan, I. D., Brown, S. M., Hager, D. N., Ali, H., Gong, M. N., Mohamed, A., Exline, M. C., Khan, A., Wilson, J. G., Qadir, N., Chang, S. Y., Ginde, A. A., Withers, C. A., Mohr, N. M., Mallow, C., Martin, E. T., Lauring, A. S., Johnson, N. J., Casey, J. D., Stubblefield, W. B., Gibbs, K. W., Kwon, J. H., Baughman, A., Chappell, J. D., Hart, K. W., Jones, I. D., Rhoads, J. P., Swan, S. A., Womack, K. N., Zhu, Y., Surie, D., McMorrow, M. L., Patel, M. M., Tenforde, M. W. 2023

  Abstract

  Understanding the changing epidemiology of adults hospitalized with coronavirus disease 2019 (COVID-19) informs research priorities and public health policies.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.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.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.

  View details for DOI 10.1093/cid/ciad276

  View details for PubMedID 37255285

• Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department. Critical care medicine Mitarai, T., Gordon, A. J., Nudelman, M. J., Urdaneta, A. E., Nesbitt, J. L., Niknam, K., Graber-Naidich, A., Wilson, J. G., Kohn, M. A. 2023

  Abstract

  OBJECTIVES: To determine whether implementation of an Emergency Critical Care Program (ECCP) is associated with improved survival and early downgrade of critically ill medical patients in the emergency department (ED).DESIGN: Single-center, retrospective cohort study using ED-visit data between 2015 and 2019.SETTING: Tertiary academic medical center.PATIENTS: Adult medical patients presenting to the ED with a critical care admission order within 12 hours of arrival.INTERVENTIONS: Dedicated bedside critical care for medical ICU patients by an ED-based intensivist following initial resuscitation by the ED team.MEASUREMENTS AND MAIN RESULTS: Primary outcomes were inhospital mortality and the proportion of patients downgraded to non-ICU status while in the ED within 6 hours of the critical care admission order (ED downgrade <6hr). A difference-in-differences (DiD) analysis compared the change in outcomes for patients arriving during ECCP hours (2 pm to midnight, weekdays) between the preintervention period (2015-2017) and the intervention period (2017-2019) to the change in outcomes for patients arriving during non-ECCP hours (all other hours). Adjustment for severity of illness was performed using the emergency critical care Sequential Organ Failure Assessment (eccSOFA) score. The primary cohort included 2,250 patients. The DiDs for the eccSOFA-adjusted inhospital mortality decreased by 6.0% (95% CI, -11.9 to -0.1) with largest difference in the intermediate illness severity group (DiD, -12.2%; 95% CI, -23.1 to -1.3). The increase in ED downgrade less than 6 hours was not statistically significant (DiD, 4.8%; 95% CI, -0.7 to 10.3%) except in the intermediate group (DiD, 8.8%; 95% CI, 0.2-17.4).CONCLUSIONS: The implementation of a novel ECCP was associated with a significant decrease in inhospital mortality among critically ill medical ED patients, with the greatest decrease observed in patients with intermediate severity of illness. Early ED downgrades also increased, but the difference was statistically significant only in the intermediate illness severity group.

  View details for DOI 10.1097/CCM.0000000000005835

  View details for PubMedID 37010317

• 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 infectious diseases Lewis, N. M., Murray, N., Adams, K., Surie, D., Gaglani, M., Ginde, A. A., McNeal, T., Ghamande, S., Douin, D. J., Talbot, H. K., Casey, J. D., Mohr, N. M., Zepeski, A., Shapiro, N. I., Gibbs, K. W., Files, D. C., Hager, D. N., Ali, H., Prekker, M. E., Frosch, A. E., Exline, M. C., Gong, M. N., Mohamed, A., Johnson, N. J., Srinivasan, V., Steingrub, J. S., Peltan, I. D., Brown, S. M., Martin, E. T., Monto, A. S., Lauring, A. S., Khan, A., Hough, C. L., Busse, L. W., Bender, W., Duggal, A., Wilson, J. G., Gordon, A. J., Qadir, N., Chang, S. Y., Mallow, C., Rivas, C., Babcock, H. M., Kwon, J. H., Chappell, J. D., Halasa, N., Grijalva, C. G., Rice, T. W., Stubblefield, W. B., Baughman, A., Lindsell, C. J., Hart, K. W., Rhoads, J. P., McMorrow, M. L., Tenforde, M. W., Self, W. H., Patel, M. M. 2023; 10 (1): ofac698

  Abstract

  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.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.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.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.

  View details for DOI 10.1093/ofid/ofac698

  View details for PubMedID 36695662

  View details for PubMedCentralID PMC9868348

• ASSOCIATION BETWEEN AN EMERGENCY CRITICAL CARE PROGRAM AND DKA CRITICAL CARE UTILIZATION IN THE ED Gupta, P., Gordon, A., Mitarai, T., Nudelman, M., Kohn, M., Wilson, J. LIPPINCOTT WILLIAMS & WILKINS. 2023: 129

  View details for Web of Science ID 000921450900252

• Comparison of test-negative and syndrome-negative controls in SARS-CoV-2 vaccine effectiveness evaluations for preventing COVID-19 hospitalizations in the United States. Vaccine Turbyfill, C., Adams, K., Tenforde, M. W., Murray, N. L., Gaglani, M., Ginde, A. A., McNeal, T., Ghamande, S., Douin, D. J., Keipp Talbot, H., Casey, J. D., Mohr, N. M., Zepeski, A., Shapiro, N. I., Gibbs, K. W., Clark Files, D., Hager, D. N., Shehu, A., Prekker, M. E., Frosch, A. E., Exline, M. C., Gong, M. N., Mohamed, A., Johnson, N. J., Srinivasan, V., Steingrub, J. S., Peltan, I. D., Brown, S. M., Martin, E. T., Lauring, A. S., Khan, A., Busse, L. W., Ten Lohuis, C. C., Duggal, A., Wilson, J. G., June Gordon, A., Qadir, N., Chang, S. Y., Mallow, C., Rivas, C., Kwon, J. H., Halasa, N., Chappell, J. D., Grijalva, C. G., Rice, T. W., Stubblefield, W. B., Baughman, A., Rhoads, J. P., Lindsell, C. J., Hart, K. W., McMorrow, M., Surie, D., Self, W. H., Patel, M. M. 2022; 40 (48): 6979-6986

  Abstract

  BACKGROUND: Test-negative design (TND) studies have produced validated estimates of vaccine effectiveness (VE) for influenza vaccine studies. However, syndrome-negative controls have been proposed for differentiating bias and true estimates in VE evaluations for COVID-19. To understand the use of alternative control groups, we compared characteristics and VE estimates of syndrome-negative and test-negative VE controls.METHODS: Adults hospitalized at 21 medical centers in 18 states March 11-August 31, 2021 were eligible for analysis. Case patients had symptomatic acute respiratory infection (ARI) and tested positive for SARS-CoV-2. Control groups were test-negative patients with ARI but negative SARS-CoV-2 testing, and syndrome-negative controls were without ARI and negative SARS-CoV-2 testing. Chi square and Wilcoxon rank sum tests were used to detect differences in baseline characteristics. VE against COVID-19 hospitalization was calculated using logistic regression comparing adjusted odds of prior mRNA vaccination between cases hospitalized with COVID-19 and each control group.RESULTS: 5811 adults (2726 cases, 1696 test-negative controls, and 1389 syndrome-negative controls) were included. Control groups differed across characteristics including age, race/ethnicity, employment, previous hospitalizations, medical conditions, and immunosuppression. However, control-group-specific VE estimates were very similar. Among immunocompetent patients aged 18-64years, VE was 93% (95% CI: 90-94) using syndrome-negative controls and 91% (95% CI: 88-93) using test-negative controls.CONCLUSIONS: Despite demographic and clinical differences between control groups, the use of either control group produced similar VE estimates across age groups and immunosuppression status. These findings support the use of test-negative controls and increase confidence in COVID-19 VE estimates produced by test-negative design studies.

  View details for DOI 10.1016/j.vaccine.2022.10.034

  View details for PubMedID 36374708

• 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. Morbidity and mortality weekly report Surie, D., Bonnell, L., Adams, K., Gaglani, M., Ginde, A. A., Douin, D. J., Talbot, H. K., Casey, J. D., Mohr, N. M., Zepeski, A., McNeal, T., Ghamande, S., Gibbs, K. W., Files, D. C., Hager, D. N., Shehu, A., Frosch, A. P., Erickson, H. L., Gong, M. N., Mohamed, A., Johnson, N. J., Srinivasan, V., Steingrub, J. S., Peltan, I. D., Brown, S. M., Martin, E. T., Khan, A., Bender, W. S., Duggal, A., Wilson, J. G., Qadir, N., Chang, S. Y., Mallow, C., Rivas, C., Kwon, J. H., Exline, M. C., Lauring, A. S., Shapiro, N. I., Halasa, N., Chappell, J. D., Grijalva, C. G., Rice, T. W., Stubblefield, W. B., Baughman, A., Womack, K. N., Hart, K. W., Swan, S. A., Zhu, Y., DeCuir, J., Tenforde, M. W., Patel, M. M., McMorrow, M. L., Self, W. H. 2022; 71 (42): 1327-1334

  Abstract

  The SARS-CoV-2 Omicron variant (B.1.1.529 or BA.1) became predominant in the United States by late December 2021 (1). BA.1 has since been replaced by emerging lineages BA.2 (including BA.2.12.1) in March 2022, followed by BA.4 and BA.5, which have accounted for a majority of SARS-CoV-2 infections since late June 2022 (1). Data on the effectiveness of monovalent mRNA COVID-19 vaccines against BA.4/BA.5-associated hospitalizations are limited, and their interpretation is complicated by waning of vaccine-induced immunity (2-5). Further, infections with earlier Omicron lineages, including BA.1 and BA.2, reduce vaccine effectiveness (VE) estimates because certain persons in the referent unvaccinated group have protection from infection-induced immunity. The IVY Network† assessed effectiveness of 2, 3, and 4 doses of monovalent mRNA vaccines compared with no vaccination against COVID-19-associated hospitalization among immunocompetent adults aged ≥18 years during December 26, 2021-August 31, 2022. During the BA.1/BA.2 period, VE 14-150 days after a second dose was 63% and decreased to 34% after 150 days. Similarly, VE 7-120 days after a third dose was 79% and decreased to 41% after 120 days. VE 7-120 days after a fourth dose was 61%. During the BA.4/BA.5 period, similar trends were observed, although CIs for VE estimates between categories of time since the last dose overlapped. VE 14-150 days and >150 days after a second dose was 83% and 37%, respectively. VE 7-120 days and >120 days after a third dose was 60%and 29%, respectively. VE 7-120 days after the fourth dose was 61%. Protection against COVID-19-associated hospitalization waned even after a third dose. The newly authorized bivalent COVID-19 vaccines include mRNA from the ancestral SARS-CoV-2 strain and from shared mRNA components between BA.4 and BA.5 lineages and are expected to be more immunogenic against BA.4/BA.5 than monovalent mRNA COVID-19 vaccines (6-8). All eligible adults aged ≥18 years§ should receive a booster dose, which currently consists of a bivalent mRNA vaccine, to maximize protection against BA.4/BA.5 and prevent COVID-19-associated hospitalization.

  View details for DOI 10.15585/mmwr.mm7142a3

  View details for PubMedID 36264830

  View details for PubMedCentralID PMC9590291

• Vaccine effectiveness of primary series and booster doses against covid-19 associated hospital admissions in the United States: living test negative design study. BMJ (Clinical research ed.) Adams, K., Rhoads, J. P., Surie, D., Gaglani, M., Ginde, A. A., McNeal, T., Talbot, H. K., Casey, J. D., Zepeski, A., Shapiro, N. I., Gibbs, K. W., Files, D. C., Hager, D. N., Frosch, A. E., Exline, M. C., Mohamed, A., Johnson, N. J., Steingrub, J. S., Peltan, I. D., Brown, S. M., Martin, E. T., Lauring, A. S., Khan, A., Busse, L. W., Duggal, A., Wilson, J. G., Chang, S. Y., Mallow, C., Kwon, J. H., Chappell, J. D., Halasa, N., Grijalva, C. G., Lindsell, C. J., Lester, S. N., Thornburg, N. J., Park, S., McMorrow, M. L., Patel, M. M., Tenforde, M. W., Self, W. H., Influenza and other Viruses in the AcutelY ill (IVY) Network, Ghamande, S., Calhoun, N., Murthy, K., Herrick, J., McKillop, A., Hoffman, E., Zayed, M., Smith, M., Kozikowski, L., De Souza, L., Ouellette, S., Bolstad, M., Coviello, B., Ciottone, R., Devilla, A., Grafals, A., Higgins, C., Ottanelli, C., Redman, K., Scaffidi, D., Weingart, A., Lewis, N., Mehkri, O., Mitchell, M., Griffith, Z., Brennan, C., Ashok, K., Poynter, B., Ten Lohuis, C., Stanley, N., Zhang, S., Prekker, M., Erickson, H., Hendrickson, A., Caspers, S., Tordsen, W., Kaus, O., Scharber, T., Lumpkin, J., Smith, C., Marshall, H., Shehu, A., Ali, H., Rothman, R. E., Mohamed, A., Nair, R., Chen, J. T., Karow, S., Robart, E., Maldonado, P. N., Khan, M., So, P., So, M., Schwartz, E., Botros, M., Hough, C. L., Jung, H., Martinez, J., Luong, A., Huynh, B., Ibrahim, H., Villanueva-Vargas, C., Villanueva-Vargas, J., Quadri, S., Gordon, A. J., Levitt, J., Perez, C., Visweswaran, A., Roque, J., Qadir, N., Frankel, T., Garner, O., Chandrasekaran, S., Douin, D., Jensen, K., Huynh, D., Steinwand, A., Withers, C., Mohr, N., Nassar, P., Landers, S., Nielsen, K., Briggs, N., Fairfield, C., Gershengorn, H., Rivas, C., Monto, A., McSpadden, E. J., Truscon, R., Kaniclides, A., Thomas, L., Bielak, R., Valvano, W. D., Fong, R., Fitzsimmons, W. J., Blair, C., Gilbert, J., Baker, L., Srinivasan, V., Crider, C. D., Steinbock, K. A., Paulsen, T. C., Anderson, L. A., Jones, I., Womack, K., Baughman, A., Kampe, C., Johnson, J., Hart, K., Rice, T., Stubblefield, W. B., Zhu, Y., Short, L. L., Ezzell, L. J., Whitsett, M. E., McHenry, R. E., Hargrave, S. J., Blair, M., Luther, J. L., Pulido, C. G., Peterson, B. P., LaRose, M., Landreth, L., Hicks, M., Parks, L., Babcock, H., Bongu, J., McDonald, D., Cass, C., Seiler, S., Park, D., Hink, T., Wallace, M., Burnham, C., Arter, O. G. 2022; 379: e072065

  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.

  View details for DOI 10.1136/bmj-2022-072065

  View details for PubMedID 36220174

• Effectiveness of the Ad26.COV2.S (Johnson & Johnson) COVID-19 Vaccine for Preventing COVID-19 Hospitalizations and Progression to High Disease Severity in the United States. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Lewis, N. M., Self, W. H., Gaglani, M., Ginde, A. A., Douin, D. J., Keipp Talbot, H., Casey, J. D., Mohr, N. M., Zepeski, A., Ghamande, S. A., McNeal, T. A., Shapiro, N. I., Gibbs, K. W., Files, D. C., Hager, D. N., Shehu, A., Prekker, M. E., Erickson, H. L., Gong, M. N., Mohamed, A., Johnson, N. J., Srinivasan, V., Steingrub, J. S., Peltan, I. D., Brown, A. M., Martin, E. T., Monto, A. S., Khan, A., Busse, L. W., Ten Lohuis, C. C., Duggal, B., Wilson, J. G., Gordon, A. J., Qadir, N., Chang, S. Y., Mallow, C., Rivas, C., Babcock, H. M., Kwon, J. H., Exline, M. C., Lauring, A. S., Halasa, N., Chappell, J. D., Grijalva, C. G., Rice, T. W., Rhoads, J. P., Jones, I. D., Stubblefield, W. B., Baughman, A., Womack, K. N., Lindsell, C. J., Hart, K. W., Zhu, Y., Adams, K., Patel, M. M., Tenforde, M. W. 2022

  Abstract

  Adults in the United States (US) began receiving the viral vector 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.In a multicenter case-control analysis of US adults (≥18 years) hospitalized March 11-December 15, 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.After excluding patients receiving mRNA vaccines, among 3,979 COVID-19 case-patients (5% vaccinated with Ad26.COV2.S) and 2.229 controls (13% vaccinated with Ad26.COV2.S), VEs of Ad26.COV2.S against COVID-19 hospitalization was 70% (95% 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%]) post-vaccination. Among hospitalized COVID-19 case-patients, VEp was 46% (18%-65%) among immunocompetent patients.The Ad26.COV2.S COVID-19 vaccine reduced the risk of COVID-19 hospitalization by 72% among immunocompetent adults without waning through 6 months post-vaccination. After hospitalization for COVID-19, vaccinated immunocompetent patients were less likely to require IMV or die compared to unvaccinated immunocompetent patients.

  View details for DOI 10.1093/cid/ciac439

  View details for PubMedID 35675695

• External validation of the 4C Mortality Score for hospitalised patients with COVID-19 in the RECOVER network. BMJ open Gordon, A. J., Govindarajan, P., Bennett, C. L., Matheson, L., Kohn, M. A., Camargo, C., Kline, J. 2022; 12 (4): e054700

  Abstract

  Estimating mortality risk in hospitalised SARS-CoV-2+ patients may help with choosing level of care and discussions with patients. The Coronavirus Clinical Characterisation Consortium Mortality Score (4C Score) is a promising COVID-19 mortality risk model. We examined the association of risk factors with 30-day mortality in hospitalised, full-code SARS-CoV-2+ patients and investigated the discrimination and calibration of the 4C Score. This was a retrospective cohort study of SARS-CoV-2+ hospitalised patients within the RECOVER (REgistry of suspected COVID-19 in EmeRgency care) network.99 emergency departments (EDs) across the USA.Patients ≥18 years old, positive for SARS-CoV-2 in the ED, and hospitalised.Death within 30 days of the index visit. We performed logistic regression analysis, reporting multivariable risk ratios (MVRRs) and calculated the area under the ROC curve (AUROC) and mean prediction error for the original 4C Score and after dropping the C reactive protein (CRP) component.Of 6802 hospitalised patients with COVID-19, 1149 (16.9%) died within 30 days. The 30-day mortality was increased with age 80+ years (MVRR=5.79, 95% CI 4.23 to 7.34); male sex (MVRR=1.17, 1.05 to 1.28); and nursing home/assisted living facility residence (MVRR=1.29, 1.1 to 1.48). The 4C Score had comparable discrimination in the RECOVER dataset compared with the original 4C validation dataset (AUROC: RECOVER 0.786 (95% CI 0.773 to 0.799), 4C validation 0.763 (95% CI 0.757 to 0.769). Score-specific mortalities in our sample were lower than in the 4C validation sample (mean prediction error 6.0%). Dropping the CRP component from the 4C Score did not substantially affect discrimination and 4C risk estimates were now close (mean prediction error 0.7%).We independently validated 4C Score as predicting risk of 30-day mortality in hospitalised SARS-CoV-2+ patients. We recommend dropping the CRP component of the score and using our recalibrated mortality risk estimates.

  View details for DOI 10.1136/bmjopen-2021-054700

  View details for PubMedID 35450898

• Selection bias in estimating the relationship between prolonged ED boarding and mortality in emergency critical care patients. Journal of the American College of Emergency Physicians open Gardner, K., Gordon, A. J., Shannon, B., Nesbitt, J., Wilson, J. G., Mitarai, T., Kohn, M. A. 2022; 3 (1): e12667

  Abstract

  Objectives: Studies have found that prolonged boarding time for intensive care unit (ICU) patients in the emergency department (ED) is associated with higher in-hospital mortality. However, these studies introduced selection bias by excluding patients with ICU admission orders who were downgraded and never arrived in the ICU. Consequently, they may overestimate mortality in prolonged ED boarders.Methods: This was a retrospective cohort study at a single center covering the period from August 14, 2015 to August 13, 2019. Adult ED patients with medical ICU admission orders and at least 6hours of subsequent critical care in either the ED or the ICU were included. Patients were classified as having either prolonged(>6hours) or non-prolonged (≤6hours) ED boarding. Downgraded patients were identified, and mortality was compared, both including and excluding downgraded patients.Results: Of 1862 patients, 612 (32.9%) had prolonged boarding; at 6hours after ICU admission order entry, they were still in the ED. The remaining 1250 (67.1%) had non-prolonged boarding; at 6hours after the ICU admission order entry, they were already in the ICU. In-hospital mortality in the non-prolonged boarding group was 18.9%. In the prolonged boarding group, 296 (48.4%) patients were downgraded in the ED and never arrived in the ICU. Including these ED downgrades, the mortality in the prolonged boarding group was 13.4% (risk difference -5.5%, 95% confidence interval [CI] -8.9% to -2.0%, P=0.0031). When we excluded downgrades, the mortality in the prolonged boarding group increased to 17.4% (risk difference -1.5%, 95% CI -6.2% to 3.2%, P=0.5720). The lower mortality in the prolonged group was attributable to lower severity of illness (mean emergency critical care SOFA [eccSOFA] difference: -0.8, 95% CI -1.1 to -0.4, P<0.0001).Conclusions: Excluding critical care patients who were downgraded in the ED leads to selection bias and overestimation of mortality among prolonged ED boarders.

  View details for DOI 10.1002/emp2.12667

  View details for PubMedID 35128534

• 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-MORBIDITY AND MORTALITY WEEKLY REPORT Tenforde, M. W., Patel, M. M., Gaglani, M., Ginde, A. A., Douin, D. J., Talbot, H., Casey, J. D., Mohr, N. M., Zepeski, A., McNeal, T., Ghamande, S., Gibbs, K. W., Files, D., Hager, D. N., Shehu, A., Prekker, M. E., Erickson, H. L., Gong, M. N., Mohamed, A., Johnson, N. J., Srinivasan, V., Steingrub, J. S., Peltan, I. D., Brown, S. M., Martin, E. T., Monto, A. S., Khan, A., Hough, C. L., Busse, L. W., Duggal, A., Wilson, J. G., Qadir, N., Chang, S. Y., Mallow, C., Rivas, C., Babcock, H. M., Kwon, J. H., Exline, M. C., Botros, M., Lauring, A. S., Shapiro, N., Halasa, N., Chappell, J. D., Grijalva, C. G., Rice, T. W., Jones, I. D., Stubblefield, W. B., Baughman, A., Womack, K. N., Rhoads, J. P., Lindsell, C. J., Hart, K. W., Zhu, Y., Naioti, E. A., Adams, K., Lewis, N. M., Surie, D., McMorrow, M. L., Self, W. H., IVY Network 2022; 71 (4): 118-124

  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.

  View details for Web of Science ID 000748639100001

  View details for PubMedID 35085218

• 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 (Clinical research ed.) Lauring, A. S., Tenforde, M. W., Chappell, J. D., Gaglani, M., Ginde, A. A., McNeal, T., Ghamande, S., Douin, D. J., Talbot, H. K., Casey, J. D., Mohr, N. M., Zepeski, A., Shapiro, N. I., Gibbs, K. W., Files, D. C., Hager, D. N., Shehu, A., Prekker, M. E., Erickson, H. L., Exline, M. C., Gong, M. N., Mohamed, A., Johnson, N. J., Srinivasan, V., Steingrub, J. S., Peltan, I. D., Brown, S. M., Martin, E. T., Monto, A. S., Khan, A., Hough, C. L., Busse, L. W., Ten Lohuis, C. C., Duggal, A., Wilson, J. G., Gordon, A. J., Qadir, N., Chang, S. Y., Mallow, C., Rivas, C., Babcock, H. M., Kwon, J. H., Halasa, N., Grijalva, C. G., Rice, T. W., Stubblefield, W. B., Baughman, A., Womack, K. N., Rhoads, J. P., Lindsell, C. J., Hart, K. W., Zhu, Y., Adams, K., Schrag, S. J., Olson, S. M., Kobayashi, M., Verani, J. R., Patel, M. M., Self, W. H., Influenza and Other Viruses in the Acutely Ill (IVY) Network 2022; 376: e069761

  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: 11690 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.

  View details for DOI 10.1136/bmj-2021-069761

  View details for PubMedID 35264324

• Effectiveness of mRNA vaccines in preventing COVID-19 hospitalization by age and burden of chronic medical conditions among immunocompetent US adults, March-August 2021. The Journal of infectious diseases Lewis, N. M., Naioti, E. A., Self, W. H., Ginde, A. A., Douin, D. J., Talbot, H. K., Casey, J. D., Mohr, N. M., Zepeski, A., Gaglani, M., Ghamande, S. A., McNeal, T. A., Shapiro, N. I., Gibbs, K. W., Files, D. C., Hager, D. N., Shehu, A., Prekker, M. E., Erickson, H. L., Gong, M. N., Mohamed, A., Henning, D. J., Steingrub, J. S., Peltan, I. D., Brown, S. M., Martin, E. T., Hubel, K., Hough, C. L., Busse, L. W., Ten Lohuis, C. C., Duggal, A., Wilson, J. G., Gordon, A. J., Qadir, N., Chang, S. Y., Mallow, C., Rivas, C., Babcock, H. M., Kwon, J. H., Exline, M. C., Halasa, N., Chappell, J. D., Lauring, A. S., Grijalva, C. G., Rice, T. W., Rhoads, J. P., Stubblefield, W. B., Baughman, A., Womack, K. N., Lindsell, C. J., Hart, K. W., Zhu, Y., Schrag, S. J., Kobayashi, M., Verani, J. R., Patel, M. M., Tenforde, M. W. 1800

  Abstract

  In a multi-state network, vaccine effectiveness (VE) against COVID-19 hospitalizations 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 higher at 96% (95% CI: 93-98%) among patients with no chronic medical conditions than patients with ≥3 categories of conditions (83% [95% CI: 76-88%]). VE was similar between those aged 18-64 years vs ≥65 years (p>0.05). Vaccine effectiveness against severe COVID-19 was very high among adults without chronic conditions and lessened with increasing burden of comorbidities.

  View details for DOI 10.1093/infdis/jiab619

  View details for PubMedID 34932114

• Natural language processing of head CT reports to identify intracranial mass effect: CTIME algorithm. The American journal of emergency medicine Gordon, A. J., Banerjee, I., Block, J., Winstead-Derlega, C., Wilson, J. G., Mitarai, T., Jarrett, M., Sanyal, J., Rubin, D. L., Wintermark, M., Kohn, M. A. 2021; 51: 388-392

  Abstract

  BACKGROUND: The Mortality Probability Model (MPM) is used in research and quality improvement to adjust for severity of illness and can also inform triage decisions. However, a limitation for its automated use or application is that it includes the variable "intracranial mass effect" (IME), which requires human engagement with the electronic health record (EHR). We developed and tested a natural language processing (NLP) algorithm to identify IME from CT head reports.METHODS: We obtained initial CT head reports from adult patients who were admitted to the ICU from our ED between 10/2013 and 9/2016. Each head CT head report was labeled yes/no IME by at least two of five independent labelers. The reports were then randomly divided 80/20 into training and test sets. All reports were preprocessed to remove linguistic and style variability, and a dictionary was created to map similar common terms. We tested three vectorization strategies: Term Frequency-Inverse Document frequency (TF-IDF), Word2Vec, and Universal Sentence Encoder to convert the report text to a numerical vector. This vector served as the input to a classification-tree-based ensemble machine learning algorithm (XGBoost). After training, model performance was assessed in the test set using the area under the receiver operating characteristic curve (AUROC). We also divided the continuous range of scores into positive/inconclusive/negative categories for IME.RESULTS: Of the 1202 CT reports in the training set, 308 (25.6%) reports were manually labeled as "yes" for IME. Of the 355 reports in the test set, 108 (30.4%) were labeled as "yes" for IME. The TF-IDF vectorization strategy as an input for the XGBoost model had the best AUROC:-- 0.9625 (95% CI 0.9443-0.9807). TF-IDF score categories were defined and had the following likelihood ratios: "positive" (TF-IDF score>0.5) LR=24.59; "inconclusive" (TF-IDF 0.05-0.5) LR=0.99; and "negative" (TF-IDF<0.05) LR=0.05. 82% of reports were classified as either "positive" or "negative". In the test set, only 4 of 199 (2.0%) reports with a "negative" classification were false negatives and only 8 of 93 (8.6%) reports classified as "positive" were false positives.CONCLUSION: NLP can accurately identify IME from free-text reports of head CTs in approximately 80% of records, adequate to allow automatic calculation of MPM based on EHR data for many applications.

  View details for DOI 10.1016/j.ajem.2021.11.001

  View details for PubMedID 34839182

• Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity. JAMA Tenforde, M. W., Self, W. H., Adams, K., Gaglani, M., Ginde, A. A., McNeal, T., Ghamande, S., Douin, D. J., Talbot, H. K., Casey, J. D., Mohr, N. M., Zepeski, A., Shapiro, N. I., Gibbs, K. W., Files, D. C., Hager, D. N., Shehu, A., Prekker, M. E., Erickson, H. L., Exline, M. C., Gong, M. N., Mohamed, A., Henning, D. J., Steingrub, J. S., Peltan, I. D., Brown, S. M., Martin, E. T., Monto, A. S., Khan, A., Hough, C. L., Busse, L. W., Ten Lohuis, C. C., Duggal, A., Wilson, J. G., Gordon, A. J., Qadir, N., Chang, S. Y., Mallow, C., Rivas, C., Babcock, H. M., Kwon, J. H., Halasa, N., Chappell, J. D., Lauring, A. S., Grijalva, C. G., Rice, T. W., Jones, I. D., Stubblefield, W. B., Baughman, A., Womack, K. N., Rhoads, J. P., Lindsell, C. J., Hart, K. W., Zhu, Y., Olson, S. M., Kobayashi, M., Verani, J. R., Patel, M. M., Influenza and Other Viruses in the Acutely Ill (IVY) Network 2021

  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.

  View details for DOI 10.1001/jama.2021.19499

  View details for PubMedID 34734975

• Comparative Effectiveness of Moderna, Pfizer-BioNTech, and Janssen (Johnson & Johnson) Vaccines in Preventing COVID-19 Hospitalizations Among Adults Without Immunocompromising Conditions - United States, March-August 2021 MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT Self, W. H., Tenforde, M. W., Rhoads, J. P., Gaglani, M., Ginde, A. A., Douin, D. J., Olson, S. M., Talbot, K., Casey, J. D., Mohr, N. M., Zepeski, A., McNeal, T., Ghamande, S., Gibbs, K. W., Files, D., Hager, D. N., Shchu, A., Prekker, M. E., Erickson, H. L., Gong, M. N., Mohamed, A., Henning, D. J., Steingrub, J. S., Peltan, I. D., ten Lohuis, C. C., Duggal, A., Wilson, J. G., Gordon, A., Qadir, N., Chang, S. Y., Mallow, C., Rivas, C., Babcock, H. M., Kwon, J. H., Exline, M. C., Halasa, N., Chappell, J. D., Lauring, A. S., Grijalva, C. G., Rice, T. W., Jones, I. D., Stubblefield, W. B., Baughman, A., Womack, K. N., Lindsell, C. J., Hart, K. W., Zhu, Y., Mills, L., Lester, S. N., Stumpf, M. M., Naioti, E. A., Kobayashi, M., Verani, J. R., Thornburg, N. J., Patel, M. M., Brown, S. M., Martin, E. T., Monto, A. S., Khan, A., Hough, C. L., Busse, L. W., IVY Network 2021; 70 (38): 1337-1343

  Abstract

  Three COVID-19 vaccines are authorized or approved for use among adults in the United States (1,2). Two 2-dose mRNA vaccines, mRNA-1273 from Moderna and BNT162b2 from Pfizer-BioNTech, received Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) in December 2020 for persons aged ≥18 years and aged ≥16 years, respectively. A 1-dose viral vector vaccine (Ad26.COV2 from Janssen [Johnson & Johnson]) received EUA in February 2021 for persons aged ≥18 years (3). The Pfizer-BioNTech vaccine received FDA approval for persons aged ≥16 years on August 23, 2021 (4). Current guidelines from FDA and CDC recommend vaccination of eligible persons with one of these three products, without preference for any specific vaccine (4,5). To assess vaccine effectiveness (VE) of these three products in preventing COVID-19 hospitalization, CDC and collaborators conducted a case-control analysis among 3,689 adults aged ≥18 years who were hospitalized at 21 U.S. hospitals across 18 states during March 11-August 15, 2021. An additional analysis compared serum antibody levels (anti-spike immunoglobulin G [IgG] and anti-receptor binding domain [RBD] IgG) to SARS-CoV-2, the virus that causes COVID-19, among 100 healthy volunteers enrolled at three hospitals 2-6 weeks after full vaccination with the Moderna, Pfizer-BioNTech, or Janssen COVID-19 vaccine. Patients with immunocompromising conditions were excluded. VE against COVID-19 hospitalizations was higher for the Moderna vaccine (93%; 95% confidence interval [CI] = 91%-95%) than for the Pfizer-BioNTech vaccine (88%; 95% CI = 85%-91%) (p = 0.011); VE for both mRNA vaccines was higher than that for the Janssen vaccine (71%; 95% CI = 56%-81%) (all p<0.001). Protection for the Pfizer-BioNTech vaccine declined 4 months after vaccination. Postvaccination anti-spike IgG and anti-RBD IgG levels were significantly lower in persons vaccinated with the Janssen vaccine than the Moderna or Pfizer-BioNTech vaccines. Although these real-world data suggest some variation in levels of protection by vaccine, all FDA-approved or authorized COVID-19 vaccines provide substantial protection against COVID-19 hospitalization.

  View details for Web of Science ID 000701940200005

  View details for PubMedID 34555004

  View details for PubMedCentralID PMC8459899

• Point-of-Care Ultrasound Predicts Clinical Outcomes in Patients With COVID-19. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine Kumar, A., Weng, I., Graglia, S., Lew, T., Gandhi, K., Lalani, F., Chia, D., Duanmu, Y., Jensen, T., Lobo, V., Nahn, J., Iverson, N., Rosenthal, M., Gordon, A. J., Kugler, J. 2021

  Abstract

  OBJECTIVES: Point-of-care ultrasound (POCUS) detects the pulmonary manifestations of COVID-19 and may predict patient outcomes.METHODS: We conducted a prospective cohort study at four hospitals from March 2020 to January 2021 to evaluate lung POCUS and clinical outcomes of COVID-19. Inclusion criteria included adult patients hospitalized for COVID-19 who received lung POCUS with a 12-zone protocol. Each image was interpreted by two reviewers blinded to clinical outcomes. Our primary outcome was the need for intensive care unit (ICU) admission versus no ICU admission. Secondary outcomes included intubation and supplemental oxygen usage.RESULTS: N=160 patients were included. Among critically ill patients, B-lines (94 vs 76%; P<.01) and consolidations (70 vs 46%; P<.01) were more common. For scans collected within 24hours of admission (N=101 patients), early B-lines (odds ratio [OR] 4.41 [95% confidence interval, CI: 1.71-14.30]; P<.01) or consolidations (OR 2.49 [95% CI: 1.35-4.86]; P<.01) were predictive of ICU admission. Early consolidations were associated with oxygen usage after discharge (OR 2.16 [95% CI: 1.01-4.70]; P=.047). Patients with a normal scan within 24hours of admission were less likely to require ICU admission (OR 0.28 [95% CI: 0.09-0.75]; P<.01) or supplemental oxygen (OR 0.26 [95% CI: 0.11-0.61]; P<.01). Ultrasound findings did not dynamically change over a 28-day scanning window after symptom onset.CONCLUSIONS: Lung POCUS findings detected within 24hours of admission may provide expedient risk stratification for important COVID-19 clinical outcomes, including future ICU admission or need for supplemental oxygen. Conversely, a normal scan within 24hours of admission appears protective. POCUS findings appeared stable over a 28-day scanning window, suggesting that these findings, regardless of their timing, may have clinical implications.

  View details for DOI 10.1002/jum.15818

  View details for PubMedID 34468039

• Sustained Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Associated Hospitalizations Among Adults - United States, March-July 2021 MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT Tenforde, M. W., Self, W. H., Naioti, E. A., Ginde, A. A., Douin, D. J., Olson, S. M., Talbot, H., Casey, J. D., Mohr, N. M., Zepeski, A., Gaglani, M., McNeal, T., Ghamande, S., Shapiro, N. I., Gibbs, K. W., Files, D., Hager, D. N., Shehu, A., Prekker, M. E., Erickson, H. L., Gong, M. N., Mohamed, A., Henning, D. J., Steingrub, J. S., Peltan, I. D., Brown, S. M., Martin, E. T., Monto, A. S., Khan, A., Hough, C. L., Busse, L. W., ten Lohuis, C. C., Duggal, A., Wilson, J. G., Gordon, A., Qadir, N., Chang, S. Y., Mallow, C., Rivas, C., Babcock, H. M., Kwon, J. H., Exline, M. C., Halasa, N., Chappell, J. D., Lauring, A. S., Grijalva, C. G., Rice, T. W., Jones, I. D., Stubblefield, W. B., Baughman, A., Womack, K. N., Lindsell, C. J., Hart, K. W., Zhu, Y., Stephenson, M., Schrag, S. J., Kobayashi, M., Verani, J. R., Patel, M. M., IVY Network Investigators 2021; 70 (34): 1156-1162

  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.

  View details for Web of Science ID 000691315200005

  View details for PubMedID 34437524

• Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing Covid-19 Hospitalizations in the United States. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Tenforde, M. W., Patel, M. M., Ginde, A. A., Douin, D. J., Talbot, H. K., Casey, J. D., Mohr, N. M., Zepeski, A., Gaglani, M., McNeal, T., Ghamande, S., Shapiro, N. I., Gibbs, K. W., Files, D. C., Hager, D. N., Shehu, A., Prekker, M. E., Erickson, H. L., Exline, M. C., Gong, M. N., Mohamed, A., Henning, D. J., Peltan, I. D., Brown, S. M., Martin, E. T., Monto, A. S., Khan, A., Hough, C. T., Busse, L., Ten Lohuis, C. C., Duggal, A., Wilson, J. G., Gordon, A. J., Qadir, N., Chang, S. Y., Mallow, C., Gershengorn, H. B., Babcock, H. M., Kwon, J. H., Halasa, N., Chappell, J. D., Lauring, A. S., Grijalva, C. G., Rice, T. W., Jones, I. D., Stubblefield, W. B., Baughman, A., Womack, K. N., Lindsell, C. J., Hart, K. W., Zhu, Y., Olson, S. M., Stephenson, M., Schrag, S. J., Kobayashi, M., Verani, J. R., Self, W. H., Influenza and Other Viruses in the Acutely Ill (IVY) Network 2021

  Abstract

  BACKGROUND: As SARS-CoV-2 vaccination coverage increases in the United States (US), there is a need to understand the real-world effectiveness against severe 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 an 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 B.1.1.7 (Alpha) was the most common variant (67.9% of viruses with lineage determined). Full vaccination (receipt of two 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% CI: 80.7 to 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 to 99.7%). 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 to 82.6%) than without immunosuppression (91.3%; 95% CI: 85.6 to 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.

  View details for DOI 10.1093/cid/ciab687

  View details for PubMedID 34358310

• Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged >= 65 Years - United States, January-March 2021 MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT Tenforde, M. W., Olson, S. M., Self, W. H., Talbot, H., Lindsell, C. J., Steingrub, J. S., Shapiro, N., Ginde, A. A., Douin, D. J., Prekker, M. E., Brown, S. M., Peltan, I. D., Gong, M. N., Mohamed, A., Khan, A., Aline, M. C., Files, D., Gibbs, K. W., Stubblefield, W. B., Casey, J. D., Rice, T. W., Grijalva, C. G., Hager, D. N., Shehu, A., Qadir, N., Chang, S. Y., Wilson, J. G., Gaglani, M., Murthy, K., Calhoun, N., Monto, A. S., Martin, E. T., Malani, A., Zimmerman, R. K., Silveira, F. P., Middleton, D. B., Zhu, Y., Wyatt, D., Stephenson, M., Baughman, A., Womack, K. N., Hart, K. W., Kobayashi, M., Verani, J. R., Patel, M. M., IVY Network, HAIVEN Invest 2021; 70 (18): 674–79

  Abstract

  Adults aged ≥65 years are at increased risk for severe outcomes from COVID-19 and were identified as a priority group to receive the first COVID-19 vaccines approved for use under an Emergency Use Authorization (EUA) in the United States (1-3). In an evaluation at 24 hospitals in 14 states,* the effectiveness of partial or full vaccination† with Pfizer-BioNTech or Moderna vaccines against COVID-19-associated hospitalization was assessed among adults aged ≥65 years. Among 417 hospitalized adults aged ≥65 years (including 187 case-patients and 230 controls), the median age was 73 years, 48% were female, 73% were non-Hispanic White, 17% were non-Hispanic Black, 6% were Hispanic, and 4% lived in a long-term care facility. Adjusted vaccine effectiveness (VE) against COVID-19-associated hospitalization among adults aged ≥65 years was estimated to be 94% (95% confidence interval [CI] = 49%-99%) for full vaccination and 64% (95% CI = 28%-82%) for partial vaccination. These findings are consistent with efficacy determined from clinical trials in the subgroup of adults aged ≥65 years (4,5). This multisite U.S. evaluation under real-world conditions suggests that vaccination provided protection against COVID-19-associated hospitalization among adults aged ≥65 years. Vaccination is a critical tool for reducing severe COVID-19 in groups at high risk.

  View details for Web of Science ID 000647643800003

  View details for PubMedID 33956782

• Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing Covid-19 Hospitalizations in the United States. medRxiv : the preprint server for health sciences Tenforde, M. W., Patel, M. M., Ginde, A. A., Douin, D. J., Talbot, H. K., Casey, J. D., Mohr, N. M., Zepeski, A., Gaglani, M., McNeal, T., Ghamande, S., Shapiro, N. I., Gibbs, K. W., Files, D. C., Hager, D. N., Shehu, A., Prekker, M. E., Erickson, H. L., Exline, M. C., Gong, M. N., Mohamed, A., Henning, D. J., Steingrub, J. S., Peltan, I. D., Brown, S. M., Martin, E. T., Monto, A. S., Khan, A., Hough, C. T., Busse, L., Lohuis, C. C., Duggal, A., Wilson, J. G., Gordon, A. J., Qadir, N., Chang, S. Y., Mallow, C., Gershengorn, H. B., Babcock, H. M., Kwon, J. H., Halasa, N., Chappell, J. D., Lauring, A. S., Grijalva, C. G., Rice, T. W., Jones, I. D., Stubblefield, W. B., Baughman, A., Womack, K. N., Lindsell, C. J., Hart, K. W., Zhu, Y., Olson, S. M., Stephenson, M., Schrag, S. J., Kobayashi, M., Verani, J. R., Self, W. H. 2021

  Abstract

  As SARS-CoV-2 vaccination coverage increases in the United States (US), there is a need to understand the real-world effectiveness against severe Covid-19 and among people at increased risk for poor outcomes.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 an mRNA vaccine (Pfizer-BioNTech or Moderna) between cases hospitalized with Covid-19 and hospital-based controls who tested negative for SARS-CoV-2.Among 1210 participants, median age was 58 years, 22.8% were Black, 13.8% were Hispanic, and 20.6% had immunosuppression. SARS-CoV-2 lineage B.1.1.7 was most common variant (59.7% of sequenced viruses). Full vaccination (receipt of two vaccine doses ≥14 days before illness onset) had been received by 45/590 (7.6%) cases and 215/620 (34.7%) controls. Overall vaccine effectiveness was 86.9% (95% CI: 80.4 to 91.2%). Vaccine effectiveness was similar for Pfizer-BioNTech and Moderna vaccines, and highest in adults aged 18-49 years (97.3%; 95% CI: 78.9 to 99.7%). 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 (59.2%; 95% CI: 11.9 to 81.1%) than without immunosuppression (91.3%; 95% CI: 85.5 to 94.7%).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.

  View details for DOI 10.1101/2021.07.08.21259776

  View details for PubMedID 34268515

  View details for PubMedCentralID PMC8282104

• Owning the Trauma Bay: Teaching Trauma Resuscitation to Emergency Medicine Residents and Nurses through In-situ Simulation. Journal of education & teaching in emergency medicine Bellino, A., Gordon, A. J., Alvarez, A., Schertzer, K. 2020; 5 (4): S108-S148

  Abstract

  The following two cases were designed to address learning objectives specific to interns, junior residents, and senior residents in emergency medicine, as well as trauma-certified emergency nurses.Traumatic and unintentional injuries account for 5.8 million deaths across the globe each year, with a high proportion of those deaths occurring within the initial hour from the time of injury. This "golden hour" begins in the pre-hospital setting yet is predominantly spent in the emergency department (ED).1 Being able to effectively manage the multidisciplinary team required to care for trauma patients is crucial to providing timely and appropriate care. In-situ simulation, where the learning case is moved out of the simulation lab and into the typical workplace, has emerged as a powerful training tool for improving care-systems and team dynamics.2,3 Multiple specialties have shown in-situ simulation to be an effective strategy to teach both educational content as well as critical procedural and communication skills.4,5 In-situ simulation training has also been applied with similar success to trauma management, allowing for the simultaneous education of different learners with different roles in trauma resuscitations.6,7 We present two in-situ simulation cases with specific educational objectives and feedback mechanisms that allow for easy implementation of a cost-effective approach to training multidisciplinary emergency medicine providers in trauma management.Educational Objectives: The core objectives of these simulations center on effective teamwork and communication during trauma resuscitation of a critically ill patient. Both cases are designed to include maneuvers that require coordinating team members' actions during a stressful situation such as rolling a vomiting patient with a head injury and applying a binder to an unstable pelvic fracture. While the cases are largely focused on improving communication, salient learning points on emergent management of intracranial hemorrhage and unstable pelvic fractures are highlighted during the encounter. In addition, this simulation module allowed for the practice of graduated level of responsibilities amongst residents in the trauma bay.Two in-situ simulation cases were run with the same group of learners using standardized patient actors as patients and functional medical equipment in actual rooms in the emergency department to recreate a realistic experience. These groups were composed of emergency medicine residents with at least one intern, one junior resident, and one senior resident in each group as well as a bedside nurse, documenting nurse, and simulation instructor. Each case was followed by a group debriefing session using multiple sources of feedback. Standardized patients, bedside nursing, and simulation instructors were all incorporated into the feedback and debriefing process.Pre- and post-simulation surveys were given to participants to assess their confidence in participating and leading trauma resuscitations.A total of 29 emergency medicine residents completed both our pre- and post-survey. We found that less than half of those surveyed felt comfortable leading trauma resuscitations. After the simulation scenarios, an overwhelming majority agreed that they felt more prepared to run trauma resuscitations as a result of the simulation experience. In their free response comments participants also remarked upon the ability of in-situ simulation to better foster realistic learning opportunities with regards to communication and resuscitation management.Based on our survey results, we found that a large portion of our participants did not feel comfortable leading trauma resuscitations. The post-survey and the free-text responses collected during the case scenarios show that our in-situ simulation proved to be an effective way to teach various types of learners new trauma roles and optimize high-stress communication during resuscitations. The use of in-situ simulation provides an effective and easily adapted framework even for those outside of academic centers and simulation labs while also offering an opportunity for multidisciplinary growth. Regular incorporation of similar learning opportunities into resident, nursing, and staff education can lead to better communication and teamwork during in-vivo patient encounters.Trauma resuscitation, in-situ simulation, code leader education, communication training.

  View details for DOI 10.21980/J8WK9X

  View details for PubMedID 37465328

  View details for PubMedCentralID PMC10332519

• Critical Care Education Day: A Novel, Multidisciplinary, and Interactive Critical Care Education Session for Emergency Medicine Residents CUREUS Htet, N. N., Gordon, A., Mitarai, T. 2020; 12 (1)

  View details for DOI 10.7759/cureus.6785

  View details for Web of Science ID 000509552400007

• Critical Care Education Day: A Novel, Multidisciplinary, and Interactive Critical Care Education Session for Emergency Medicine Residents. Cureus Htet, N. N., Gordon, A. J., Mitarai, T. 2020; 12 (1): e6785

  Abstract

  Critical care medicine (CCM) is central to emergency medicine (EM) resident education. We feel that the traditional lecture format is not the ideal way to teach EM critical care, which requires integration and prioritization of diagnostic workup and team-based resuscitation under time pressure. We describe a novel critical care education day where an interactive, practical, and multidisciplinary critical care educational experience was provided for EM residents using case-based small-group sessions and fast-paced simulation.

  View details for DOI 10.7759/cureus.6785

  View details for PubMedID 32140345

  View details for PubMedCentralID PMC7045984

• eccSOFA: SOFA illness severity score adapted to predict in-hospital mortality in emergency critical care patients. The American journal of emergency medicine Niknam, K. n., Nesbitt, J. n., Mitarai, T. n., Nudelman, M. J., Gordon, A. J., Wilson, J. G., Kohn, M. A. 2020; 41: 145–51

  Abstract

  Boarding of ICU patients in the ED is increasing. Illness severity scores may help emergency physicians stratify risk to guide earlier transfer to the ICU and assess pre-ICU interventions by adjusting for baseline mortality risk. Most existing illness severity scores are based on data that is not available at the time of the hospital admission decision or cannot be extracted from the electronic health record (EHR). We adapted the SOFA score to create a new illness severity score (eccSOFA) that can be calculated at the time of ICU admission order entry in the ED using EHR data. We evaluated this score in a cohort of emergency critical care (ECC) patients at a single academic center over a period of 3 years.This was a retrospective cohort study using EHR data to assess predictive accuracy of eccSOFA for estimating in-hospital mortality risk. The patient population included all adult patients who had a critical care admission order entered while in the ED of an academic medical center between 10/24/2013 and 9/30/2016. eccSOFA's discriminatory ability for in-hospital mortality was assessed using ROC curves.Of the 3912 patients whose in-hospital mortality risk was estimated, 2260 (57.8%) were in the low-risk group (scores 0-3), 1203 (30.8%) in the intermediate-risk group (scores 4-7), and 449 (11.5%) in the high-risk group (scores 8+). In-hospital mortality for the low-, intermediate, and high-risk groups was 4.2% (95%CI: 3.4-5.1), 15.5% (95% CI 13.5-17.6), and 37.9% (95% CI 33.4-42.3) respectively. The AUROC was 0.78 (95%CI: 0.75-0.80) for the integer score and 0.75 (95% CI: 0.72-0.77) for the categorical eccSOFA.As a predictor of in-hospital mortality, eccSOFA can be calculated based on variables that are commonly available at the time of critical care admission order entry in the ED and has discriminatory ability that is comparable to other commonly used illness severity scores. Future studies should assess the calibration of our absolute risk predictions.

  View details for DOI 10.1016/j.ajem.2020.12.018

  View details for PubMedID 33453549

• The Birth of a Return to work Policy for New Resident Parents in Emergency Medicine ACADEMIC EMERGENCY MEDICINE Gordon, A., Sebok-Syer, S. S., Dohn, A. M., Smith-Coggins, R., Wang, N., Williams, S. R., Gisondi, M. A. 2019; 26 (3): 317–26

  View details for DOI 10.1111/acem.13684

  View details for Web of Science ID 000461220000006

• The Birth of a Return to Work Policy for New Resident Parents in Emergency Medicine. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Gordon, A. J., Sebok-Syer, S., Dohn, A. M., Smith-Coggins, R., Wang, N. E., Williams, S. R., Gisondi, M. A. 2019

  Abstract

  OBJECTIVE: With the rising number of female physicians, there will be more children than ever born in residency and the current system is inadequate to handle this increase in new resident parents. Residency is stressful and rigorous in isolation, let alone when pregnant or with a new child. Policies that ease these stressful transitions are generally either insufficient or do not exist. Therefore, we created a comprehensive Return to Work Policy for resident parents and piloted its implementation. Our policy aims to: 1) establish a clear, shared understanding of the regulatory and training requirements as they pertain to parental leave, 2) facilitate a smooth transition for new parents returning back to work, and 3) summarize the local and institutional resources available for both males and females during residency training.METHOD: In Fall 2017, a task force was convened to draft a Return to Work Policy for New Resident Parents. The task force included 9 key stakeholders (i.e., residents, faculty, and administration) at our institution and was made up of 3 Graduate Medical Education (GME) Program Directors, a Vice Chair of Education, a Designated Institutional Official (DIO), a Chief Resident, and 3 members of our academic department's Faculty Affairs Committee. The task force was selected because of individual expertise in gender equity issues, mentorship of resident parents, GME, and departmental administration.RESULTS: After development, the policy was piloted from November 2017 to June 2018. Our pilot implementation period included 7 new resident parents. All of these residents received schedules that met the return to work scheduling terms of our Return to Work Policy including no overnight shifts, no sick call, no more than 3 shifts in a row. Of equal importance, throughout our pilot, the emergency department schedules at all of our clinical sites remained fully staffed and our sick call pool was unaffected.CONCLUSION: Our Return to Work Policy for New Resident Parents provides a comprehensive guide to training requirements and family leave policies, an overview of available resources, and a scheduling framework that makes for a smooth transition back to clinical duties. This article is protected by copyright. All rights reserved.

  View details for PubMedID 30636353