Hector Gonzalez

All Publications

• Pupillometry in the Emergency Department: A Tool for Predicting Patient Disposition. The western journal of emergency medicine Gonzalez, H. J., Chen, Y., Addo, N., Madhok, D. Y. 2025; 26 (4): 1078-1085

  Abstract

  INTRODUCTION: The ability to accurately assess and predict the disposition of comatose patients from within the emergency department (ED) remains a critical challenge. Traditional methods lack precision and consistency. Our goal was to evaluate the prognostic capability of the neurological pupil index (NPI) in predicting patient disposition from within the ED.METHOD: This prospective observational study followed 50 comatose patients (Glasgow Coma Scale [GSC] score < 9) who were enrolled via convenience sampling and subsequently treated in the ED at a Level 1 trauma center and public safety-net hospital in San Francisco, CA. We calculated NPI scores and collected data on patient demographics, clinical characteristics, and outcomes. The NPI scores were categorized into three groups: 0 (very poor); 0.1-3.0 (poor to moderate); and 3.1-5.0 (good). We used ANOVA, the Pearson chi-squared test, Wilcoxon rank-sum test, and Fisher exact test to assess the association between NPI scores and discharge status. Results were reported as odds ratios with 95% confidence intervals, with a P-value < .05 considered statistically significant.RESULTS: The median age of patients in this study was 58 years (IQR 42-74), and 66% were male. Higher NPI scores (five-point scale with 3.1-5.0 considered normal) were significantly associated with an increased likelihood of ED discharge (82%), , while lower NPI scores (0, nonreactive pupil) were predominantly associated with hospital admission (92%) (P < .001). Significant predictors of discharge status included patient age, GCS scores, and coma etiology.CONCLUSION: This study highlights the utility of the NPI in predicting patient disposition from within the ED. Higher NPI scores were strongly associated with an increased likelihood of ED discharge. These findings support the idea that NPI has the potential to enhance the accuracy of prognostic assessments, in comparison to subjective characterizations of pupil activity. Additional research with larger, multicenter cohorts are needed to confirm these results and establish standardized protocols for integration of NPI in ED workflow.

  View details for DOI 10.5811/westjem.39912

  View details for PubMedID 40794983

• Career Trajectory After General Surgery Residency: Do Academic Program Graduates Pursue Academic Surgery? Annals of surgery Green, A., Sommer, E. R., Johnson, M. R., Gonzalez, H., Sia, T., Spain, D. A., Choi, J. 2024

  Abstract

  Determine the proportion of contemporary US academic general surgery residency program graduates who pursue academic careers and identify factors associated with pursuing academic careers.Many academic residency programs aim to cultivate academic surgeons, yet the proportion of contemporary graduates who choose academic careers is unclear. The potential determinants that affect graduates' decisions to pursue academic careers remain underexplored.We collected program and individual-level data on 2015 and 2018 graduates across 96 US academic general surgery residency programs using public resources. We defined those pursuing academic careers as faculty within US allopathic medical school-affiliated surgery departments who published two or more peer-reviewed publications as the first or senior author between 2020-2021. After variable selection using sample splitting LASSO regression, multivariable regression evaluated association with pursuing academic careers among all graduates, and graduates of top-20 residency programs. Secondary analysis using multivariable ordinal regression explored factors associated with high research productivity during early faculty years.Among 992 graduates, 166 (17%) were pursuing academic careers according to our definition. Graduating from a top-20 ranked residency program (OR[95%CI]: 2.34[1.40-3.88]), working with a longitudinal research mentor during residency (OR[95%CI]: 2.21[1.24-3.95]), holding an advanced degree (OR[95%CI]: 2.20[1.19-3.99]), and the number of peer-reviewed publications during residency as first or senior author (OR[95%CI]: 1.13[1.07-1.20]) were associated with pursuing an academic surgery career, while the number of peer-reviewed publications before residency was not (OR[95%CI]: 1.08[0.99-1.20]). Among top 20 program graduates, working with a longitudinal research mentor during residency (OR[95%CI]: 0.95[0.43-2.09]) was not associated with pursuing an academic surgery career. The number of peer-reviewed publications during residency as first or senior author was the only variable associated with higher productivity during early faculty years (OR[95%CI]: 1.12[1.07-1.18]).Our findings suggest programs that aim to graduate academic surgeons may benefit from ensuring trainees receive infrastructural support and demonstrate sustained commitment to research throughout residency. Our results should be interpreted cautiously as the impact of unmeasured confounders is unclear.

  View details for DOI 10.1097/SLA.0000000000006307

  View details for PubMedID 38652655

• Assessing Trust in Physician and Vaccine Hesitancy Among Hispanic/Latinx Parents. Hispanic health care international : the official journal of the National Association of Hispanic Nurses Gonzalez, H., Burke, R. V., Patel, M. S., Pehlivanova, M. 2023: 15404153231187379

  Abstract

  Introduction: Representing the USA's largest ethnic/racial group, Hispanic/Latinx (HL) experience health challenges of proportional magnitude. This study investigates the prevalence of vaccine hesitancy among HL adults and trust in their child's pediatrician. Methods: HL parents of children who receive medical care at one of the largest Federally Qualified Health Centers in the United States completed a survey examining associations between physician trust, vaccine hesitancy, and demographics. Data were subjected to ANOVA via SAS9 version 9.0 (Cary, NC) and SPSS version 27 (Chicago, IL) software. Results: With a total of 500 surveys completed (51% response rate; 81% completion rate), the prevalence of vaccine hesitancy amounted to 15.4% (n = 77). Parents with university-level education displayed higher levels of trust and perceptions in favor of routine vaccination practices (p < .01). When medical visits were conducted in Spanish, parents exhibited lower levels of trust and were more vaccine-hesitant (p < .01). Conclusions: Vaccine literacy must be prioritized in early education to reach parents who may not achieve college degrees. Ensuring language concordance within patient-physician dyads may maximize the potential for vaccine uptake and physician trust.

  View details for DOI 10.1177/15404153231187379

  View details for PubMedID 37438967