Nicholas Geoffrey Ashenburg

All Publications

• Identifying High-Priority Ethical Challenges for Precision Emergency Medicine: Nominal Group Study. JMIR formative research Rose, C., Shearer, E., Woller, I., Foster, A., Ashenburg, N., Kim, I., Newberry, J. 2025; 9: e68371

  Abstract

  Precision medicine promises to revolutionize health care by providing the right care to the right patient at the right time. However, the emergency department's unique mandate to treat "anyone, anywhere, anytime" creates critical tensions with precision medicine's requirements for comprehensive patient data and computational analysis. As emergency departments serve as health care's safety net and provide a growing proportion of acute care in America, identifying and addressing the ethical challenges of implementing precision medicine in this setting is crucial to prevent exacerbation of existing health care disparities. The rapid advancement of precision medicine technologies makes it imperative to understand these challenges before widespread implementation in emergency care settings.This study aimed to identify high priority ethical concerns facing the implementation of precision medicine in the emergency department.We conducted a qualitative study using a modified nominal group technique (NGT) with emergency physicians who had previous knowledge of precision medicine concepts. The NGT process consisted of four phases: (1) silent generation of ideas, (2) round-robin sharing of ideas, (3) structured discussion and clarification, and (4) thematic grouping of priorities. Participants represented diverse practice settings (county hospital, community hospital, academic center, and integrated managed care consortium) and subspecialties (education, ethics, pediatrics, diversity, equity, inclusion, and informatics) across various career stages from residents to late-career physicians.A total of 12 emergency physicians identified 82 initial challenges during individual ideation, which were consolidated to 48 unique challenges after removing duplicates and combining related items. The average participant contributed 6.8 (SD 2.9) challenges. These challenges were organized into a framework with 3 themes: values, privacy, and justice. The framework identified the need to address these themes across 3 time points of the precision medicine process: acquisition of data, actualization in the care setting, and the after effects of its use. This systematic organization revealed interrelated concerns spanning from data collection and bias to implementation challenges and long-term consequences for health care equity.Our study developed a novel framework that maps critical ethical challenges across 3 domains (values, privacy, and justice) and 3 temporal stages of precision medicine implementation. This framework identifies high-priority areas for future research and policy development, particularly around data representation, privacy protection, and equitable access. Successfully addressing these challenges is essential to realize precision medicine's potential while preserving emergency medicine's core mission as health care's safety net.

  View details for DOI 10.2196/68371

  View details for PubMedID 39916376

• Development of a model predicting falls in older emergency department patients using smartphone-based mobility measures. Journal of the American Geriatrics Society Suffoletto, B., Kim, D., Toth, C., Mayer, W., Ashenburg, N., Lin, M., Losak, M. 2024

  Abstract

  While emergency departments (EDs) are crucial for identifying patients at risk for falls, existing fall risk measures are often inaccurate. This study aimed to assess whether iPhone sensor-based mobility measures collected after ED discharge can improve fall prediction compared with traditional ED-based screening measures.This single-center, observational cohort study recruited ED patients aged 60 or older who owned an iPhone. Participants completed baseline assessments, downloaded a custom app to track mobility measures from the iPhone, and were followed for 90 days post-discharge. Fall outcomes were self-reported via the app or follow-up phone calls. Logistic regression and the LASSO technique were employed to identify significant predictors. The discriminative ability of the models was assessed by comparing the C-statistics.Of the 149 participants enrolled, 76.5% (N = 114) provided at least 7 days of post-discharge iPhone sensor-based mobility data. The cohort had a mean age of 73 years, with 16.7% (N = 19) experiencing a fall. Participants who fell showed a significantly greater increase in daily steps over time compared with those who did not (p = 0.002). The extended logistic regression model, by incorporating mean gait asymmetry and change in step count, demonstrated a higher but nonsignificant improvement in discriminative ability (C-statistic = 0.84) compared with the base model (C-statistic = 0.79).This study demonstrates that iPhone mobility measures collected after ED discharge can enhance fall prediction relative to self-reported fall risk screening questions in older adults. The strongest mobility predictors were gait asymmetry and changes in step count. While the findings suggest that post-discharge mobility monitoring could improve fall prevention strategies, further validation in diverse populations is necessary.

  View details for DOI 10.1111/jgs.19303

  View details for PubMedID 39653611

• Man with scrotal pain and swelling. Journal of the American College of Emergency Physicians open Allen, C. W., Liao, C., Hill, C., Batchelor, T. J., Ashenburg, N. G. 2024; 5 (5): e13289

  View details for DOI 10.1002/emp2.13289

  View details for PubMedID 39239363

  View details for PubMedCentralID PMC11375321

• Feasibility of Measuring Smartphone Accelerometry Data During a Weekly Instrumented Timed Up-and-Go Test After Emergency Department Discharge: Prospective Observational Cohort Study. JMIR aging Suffoletto, B., Kim, D., Toth, C., Mayer, W., Glaister, S., Cinkowski, C., Ashenburg, N., Lin, M., Losak, M. 2024; 7: e57601

  Abstract

  Older adults discharged from the emergency department (ED) face elevated risk of falls and functional decline. Smartphones might enable remote monitoring of mobility after ED discharge, yet their application in this context remains underexplored.This study aimed to assess the feasibility of having older adults provide weekly accelerometer data from an instrumented Timed Up-and-Go (TUG) test over an 11-week period after ED discharge.This single-center, prospective, observational, cohort study recruited patients aged 60 years and older from an academic ED. Participants downloaded the GaitMate app to their iPhones that recorded accelerometer data during 11 weekly at-home TUG tests. We measured adherence to TUG test completion, quality of transmitted accelerometer data, and participants' perceptions of the app's usability and safety.Of the 617 approached patients, 149 (24.1%) consented to participate, and of these 149 participants, 9 (6%) dropped out. Overall, participants completed 55.6% (912/1639) of TUG tests. Data quality was optimal in 31.1% (508/1639) of TUG tests. At 3-month follow-up, 83.2% (99/119) of respondents found the app easy to use, and 95% (114/120) felt safe performing the tasks at home. Barriers to adherence included the need for assistance, technical issues with the app, and forgetfulness.The study demonstrates moderate adherence yet high usability and safety for the use of smartphone TUG tests to monitor mobility among older adults after ED discharge. Incomplete TUG test data were common, reflecting challenges in the collection of high-quality longitudinal mobility data in older adults. Identified barriers highlight the need for improvements in user engagement and technology design.

  View details for DOI 10.2196/57601

  View details for PubMedID 39258924

• Woman with growing scalp mass. Journal of the American College of Emergency Physicians open Gallegos, M., Ashenburg, N., Duanmu, Y. 2024; 5 (4): e13227

  View details for DOI 10.1002/emp2.13227

  View details for PubMedID 38988592

• The Role of Large Language Models in Transforming Emergency Medicine: Scoping Review. JMIR medical informatics Preiksaitis, C., Ashenburg, N., Bunney, G., Chu, A., Kabeer, R., Riley, F., Ribeira, R., Rose, C. 2024; 12: e53787

  Abstract

  Artificial intelligence (AI), more specifically large language models (LLMs), holds significant potential in revolutionizing emergency care delivery by optimizing clinical workflows and enhancing the quality of decision-making. Although enthusiasm for integrating LLMs into emergency medicine (EM) is growing, the existing literature is characterized by a disparate collection of individual studies, conceptual analyses, and preliminary implementations. Given these complexities and gaps in understanding, a cohesive framework is needed to comprehend the existing body of knowledge on the application of LLMs in EM.Given the absence of a comprehensive framework for exploring the roles of LLMs in EM, this scoping review aims to systematically map the existing literature on LLMs' potential applications within EM and identify directions for future research. Addressing this gap will allow for informed advancements in the field.Using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) criteria, we searched Ovid MEDLINE, Embase, Web of Science, and Google Scholar for papers published between January 2018 and August 2023 that discussed LLMs' use in EM. We excluded other forms of AI. A total of 1994 unique titles and abstracts were screened, and each full-text paper was independently reviewed by 2 authors. Data were abstracted independently, and 5 authors performed a collaborative quantitative and qualitative synthesis of the data.A total of 43 papers were included. Studies were predominantly from 2022 to 2023 and conducted in the United States and China. We uncovered four major themes: (1) clinical decision-making and support was highlighted as a pivotal area, with LLMs playing a substantial role in enhancing patient care, notably through their application in real-time triage, allowing early recognition of patient urgency; (2) efficiency, workflow, and information management demonstrated the capacity of LLMs to significantly boost operational efficiency, particularly through the automation of patient record synthesis, which could reduce administrative burden and enhance patient-centric care; (3) risks, ethics, and transparency were identified as areas of concern, especially regarding the reliability of LLMs' outputs, and specific studies highlighted the challenges of ensuring unbiased decision-making amidst potentially flawed training data sets, stressing the importance of thorough validation and ethical oversight; and (4) education and communication possibilities included LLMs' capacity to enrich medical training, such as through using simulated patient interactions that enhance communication skills.LLMs have the potential to fundamentally transform EM, enhancing clinical decision-making, optimizing workflows, and improving patient outcomes. This review sets the stage for future advancements by identifying key research areas: prospective validation of LLM applications, establishing standards for responsible use, understanding provider and patient perceptions, and improving physicians' AI literacy. Effective integration of LLMs into EM will require collaborative efforts and thorough evaluation to ensure these technologies can be safely and effectively applied.

  View details for DOI 10.2196/53787

  View details for PubMedID 38728687

• Eight weeks pregnant woman with heavy vaginal bleeding. Journal of the American College of Emergency Physicians open Moody, G. G., Batchelor, T. J., Ashenburg, N. 2024; 5 (1): e13113

  View details for DOI 10.1002/emp2.13113

  View details for PubMedID 38333104

  View details for PubMedCentralID PMC10850606

• The Role Of POCUS for the initial detection of testicualr cancer in the emergency department Visual Journal of Emergency Medicine Henderson, J., Ashenburg, N., Batchelor, T. 2024

  View details for DOI 10.1016/j.visj.2024.102033

• Point-of-care Ultrasound Diagnosed Intraocular Breast Metastasis Clinical Practice and Cases in Emergency Medicine Yusuf, H. M., Ashenburg, N., Batchelor, T. 2024

  View details for DOI 10.5811/cpcem.1686

• Complete molar pregnancy found on point-of-care ultrasound in a woman presenting for dyspnea and fatigue Visual Journal of Emergency Medicine Wagner, T., Ashenburg, N., Batchelor, T. 2024; 35

  View details for DOI 10.1016/j.visj.2024.101946

• Rapid diagnosis of quadriceps tendon rupture using bedside ultrasound. Visual Journal of Emergency Medicine Ten, N., Ashenburg, N., Batchelor, T. 2024; 36

  View details for DOI 10.1016/j.visj.2024.102049

• Improved First Dose Conversion of Supraventricular Tachycardia Using Weight-Based Adenosine. Cureus Deck, C. M., Dang, B., Ashenburg, N., Rice, B. 2023; 15 (3): e35995

  Abstract

  Introduction Paroxysmal supraventricular tachycardia (PSVT) is an often-recurring tachyarrhythmia that frequently results in emergency department visits and is commonly treated using intravenous adenosine. Given the anecdotal variable success of adenosine, the question arose of which patient factors may affect its success. This retrospective cohort analysis seeks to test the hypothesis that adult patients who receive adenosine at doses of ≥0.1mg/kg will have greater rates of successful conversion upon receipt of the first dose of adenosine. Methods This retrospective cohort analysis examines the charts from patients with known paroxysmal supraventricular tachycardia from November 1, 2015, through March 31, 2020, who were treated with intravenous adenosine. The primary outcome was the first-dose success of adenosine when stratified by patient weight (greater than 0.1mg/kg or less than 0.1mg/kg). Baseline characteristics and adverse effects were also collected. Results Seventy-six patients were included in the analysis. Patients who received adenosine at doses greater than or equal to 0.1mg/kg were more likely to convert to sinus rhythm than those who received doses less than 0.1mg/kg (p=0.006). No difference in adverse effects was noted between the groups (p=0.75). Conclusion This retrospective cohort analysis found that patients who received adenosine at doses greater than or equal to 0.1mg/kg for the treatment of PSVT were more likely to convert to sinus rhythm than those who received lower doses, with no difference in adverse effects. This hypothesis-generating finding provides the basis for a subsequent randomized, controlled trial to investigate the effectiveness and safety of weight-based adenosine.

  View details for DOI 10.7759/cureus.35995

  View details for PubMedID 37041920

  View details for PubMedCentralID PMC10083097

• 19-Year-Old with Sudden Onset Left Testicular Pain. Clinical practice and cases in emergency medicine Small, E., Ashenburg, N., Schertzer, K. 2022; 6 (4): 327-329

  Abstract

  A previously healthy 19-year-old man presented to the emergency department with severe, sudden onset of left testicular pain. Physical exam revealed a left high-riding, horizontally oriented testicle without cremasteric reflex. Point-of-care ultrasound was used to confirm the diagnosis of testicular torsion, as well as to guide manual detorsion, verifying return of blood flow after reduction.Testicular torsion is a urologic emergency in which testicular viability is time dependent. Point-of-care ultrasound can be an important and helpful tool to not only confirm suspicion but help guide adequacy of blood flow return after manual detorsion in conjunction with comprehensive ultrasound.

  View details for DOI 10.5811/cpcem.2022.7.56747

  View details for PubMedID 36427024

• Converting an ED Fast Track to an ED Virtual Visit Track NEJM Catalyst Innovations in Care Delivery Ashenburg, N., Ribeira, R., Lindquist, B., Matheson, L., Shen, S., Yiadom, M. 2022; 3 (11)

  View details for DOI 10.1056/CAT.22.0130

• A Distance-Learning Approach to Point-of-Care Ultrasound Training (ADAPT): A Multi-Institutional Educational Response During the COVID-19 Pandemic. Academic medicine : journal of the Association of American Medical Colleges Nix, K., Liu, E. L., Oh, L., Duanmu, Y., Fong, T., Ashenburg, N., Liu, R. B. 2021

  Abstract

  PROBLEM: The COVID-19 pandemic significantly disrupted point-of-care ultrasound (POCUS) education. Medical schools and residency programs placed restrictions on bedside teaching and clinical scanning as part of risk mitigation. In response, POCUS faculty nationwide from 15 institutions collaborated on an alternative model of ultrasound education, A Distance-learning Approach to POCUS Training (ADAPT).APPROACH: ADAPT was repeated monthly from April 1 through June 30, 2020. It accommodated 70 learners, who included 1- to 4-week rotators and asynchronous learners. The curriculum included assigned pre-work and learning objectives covering 20 core POCUS topics. A rotating group of 30 faculty and fellows delivered daily virtual teaching sessions that included gamification to increase learner engagement and hands-on instruction through teleguidance. After participation, faculty and learners completed anonymous surveys.OUTCOMES: Educators reported a significant decrease in preparatory time (6.2 vs. 3.1 hours per week, P < .001) dedicated to ultrasound education after implementing ADAPT. The majority of 29 learners who completed surveys felt "somewhat confident" or "very confident" in their ability to acquire (n = 25, 86.2%) and interpret (n = 27, 93.1%) ultrasound images after the intervention; the majority of 22 educators completing surveys rated the program "somewhat effective" or "very effective" at contributing to learner's ability to acquire (n = 13, 59.1%) and interpret (n = 20, 90.9%) images. Most learners (n = 28, 96.6%) and all educators (n = 22, 100%) were "satisfied" or "very satisfied" with ADAPT as a whole, and the large majority of educators were "very likely" (n = 18, 81.8%) to recommend continued use of this program.NEXT STEPS: A virtual curriculum that pools the efforts of multiple institutions nationwide was implemented rapidly and effectively while satisfying educational expectations of both learners and faculty. This collaborative framework can be replicated and may be generalizable to other educational objectives.

  View details for DOI 10.1097/ACM.0000000000004399

  View details for PubMedID 34524135

• Using a Simulated Model and Mastery Learning Approach to Teach the Ultrasound-guided Serratus Anterior Plane Block to Emergency Medicine Residents: A Pilot Study. AEM education and training Rider, A. C., Miller, D. T., Ashenburg, N., Duanmu, Y., Lobo, V., Schertzer, K., Sebok-Syer, S. S. 2021; 5 (3): e10525

  Abstract

  Background: The serratus anterior plane block (SAPB) is a safe, single-injection alternative for pain control in patients with rib fractures. This pilot study aims to teach the ultrasound-guided SAPB to emergency medicine (EM) residents using a mastery learning approach.Methods: A 19-item checklist was created and mastery was determined to be 17 of 19 items correct. This pass score was established using a Mastery Angoff standard-setting exercise with a group of EM experts. Learners participated in baseline testing on a simulated model and performance was assessed by two raters. Learners then watched an instructional video and participated in an individualized teaching session. Learners underwent deliberate practice followed by posttesting until mastery was achieved. Score differences in baseline testing and posttesting were analyzed using a paired t-test. Pre- and posttesting surveys were also completed by participants.Results: Twenty-eight PGY-1 to -4 residents volunteered to participate in the study. The range of reported SAPBs seen previously was 0 to 5. The mean (±SD) number of items correct on the checklist for initial testing was 8.5 of 19 (±2.7), while the mean (±SD) final score was 18 of 19 (±0.6; p<0.001). All participants met mastery standards after the curriculum intervention. Median self-reported procedural confidence was 2 out of 5 on a 5-point Likert scale before the session and 5 out of 5 after the session (Z=-4.681, p<0.001).Conclusions: Using a mastery learning approach and simulated model, we were able to successfully train EM residents to perform the SAPB at a level of mastery and increase their overall confidence in executing this procedure.

  View details for DOI 10.1002/aet2.10525

  View details for PubMedID 34041432

• Nephrolithiasis diagnoised by point of care ultrasound Visual Journal of Emergency Medicine Edgar, L., Ashenburg, N. 2020; 21 (October)

  View details for DOI 10.1016/j.visj.2020.100804

• Intra-Articular Catheter Placement: A Novel Approach for Simulating Ankle Effusions in Cadaver Models. The western journal of emergency medicine Ross, G. A., Ashenburg, N. G., Wynn, W. D., McCarthy, J. J., Clendening, A. M., Presley, B. C., Kubalak, S. W., Barnes, R. M. 2019; 20 (1): 92-93

  View details for DOI 10.5811/westjem.2018.9.39810

  View details for PubMedID 30643607

  View details for PubMedCentralID PMC6324721

• Walking on eggshells: Point of Care Ultrasound for Patellar Fractures Visual Journal of Emergency Medicine Winstead-derlega, C., Makhijani, P., Ashenburg, N. 2019; 15

  View details for DOI 10.1016/j.visj.2018.100804