Shefali Dujari, MD

All Publications

• High Stakes, High Dose? Retrospective Treatment Outcomes of Coccidioidal Meningitis Treated With Steroids. The Neurohospitalist Dhillon, H., Pescaru, H. T., Dujari, S., Ding, V., Desai, M., Galetta, K. 2026: 19418744261424934

  Abstract

  Coccidioidal vasculitis is a serious complication of coccidioidal infection. Prior studies suggest that steroids may reduce the risk of secondary vasculitis in coccidioidal meningitis (CM), but data on optimal dosing are limited. This study compared the characteristics and outcomes of CM patients with vasculitis who received different steroid doses.The Stanford Research Data Repository was used to identify adult patients diagnosed with coccidioidal meningitis from 1992 to 2024. Patients were divided into those who received no steroids, low or medium dose steroids, and high dose steroids. Characteristics at admission were compared by steroid use category, and their association with clinical outcomes were assessed.A total of 65 patients with CM were identified, with mean (standard deviation) age 45 (17) and 35% female. A higher percentage of patients not treated with steroids had a better modified Rankin score (mRS) of 2 or lower on admission compared to patients who were treated with steroids (standardized mean difference [SMD] = 0.67). Compared to patients who received a low/medium dose, those who received a high dose were 32% (95% CI 0.12, 3.61; P = 0.65) less likely to experience death or vasculitis.There is a complex relationship between the use of steroids and outcomes among patients with CM. Among steroid recipients, those who received high dose steroids may achieve better long-term outcomes. A larger study is needed to validate these findings.

  View details for DOI 10.1177/19418744261424934

  View details for PubMedID 41660372

  View details for PubMedCentralID PMC12880924

• Neurohospitalist Core Competencies. The Neurohospitalist Wold, J. J., Robertson, J., Jeevarajan, J. A., Knox, M. G., Thatikunta, P., Solorzano, G. E., Galetta, K., Dujari, S., Goyal, T., Ehrlich, M. E., Donnelly, J. P., Marriott, E., Mandge, V. A., Dhoot, R. S., Luedke, M. W., Maas, M. B., Yu, M. Y., Toledano, M., Mustafa, R., Palaganas, J. L., Kvam, K., Dugue, R., Meltzer, E., Touma, L., Shah, M. P., Douglas, V. C., Orjuela, K., Scott, B. J., Klein, J. P., Likosky, D. J., Simpson, J. R., Richie, M. B., Dohle, C., Morris, J. G., Gold, C. A. 2024: 19418744241297187

  Abstract

  The Neurohospitalist Core Competencies comprise a set of competency-based learning objectives that encapsulate the knowledge, skills, and attitudes of neurohospitalitists who specialize in the care of hospitalized patients with neurologic conditions. These competencies serve to characterize the rapidly expanding field of neurohospitalist medicine. The 27 chapters are divided into 3 sections entitled: neurological conditions, clinical interventions and interpretation of ancillary studies, and neurohospitalist role in the healthcare system. Each individual learning objective in the chapters describes a specific concept with an action verb to illustrate the behavior that the neurohospitalist exhibits. The individual neurohospitalist may not exhibit mastery in each of the topics included as individual practices vary in scope and practice pattern. A few examples of how the complete set of competencies may be used include in the creation of curricula for neurohospitalist fellowships, to assist in defining the scope of practice of neurohospitalists for administrative leaders of hospitals and departments, and in influencing the direction of further research and quality improvement in the field.

  View details for DOI 10.1177/19418744241297187

  View details for PubMedID 39610897

  View details for PubMedCentralID PMC11600417

• Education Research: Educational Outcomes Associated With the Introduction of a Neurohospitalist Program. Neurology. Education Dujari, S., Scott, B. J., Gold, C. A., Weng, Y., Kvam, K. A. 2024; 3 (2): e200131

  Abstract

  Background and Objectives: As the prevalence of the neurohospitalist (NH) practice model grows, understanding its effect on trainee education is imperative. We sought to determine the impact of an academic NH program on neurology resident evaluations of faculty teaching.Methods: We performed a retrospective study of faculty teaching evaluations before and after the implementation of a full-time NH service. Primary outcomes were neurology resident evaluations of faculty teaching, which were compared in the pre-NH period (August 2010-July 2014) vs the post-NH period (August 2016-July 2018). In a secondary analysis, we used the difference-in-difference approach to analyze the effect of introducing the NH service on resident evaluation of faculty teaching compared with stroke and neurocritical care faculty controls. We performed an additional descriptive analysis of medical student evaluation of faculty teaching and described Residency In-service Training Exam scores and Accreditation Council for Graduate Medical Education (ACGME) resident survey data before and after the intervention.Results: There were 368 resident and 360 medical student evaluations of faculty teaching during the study period. Compared to the pre-NH period, the post-NH period had significantly higher resident evaluations of faculty teaching in 19 of 27 questions of faculty teaching, across 5 of the 6 ACGME core competencies. Within the competencies of patient care, practice-based learning and improvement, and systems-based practice, the NH teaching faculty were rated significantly higher across all questions. In the difference-in-difference model, resident evaluations of faculty teaching following the implementation of the NH service remained significantly improved compared with controls in teaching evidence-based medicine, teaching diagnostic algorithms, and explaining rationale for clinical decisions. Medical student ratings of faculty teaching were unchanged in the pre-NH and the post-NH period.Discussion: Neurology residents may benefit from the clinical expertise of NHs and their ability to teach evidence-based practice and role model systems-based practice. Given the central role NHs may play in trainee education, additional focus on both the local and national levels should be dedicated to further developing the teaching skills of NHs.

  View details for DOI 10.1212/NE9.0000000000200131

  View details for PubMedID 39359890

• Education Research: Sustained Implementation of Quality Improvement Practices Is Observed in Early Career Physicians Following a Neurology Resident QI Curriculum. Neurology. Education Xiong, K., Miller-Kuhlmann, R. K., Scott, B. J., He, Z., Dujari, S., Gold, C., Kvam, K. 2024; 3 (2): e200137

  Abstract

  Background and Objectives: The Accreditation Council for Graduate Medical Education and American Board of Psychiatry and Neurology expect engagement in quality improvement (QI) activities for all residents and practicing neurologists. Our neurology residency program instituted an experiential Neurology Residency QI Curriculum in 2015 for all residents. In this study, we aimed to characterize the role of QI engagement in the early-career paths of program graduates.Methods: We distributed an online survey evaluating QI training, scholarship, and leadership (before, during, and after residency training) to all individuals who graduated from our residency program (graduation years 2017-2021). Primary outcomes were QI project leadership or mentorship and QI scholarship (projects, posters, and publications) after residency. Predictors of these outcomes were also evaluated using Fisher exact test.Results: Twenty-nine of 50 graduates (58%) completed the survey. Median time from residency graduation was 3 years. Of the respondents, 14% actively participated in a QI project before residency, 83% during residency, and 48% after graduating. In addition, 41% had led or mentored a QI project and 34% had performed QI scholarship since residency. Fourteen percent of participants held formal roles in QI or patient safety, while 24% received formal full-time equivalents for QI work. Significant predictors (p < 0.05) of QI leadership included older age, time since graduation, rank, and participation in Clinical Effectiveness Leadership Training (CELT-an institutional QI faculty development course). Significant predictors (p < 0.05) of QI scholarship included older age, time since graduation, participation in CELT, and participation in QI scholarship during residency. QI training, participation, and/or project leadership before residency did not predict either QI leadership or scholarship after residency.Discussion: Many neurology residency graduates continued to lead QI projects and produce QI scholarship in the early years after graduation. However, receiving protected time for leadership and academic work in this area is uncommon. Our findings suggest that more infrastructure, including training, career development, and mentorship, can foster neurologists interested in leading in quality and patient safety. In academic models, promotion pathways that support academic advancement for faculty leading in QI are needed.

  View details for DOI 10.1212/NE9.0000000000200137

  View details for PubMedID 39359889

• Inpatient Neurology Deaths and Factors Associated With Discharge to Hospice. The Neurohospitalist Dujari, S., Wei, J., Kraler, L., Goyal, T., Bernier, E., Schwartz, N., Hirsch, K., Gold, C. A. 2023; 13 (4): 337-344

  Abstract

  The Neurology Mortality Review Committee at our institution identified variability in location of death for patients on our inpatient neurology services. Hospice may increase the number of patients dying in their preferred locations. This study aimed to characterize patients who die on inpatient neurology services and explore barriers to discharge to hospice.This retrospective study was completed at a single, quaternary care medical center that is a Level I Trauma Center and Comprehensive Stroke Center. Patients discharged by an inpatient neurology service between 6/2019-1/2021 were identified and electronic medical record review was performed on patients who died in the hospital and who were discharged to hospice.69 inpatient deaths and 74 discharges to hospice occurred during the study period. Of the 69 deaths, 54 occurred following withdrawal of life sustaining treatment (WLST), of which 14 had a referral to hospice placed. There were 88 "hospice-referred" patients and 40 "hospice-eligible" patients. Hospice-referred patients were less likely to require the intensive care unit than hospice-eligible patients. Hospice-referred patients had their code status changed to Do Not Intubate earlier and were more likely to have advanced directives available.Our data highlight opportunities for further research to improve discharge to hospice including interhospital transfers, advanced directives, earlier goals of care discussions, palliative care consultations, and increased hospice bed availability. Importantly, it highlights the limitations of using in-hospital mortality as a quality indicator in this patient population.

  View details for DOI 10.1177/19418744231174577

  View details for PubMedID 37701246

  View details for PubMedCentralID PMC10494814

• Inpatient Neurology Deaths and Factors Associated With Discharge to Hospice NEUROHOSPITALIST Dujari, S., Wei, J., Kraler, L., Goyal, T., Bernier, E., Schwartz, N., Hirsch, K., Gold, C. A. A. 2023

  View details for DOI 10.1177/19418744231174577

  View details for Web of Science ID 000983969300001

• The Most Effective Interventions for Resident Well-being during the COVID-19 Pandemic Chen, J., Dujari, S., Pavitt, S., Miller-Kuhlmann, R., Vora, N. LIPPINCOTT WILLIAMS & WILKINS. 2021

  View details for Web of Science ID 000729283603315

• Administration of Dexamethasone for Bacterial Meningitis: An Unreliable Quality Measure. The Neurohospitalist Dujari, S., Gummidipundi, S., He, Z., Gold, C. A. 2021; 11 (2): 101-106

  Abstract

  To validate the use of administrative data to identify patients with bacterial meningitis and quantify the rate of dexamethasone administration as defined in the American Academy of Neurology Inpatient and Emergency Care Quality Measurement Set.The Vizient Clinical Data Base and Resource Manager was used to identify patients with International Classification of Diseases, Tenth Revision (ICD-10) codes for bacterial meningitis from October 2015 to June 2019. Chart review was performed on patients identified at a single quaternary-care hospital. The positive predictive value (PPV) of Vizient was determined. Demographic, clinical, and laboratory data were assessed using descriptive statistics.Of all hospitals that submitted complete data to Vizient during the study period, a median of 19 patients per hospital had ICD-10 codes for bacterial meningitis in the 45-month period. We identified 79 patients using Vizient at our institution of whom 69 had a diagnosis of bacterial meningitis confirmed by chart review (PPV = 87%). 15 patients were eligible to receive dexamethasone per the quality measurement set. Six of these patients (40%) received dexamethasone.It is feasible to use the Vizient Clinical Data Base and Resource Manager to identify patients with bacterial meningitis. Due to low prevalence across multiple institutions and high rate of exclusion criteria at our institution, this study suggests that the rate of dexamethasone administration in bacterial meningitis may be an unreliable indicator of quality of care provided by inpatient neurologists. The creation of a registry for hospitalized neurology patients could enhance development of future quality measures.

  View details for DOI 10.1177/1941874420969556

  View details for PubMedID 33791051

  View details for PubMedCentralID PMC7958681

• ACEP Guidelines on Acute Nontraumatic Headache Diagnosis and Management in the Emergency Department, Commentary on Behalf of the Refractory, Inpatient, Emergency Care Section of the American Headache Society. Headache Peretz, A. n., Dujari, S. n., Cowan, R. n., Minen, M. n. 2020

  Abstract

  The American College of Emergency Physicians (ACEP) published guidelines in July 2019 on the diagnosis and management of acute nontraumatic headaches in the emergency department, focusing predominantly on the diagnosis of subarachnoid hemorrhage and the role of imaging and lumbar puncture in diagnosis. The ACEP Clinical Policies document is intended to aide Emergency Physicians in their approach to patients presenting with acute headache and to improve the accuracy of diagnosis, while promoting safe patient care practices. The Clinical Policies document also highlights the need for future research into best practices to distinguish primary from secondary headaches and the efficacy and safety of current treatment options for acute headaches. The following commentary on these guidelines is intended to support and expand on these guidelines from the Headache specialists' perspective, written on behalf of the Refractory, Inpatient, Emergency Care section of the American Headache Society (AHS). The commentary have been reviewed and approved by Board of Directors of the AHS.

  View details for DOI 10.1111/head.13744

  View details for PubMedID 31944291

• Utilization, yield, and accuracy of the FilmArray Meningitis/Encephalitis panel with diagnostic stewardship and testing algorithm. Journal of clinical microbiology Broadhurst, M. J., Dujari, S. n., Budvytiene, I. n., Pinsky, B. A., Gold, C. A., Banaei, N. n. 2020

  Abstract

  Background: The impact of diagnostic stewardship and testing algorithms on utilization and performance of the FilmArray® Meningitis/Encephalitis (ME) Panel has received limited investigation.Methods: We performed a retrospective single-center cohort study assessing all individuals with suspected ME between February 2017 and April 2019 for whom the ME Panel was ordered. Testing was restricted to patients with cerebrospinal fluid (CSF) pleocytosis. Positive ME Panel results were confirmed before reporting through correlation with direct stain (Gram and Calcofluor white) and CSF Cryptococcal antigen or by repeat ME Panel testing. Outcomes included ME Panel test utilization rate, negative predictive value of non-pleocytic CSF samples, test yield and false-positivity rate, and time to appropriate de-escalation of acyclovir.Results: Restricting testing to pleocytic CSF samples reduced ME Panel utilization by 42.7% (263 vs 459 tests performed) and increased test yield by 61.8% (18.6% vs 11.5% positivity rate; P < 0.01) with application of criteria. The negative predictive value of normal CSF WBC for ME Panel targets was 100% (195/195) for non-viral targets and 98.0% (192/196) overall. All pathogens detected in non-pleocytic CSF samples were herpesviruses. Application of a selective testing algorithm based on repeat testing of non-viral targets avoided 75% (3/4) of false-positive results without generating false-negative results. Introduction of the ME panel reduced the duration of acyclovir treatment from an average of 66 hours (SD, 43) to 46 hours (SD, 36) (P = 0.03).Conclusions: Implementation of the ME Panel with restriction criteria and a selective testing algorithm for non-viral targets optimizes its utilization, yield and accuracy.

  View details for DOI 10.1128/JCM.00311-20

  View details for PubMedID 32493787

• Infected Implantable Pulse Generator NEUROHOSPITALIST Dujari, S., Gold, C. A. 2019; 9 (3): 172–73

  View details for DOI 10.1177/1941874418809869

  View details for Web of Science ID 000471642900011

  View details for PubMedID 31244976

  View details for PubMedCentralID PMC6582390

• Making Well Neurologists: A Multifaceted Program for Neurology Trainee and Faculty Wellbeing Miller-Kuhlmann, R., Murray, N., Dujari, S., Karamian, A., Hamidi, M., Su, E., Bozinov, N., McGranahan, T. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for Web of Science ID 000475965902083

• Design and Implementation of a Novel Acute Stroke Code for the Extended Window of Endovascular Treatment Legault, C., Dujari, S., Shen, S. H., Wagner, A. M., Albers, G., Bernier, E., Callagy, P., Vora, N. LIPPINCOTT WILLIAMS & WILKINS. 2018

  View details for Web of Science ID 000453090803006