Brandon Maughan MD, MHS, MSHP, FACEP
Assistant Professor, Emergency Medicine
Dr. Maughan is an Assistant Professor in the Department of Emergency Medicine at OHSU. After completing postgraduate training in health policy at the Johns Hopkins Bloomberg School of Public Health, Dr. Maughan attended medical school at Case Western Reserve University and completed his residency and chief residency at Brown University / Rhode Island Hospital. He continued his training at the Robert Wood Johnson Foundation Clinical Scholars Program at the University of Pennsylvania, where he also completed a master’s degree in policy research and served as a fellow at the Leonard Davis Institute for Health Economics. He joined OHSU in 2018.
Diagnosis and treatment of pulmonary embolism (PE) are the central focus of Dr. Maughan’s current research. Up to 1 million people experience PE annually in the United States, and approximately 200,000 of these episodes are fatal. PE may be diagnosed by imaging tests such as computed tomography pulmonary angiography (CTPA) or lung ventilation-perfusion (V/Q) scintigraphy. However, these tests present can radiation risks to patients and can increase costs, so clinical practice guidelines recommend imaging for PE be limited to patients at increased risk based on clinical history, exam, and blood tests (e.g., d-dimer). However, despite a similar incidence of PE in women and men, more than two-thirds of emergency department CTPA tests occur in women, and the yield of these CTPA tests is far lower in women (6.7%) than in men (17%). Reasons for these differences are unknown; there are few data on sex-based differences in PE risk stratification. Once PE is diagnosed, patients are traditionally hospitalized to start treatment with intravenous anticoagulants, but the advent of new oral anticoagulants has made it possible for patients at low risk for complications to be discharged home. However, there is no clearly optimal approach for identifying patients who are appropriate for this outpatient treatment, and there is little data on patients’ comfort with this treatment option.
To better understand the sex-based disparities in the diagnosis of PE, Dr. Maughan is working with an international research group to examine differences in the performance of PE risk-stratification tools between men and women. He is also conducting a mixed-methods study on patients’ decision to pursue outpatient treatment of PE, including assessment of emergency department patients’ preferences and their physicians’ perceptions of risk. Lastly, to measure the impact of changing these approaches to PE diagnosis and treatment, Dr. Maughan is developing a decision analysis and cost-effectiveness analysis model to estimate the effects on patient outcomes and costs.
Mentors: Craig Newgard, MD, MPH; Cynthia Morris, PhD; Jeffrey Kline, MD; Karen Eden, PhD; Aaron Caughey, MD, PhD; John McConnell, PhD