Emergency Medicine

Center for Policy and Research in Emergency Medicine (CPR-EM)


The OHSU Center for Policy and Research in Emergency Medicine's breakthrough research leads to new standards of care and a better understanding of important issues involving emergency medicine, disaster preparedness, and toxicology.

At the OHSU Center for Policy and Research in Emergency Medicine (CPR-EM), our mission consists of reducing inequities, including, but not limited to, those based on race, ethnicity, gender, sexual orientation, gender identity, immigration status, religion, and disability. In particular, we acknowledge the legacy of racism that is embedded in American society and institutions, and we are actively working to be catalysts of change to dismantle these harmful structures. Our commitment involves reflecting principles of equity across all functions of our organization, including in its culture, governance, hiring practices, salaries, research areas of focus, and the conduct of our research.  

Read the full CPR-EM Equity Operating Guidelines Beliefs and Values Statement

ICECAP Llama Event
Llama visit at Adventist Health Portland's ED to celebrate the 3-year anniversary of the ICECAP Study. Adventist continues to be a national leader in this study with the 2nd highest enrolling site (60+ sites nationwide ). - October 2023

In this season of gratitude, we are reminded of how lucky we are to have all of you as colleagues! You make the trying times better, and your small acts of kindness can multiply and trickle to others. What we do is challenging, and we appreciate all that you do towards our education, research, and clinical missions. No matter how you celebrate the upcoming season, we hope you find ways to appreciate yourselves as well as those around you.

- Bory Kea, MD, MCR, FACEP - Director of Clinical Trial, Department of Emergency Medicine

Current Newsletter

Mariam Anwar Research Week 2023
Build EXITO Scholar, Mariam Anwar, Presenting at Research Week - May 2023

Interested in expanding your career to include Emergency Care Research? CPR-EM offers a variety of training programs for many experiential levels. Learn about all of our opportunities here, or click on a link below to be directed to that specific program. 

Mar/Apr/May 2024

Influence of time-to-diagnosis on time-to-percutaneous coronary intervention for emergency department ST-elevation myocardial infarction patients: Time-to-electrocardiogram matters.  Yiadom MYAB, Gong W, Patterson BW, Baugh CW, Mills AM, Gavin N, Podolsky SR, Mumma BE, Tanski M, Salazar G, Azzo C, Dorner SC, Hadley K, Bloos SM, Bunney G, Vogus TJ, Liu D. J Am Coll Emerg Physicians Open. 2024 May 8;5(3):e13174. doi: 10.1002/emp2.13174. eCollection 2024 Jun.  PMID: 38726468 

Standardisation facilitates reliable interpretation of ETCO2 during manual cardiopulmonary resuscitation. Gutiérrez JJ, Urigüen JA, Leturiondo M, Sandoval CL, Redondo K, Russell JK, Daya MR, Ruiz de Gauna S. Resuscitation. 2024 May 31;200:110259. doi: 10.1016/j.resuscitation.2024.110259. Online ahead of print. PMID: 38823474 

The Impact of a One-Day Workshop on Good Psychiatric Management for Adolescent (GPM-A) Borderline Personality Disorder. Usher C, Freeman I, Wesemann D, Ross E, Fleisher C, Choi-Kain L. Acad Psychiatry. 2024 May 23. doi: 10.1007/s40596-024-01984-w. Online ahead of print. PMID: 38782842 

Ketamine for mood disorders, anxiety, and suicidality in children and adolescents: a systematic review. Bruton AM, Wesemann DG, Machingo TA, Majak G, Johnstone JM, Marshall RD. Eur Child Adolesc Psychiatry. 2024 May 16. doi: 10.1007/s00787-024-02458-y. Online ahead of print. PMID: 38750191  

Increasing Use of Rapid Magnetic Resonance Imaging for Children with Blunt Head Injury.Burns BS, Nouboussi N, DeVane K, Andrews W, Selden NR, Lin A, Pettersson D, Jafri M, Sheridan D. J Pediatr. 2024 May 14;272:114099. doi: 10.1016/j.jpeds.2024.114099. Online ahead of print. PMID: 38754775 

Emergency department pediatric readiness of United States trauma centers in 2021: Trauma center facility characteristics and opportunities for improvement. Melhado CG, Remick K, Miskovic A, Patel B, Hewes HA, Newgard CD, Nathens AB, Macias C, Gray L, Yorkgitis BK, Dingeldein MW, Jensen AR. J Trauma Acute Care Surg. 2024 May 13. doi: 10.1097/TA.0000000000004387. Online ahead of print. PMID: 38736042 

Survival After Intra-Arrest Transport vs On-Scene Cardiopulmonary Resuscitation in Children. Okubo M, Komukai S, Izawa J, Chung S, Drennan IR, Grunau BE, Lupton JR, Ramgopal S, Rea TD, Callaway CW.  JAMA Netw Open. 2024 May 1;7(5):e2411641. doi: 10.1001/jamanetworkopen.2024.11641. PMID: 38767920 

Heavy Metal Contamination of Consumer Products: an Analysis of New York City Health Department Data.  DeLoughery EP, Hendrickson RG. J Occup Environ Med. 2024 May 1. doi: 10.1097/JOM.0000000000003129. Online ahead of print. PMID: 38688474 

Shorter Door-to-ECG Time Is Associated with Improved Mortality in STEMI Patients. Yiadom MYAB, Gong W, Bloos SM, Bunney G, Kabeer R, Pasao MA, Rodriguez F, Baugh CW, Mills AM, Gavin N, Podolsky SR, Salazar GA, Patterson B, Mumma BE, Tanski ME, Liu D. J Clin Med. 2024 Apr 30;13(9):2650. doi: 10.3390/jcm13092650. PMID: 38731180  

Composition of buprenorphine prescribing networks in Medicaid and association with quality of care. Zhu JM, Charlesworth CJ, Stein BD, Drake C, Polsky D, Korthuis PT, McConnell KJ. J Subst Use Addict Treat. 2024 Apr 18;163:209363. doi: 10.1016/j.josat.2024.209363. Online ahead of print. PMID: 38641055 

Metrics of impulsiveness of manual chest compressions for out-of-hospital cardiopulmonary resuscitation. Urigüen JA, Ruiz de Gauna S, Gutiérrez JJ, Azcárate I, Leturiondo M, Redondo K, Russell JK, Daya MR. Heliyon. 2024 Mar 27;10(7):e28739. doi: 10.1016/j.heliyon.2024.e28739. eCollection 2024 Apr 15. PMID: 38601572  

Differences in healthcare utilization between enrollees of fully integrated dual eligible special needs plans versus non-fully integrated plans. Kim H, Senders A, Sergi C, Simeon E, Huang SS, Dodge HH, McConnell KJ, Roberts ET. J Am Geriatr Soc. 2024 Apr 5. doi: 10.1111/jgs.18916. Online ahead of print. PMID: 38581144 

Better together: A multistakeholder approach to developing specialty-wide entrustable professional activities in emergency medicine. Caretta-Weyer HA, Sebok-Syer SS, Morris AM, Schnapp BH, Fant AL, Scott KR, Pirotte M, Gisondi MA, Yarris LM. AEM Educ Train. 2024 Mar 25;8(2):e10974. doi: 10.1002/aet2.10974. eCollection 2024 Apr.  PMID: 38532740 

Development and validation of a prehospital termination of resuscitation (TOR) rule for out - of hospital cardiac arrest (OHCA) cases using general purpose artificial intelligence (AI). Kajino K, Daya MR, Onoe A, Nakamura F, Nakajima M, Sakuramoto K, Ong MEH, Kuwagata Y. Resuscitation. 2024 Apr;197:110165. doi: 10.1016/j.resuscitation.2024.110165. Epub 2024 Mar 5. PMID: 38452995 

An Executive Summary of the National Trauma Research Action Plan (NTRAP). Bulger EM, Bixby PJ, Price MA, Villarreal CL, Moreno AN, Herrera-Escobar JP, Bailey JA, Brasel KJ, Cooper ZR, Costantini TW, Gibran NS, Groner JI, Joseph BA, Newgard CD, Stein DM. J Trauma Acute Care Surg. 2024 Mar 25. doi: 10.1097/TA.0000000000004279. Online ahead of print. PMID: 38523118 

Pandemic phase-related racial and ethnic disparities in COVID-19 positivity and outcomes among patients presenting to emergency departments during the first two pandemic waves in the USA. Khosla S, Del Rios M, Chisolm-Straker M, Bilal S, Jang TB, Wang H, Hartley M, Loo GT, d'Etienne JP, Newgard CD, Courtney DM, Choo EK, Lin MP, Kline JA. Emerg Med J. 2024 Mar 21;41(4):201-209. doi: 10.1136/emermed-2023-213101. PMID: 38429072 

Timing and causes of death to 1 year among children presenting to emergency departments. Ames SG, Salvi A, Lin A, Malveau S, Mann NC, Jenkins PC, Hansen M, Papa L, Schmitz S, Sabogal C, Newgard CD; Pediatric Readiness Study Group. Acad Emerg Med. 2024 Mar 18. doi: 10.1111/acem.14875. Online ahead of print. PMID: 38499441 

Increasing Exposure of Young Children to Illicit Fentanyl in the United States. Temple C, Hendrickson RG. N Engl J Med. 2024 Mar 7;390(10):956-957. doi: 10.1056/NEJMc2313270. PMID: 38446682  

Dynamic electrocardiogram changes are a novel risk marker for sudden cardiac death. Pham HN, Holmstrom L, Chugh H, Uy-Evanado A, Nakamura K, Zhang Z, Salvucci A, Jui J, Reinier K, Chugh SS. Eur Heart J. 2024 Mar 7;45(10):809-819. doi: 10.1093/eurheartj/ehad770. PMID: 37956651 

Virtual Interviews and the Pediatric Emergency Medicine Match Geography: A National Survey. Baghdassarian A, Bailey JA, Caglar D, Eckerle M, Fang A, McVety K, Ngo T, Rose JA, Ganis Roskind C, Tavarez MM, Benedict FT, Nagler J, Langhan ML. West J Emerg Med. 2024 Mar;25(2):186-190. doi: 10.5811/westjem.18581. PMID: 38596916  

Impact of social media "challenges" on poison center case volume for intentional ingestions among school-aged children: an observational study. Marshall RD, Bailey J, Lin A, Sheridan DC, Hendrickson RG, Hughes A, Horowitz BZ. Clin Toxicol (Phila). 2024 Mar;62(3):183-189. doi: 10.1080/15563650.2024.2331064. Epub 2024 Apr 8. PMID: 38587109 

Teaching residents to teach: A pilot study for an innovative online curriculum. Karademos JE, Yarris LM, Steinberg E. AEM Educ Train. 2024 Feb 21;8(1):e10946. doi: 10.1002/aet2.10946. eCollection 2024 Feb. PMID: 38510733 

Research Expertise

Director, Center for Policy & Research in Emergency Medicine

As an emergency physician and physician-scientist, Dr. Newgard has ample experience studying, evaluating, and seeking to improve emergency care. He is the Director of the Center for Policy and Research in Emergency Medicine at OHSU, a position that bridges emergency care research and health policy. To date, his research has focused on EMS, field trauma triage, trauma systems, and the use of advanced statistical methods to evaluate these areas. Dr. Newgard has been continuously funded through federal research grants for over 20 years and has been very involved in large, collaborative, multi-site research efforts during this time.  

1. Improving emergency services and trauma care for children and adults.

Emergency services and trauma systems have had large gaps in the evidence base for patients at the extremes of age, namely children and older adults. Differences in these populations are due to unique responses to injury, differences in clinical management, the need for different provider training, comorbidity burdens, plus different trajectories and outcomes after injury. Dr. Newgard has worked to fill this void through multi-site research linking records across multiple phases of care and hundreds of hospitals, targeting key aspects of emergency care for children and adults.

2. Improving the process, efficiency and understanding of out-of-hospital trauma triage.

Trauma is the most common reason for 911 EMS transports, which is directed by national guidelines for field triage, one of the few aspects of EMS care that has national guidelines. Dr Newgard published a large body of work seeking to understand the process, outcomes, and costs associated with field triage, including the only prospective validation and cost-effectiveness analysis of the national guidelines. Many of these aspects have been poorly understood prior to this work. Five publications were cited in the 2011 revision of the national guidelines for field triage (the most recent revision), helping to shape the day-to-day practice of out-of-hospital care for injured patients across the U.S.

3. Statistics and methodology of emergency care research.

Dr. Newgard has helped catalyze the integration of several advanced statistical methods into the field of emergency care research. While these methods had been developed and used in other fields (biostatistics, econometrics), they have been under-utilized in emergency care research. The topics include multiple imputation of missing values, probabilistic linkage (combining disparate datasets without a unique identifier), and the use of electronic health records for EMS research. His methodologic expertise combined with an intimate understanding of emergency care delivery systems has been utilized in multiple federally-funded research projects.

4. Generating large, multi-site data registries to catalyze scientific discovery in emergency care.

Dr. Newgard has used his methodological skills and interest in large, population-based data to develop multiple data registries in emergency care. Two of these registries were developed through the NHLBI-funded Resuscitation Outcomes Consortium (ROC) and generated over 40 original research publications through the ROC network. Several of these publications have been integrated to national and international guidelines (e.g., National Guidelines for Field Triage and the AHA Advanced Cardiac Life Support algorithm) and serve as the basis for national quality improvement efforts (e.g., ACS Trauma Quality Improvement Project). Development of these registries demonstrates “team science” through collaboration with large inter-disciplinary teams.

Complete List of Published Work in: MyBibliography:  https://www.ncbi.nlm.nih.gov/myncbi/craig.newgard.1/bibliography/public/

Dr. Choo is an emergency medicine physician and core research faculty in the Center for Policy & Research, Department of Emergency Medicine, Oregon Health & Science University. She has considerable expertise in employing quantitative, qualitative, and mixed-method study designs to examine the experience of patients, clinicians, and administrators in emergency and primary care systemsOne of Dr. Choo's focused interests has been on the impact of gender on emergency presentations and care. She co-founded the Division of Sex and Gender in Emergency Care at Brown University, including establishing the division’s two-year research fellowship that trains early investigators in methodologic approaches to gender-related research. Dr. Choo is the health services fellowship director in the Center for Policy and Research in Emergency Medicine at OHSU. 

  1. Investigating epidemiologic data related to opioid and cannabis use and drug use policy. Dr. Choo has applied her skill set to examining large, complex state and national datasets to examine trends in drug use, particularly related to opioid and marijuana use, gaining experience in managing and analyzing such data to inform policy and shape future areas of research.
  1. Understanding the influence of gender on emergency care interventions. Emergency care drug and alcohol interventions have largely failed to include gender-specific considerations or common co-existing problems. Her research has focused on the differences between men and women with substance use disorders and the influence of co-existing violence involvement and substance use disorders on screening and interventions. By drawing attention to the important role of gender and violence in the development of substance use disorders, specific barriers to treatment and recovery, and differential responsiveness to ED-based interventions based on gender and violence involvement, my body of work has supported interventions specific to these factors. Dr. Choo developed a Web-based brief intervention for women with drug use and IPV, using interviews with the target population to guide the language, content, and format of the intervention. 
  1. Establishing gender-focused technology-based screening interventions for drug use and violence in the emergency care setting. Dr. Choo's work has included integrated qualitative and quantitative research to develop technology-based screening and behavioral interventions for the emergency care setting and to evaluate their feasibility and acceptability. She has used tailored Web-based screening assessments and developed videos incorporating women with coexisting disorders to increase the relevance and human connection of interventions delivered through a Web-based medium. 
  1. Investigating epidemiologic data related to opioid and cannabis use and drug use policy. Dr. Choo completed fellowship training in health services and health policy research. She has applied this skill set to examining large, complex state and national datasets to examine trends in drug use, particularly related to opioid and marijuana use, gaining experience in managing and analyzing such data to inform policy and shape future areas of research. 
  1. Understanding influences on the careers of women in medicine.  Dr. Choo's research has included investigations of the persistent gender gaps in the careers of women in medicine and science, including experiences of discrimination and the sequelae on mental health and burnout.

Complete List of Published Work in MyBibliography:  


Dr. Hansen is a physician-scientist dual-boarded in Emergency Medicine and Pediatric Emergency Medicine. Dr. Hansen has research funding from AHRQ and NHLBI to study prehospital care for critically ill children with a focus on airway management, cardiac arrest, and respiratory emergencies. Other interests include medical technology development and global health systems development.

1. Pediatric Patient Safety in Out-of-Hospital Care:  Dr. Hansen's primary interest is in improving out-of-hospital care for severely ill or injured children. He recently published a paper in JAMA Open describing critical differences in adult and pediatric cardiac arrest resuscitation quality using a simulation model. He also completed a study published in JAMA pediatrics that identifies a previously unrecognized problem in safety dosing epinephrine to children suffering a cardiac arrest and subsequently published a paper in JAMA Open detailing an intervention that solved this problem. Dr. Hansen has had a sustained focus on improving out-of-hospital pediatric airway management. He is a co-investigator in the recently funded PEDI-PART trial, which is a landmark randomized trial of pediatric airway devices in EMS. In a prior study, he identified critical challenges in monitoring pediatric vital signs during prehospital airway management procedures. Finally, he conducted a medical record review that identified the significant types and rates of safety events that take place during out-of-hospital pediatric airway management.

2. Out-of-Hospital Cardiac Arrest Resuscitation Science: One of his publications (“a” below) was a key article cited in changes to the 2019 American Heart Association Pediatric Advanced Life Support guidelines where BVM recommended as reasonable for Pediatric OHCA. Overall, Dr. Hansen has an interest in identifying interventions or changes in practice that can improve outcomes for patients who have suffered an out-of-hospital cardiac arrest. He has focused work on airway management in these patients and has conducted work finding that intubation is associated with poorer outcomes from cardiac arrest. In addition, he led a study that found shorter times to the first dose of epinephrine was associated with improved survival from cardiac arrest from non-shockable rhythms.

3. Pediatric prehospital readiness: Dr. Hansen's current R01 grant from AHRQ focuses on identifying the potential benefits of improving pediatric readiness among EMS agencies. He is partnering with the HRSA-funded National Prehospital Pediatric Readiness Project (NPRP), who developed a readiness assessment tool that will be deployed nationwide. This work builds from recent studies showing that improved pediatric ED readiness is associated with higher survival from critical emergencies.

4. Medical Technology Development: Dr. Hansen co-developed a technology to measure capillary refill time (CRT) electronically. CRT is an important marker of microcirculatory function. A company he co-founded, Promedix Inc., is currently in the process of obtaining FDA clearance and gathering clinical evidence on electronically measured CRT and sepsis.

Complete List of Published Work in MyBibliography:  


Biography: Joshua Lupton, MD, MPH, MPhil, is a cardiac arrest survivor, emergency physician, and researcher who studies ways to improve treatment and increase survival for patients suffering out-of-hospital cardiac arrest. After receiving his undergraduate degree from the University of Oregon, Dr. Lupton was selected as a Marshall Scholar and received an MPH from the London School of Hygiene and Tropical Medicine and an MPhil from the University of Cambridge. After medical school at Johns Hopkins University School of Medicine, Dr. Lupton completed his residency in Emergency Medicine and a fellowship in Emergency Care Research at Oregon Health and Science University. Dr. Lupton coordinates the Portland Cardiac Arrest Epidemiologic Registry (PDX Epistry), working closely with regional emergency medical services agencies and hospitals.

Dr. Lupton’s Research Interests: Dr. Lupton focuses on observational and interventional research to optimize the care of out-of-hospital cardiac arrest patients so as to increase the proportion of patients surviving with a good outcome. Currently, only 10% of patients suffering out-of-hospital cardiac arrest survive across the United States. However, this survival can range significantly with higher performing systems of care having significantly greater survival. Focusing on this natural variation, Dr. Lupton aims to explore the specific aspects of care – and the optimal delivery of these – to maximize survival.

Dr. Lupton coordinates the Portland Cardiac Arrest Epidemiologic Registry (PDX Epistry), a continuation of the Portland metropolitan Resuscitation Outcomes Consortium Registry that has been active since 2005. This registry allows for detailed observational studies to generate hypothesis for testable interventions in future trials.

Complete List of Published Work in MyBibliography:


Dr. Kea is an Associate Professor in Emergency Medicine in the Dept of Emergency at OHSU, and a physician-scientist focused on improving acute neuroscience and cardiovascular care through evidence-based guidelines and novel treatment strategies to improve clinical outcomes. She is the Director of Clinical Trials for emergency medicine at OHSU, and has been the site PI for multiple diagnostic and interventional studies, and collaborated with other departments and institutions to enroll patients for sepsis, COVID, and heart failure studies. She is also the Co-PI of the OHSU Hub for SIREN (NINDS/NHLBI), a network of hospitals performing emergency care research.  She is a product of the NIH training pipeline, beginning with an initial week-long exposure to NIH for underserved undergraduates students, subsequent NHGRI summer undergraduate research experience, followed by an NHLBI-funded ROC fellowship at OHSU, NHLBI K12 institutional scholar, NHLBI K08, and now an NHLBI Early Stage Investigator R01. Her R01 is a multi-centered stepped wedge cluster randomized clinical trial multi-centered stepped-wedge randomized clinical trial utilizing a novel clinical decision support tool to improve stroke prevention in patients with atrial fibrillation. This mixed-method study enrolls patients and providers and uses large databases to collect quantitative data.

  1. With respect to clinical trials methodology, Dr. Kea has contributed with her early research and her most recent experiences as a site co-I and PI. Dr. Kea's early research sought to determine a genetic basis for dermatomyositis (DM) as there was little knowledge about DM or its treatment options. She has recruited, enrolled, and collected skin biopsies from both healthy controls and patients with dermatomyositis. She developed the protocol for RNA extraction (still in use at Stanford) and gene expression analysis on gene chips developed by our lab (Dr. Patrick Brown).  This work laid the foundation for determining the biologic signatures for DM and potential gene targets for treatment. Most recently, Dr. Kea has assisted the PETAL-network (an NIH-sponsored network for pulmonary critical care) as a site co-investigator for randomized-controlled clinical trials for patients with acute respiratory distress using an early neuromuscular blockade as well as for sepsis care with a variety of interventions (including vitamin D, high volume vs. low volume fluid resuscitation, and vitamin C, thiamine and steroid). For SIREN, Dr. Kea was the site PI of the Clinical Trial of COVID-19 Convalescent Plasma in Outpatients (4th highest enrolling site in the network). She is also leading two OHSU sites in enrolling patients (257 patients) to determine the utility of COVID-19 antigen testing. She has collaborated with nursing, hospital medicine, blood bank, subspecialty groups, and therapeutic committees. She also educates clinicians, nurses, and pharmacists on the studies, assists in recruiting patients and troubleshoot to increase enrollment and improves integration into clinical workflow. OHSU is often the top enroller in these network studies.
  2. Atrial fibrillation (AF) is a common arrhythmia that presents to the Emergency Department (ED) with wide inter-variation of EM management globally. Dr. Kea has used different methodologies to determine current prescribing practices of EM providers and practices gaps from current professional AF guidelines on both a local and national level, and provider barriers to optimal oral anticoagulation (OACs) prescribing. And initial chart review study informed the design my NHLBI K08 and the decision to obtain a larger sample of patients from a network of hospitals. On a national level, she has obtained a representative cohort of Medicare beneficiaries from 2011-2012. The results were subsequently published in the Journal of American College of Cardiology. To further understand practice gaps, Dr. Kea has undertook a qualitative study interviewing both ED providers and patients regarding barriers to optimal AF management, and more specifically around OACs. Other than editorials, this was the first qualitative study addressing EM provider barriers to ED AF management and OAC prescribing, Her K08 work with Kaiser Northern California’s 21 hospitals has similarly demonstrated low amounts of ED prescribing, with women less likely to receive appropriate stroke prophylaxis compared to men (submitted to Ann of EM). Using the GLORIA-AF database, Dr. Kea's team also found variability in prescribing anticoagulants internationally (in press). These data laid the groundwork for my R01, a multi-centered stepped wedge cluster randomized clinical trial utilizing a novel clinical decision support tool to improve stroke prevention in patients with atrial fibrillation (1R01HL157598).
  3.  In order to improve the reliability of manuscripts and create a more informed and discriminating reader, she and her colleagues wrote a two-part series on bias in studies of diagnostic tests.  The ability to recognize and discern different types of bias is important to understanding the relevance, flaws, and applicability of a study to the reader’s population.  They created examples that an emergency provider would encounter and whether renowned studies would apply to those examples, and flaws within them. Dr. Kea and colleagues also discussed that sometimes bias may be necessary due to the ethics of a study, but does not discount the study. In all, they are a practical and readily usable methods of recognizing bias. 
  4. Opioid abuse is a well-known epidemic, and emergency populations are potentially at high risk for abuse. To determine the contribution of ED to the epidemic of opioid prescribing, she described the trends of ED opioid prescribing using a multistage, probability sample of US ED visits. This data of 502.4 million ED discharges from 2006-2010, showed no increasing trends in ED prescribing and contributed the national EM discussion on the role EM in opioid prescribing.    
  5. Dr. Kea has contributed to the derivation of two clinical decision instruments by playing a key role in the data analysis phase using recursive partitioning: (1) a pilot study on the development of a clinical decision instrument for endocarditis in intravenous drugs users, and (2) derivation of criteria for selective chest x-ray imaging in blunt trauma. This second project led to funding from a CTSI grant, which she used to develop a multi-center study to determine the utility of chest CT in blunt trauma patients. During this project, Dr. Kea managed many research assistants, performed data management of a large data set, communicated with other institutions, and performed statistical analyses, and manuscript composition. This study was awarded the American College of Emergency Physician’s Best Resident Paper in 2011, and has prompted a larger multi-center study on a clinical decision instrument for selective chest CT in blunt trauma.

Complete List of Published Work in MyBibliography:   https://www.ncbi.nlm.nih.gov/myncbi/bory.kea.1/bibliography/public/  

Dr. Maughan completed a two- year research fellowship in the Robert Wood Johnson Foundation Clinical Scholars Program at the University of Pennsylvania. His research training primarily focused on epidemiology, study design, regression analysis, and experimental quantitative methods for health services research. Dr. Maughan's long-term career goal is to become an independently funded physician-scientist with expertise in identifying biological (sex-based) and behavioral (gender-based) differences in diagnosis and treatment of acute cardiopulmonary disease in the emergency care setting, with the aim of developing interventions to improve patient outcomes and equity of care. He studies these elements to regard to the care of pulmonary embolism (PE), the third leading cardiovascular cause of death in the US and a frequent diagnostic consideration in emergency department (ED) patients with chest pain or shortness of breath. Diagnosis of PE is challenging since only 1-2% of the 16 million annual ED patients with these common symptoms have PE. Insufficient testing can result in harm from missed PE diagnosis, while overtesting leads to wasteful resource use and unnecessary radiation exposure from diagnostic imaging such as CT pulmonary angiography (CTPA). To reduce these harms, guidelines recommend physicians use d-dimer, a plasma biomarker of thrombosis, to initially screen patients who have concerning symptoms but are not at high risk for PE. While PE incidence is similar by sex, women undergo PE testing nearly twice as often as men,suggesting risks of missed diagnosis in men and harms of overtesting in women.

  1. Pulmonary embolism (PE) is the third leading cardiovascular cause of death in the United States and is a frequent diagnostic consideration in emergency department (ED) patients with chest pain or shortness of breath. Historically, treatment options for PE were rather narrow in scope and typically require hospital admission, yet recent advances have broadened the available treatments for both high-risk (i.e., severe) and low-risk PE.  Dr. Maughan's research summarized recent advances in PE treatment and identified key unmet research needs for future investigation.
  2. Over 75,000 people die of opioid overdoses each year in the United States. A key strategy for reducing opioid-related mortality includes a reduction in the quantity and duration of opioid analgesic prescriptions, especially for patients in whom pain can be treated effectively with other analgesics. As a Robert Wood Johnson Clinical Scholar at the University of Pennsylvania, Dr. Maughan explored opioid use patterns in these populations. First, with grant support from the Leonard Davis Institute for Health Economics, he conducted a pilot randomized trial that assessed the quantity of opioid analgesic used after dental surgery (wisdom tooth extraction) and assessed patient response to an educational intervention regarding disposal of unused pills. Dr. Maughan helped identify that more than half (54%) of opioids prescribed in this setting were not used, suggesting that oral surgeons could substantially reduce opioid prescribing and reduce the risk of drug misuse or diversion. Dr. Maughan also examined prescription opioid use patterns among women following the delivery of an infant. Using a large national claims dataset that included 870,000 postpartum women, they found a 7-fold variation (7.6–53.4%) in the proportion of women who filled opioid prescriptions within four days of uncomplicated vaginal delivery. Another important policy strategy for reducing overdose morbidity is to identify patients with substance use disorders who are at especially high risk for overdose. In collaboration with the Texas Department of State Health Services, Dr. Maughan conducted two record-linkage studies to assess short-term overdose death rates among patients recently discharged from substance abuse treatment programs. They identified that drug-related death was significantly higher after treatment discharge among patients who used opioids, particularly after completion of residential therapy.
  3. Although nearly all states have established prescription drug monitoring programs (PDMPs) to improve the safety of high-risk prescription medications, the effect of these programs on rates of fatal and nonfatal overdose was unclear. Using Drug Abuse Warning Network public use files in a generalized estimating equations framework, Dr. Maughan conducted two analyses to measure the impact of these programs on rates of emergency department visits for opioid-related and benzodiazepine-related overdose. An important policy consideration in PDMP implementation is selecting who can access the database. Some state health departments required PDMP use for routine opioid prescriptions yet restricted PDMP access to a narrow set of clinicians. To inform further policy development, Dr. Maughan conducted a study to measure the time burden and financial cost of mandating physician PDMP use rather than permitting the delegation of this task to other clinical staff members. The analysis concluded that PDMP use could be maintained yet costs to the health system could be reduced by over 60% if policies were adopted to permit other clinical staff to use these data.
  4. Payment for healthcare services has a major impact on the availability and quality of care. Bundled payment models for Medicare have successfully reduced payments for services, yet policymakers have raised concerns that the financial incentives of these programs could restrict access to care or result in poorer outcomes for patients with vulnerabilities such as low socioeconomic status or dementia. Dr. Maughan analyzed the Bundled Payment for Care Improvement (BPCI) program, an alternative Medicare payment model authorized by the Affordable Care Act, and our research identified that this program was not associated with reductions in quality of care for patients with vulnerabilities.
  5. Choosing Wisely is a national program from the American Board of Internal Medicine Foundation that is designed to improve medical resource stewardship by promoting discussions between physicians and patients regarding the value of medical tests and treatment. The emergency department is a high-risk clinical environment in which physicians often must make time-sensitive decisions on the use of expensive medical resources for patients with whom they have no existing relationship. Dr. Maughan measured awareness of the Choosing Wisely program among leaders in the emergency medicine community and identified opportunities for emergency physicians to collaborate with other specialists on reducing unnecessary testing and improving the value of emergency care.

Complete List of Published Works in MyBibliography:


Dr. Nikolai Schnittke is a graduate of the Tufts University MSTP program where his research focused on neuronal regeneration of the olfactory epithelial system after injury. This interest in acute injury led him to training in Emergency Medicine at the University of Wisconsin where he discovered the power point-of-care ultrasound as a rapid diagnostic assay to assess patients with acute pathology.

He is particularly interested in ways that ultrasound can be brought outside of the typical hospital environment such as to the prehospital and global health settings. A common barrier in many of these settings is the lack of trained personnel to obtain and interpret ultrasound images at an expert level. In 2020, Nikolai joined a federally funded partnership with BARDA (The Biomedical Advanced Research Development Authority) and the Center for Regenerative Medicine at OHSU to focus on machine learning approaches to ultrasound training and image interpretation. He is the principal investigator for a multi-center study to develop and validate machine learning algorithms to improve FAST exam image acquisition and interpretation, and is a co-investigator for similar approaches to lung ultrasound automated tools. The goal is to bring ultrasound directly to the bedside, so that it can be accessible to all patients who need it in real time to make time-sensitive treatment and management decisions.

Nikolai's other interests include global health resident education through leading a "Global Health and Limited Resource Medicine" education track and exploring ways to reduce barriers to ultrasound use by ED physicians.

When not covered in ultrasound gel or waving his hands to show how to move an ultrasound probe, Nikolai enjoys wandering the mountains and coast of the Pacific Northwest with his family and friends.

Complete List of Published Work in MyBibliography:


Dr. Sheridan is a pediatric emergency physician and a physician-scientist in the Oregon Health & Science University Department of Emergency Medicine, with a joint appointment in the Department of Pediatrics. In addition to his clinical training, he earned a Master’s degree in Clinical Research (MCR), which provided coursework in epidemiology, biostatistics, clinical trial design, implementation science, and data analysis. Dr. Sheridan's research includes publications mainly in emergency care around adolescent mental health, development of new technology, evaluation of new interventions, observational research, and randomized controlled trials. Much of his work has focused on medical device development as an academic physician-scientist. He has filed 7 patents and one technology has become an OHSU startup company. Through this innovation work Dr. Sheridan has had to learn first-hand the processes and methods for moving a device from concept to commercialization.

1. Adolescent Mental Health Crises and Emergency Care

Through problem-based innovation in the ED, Dr. Sheridan has recognized the critical need for improved emergency care research in adolescent mental health. There has been a paucity of literature on adolescent children presenting to EDs in crisis, which my work has begun to address. Dr. Sheridan's foundational work has shown evidence of a rapidly growing population of children presenting to EDs in crisis, the prevalence of adolescent suicidality and care received in the ED, and the need for improved outpatient monitoring. His K12 project was aimed at providing a foundation in this area and his K23 is exploring it further in a more rigorous approach. The current study focuses on EMA, machine learning and wearable technology to assess dynamic changes in acute adolescent suicidality.   

2. Device Development in Pediatric Emergency Care

Medical devices are often created by industry with little clinician involvement, resulting in technology that is often too expensive, not indicated, or ineffective. Dr. Sheridan has founded an innovation division in our department that has developed infrastructure for combining physicians and engineers to develop technology through an innovation based process. This has resulted in funding, intellectual property and prototypes in clinical testing. One technology has been spun out of OHSU as a startup company.  

3. New Imaging Modalities with Decreased Risk for Acute Pediatric Head Trauma

Pediatric head injuries account for millions of ED visits per year and carry significant morbidity and mortality in children. The current imaging test of choice is a CT scan, but this entails significant radiation exposure that can result in future malignancy at a risk of approximately 1:1000 scans. “Quick brain” MRI has introduced the possibility of obtaining rapid-sequence neuroimaging without radiation. Dr. Sheridan completed a retrospective study showing 100% sensitivity of MRI to detect injuries that catalyzed a prospective observational study at our pediatric trauma center evaluating the diagnostic utility of quick brain MRI versus head CT among children presenting with acute head trauma. As the PI, he brought together 5 specialties across the institution to collaborate on the trial resulting in a publication that has resulted in practice guidelines for neuroimaging in pediatric trauma.

Complete List of Published Work in MyBibliography: