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11 results on '"Lara K. Kulchycki"'

1. Prevalence and Characteristics of Traumatic Intracranial Hemorrhage in Elderly Fallers Presenting to the Emergency Department without Focal Findings

Author

Larry A. Nathanson, Alan Abrams, Anupama Gangavati, Richard E. Wolfe, Lara K. Kulchycki, J. Lawrence Mottley, Dan K. Kiely, Sean P. Kelly, and Lewis A. Lipsitz

Subjects
Geriatrics, medicine.medical_specialty, business.industry, Medical record, Warfarin, Poison control, Retrospective cohort study, Odds ratio, Emergency department, nervous system diseases, Internal medicine, Physical therapy, Medicine, cardiovascular diseases, Geriatrics and Gerontology, business, Prospective cohort study, medicine.drug
Abstract

OBJECTIVES: To determine the prevalence and associated characteristics of traumatic intracranial hemorrhage (ICH) in elderly fallers presenting to the emergency department (ED) without focal findings. DESIGN: Retrospective cohort study. SETTING: University-affiliated teaching hospital ED. PARTICIPANTS: Patients aged 65 and older presenting with a fall to the ED and undergoing a head computed tomography (CT) scan. MEASUREMENTS: Electronic medical records and CT scans of 404 consecutive patients were reviewed. Characteristics of patients with and without ICH were compared using unadjusted analyses. Patients taking warfarin, aspirin, or clopidogrel alone or in combination were compared with those not taking these medications. Multivariate logistic regression analyses were performed to determine variables independently associated with ICH. RESULTS: Forty-seven of 404 elderly fallers (11.6%) without focal findings had an ICH. Unadjusted analyses in these pilot data showed that warfarin was not significantly associated with ICH. Multivariate analyses indicated that elderly people living in at home were more likely to have ICH than those living in nursing homes or assisted living facilities (odds ratio (OR)=3.2, 95% confidence interval (CI)=1.30-8.13) and that those with head trauma were more likely to have ICH than those without (OR=3.9, 95% CI=1.25-7.80). Aspirin was found to be protective (OR=0.49, 95% CI=0.24-0.98). CONCLUSION: ICH is common in elderly fallers presenting to the ED without focal findings. Anticoagulation alone did not appear to increase the risk of ICH, and aspirin was found to be protective, but prospective studies are needed to better assess this relationship. Language: en

Published
2009
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2. Risk Factors for Death in Elderly Emergency Department Patients with Suspected Infection

Author

Nathan I. Shapiro, Richard E. Wolfe, Lara K. Kulchycki, Christopher Fischer, and Jeffrey M. Caterino

Subjects
medicine.medical_specialty, business.industry, Emergency department, Odds ratio, Logistic regression, Confidence interval, Surgery, Internal medicine, Cohort, medicine, Geriatrics and Gerontology, Risk factor, Prospective cohort study, business, Cohort study
Abstract

OBJECTIVES: To identify independent risk factors for death in elderly emergency department (ED) patients admitted for infection and to derive and validate a mortality-prediction rule for such patients. DESIGN: Prospective cohort study. SETTING: Tertiary hospital ED with 55,000 annual visits. PARTICIPANTS: ED patients aged 65 and older admitted for infection between December 2003 and September 2004 in the derivation cohort and October 2005 and October 2006 in the validation cohort. MEASUREMENTS: Primary outcome: 28-day in-hospital mortality. Data were extracted from charts, and multivariate logistic regression were performed to identify independent mortality predictors. A prediction model was constructed and then validated in a second cohort. RESULTS: Nine hundred thirty-five patients were included in the derivation cohort and 2,015 in the validation cohort. Mortality was 6% in the derivation cohort and 7% in the validation cohort. In the derivation cohort, logistic regression revealed five independent mortality predictors: respiratory compromise (respiratory rate >20 breaths per minute or hypoxemia) (odds ratio (OR)=4.0, 95% confidence interval (CI)=1.7–9.4), tachycardia (heart rate ≥120 betas per minute; OR=3.2, 95% CI=1.6–6.3), cardiovascular failure (systolic blood pressure

Published
2009
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4. Contributors

Author

Yasser A. Alaska, Abdulaziz D. Aldawas, Saleh Ali Alesa, George A. Alexander, Hazem H. Alhazmi, Nawfal Aljerian, Majed AlJohani, Khaldoon H. AlKhaldi, Bryant Allen, Bader S. Alotaibi, Mohammad Alotaibi, Evan Avraham Alpert, Rakan S. Al-Rasheed, Mai Alshammari, Asaad Alsufyani, Siraj Amanullah, Ali Ardalan, Andrew W. Artenstein, Miriam Aschkenasy, Matthew R. Babineau, Kavita Babu, Olivia E. Bailey, Gregory T. Banner, Fermin Barrueto, Susan A. Bartels, Bruce M. Becker, Paul D. Biddinger, Eike Blohm, Susan R. Blumenthal, Stephen W. Borron, Michelangelo Bortolin, Michael Bouton, Peter Brewster, Churton Budd, James M. Burke, Frederick M. Burkle, Lynne Barkley Burnett, Nicholas V. Cagliuso, John D. Cahill, David W. Callaway, Duane C. Caneva, David M. Canther, Srihari Cattamanchi, Edward W. Cetaruk, James C. Chang, Zeno L. Charles-Marcel, Anna I. Cheh, David T. Chiu, Teriggi J. Ciccone, Gregory R. Ciottone, Jonathan Peter Ciottone, Robert A. Ciottone, Diana Clapp, Raphael G. Cohen, Kathe M. Conlon, Joanne Cono, Hilarie Cranmer, Cord W. Cunningham, Steven O. Cunnion, Alison Sisitsky Curcio, Robert G. Darling, Neil B. Davids, Timothy E. Davis, Scott Deitchman, John B. Delaney, Francesco Della Corte, Gerard DeMers, William E. Dickerson, Sharon Dilling, Ahmadreza Djalali, Joseph Donahue, K. Sophia Dyer, Jason Dylik, Benjamin Easter, Laura Ebbeling, Nir Eyal, Andrew J. Eyre, Saleh Fares, Katherine Farmer, Denis J. FitzGerald, Elizabeth Foley, Kerry Fosher, David Freeman, Robert L. Freitas, Franklin D. Friedman, Frederick Fung, Fiona E. Gallahue, Lucille Gans, Stephanie Chow Garbern, Mark E. Gebhart, James Geiling, Brian C. Geyer, Mary Jo Giordano, William A. Gluckman, J. Scott Goudie, Robert M. Gougelet, Benjamin Graboyes, Michael I. Greenberg, P. Gregg Greenough, Ashley L. Greiner, Mark Greve, Stephen Grosse, Shamai A. Grossman, Tee L. Guidotti, Jason B. Hack, Matthew M. Hall, John W. Hardin, John L. Hick, Nishanth S. Hiremath, Steven Horng, Geoffrey D. Horning, Kurt R. Horst, Ali A. Hosin, Amer Hosin, Hans R. House, Pier Luigi Ingrassia, Patrick M. Jackson, Irving 'Jake' Jacoby, Rajnish Jaiswal, Adam J. Janicki, Gregory Jay, Miriam John, Shawn E. Johnson, James R. Johnston, Jerrilyn Jones, Michael D. Jones, Josh W. Joseph, Patrice Joseph, Alexis Kearney, Donald Keen, Mark E. Keim, Elizabeth Kenez, Katharyn E. Kennedy, Anas A. Khan, Chetan U. Kharod, Sylvia H. Kim, Kevin King, Mark A. Kirk, Leo Kobayashi, Lara K. Kulchycki, Rick G. Kulkarni, Joseph Lauro, Benjamin J. Lawner, David V. Le, Debra Lee, Terrance T. Lee, Jay Lemery, Jeanette A. Linder, Lawrence S. Linder, Michael A. Loesch, Heather Long, Kate Longley-Wood, Michael D. Mack, John M. Mackay, Laura Macnow, James M. Madsen, Brian J. Maguire, Patrick J. Maher, Selwyn E. Mahon, John D. Malone, Marco Mangini, Paul M. Maniscalco, David Marcozzi, Pietro D. Marghella, Jeff Matthews, Peter McCahill, Sean D. McKay, C. Crawford Mecham, Mandana Mehta, Patricia L. Meinhardt, Laura Diane Melville, Angela M. Mills, Andrew M. Milsten, Clifford S. Mitchell, Dale M. Molé, Michael Sean Molloy, John Moloney, Ilaria Morelli, Jerry L. Mothershead, John Mulhern, Nicole F. Mullendore, Larry A. Nathanson, Amelia Marie Nelson, Erica L. Nelson, Lewis S. Nelson, Carey Nichols, Mariann Nocera, Erin E. Noste, Catherine Y. Ordun, Peter D. Panagos, Robert Partridge, Jeffrey S. Paul, Catherine Pettit, James Pfaff, James P. Phillips, Jason Pickett, William Porcaro, Thérèse M. Postel, Charles N. Pozner, P.R. Vidyalakshmi, Lawrence Proano, Peter B. Pruitt, Jeffrey S. Rabrich, Jeffrey D. Race, Luca Ragazzoni, Najma Rahman-Kahn, Kristin Allyce Reed, Wende R. Reenstra, Paul P. Rega, Michael J. Reilly, Andrew T. Reisner, Marc C. Restuccia, James J. Rifino, James Michael Riley, Paul M. Robben, Kevin M. Ryan, Heather Rybasack-Smith, Leon D. Sanchez, Ritu R. Sarin, Debra D. Schnelle, Valarie Schwind, Malcolm Seheult, Kinjal N. Sethuraman, Geoffrey L. Shapiro, Marc J. Shapiro, Sam Shen, Suzanne M. Shepherd, William H. Shoff, Craig Sisson, Alexander P. Skog, Jonathan E. Slutzman, Devin M. Smith, E. Reed Smith, Jack E. Smith, Peter B. Smulowitz, Angela M. Snyder, Joshua J. Solano, John Sorenson, Kimberly A. Stanford, Charles Stewart, M. Kathleen Stewart, Carol Sulis, Robert J. Tashjian, Elizabeth S. Temin, Andrea G. Tenner, Craig D. Thorne, Jason A. Tracy, Milana Trounce, Jonathan Harris Valente, Alice Venier, Faith Vilas, Gary M. Vilke, Janna H. Villano, Barbara Vogt, Amalia Voskanyan, Scott G. Weiner, Brielle Weinstein, Eric S. Weinstein, Scott D. Weir, Roy Karl Werner, Sage W. Wiener, Kenneth A. Williams, Robyn Wing, Wendy Hin-Wing Wong, Richard E. Wolfe, Stephen P. Wood, Robert H. Woolard, Prasit Wuthisuthimethawee, Kevin Yeskey, Sami A. Yousif, Nadine A. Youssef, and Brian J. Yun

Published
2016
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5. Geriatric Neurologic Emergencies

Author

Jonathan A. Edlow and Lara K. Kulchycki

Subjects
Geriatrics, medicine.medical_specialty, Resuscitation, Health Services for the Aged, business.industry, Subspecialty, United States, Treatment Outcome, Lower threshold, Central Nervous System Diseases, Intensive care, Emergency medicine, Emergency Medicine, medicine, Humans, Emergencies, Presentation (obstetrics), Neurologic disease, Intensive care medicine, business, Aged
Abstract

Geriatrics is an important subspecialty within the field of emergency medicine and represents a burgeoning area of practice. The special vulnerability of elderly patients to neurologic disease and injury and the comparative subtlety of clinical presentation mean that physicians should have a lower threshold for laboratory studies, radiologic imaging, consultation, and admission. Transferring appropriate patients to tertiary centers that offer specialized trauma and neurologic and neurosurgical care greatly enhances survival and functional outcomes.

Published
2006
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6. Risk factors for death in elderly emergency department patients with suspected infection

Author

Jeffrey M, Caterino, Lara K, Kulchycki, Christopher M, Fischer, Richard E, Wolfe, and Nathan I, Shapiro

Subjects
Aged, 80 and over, Male, Chi-Square Distribution, Comorbidity, Infections, Logistic Models, Predictive Value of Tests, Risk Factors, Humans, Female, Hospital Mortality, Prospective Studies, Emergency Service, Hospital, Aged
Abstract

To identify independent risk factors for death in elderly emergency department (ED) patients admitted for infection and to derive and validate a mortality-prediction rule for such patients.Prospective cohort study.Tertiary hospital ED with 55,000 annual visits.ED patients aged 65 and older admitted for infection between December 2003 and September 2004 in the derivation cohort and October 2005 and October 2006 in the validation cohort.28-day in-hospital mortality. Data were extracted from charts, and multivariate logistic regression were performed to identify independent mortality predictors. A prediction model was constructed and then validated in a second cohort.Nine hundred thirty-five patients were included in the derivation cohort and 2,015 in the validation cohort. Mortality was 6% in the derivation cohort and 7% in the validation cohort. In the derivation cohort, logistic regression revealed five independent mortality predictors: respiratory compromise (respiratory rate20 breaths per minute or hypoxemia) (odds ratio (OR)=4.0, 95% confidence interval (CI)=1.7-9.4), tachycardia (heart rateor = 120 betas per minute; OR=3.2, 95% CI=1.6-6.3), cardiovascular failure (systolic blood pressure90 mmHg despite fluid challenge or lactateor = 4.0; OR=9.0, 95% CI=4.7-17), preexisting terminal illness (OR=5.7, 95% CI=2.2-15), and platelet count less than 150,000/mm3 (OR=2.7, 95% CI=1.3-5.6). Mortality increased with the number of factors: 0.51% for no factors, 3.1% for one factor, 14% for two factors, 47% for three or more risk factors. The c-statistic was 0.87 for the derivation model and 0.74 for the validation model. Almost 80% of patients in both cohorts were in low-risk groups (0 or 1 factor).A rule derived from five readily available variables predicts mortality in infected elderly ED patients and allows identification of a large low-risk subgroup.

Published
2009

7. Prevalence and characteristics of traumatic intracranial hemorrhage in elderly fallers presenting to the emergency department without focal findings

Author

Anupama S, Gangavati, Dan K, Kiely, Lara K, Kulchycki, Richard E, Wolfe, J Lawrence, Mottley, Sean P, Kelly, Larry A, Nathanson, Alan P, Abrams, and Lewis A, Lipsitz

Subjects
Aged, 80 and over, Male, Chi-Square Distribution, Ticlopidine, Aspirin, Anticoagulants, Intracranial Hemorrhage, Traumatic, Clopidogrel, Logistic Models, Risk Factors, Prevalence, Humans, Accidental Falls, Female, Warfarin, Emergency Service, Hospital, Tomography, X-Ray Computed, Aged, Retrospective Studies
Abstract

To determine the prevalence and associated characteristics of traumatic intracranial hemorrhage (ICH) in elderly fallers presenting to the emergency department (ED) without focal findings.Retrospective cohort study.University-affiliated teaching hospital ED.Patients aged 65 and older presenting with a fall to the ED and undergoing a head computed tomography (CT) scan.Electronic medical records and CT scans of 404 consecutive patients were reviewed. Characteristics of patients with and without ICH were compared using unadjusted analyses. Patients taking warfarin, aspirin, or clopidogrel alone or in combination were compared with those not taking these medications. Multivariate logistic regression analyses were performed to determine variables independently associated with ICH.Forty-seven of 404 elderly fallers (11.6%) without focal findings had an ICH. Unadjusted analyses in these pilot data showed that warfarin was not significantly associated with ICH. Multivariate analyses indicated that elderly people living in at home were more likely to have ICH than those living in nursing homes or assisted living facilities (odds ratio (OR)=3.2, 95% confidence interval (CI)=1.30-8.13) and that those with head trauma were more likely to have ICH than those without (OR=3.9, 95% CI=1.25-7.80). Aspirin was found to be protective (OR=0.49, 95% CI=0.24-0.98).ICH is common in elderly fallers presenting to the ED without focal findings. Anticoagulation alone did not appear to increase the risk of ICH, and aspirin was found to be protective, but prospective studies are needed to better assess this relationship.

Published
2009

8. Altered mental status

Author

Stephen J. Traub, Lara K. Kulchycki, Laura Macnow, and Jason Wong

Subjects
Adult, Diagnosis, Differential, medicine.medical_specialty, Altered Mental Status, business.industry, Emergency Medicine, medicine, Humans, Female, Psychiatry, business, Methemoglobinemia
Published
2008

9. Traumatic esophageal perforation

Author

Lara K. Kulchycki, Leon D. Sanchez, and Adam Z. Barkin

Subjects
Adult, Male, medicine.medical_specialty, Esophageal Perforation, business.industry, medicine.medical_treatment, Treatment outcome, Perforation (oil well), Surgery, Diagnosis, Differential, Electrocardiography, Treatment Outcome, Thoracotomy, Blunt trauma, X ray computed, Percutaneous endoscopic gastrostomy, Emergency Medicine, Internal Medicine, Medicine, Humans, Radiography, Thoracic, Esophageal injury, business, Tomography, X-Ray Computed
Published
2006

10. CONTRIBUTORS

Author

GEORGE A. ALEXANDER, ANGELA C. ANDERSON, ANDREW W. ARTENSTEIN, KAVITA BABU, FERMIN BARRUETO, CARRIE BARTON, BRUCE M. BECKER, MATTHEW BERKMAN, ANDREW I. BERN, MILANA BOUKHMAN, PETER BREWSTER, CHURTON BUDD, JAMES M. BURKE, FREDERICK M. BURKLE, LYNNE BARKLEY BURNETT, NICHOLAS VINCENT CAGLIUSO, JOHN D. CAHILL, DUANE C. CANEVA, JULIE ANN P. CASANI, MARY W. CHAFFEE, HENRY C. CHANG, JAMES C. CHANG, ANNA I. CHEH, ESTHER H. CHEN, TERIGGI J. CICCONE, MARIANNE E. CINAT, GREGORY R. CIOTTONE, ROBERT A. CIOTTONE, STEVEN T. COBERY, JOANNE CONO, KELLY J. CORRIGAN, FRANCESCO Della CORTE, CHRISTO C. COURBAN, HILARIE CRANMER, STEPHEN O. CUNNION, ROBERT G. DARLING, DAVID DAVIS, TIMOTHY DAVIS, JENNIFER E. DELAPENA, CHAYAN DEY, WILLIAM E. DICKERSON, ERIC W. DICKSON, SHARON DILLING, K. SOPHIA DYER, JASON DYLIK, JONATHAN A. EDLOW, MARSHALL EIDENBERG, KHAMA D. ENNIS-HOLCOMB, DENIS J. FITZGERALD, KERRY FOSHER, ROBERT L. FREITAS, RYAN FRIEDBERG, FRANKLIN D. FRIEDMAN, FREDERICK FUNG, ROBERT D. FURBERG, WADE GAASCH, FIONA E. GALLAHUE, LUCILLE GANS, ALESSANDRo GEDDO, JAMES GEILING, PAUL GIANNONE, WILLIAM GLUCKMAN, SUSAN E. GORMAN, J. SCOTT GOUDIE, ROBERT M. GOUGELET, MARK A. GRABER, JILL A. GRANT, MICHAEL I. GREENBERG, P. GREGG GREENOUGH, SHAMAI A. GROSSMAN, TEE L. GUIDOTTI, DEBORAH GUTMAN, PINCHAS HALPERN, DAN HANFLING, RACHEL HAROZ, BONNIE H. HARTSTEIN, JOHN L. HICK, STEPHEN F. HOOD, MICHAEL HOROWITZ, KURT R. HORST, HANS R. HOUSE, CURTIS J. HUNTER, JASON IMPERATO, PIER LUIGi INGRASSIA, IRVING JACOBY, THEA JAMES, DAVID JASLOW, GREGORY D. JAY, MIRIAM JOHN, MICHAEL D. JONES, JEFFRY L. KASHUK, MARK E. KEIM, KATHARYN E. KENNEDY, PAUL D. KIM, SYLVIA H. KIM, LEO KOBAYASHI, LARA K. KULCHYCKI, RICK G. KULKARNI, CHRISTOPHer R. LANG, GREGORY L. LARKIN, THOMAS P. LeBosquet, BRUCE Y. LEE, CATHERINE Y. LEE, DAVID C. LEE, JAY LEMERY, DANIEL L. LEMKIN, JEANETTE A. LINDER, LAWRENCE S. LINDER, SHAN W. LIU, CRAIG H. LLEWELLYN, FRANCESCA LOMBARDI, HEATHER LONG, EDWARD B. LUCCI, DONALD MACMILLAN, LAURA MACNOW, JAMES M. MADSEN, BRIAN J. MAGUIRE, JOHN D. MALONE, PAUL M. MANISCALCO, DAVID MARCOZZI, PIETRO D. MARGHELLA, JAMES F. MARTIN, JAMES MCKINNELL, MICHELLE MCMAHON-DOWNER, C. CRAWFOrd MECHEM, SUMERU MEHTA, PATRICIA L. MEINHARDT, LAURA DIAne MELVILLE, JEFFERY C. METZGER, ANGELA M. MILLS, ANDREW M. MILSTEN, CLIFFORD S. MITCHELL, ELIZABETH L. MITCHELL, DALE M. MOLÉ, LOUIS N. MOLINO, JOHN MOLONEY, SEAN MONTGOMERY, JERRY L. MOTHERSHEAD, LEWIS S. NELSON, CONSTANCE G. NICHOLS, PATRICIA A. NOLAN, DANIEL F. NOLTKAMPER, DZIWE W. NTABA, ANDREW S. NUGENT, NEILL S. OSTER, PETER D. PANAGOS, ROBERT PARTRIDGE, NICKI PESIK, JAMES PFAFF, WILLIAM PORCARO, LAWRENCE PROANO, NAJMA RAHMAN-KAHN, VITTORIO J. RAHO, PRASANTHI RAMANUJAM, WENDE R. REENSTRA, ANDREW REISNER, MARK C. RESTUCCIA, JAMES MIChael RILEY, ALBERT J. ROMANOSKY, PETER ROSEN, MARC S. ROSENTHAL, JONATHAN M. RUBIN, LEON D. SANCHEZ, DEBRA D. SCHNELLE, JEREMIAH D. SCHUUR, ERIC M. SERGIENKO, KINJAL SETHURAMAN, MARC J. SHAPIRO, SAM SHEN, SUZANNE M. SHEPHERD, WILLIAM H. SHOFF, SEAN MICHael SILER, ALISON SISITSKY, CRAIG SISSON, PETER B. SMULOWITZ, JOHN H. SORENSON, CHARLES STEWART, M. KATHLEen STEWART, KENT J. STOCK, CAROL SULIS, NICHOLAS SUTINGCO, NELSON TANG, ELIZABETH TEMIN, RICHARD A. TEMPEL, CRAIG D. THORNE, JASON A. TRACY, STEPHEN J. TRAUB, JONATHAN Harris VALENTE, VICTORIA M. VANDERKAM, CAROL L. VENABLE, FAITH VILAS, GARY M. VILKE, BARBARA Vogt SORENSON, SCOTT G. WEINER, ERIC S. WEINSTEIN, ROY KARL WERNER, SAGE W. WIENER, ABIGAIL WILLIAMS, KENNETH A. WILLIAMS, TRACY E. WIMBUSH, ROBERT H. WOOLARD, KEVIN YESKEY, SANDRA S. YOON, and PATRICK ZELLEY

Published
2006
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