Research Summary

The Mission of the division of Emergency Medicine Research is "to research ways to diagnose and treat life-threatening illnesses." As a result, the scope of interests ranges from social science to cell physiology. Clinicians in the department tend to research disease entities or organ systems relevant to acute care. The individuals who were able to provide a description of their research activities are listed alphabetically below.

Contact Information

Jeffrey A. Kline, MD; John A. Watts, PhD

Faculty Research Interests

Andrew W. Asimos, MD   
Director of Emergency Stroke Care

Research Interests: Stroke, Acute Neuroimaging in Stroke, Traumatic Brain Injury, Neurologic Emergencies

Dr. Asimos has been an investigator in muti-center Traumatic Brain Injury and stroke trials, including those evaluating CP-101,606, Maxipost, and Activated Recombinant Factor VII. He has also lead extramurally funded investigator-initiated trials in stroke and TIA.

Dr. Asimos has collaborated with other stroke and TBI investigators both regionally and nationally. In 2008, he will be completing his work as PI on a risk stratification validation study for stroke after TIA, which was conducted at 16 N.C. hospitals.  In 2007-08, Dr. Asimos served as the faculty preceptor for a resident project involving dysphagia screening in the ED after acute stroke. Over the next three years, Dr. Asimos plans to continue to collaborate with other regional and national investigators in stroke-related research projects.

He was recently awarded the 2006 Emergency Medicine Foundation Directed Neurological Emergencies Grant to lead a multicenter study seeking to validate short term stroke risk stratification criteria for patients diagnosed with a presumed TIA.

Recent Publications

Asimos AW, Enright D, Huston S, Mettam L. JCAHO stroke center certification as a strategy for a statewide system of acute stroke care in North Carolina. Acad Emerg Med 2007; 14: S62-63. [Abstract]

Yurkewicz L, Weaver J, Bullock MR, Marshall LF. The effect of the selective NMDA receptor antagonist traxoprodil in the treatment of traumatic brain injury. J Neurotrauma 2005; 22: 1428-1443. [PMID: 16379581]

Asimos AW, Norton HJ, Price MF, Cheek WM. Therapeutic yield and outcomes of a community teaching hospital code stroke protocol. Acad Emerg Med 2004; 11: 361-370. [PMID: 15064210]

Current, Recent and Pending Grant Support

Grant Title: A Prospective Validation Study of the ABCD Score and Kaiser Criteria for Short-term Stroke Risk after Emergency Department Diagnosis of TIA
Funding Agency: Boehringer Ingelheim Pharmaceuticals, Inc.
Role: Lead Investigator
Years: 2007-2008

Grant Title: Prospective Validation Study of the ABCD Score and Kaiser Criteria for Short-term Stroke Risk after Emergency Department Diagnosis of TIA
Funding Agency: EMF/FERNE
Role: Lead Investigator
Years: 2006-2008

Grant Title: North Carolina Acute Stroke Registry: An Implementation Study
Funding Agency: CDC
Role: Sub-Investigator
Years: 2004-2007

Alan E. Jones, MD
Director of Emergency Medicine Critical Care Services
Associate Director of Emergency Medicine Clinical Research

Research Interests: Undifferentiated Shock, Septic Shock, Post-Cardiac Arrest Shock, Therapeutic Hypothermia

Dr. Jones primary research interest is in the area of diagnosis and treatment of shock in adults and general critical care in the emergency department. He presently is funded by the NIH to investigate less invasive resuscitation algorithms in the early treatment of septic shock and the EMF to investigate breath based monitoring of shock resuscitation. He is the co-founder of the Emergency Medicine Shock Research Network (EMSHOCKNET) which is an organized multi-center network of investigators who perform clinical research trials focused on diagnosis and treatment in various forms of shock. Dr. Jones also regularly mentors medical students, residents and junior faculty in various research projects and serves as a co-mentor for the CMC research fellowship.

Dr. Jones finished his residency in Emergency Medicine at CMC followed by a one year Clinical Research Fellowship. Following his fellowship he secured funding from the Emergency Medicine Foundation to study the prognostic significance of hypotension in emergency department patients. In 2006 Dr. Jones became the first principle investigator at CMC to receive a K23 Career Development Award from the National Institutes of Health. The aim of this award was to obtain advanced didactic training in clinical research and to investigate less invasive early resuscitation strategies in septic shock. As a part of his K23, he is presently enrolled in a Masters of Public Health program and is conducting a large multi-center randomized controlled trial of two resuscitation protocols for septic shock. In the next three years, Dr. Jones aims to submit his first RO1 to the NIH focused on a novel early treatment of septic shock and begin to develop a new line of research in post-cardiac arrest shock.

Dr. Jones has received the following awards from Carolinas Medical Center: Outstanding Senior Resident Award, Emergency Medicine (2002) and Outstanding Resident Research Achievement Award, Emergency Medicine (2002). He has also received the Young Investigator Clinical Science Oral Presentation Award for "Randomized controlled trial of early versus delayed ultrasound for the diagnosis of undifferentiated hypotension in emergency department patients" (2003), the Young Investigator Award (2005) and the Best Faculty Oral Research Presentation Award for "Emergency department hypotension predicts sudden unexpected in-hospital mortality" (2006) from the Society for Academic Emergency Medicine (SAEM). As a journal reviewer, Dr. Jones has received the Outstanding Reviewer Award from Academic Emergency Medicine (2005, 2006) and the Top Peer Reviewer Award from the Annals of Emergency Medicine (2005, 2006 and 2007).  He has served on the SAEM Grants Committee and the Emergency Medicine Foundation Scientific Review Committee.  He has also held various editorial posts with Academic Emergency Medicine as a decision, associate and section editor and with the Annals of Emergency Medicine as a consulting editor.

Recent Publications

AE Jones, K Saak, JA Kline. Performance of the mortality in emergency department sepsis score for predicting hospital mortality among patients with severe sepsis and septic shock. Am J Emerg Med 2008; in press.

Jones AE, Shapiro NI, Kilgannon JH, Trzeciak S; Emergency Medicine Shock Research Network (EMSHOCKNET) investigators. Goal-directed hemodynamic optimization in the post-cardiac arrest syndrome: a systematic review. Resuscitation 2008; 77: 26-29. [PMID: 18164117]

Jones AE, Leonard MM, Hernandez-Nino J, Kline JA. Determination of the effect of in vitro time, temperature, and tourniquet use on whole blood venous point-of-care lactate concentrations. Acad Emerg Med 2007; 14: 587-591. [PMID: 17513689]

Jones AE, Shapiro NI, Roshon M. Implementing early goal-directed therapy in the emergency setting: the challenges and experiences of translating research innovations into clinical reality in academic and community settings. Acad Emerg Med 2007; 14: 1072-1078. [PMID: 17630356]

Jones AE, Focht A, Horton JM, Kline JA. Prospective external validation of the clinical effectiveness of an emergency department-based early goal-directed therapy protocol for severe sepsis and septic shock. Chest 2007; 132: 425-432. [PMID: 17573521]

Current, Recent and Pending Grant Support

Grant Title: Randomized Clinical Trial of a Less-invasive Resuscitation Protocol for Sepsis
Funding Agency: NIH/NIGMS (1K23GM076652-01A1)
Role: Principal Investigator
Years: 2006-2011

Grant Title: Contrast Nephropathy from Computed Tomography Angiography in the Emergency Department
Funding Agency: Emergency Medicine Foundation
Role: Primary Mentor
Years: 2007-2008

Grant Title: The Use of Capnography to Identify Elevated Lactate and Lactate Clearance in Emergency Department Patients with Severe Sepsis and Septic Shock
Funding Agency: Emergency Medicine Foundation                    
Role: Principal Investigator
Years: 2007-2008

Grant Title: Expired CO2/O2 to diagnose pulmonary embolism
Funding Agency: NIH/NHLBI 1R42HL086316-01
Role: Consultant
Years: 2006-2008

Jeffrey A. Kline, MD   
Director of Emergency Medicine Research

Research Interests: Pulmonary embolism, Sepsis

Summary of Dr. Kline's research activity:

• Diagnosis, risk-stratification and treatment of pulmonary embolism in humans
• Mechanisms of right ventricular damage in pulmonary embolism in rats
• Breath-based diagnosis
• Methods of pretest probability computation
• Clinical research methodology
• Mentoring in emergency medicine research

Dr. Kline's research has focuses on screening, risk stratifying and treating pulmonary embolism (PE). He has built and patented a device to help diagnose and exclude PE based upon instant analysis of exhaled partial pressures of CO2 and O2 and co-founded BreathQuant Medical LLC, spearheaded the formation of a joint venture between DEKA Research and Development, Carolinas HealthCare System, and WFD Ventures. Together, acquired private funding and an STTR award from the NIH, and recently completed a 500 patients, four center, FDA-regulated pivotal study of this device. This will be the first ever FDA-approved breath-based diagnostic device. Dr. Kline also a patent pending on novel method to quantitate pretest probability that I call attribute matching (US patent pending). The primary goal of this technology is to provide quantitative rationale for clinicians to not order an expensive test -- such as computerized tomography. As PI, Dr. Kline received two STTR awards from the NIH to advance this technology. To help further the use of quantitative probability assessment in the real world, he recently applied to the American Medical Association for a CPT code to reimburse clinicians for the work required to use a multivariable model to assess probability of disease at the bedside.

Additionally, in the laboratory, Dr. Kline uses a rat model of PE to study the role of inflammation on right heart and lung damage after PE. This work dovetails with his work in humans that includes his NIH RO1 funded work that studied novel biomarkers to prognose submassive PE, and a six-center RCT of tenecteplase to treat submassive PE.  
 
Dr. Kline has trained eight research fellows in emergency medicine; of these, six are in academic practice. He remains an active research mentor to faculty, fellows and residents in emergency medicine.

Recent Publications

Jones AE, Fordham Z, Yiannibas V, Kline JA. Frequency of thromboprophylaxis and incidence of in-hospital venous thromboembolism in a cohort of emergency department patients J Thromb Thrombolysis 2008; in press.

Mitchell AM, Kline JA. Systematic bias introduced by the informed consent process in a diagnostic research study. Acad Emerg Med 2008; 15: 225-230. [PMID: 18304052]

Runyon MS, Beam DM, King MC, Lipford EH, Kline JA. Comparison of the SimpliFY? D-dimer performed at the bedside to a laboratory-based quantitative assay for the diagnosis of pulmonary embolism in a low prevalence emergency department population. Emerg Med J 2008; 25: 70-75. [PMID: 18212136]

Kline JA, Hogg MM, Mauerhan DR, Frick SL. Impact of anaesthesia-surgery on D-dimer concentration and end-tidal CO2 and O2 in patients undergoing surgery associated with high risk for pulmonary embolism. Clin Physiol Funct Imaging 2008; 28: 161-168. [PMID: 18279423]

Stevinson BG, Hernandez-Nino J, Rose G, Kline JA. Echocardiographic and functional cardiopulmonary problems 6 months after first-time pulmonary embolism in previously healthy patients. Eur Heart J 2007; 28: 2517-2524. [PMID: 17670755]

Current, Recent and Pending Grant Support

Grant Title: Randomized Clinical Trial for a Non-invasive Resuscitation Protocol for Sepsis
Funding Agency: NIH/GMS (K23 GM076652-01)
Role: Project Preceptor/Mentor
Years: 2006-2011

Grant Title: Randomized Trial of Tenecteplase to Treat Submassive Pulmonary Embolism
Funding Agency: Genentech
Role: Principal Investigator
Year: 2008

Grant Title: Expired CO2/O2 to diagnose pulmonary embolism
Funding Agency: NIH/NHLBI (Fast-track R42 HL086316-01)
Role: Principal Investigator
Years: 2006-2008  

Alice M. Mitchell, MD
Assistant Director of Clinical Research

Research Interests: Diagnostic Testing in the Emergency Department, Contrast Nephropathy, Diagnostic and Prognostic Biological Markers, Acute Coronary Syndromes, Pulmonary Embolism, Research Ethics, Medical Education

Dr. Mitchell's major research interests are focus on improving the use and application of new and existing diagnostic methods in the emergency department setting. She is particularly interested in the use of imaging technology and the related potential complications of these tests such as contrast nephropathy.  She is also very interested in the education of rising physicians, and clinical and translational researchers at the undergraduate, graduate and post-graduate levels.

Dr. Mitchell received a Bachelor of Science in Chemistry from Utah State University, as well as a Master's of Science in Chemistry and Medical Doctor Degree from the University of Utah.  Subsequently, her residency and research fellowship were completed at Carolinas Medical Center. She also earned a certificate in Core Public Health Concepts from the University of North Carolina at Chapel Hill. 

Recent Publications

Mitchell AM, Kline JA. Contrast nephropathy following computed tomography angiography of the chest for pulmonary embolism in the emergency department. J Thromb Haemost 2007; 5: 50-54. [PMID: 17026644]

Mitchell AM, Kline JA. Systematic bias introduced by the informed consent process in a diagnostic research study. Acad Emerg Med 2008; 15: 225-230. [PMID: 18304052]

Kruse L, Mitchell AM, Camargo CA Jr, Hernandez J, Kline JA. Frequency of thrombophilia-related genetic variations in patients with idiopathic pulmonary embolism in an urban emergency department. Clin Chem 2006; 52: 1026-1032. [PMID: 16574759]

Mitchell AM, Garvey JL, Kline JA. Multimarker Panel to rule out acute coronary syndromes in low-risk patients.  Acad Emerg Med 2006; 13: 803-806. [PMID: 16723729]

Kline JA, Runyon MS, Webb WB, Jones AE, Mitchell AM. Prospective study of the diagnostic accuracy of the simplify D-dimer assay for pulmonary embolism in emergency department patients. Chest 2006; 129: 1417-1423. [PMID: 16778257]

Current, Recent and Pending Grant Support

Grant Title: Nephropathy from Computed Tomography Angiography in the Emergency Department
Funding Agency: Emergency Medicine Foundation
Role: Principal Investigator
Years: 2007-current

Grant Title: Sample Collection for Pulmonary Embolism
Funding Agency: Biosite, Inc.
Role: Principal Investigator
Years: 2005-current

Vivek Tayal, MD
Director of Emergency Ultrasound

Research Interests: Emergency Ultrasound, Any Bedside Clinical Ultrasound, Imaging, Airway, Quality of Care

Dr. Tayal is interested in ultrasound, airway and quality of care ultrasound.  He involves residents, fellows and other attendings in his research.
             
Recent Publications

Tayal VS, Bullard M, Swanson DR, Schulz CJ, Bacalis KN, Bliss SA, Norton HJ. Emergency department endovaginal pelvic US in non-pregnant women with RLQ pain.  Am J Emerg Med 2008; 26: 81-85.

Bahner D, Blaivas M, Cohen HL, Fox JC, Hoffenberg S, Kendall J, Langer J, McGahan JP, Sierzenski P, Tayal VS; American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of the focused assessment with sonography for trauma (FAST) examination. J Ultrasound Med 2008; 27: 313-318. [PMID: 18204028]

Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 2007; 49: 508-514. [PMID: 16997419]

O'Malley P, Tayal VS. Use of emergency musculoskeletal sonography in diagnosis of an open fracture of the hand. J Ultrasound Med 2007; 26: 679-682. [PMID: 17460012]

Tayal VS, Antoniazzi J, Pariyadath M, Norton HJ. Prospective use of ultrasound imaging to detect bony hand injuries in adults. J Ultrasound Med 2007; 26: 1143-1148. [PMID: 17715307]

John A. Watts, Jr., PhD
Director of Emergency Medicine Preclinical Research

Research Interests: Pulmonary embolism, Heart function, Inflammation
 
Dr. Watts' main research interest is to investigate mechanisms contributing to right ventricular damage during pulmonary embolism. Pulmonary embolism occurs when a venous blood clot breaks free and lodges in the blood vessels of the lungs. This causes increased pulmonary vascular pressure, resulting in increased stretch, shear forces and work, and decreased blood flow to the right ventricle. Right ventricular damage is associated with a dramatic increase in mortality and morbidity in patients with pulmonary embolism. The goal of Dr. Watts' research is to develop therapies to protect the right ventricle during the time when the blood clot is being cleared from the lungs, to reduce mortality and to enhance the quality of life for the survivors of pulmonary embolism.
 
His group's recent studies in rodent models of pulmonary embolism show that early pro-inflammatory responses in the heart contribute to the extension of heart damage, while later responses contribute to healing of the heart. Current experiments examine the signaling pathways responsible for the early increase in damaging inflammation and test interventions designed to reduce the heart damage for translation into clinical studies.
 
Dr. Watts obtained his PhD degree in Zoology from the University of Maryland. His postdoctoral training prepared him for the study of cardiac function and an understanding of processes involved in cardiac cell death. Dr. Watts taught physiology courses and studied myocardial ischemia as a Professor in Biology at the University of North Carolina at Charlotte for 15 years and then joined the Emergency Medicine Department at Carolinas Medical Center in 1994, where his major research efforts centered on cardiac function in the setting of hemorrhagic shock, septic shock and, most recently, pulmonary embolism. Dr. Watts serves as in a number of associations, including:

• Board of Directors, Mid-Atlantic Affiliate, American Heart Association, 2007-2009
• Chair, Mid-Atlantic Research Committee, American Heart Association, 2006-2007 
• Steering Committee, Mid-Atlantic Affiliate, American Heart Association, 2006-2007 
• Delegate to National Research Strategic Planning, American Heart Association, 2006-2007 
• Board of Directors, North Carolina Association of Biomedical Researchers, 2004-2007 
• Mid Atlantic Research Committee, American Heart Association, 2002-2007 

Having shown that neutrophil influx contributes to right ventricular dysfunction during pulmonary embolism, Dr. Watts' most recent work is focused on defining the mechanisms that upregulate the inflammatory response in this setting. He hopes to intervene in these processes to provide a protective temporal "bridge" for the heart in patients while the clot burden is being reduced in the lungs.

Recent Publications

Zagorski J, Gellar MA, Obraztsova M, Kline JA, Watts JA. Inhibition of CINC-1 decreases right ventricular damage caused by experimental pulmonary embolism. J Immunol 2007; 179: 7820-7826. [PMID: 18025228]

Watts JA, Zagorski J, Gellar MA, Stevinson BG, Kline JA. Cardiac inflammation contributes to right ventricular dysfunction following experimental pulmonary embolism in rats. J Mol Cell Cardiol 2006; 41: 296-307. [PMID: 16814320]

Watts JA, Kline JA.  Bench-to-Bedside: The role of mitochondrial medicine in the pathogenesis and treatment of cellular injury.  Acad Emerg Med 2003; 10: 885-897. [PMID: 12957984]

Zagorski J, Debelak J, Gellar M, Watts JA, Kline JA. Chemokines accumulate in the lungs of rats with severe pulmonary embolism induced by polystyrene microspheres. J Immunol 2003; 171: 5529-5536. [PMID: 14607960]

Jones AE, Watts JA, Debelak JP, Thornton LR, Younger JG, Kline JA.  Inhibition of prostaglandin synthesis during polystyrene microsphere-induced pulmonary embolism in the rat. Am J Physiol Lung Resp Physiol 2003; 284: L1072-L1081. [PMID: 12639842]

Current, Recent and Pending Grant Support
 
Grant Title: Regulation of inflammation in right ventricular damage and repair following experimental pulmonary embolism in rats
Funding Agency: American Heart Association, Mid-Atlantic Affiliate
Role: Principal Investigator
Years: 2008-2010
(Pending)

Grant Title: Medical Student Research Training Fellowship
Funding Agency: Howard Hughes Medical Institute
Role: Mentor
Years: 2005-2006

Grant Title: Research Fellowship
Funding Agency: Emergency Medicine Foundation
Role: Co-Investigator
Years: 2004-2005

Center for Injury Prevention

Robert W. Schafermeyer, MD, Medical Director of Center for Injury Prevention
          
Janice Williams, MS Ed, Director of Center for Injury Prevention

Injury Prevention Research Summary

The Carolinas Center for Injury Prevention is active in several areas of injury prevention. Most activities center on the reduction of injury, public education and the development/translation of best practices.  Many of the activities are accomplished through developed collaborations within our local healthcare system units and with our local and regional community-based partners allowing the center to participate in a wide breadth of collaborative, multi-site, and independent research projects.

Research Interests

• Traffic/Motor Vehicle safety which covers child passenger safety, teen driving, seatbelt use, policy changes, and education.  
• Childhood Injury prevention
• Translational and Dissemination based injury prevention research across the ages
• Healthcare and community-based injury prevention research across the ages

Major Research Activities

Past research activities have included:

• Evaluation of the Health and Safety Councils
• Teen Driver Safety Guide, development of a DWI educational intervention for the Hispanic Community for North Carolina
• Evaluation of Boating Injuries and Evaluation of utilization of nurses to increase Alcohol Screening and Brief Interventions in an Emergency room as multi-site studies with the Emergency Nurses Association
• Evaluation of a direct mail pieces' impact on a pool barrier education campaign.

Current work includes:

• Evaluation of a teen driving outreach program
• Evaluation of a behavioral intervention to increase screening and brief intervention in a specific healthcare setting (a technique to reduce alcohol-related injuries through screening by healthcare professionals and referral of those patients interested in treatment)
• Translational research of the NICHD pediatric office based Safe and Sound injury prevention program and the parameters that will increases its utilization in the healthcare setting (parents answer questions about safety activities in their homes and any identified problems are printed on a document that is handed to the primary care physician who counsels the parent on needed safety actions in the home)
• One of six nationwide sites for the evaluation of utilizing public health techniques for increasing the dissemination of the Safe Routes to School Program
• Evaluation of a Multi-Factorial Falls Prevention Program in a Healthcare system
• Evaluation of the development and dissemination of an injury prevention policy (safe sleep) in a healthcare system

Recent Publications

Weaver N, Williams J, Botello-Harbaum M, Jacobsen H, Nansel T. Translation of a pediatric injury prevention program into pediatric office settings. J Healthc Manag 2008; in press.

Current, Recent and Pending Grant Support

Grant Title: Development of Pool Barrier Campaign, Development of Safe Kids Week, Development of a Bike train the trainer session, Development of a Child Passenger Outreach Program with law enforcement, Development of a Walk to School Day Program
Funding Agency: National Safe Kids
Role: Development and Implementation of Programs
Years: 2006-Present

Grant Title: Safe N Sound
Funding Agency: National Institutes of Child Health and Development 
Role: Coordinate and Conduct Translational Research
Years: 2006-2009

Grant Title: Can Public Health make a difference in development of a Safe Routes to School Program
Funding Agency: State Territorial and Directors Association
Role: Co Coordinator of the Project
Years: 2007-2008

Grant Title: DWI outreach in a Spanish Speaking community and Behavioral Interventions influencing SBIRT in an Emergency Room
Funding Agency: Mecklenburg County Alcohol Beverage Control Board
Role: Coordinate and Conduct Research and Program Development
Years: 2003, 2007

Grant Title: Utilizing SBIRT in an Emergency Room and Boat Injury Causality
Funding Agency: Emergency Nurses Association
Role: Coordinate and conduct research study and data collection
Year: 2006

Grant Title: Evaluation of a Teen Driving Guide
Funding Agency: Centers For Disease Control as a contract with University of North Carolina at Charlotte
Role: Coordinate community based research study
Years: 2005, 2006

Grant Title: Highway Safety Interventions
Funding Agency: Governors Highway Safety Program
Role: Coordination and Development of Programs
Years: 1998-2006

Grant Title: Development of an Injury Prevention Training Program
Funding Agency: Duke Endowment
Role: Development and Delivery of a Program
Years: 2003-2004