Bio

Clinical Focus


  • Emergency Medicine

Academic Appointments


Professional Education


  • Residency:Lucile Packard Children's Hospital at Stanford (2012) CA
  • Medical Education:Stanford School of Medicine (2009) CA
  • Master of Arts, Harvard University, Statistics (2002)

Community and International Work


  • Stanford Emergency Medicine International

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

Research & Scholarship

Current Research and Scholarly Interests


Pulmonary Embolism: My research focuses on finding means to predict who and a pulmonary embolism, and also who is likely to die and who is likely to live with a pulmonary embolism, so that we can use that information to more effectively and efficiently treat patients depending on their level of risk. In the end, it means tailoring therapy for patients with pulmonary embolism- those with high to intermediate risk of mortality and morbidity will likely in the future receive more intensive treatments than they do today, and those with low risk may someday be found to be safe going home after a short period of observation, no longer requiring hospitalization.

International Emergency Health Systems Development: Emergency Medicine is a relatively new speciality in the United States, and in much of the world does not exist as a physician specialty. Moreover, most countries do not have a well organized Emergency Medical Service (EMS) staffed with attendants trained on delivering emergency care in the field and on ambulances. My research here is on how to best organize out-of-hospital (EMS) systems as well as in hospital emergency departments, and in so doing design and implement emergency systems for entire nations. My greatest interest is in determining whether evidence exists to suggest whether private (not for profit and for profit) or public (government-run) systems are the most efficient and reliable for providing care to all people in need, rich and poor, urban and rural, insured and uninsured.

Publications

Journal Articles


  • Clinical Features of Patients With Pulmonary Embolism and a Negative PERC Rule Result ANNALS OF EMERGENCY MEDICINE Kline, J. A., Slattety, D., O'Neil, B. J., Thompson, J. R., Miller, C. D., Schreiber, D., Briese, B. A., Pollack, C. V. 2013; 61 (1): 122-124
  • Therapy and outcomes in massive pulmonary embolism from the Emergency Medicine Pulmonary Embolism in the Real World Registry AMERICAN JOURNAL OF EMERGENCY MEDICINE Lin, B. W., Schreiber, D. H., Liu, G., Briese, B., Hiestand, B., Slattery, D., Kline, J. A., Goldhaber, S. Z., Pollack, C. V. 2012; 30 (9): 1774-1781

    Abstract

    Clinical guidelines recommend fibrinolysis or embolectomy for acute massive pulmonary embolism (PE) (MPE). However, actual therapy and outcomes of emergency department (ED) patients with MPE have not previously been reported. We characterize the current management of ED patients with MPE in a US registry.A prospective, observational, multicenter registry of ED patients with confirmed PE was conducted from 2006 to 2008. Massive PE was defined as PE with an initial systolic blood pressure less than 90 mm Hg. We compared inpatient and 30-day mortality, bleeding complications, and recurrent venous thromboembolism.Of 1875 patients enrolled, 58 (3.1%) had MPE. There was no difference in frequency of parenteral anticoagulation (98.3% [95% confidence interval {CI}, 90.5-101.6] vs 98.5% [95% CI, 97.9-99.1], P = .902) between patients with and without MPE. Fibrinolytic therapy and embolectomy were infrequently used but were used more in patients with MPE than in patients without MPE (12.1% [95% CI, 3.7-20.5] vs 2.4% [95% CI, 1.7-3.1], P < .001, and 3.4% [95% CI, 0.0-8.1] vs 0.7% [95% CI, 0.3-1.1], P = .022, respectively). Comparison of outcomes revealed higher all-cause inpatient mortality (13.8% [95% CI, 4.9-22.7] vs 3.0% [95% CI, 2.2-3.8], P < .001), higher risk of inpatient bleeding complications (10.3% [95% CI, 2.5-18.1] vs 3.5% [95% CI, 2.7-4.3], P = .007), and a higher 30-day mortality (14.0% [95% CI, 4.4-23.6] vs 1.8% [95% CI, 1.2-2.4], P < .001) for patients with MPE.In a contemporary registry of ED patients, MPE mortality was 4-fold higher than patients without MPE, yet only 12% of the MPE cohort received fibrinolytic therapy. Variability exists between the treatment of MPE and current recommendations.

    View details for DOI 10.1016/j.ajem.2012.02.012

    View details for Web of Science ID 000311997600017

    View details for PubMedID 22633723

  • USE OF CADAVER MODELS IN POINT-OF-CARE EMERGENCY ULTRASOUND EDUCATION FOR DIAGNOSTIC APPLICATIONS JOURNAL OF EMERGENCY MEDICINE Zaia, B. E., Briese, B., Williams, S. R., Gharahbaghian, L. 2012; 43 (4): 683-691

    Abstract

    As the use of bedside emergency ultrasound (US) increases, so does the need for effective US education.To determine 1) what pathology can be reliably simulated and identified by US in human cadavers, and 2) feasibility of using cadavers to improve the comfort of emergency medicine (EM) residents with specific US applications.This descriptive, cross-sectional survey study assessed utility of cadaver simulation to train EM residents in diagnostic US. First, the following pathologies were simulated in a cadaver: orbital foreign body (FB), retrobulbar (RB) hematoma, bone fracture, joint effusion, and pleural effusion. Second, we assessed residents' change in comfort level with US after using this cadaver model. Residents were surveyed regarding their comfort level with various US applications. After brief didactic sessions on the study's US applications, participants attempted to identify the simulated pathology using US. A post-lab survey assessed for change in comfort level after the training.Orbital FB, RB hematoma, bone fracture, joint effusion, and pleural effusion were readily modeled in a cadaver in ways typical of a live patient. Twenty-two residents completed the pre- and post-lab surveys. After training with cadavers, residents' comfort improved significantly for orbital FB and RB hematoma (mean increase 1.6, p<0.001), bone fracture (mean increase 2.12, p<0.001), and joint effusion (1.6, p<0.001); 100% of residents reported that they found US education using cadavers helpful.Cadavers can simulate orbital FB, RB hematoma, bone fracture, joint effusion, and pleural effusion, and in our center improved the comfort of residents in identifying all but pleural effusion.

    View details for DOI 10.1016/j.jemermed.2012.01.057

    View details for Web of Science ID 000309576700044

    View details for PubMedID 22504086

  • Thrombolysis for normotensive patients with acute symptomatic pulmonary embolism: a rebuttal JOURNAL OF THROMBOSIS AND HAEMOSTASIS Kline, J. A., Pollack, C. V., Schreiber, D., BRIESE, B. 2012; 10 (9): 1973-1974
  • Clinical Characteristics, Management, and Outcomes of Patients Diagnosed With Acute Pulmonary Embolism in the Emergency Department Initial Report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry) JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Pollack, C. V., Schreiber, D., Goldhaber, S. Z., Slattery, D., Fanikos, J., O'Neil, B. J., Thompson, J. R., Hiestand, B., Briese, B. A., Pendleton, R. C., Miller, C. D., Kline, J. A. 2011; 57 (6): 700-706

    Abstract

    In a large U.S. sample, this study measured the presentation features, testing, treatment strategies, and outcomes of patients diagnosed with pulmonary embolism (PE) in the emergency department (ED).No data have quantified the demographics, clinical features, management, and outcomes of outpatients diagnosed with PE in the ED in a large, multicenter U.S. study.Patients of any hemodynamic status were enrolled from the ED after confirmed acute PE or with a high clinical suspicion prompting anticoagulation before imaging for PE. Exclusions were inability to provide informed consent (where required) or unavailability for follow-up.A total of 1,880 patients with confirmed acute PE were enrolled from 22 U.S. EDs. Diagnosis of PE was based upon positive results of computerized tomographic pulmonary angiogram in most cases (n = 1,654 [88%]). Patients represented both sexes equally, and racial and ethnic composition paralleled the overall U.S. ED population. Most (79%) patients with PE were employed, and one-third were older than age 65 years. The mortality rate directly attributed to PE was 20 in 1,880 (1%; 95% confidence interval [CI]: 0% to 1.6%). Mortality from hemorrhage was 0.2%, and the all-cause 30-day mortality rate was 5.4% (95% CI: 4.4% to 6.6%). Only 3 of 20 patients with major PE that ultimately proved fatal had systemic anticoagulation initiated before diagnostic confirmation, and another 3 of these 20 received a fibrinolytic agent.Patients diagnosed with acute PE in U.S. EDs have high functional status, and their mortality rate is low. These registry data suggest that appropriate initial medical management of ED patients with severe PE with anticoagulation is poorly standardized and indicate a need for research to determine the appropriate threshold for empiric treatment when PE is suspected before diagnostic confirmation.

    View details for DOI 10.1016/j.jacc.2010.05.071

    View details for Web of Science ID 000286880100010

    View details for PubMedID 21292129

Stanford Medicine Resources: