Lia Losonczy | Johns Hopkins University (original) (raw)
Papers by Lia Losonczy
Ovid Technologies (Wolters Kluwer Health), 2019
Journal of Epidemiology and Global Health
Cureus
Compartment syndrome can be a limb-threatening emergency that may require immediate intervention.... more Compartment syndrome can be a limb-threatening emergency that may require immediate intervention. It usually involves the extremities but any closed compartment of the body is susceptible to it. Paraspinal compartment extends on both sides of the spine. Prolonged lying on the back in unconscious patients leads to muscle edema which eventually leads to increase pressure in the compartment. Neurovascular comprise is a dreaded complication of compartment syndrome. Paraspinal compartment is a potential site of compartment syndrome particularly in unconscious patients and it requires prompt diagnosis, careful monitoring, immediate medical attention and even warranting surgical intervention in certain cases.
The Journal of Bone and Joint Surgery
Annals of Emergency Medicine
PLOS ONE
Objective Critical illness affects health systems globally, but low-and middle-income countries (... more Objective Critical illness affects health systems globally, but low-and middle-income countries (LMICs) bear a disproportionate burden. Due to a paucity of data, the capacity to care for critically ill patients in LMICs is largely unknown. Haiti has the lowest health indices in the Western Hemisphere. In this study, we report results of the first known nationwide survey of critical care capacity in Haiti.
Journal of Global Health Reports
Resuscitation, Mar 1, 2018
Emergency medicine journal : EMJ, Jan 22, 2017
Patients commonly come to the emergency department (ED) with social needs. To address this, we cr... more Patients commonly come to the emergency department (ED) with social needs. To address this, we created the Highland Health Advocates (HHA), an ED-based help desk and medical-legal partnership using undergraduate volunteers to help patients navigate public resources and provide onsite legal and social work referrals. We were able to provide these services in English and Spanish. We aimed to determine the social needs of the patients who presented to our ED and the potential impact of the programme in resolving those needs and connecting them to a 'medical home' (defined as a consistent, primary source of medical care such as a primary care doctor or clinic). ED patients at a US safety net hospital were enrolled in a 1:2 ratio in a quasi-experiment comparing those who received intervention from the HHA during a limited access rollout with controls who received usual care on days with no help desk. We collected a baseline social needs evaluation, with follow-up assessments at 1...
Resuscitation, 2018
We aim to evaluate if point-of-care ultrasound use in cardiac arrest is associated with CPR pause... more We aim to evaluate if point-of-care ultrasound use in cardiac arrest is associated with CPR pause duration. This is a prospective cohort study of patients with cardiac arrest (CA) presenting to an urban emergency department from July 2016 to January 2017. We collected video recordings of patients with CA in designated code rooms with video recording equipment. The CAs recordings were reviewed and coded by two abstractors. The primary outcome was the difference CPR pause duration when POCUS was and was not performed. A total of 110 CPR pauses were evaluated during this study. The median CPR pause with POCUS performed lasted 17s (IQR 13 - 22.5) versus 11s (IQR 7 - 16) without POCUS. In addition, multiple regression analysis demonstrated that POCUS was associated with longer pauses (6.4s, 95%CI 2.1- 10.8); ultrasound fellowship trained faculty trended towards shorter CPR pauses (-4.1s, 95%CI -8.8-0.6) compared to non-ultrasound fellowship trained faculty; and when the same provider led...
The American Journal of Emergency Medicine, 2015
JAMA Surgery, 2015
Significant health inequities persist among minority and socially disadvantaged patients. Better ... more Significant health inequities persist among minority and socially disadvantaged patients. Better understanding of how unconscious biases affect clinical decision making may help to illuminate clinicians' roles in propagating disparities. To determine whether clinicians' unconscious race and/or social class biases correlate with patient management decisions. We conducted a web-based survey among 230 physicians from surgery and related specialties at an academic, level I trauma center from December 1, 2011, through January 31, 2012. We administered clinical vignettes, each with 3 management questions. Eight vignettes assessed the relationship between unconscious bias and clinical decision making. We performed ordered logistic regression analysis on the Implicit Association Test (IAT) scores and used multivariable analysis to determine whether implicit bias was associated with the vignette responses. Differential response times (D scores) on the IAT as a surrogate for unconscious bias. Patient management vignettes varied by patient race or social class. Resulting D scores were calculated for each management decision. In total, 215 clinicians were included and consisted of 74 attending surgeons, 32 fellows, 86 residents, 19 interns, and 4 physicians with an undetermined level of education. Specialties included surgery (32.1%), anesthesia (18.1%), emergency medicine (18.1%), orthopedics (7.9%), otolaryngology (7.0%), neurosurgery (7.0%), critical care (6.0%), and urology (2.8%); 1.9% did not report a departmental affiliation. Implicit race and social class biases were present in most respondents. Among all clinicians, mean IAT D scores for race and social class were 0.42 (95% CI, 0.37-0.48) and 0.71 (95% CI, 0.65-0.78), respectively. Race and class scores were similar across departments (general surgery, orthopedics, urology, etc), race, or age. Women demonstrated less bias concerning race (mean IAT D score, 0.39 [95% CI, 0.29-0.49]) and social class (mean IAT D score, 0.66 [95% CI, 0.57-0.75]) relative to men (mean IAT D scores, 0.44 [95% CI, 0.37-0.52] and 0.82 [95% CI, 0.75-0.89], respectively). In univariate analyses, we found an association between race/social class bias and 3 of 27 possible patient-care decisions. Multivariable analyses revealed no association between the IAT D scores and vignette-based clinical assessments. Unconscious social class and race biases were not significantly associated with clinical decision making among acute care surgical clinicians. Further studies involving real physician-patient interactions may be warranted.
Current Environmental Health Reports, 2014
Background Legislations banning smoking in indoor public places and workplaces are being implemen... more Background Legislations banning smoking in indoor public places and workplaces are being implemented worldwide to protect the population from secondhand smoke exposure. Several studies have reported reductions in hospitalizations for acute coronary events following the enactment of smokefree laws. Objective We set out to conduct a systematic review and meta-analysis of epidemiologic studies examining how legislations that ban smoking in indoor public places impact the risk of acute coronary events. Methods We searched MEDLINE, EMBASE, and relevant bibliographies including previous systematic reviews for studies that evaluated changes in acute coronary events, following implementation of smoke-free legislations. Studies were identified through December 2013. We pooled relative risk (RR) estimates for acute coronary events comparing post-vs. prelegislation using inverse-variance weighted random-effects models.
Journal of Trauma and Acute Care Surgery, 2014
Recent studies have found that unconscious biases may influence physicians&am... more Recent studies have found that unconscious biases may influence physicians' clinical decision making. The objective of our study was to determine, using clinical vignettes, if unconscious race and class biases exist specifically among trauma/acute care surgeons and, if so, whether those biases impact surgeons' clinical decision making. A prospective Web-based survey was administered to active members of the Eastern Association for the Surgery of Trauma. Participants completed nine clinical vignettes, each with three trauma/acute care surgery management questions. Race Implicit Association Test (IAT) and social class IAT assessments were completed by each participant. Multivariable, ordered logistic regression analysis was then used to determine whether implicit biases reflected on the IAT tests were associated with vignette responses. In total, 248 members of the Eastern Association for the Surgery of Trauma participated. Of these, 79% explicitly stated that they had no race preferences and 55% stated they had no social class preferences. However, 73.5% of the participants had IAT scores demonstrating an unconscious preference toward white persons; 90.7% demonstrated an implicit preference toward upper social class persons. Only 2 of 27 vignette-based clinical decisions were associated with patient race or social class on univariate analyses. Multivariable analyses revealed no relationship between IAT scores and vignette-based clinical assessments. Unconscious preferences for white and upper-class persons are prevalent among trauma and acute care surgeons. In this study, these biases were not statistically significantly associated with clinical decision making. Further study of the factors that may prevent implicit biases from influencing patient management is warranted. Epidemiologic study, level II.
The Journal of emergency medicine, Jan 2, 2015
Catastrophic antiphospholipid syndrome (CAPS) is a rare disease that causes rapid vascular occlus... more Catastrophic antiphospholipid syndrome (CAPS) is a rare disease that causes rapid vascular occlusion in multiple organ systems. Initial presentation varies depending on the organs affected. Although headache is a common complaint in the emergency department (ED), it is a very rare presentation of CAPS. A 43-year-old previously healthy woman presented to the ED with severe headache. Subarachnoid hemorrhage was excluded and she was discharged home. She returned 36 h later with diabetic ketoacidosis, hyperthyroidism, and thrombosis in her cerebral venous sinus, aorta and splenic artery. She was treated with heparin, steroids, plasmapharesis, and i.v. immunoglobulin, after which she improved. This constellation of symptoms is highly suggestive of CAPS initiated by a polyglandular autoimmune syndrome, despite negative serology. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although a rare cause of headache, CAPS is a potentially fatal disease that requires early identification and...
Journal of the American College of Surgeons, 2012
Ovid Technologies (Wolters Kluwer Health), 2019
Journal of Epidemiology and Global Health
Cureus
Compartment syndrome can be a limb-threatening emergency that may require immediate intervention.... more Compartment syndrome can be a limb-threatening emergency that may require immediate intervention. It usually involves the extremities but any closed compartment of the body is susceptible to it. Paraspinal compartment extends on both sides of the spine. Prolonged lying on the back in unconscious patients leads to muscle edema which eventually leads to increase pressure in the compartment. Neurovascular comprise is a dreaded complication of compartment syndrome. Paraspinal compartment is a potential site of compartment syndrome particularly in unconscious patients and it requires prompt diagnosis, careful monitoring, immediate medical attention and even warranting surgical intervention in certain cases.
The Journal of Bone and Joint Surgery
Annals of Emergency Medicine
PLOS ONE
Objective Critical illness affects health systems globally, but low-and middle-income countries (... more Objective Critical illness affects health systems globally, but low-and middle-income countries (LMICs) bear a disproportionate burden. Due to a paucity of data, the capacity to care for critically ill patients in LMICs is largely unknown. Haiti has the lowest health indices in the Western Hemisphere. In this study, we report results of the first known nationwide survey of critical care capacity in Haiti.
Journal of Global Health Reports
Resuscitation, Mar 1, 2018
Emergency medicine journal : EMJ, Jan 22, 2017
Patients commonly come to the emergency department (ED) with social needs. To address this, we cr... more Patients commonly come to the emergency department (ED) with social needs. To address this, we created the Highland Health Advocates (HHA), an ED-based help desk and medical-legal partnership using undergraduate volunteers to help patients navigate public resources and provide onsite legal and social work referrals. We were able to provide these services in English and Spanish. We aimed to determine the social needs of the patients who presented to our ED and the potential impact of the programme in resolving those needs and connecting them to a 'medical home' (defined as a consistent, primary source of medical care such as a primary care doctor or clinic). ED patients at a US safety net hospital were enrolled in a 1:2 ratio in a quasi-experiment comparing those who received intervention from the HHA during a limited access rollout with controls who received usual care on days with no help desk. We collected a baseline social needs evaluation, with follow-up assessments at 1...
Resuscitation, 2018
We aim to evaluate if point-of-care ultrasound use in cardiac arrest is associated with CPR pause... more We aim to evaluate if point-of-care ultrasound use in cardiac arrest is associated with CPR pause duration. This is a prospective cohort study of patients with cardiac arrest (CA) presenting to an urban emergency department from July 2016 to January 2017. We collected video recordings of patients with CA in designated code rooms with video recording equipment. The CAs recordings were reviewed and coded by two abstractors. The primary outcome was the difference CPR pause duration when POCUS was and was not performed. A total of 110 CPR pauses were evaluated during this study. The median CPR pause with POCUS performed lasted 17s (IQR 13 - 22.5) versus 11s (IQR 7 - 16) without POCUS. In addition, multiple regression analysis demonstrated that POCUS was associated with longer pauses (6.4s, 95%CI 2.1- 10.8); ultrasound fellowship trained faculty trended towards shorter CPR pauses (-4.1s, 95%CI -8.8-0.6) compared to non-ultrasound fellowship trained faculty; and when the same provider led...
The American Journal of Emergency Medicine, 2015
JAMA Surgery, 2015
Significant health inequities persist among minority and socially disadvantaged patients. Better ... more Significant health inequities persist among minority and socially disadvantaged patients. Better understanding of how unconscious biases affect clinical decision making may help to illuminate clinicians' roles in propagating disparities. To determine whether clinicians' unconscious race and/or social class biases correlate with patient management decisions. We conducted a web-based survey among 230 physicians from surgery and related specialties at an academic, level I trauma center from December 1, 2011, through January 31, 2012. We administered clinical vignettes, each with 3 management questions. Eight vignettes assessed the relationship between unconscious bias and clinical decision making. We performed ordered logistic regression analysis on the Implicit Association Test (IAT) scores and used multivariable analysis to determine whether implicit bias was associated with the vignette responses. Differential response times (D scores) on the IAT as a surrogate for unconscious bias. Patient management vignettes varied by patient race or social class. Resulting D scores were calculated for each management decision. In total, 215 clinicians were included and consisted of 74 attending surgeons, 32 fellows, 86 residents, 19 interns, and 4 physicians with an undetermined level of education. Specialties included surgery (32.1%), anesthesia (18.1%), emergency medicine (18.1%), orthopedics (7.9%), otolaryngology (7.0%), neurosurgery (7.0%), critical care (6.0%), and urology (2.8%); 1.9% did not report a departmental affiliation. Implicit race and social class biases were present in most respondents. Among all clinicians, mean IAT D scores for race and social class were 0.42 (95% CI, 0.37-0.48) and 0.71 (95% CI, 0.65-0.78), respectively. Race and class scores were similar across departments (general surgery, orthopedics, urology, etc), race, or age. Women demonstrated less bias concerning race (mean IAT D score, 0.39 [95% CI, 0.29-0.49]) and social class (mean IAT D score, 0.66 [95% CI, 0.57-0.75]) relative to men (mean IAT D scores, 0.44 [95% CI, 0.37-0.52] and 0.82 [95% CI, 0.75-0.89], respectively). In univariate analyses, we found an association between race/social class bias and 3 of 27 possible patient-care decisions. Multivariable analyses revealed no association between the IAT D scores and vignette-based clinical assessments. Unconscious social class and race biases were not significantly associated with clinical decision making among acute care surgical clinicians. Further studies involving real physician-patient interactions may be warranted.
Current Environmental Health Reports, 2014
Background Legislations banning smoking in indoor public places and workplaces are being implemen... more Background Legislations banning smoking in indoor public places and workplaces are being implemented worldwide to protect the population from secondhand smoke exposure. Several studies have reported reductions in hospitalizations for acute coronary events following the enactment of smokefree laws. Objective We set out to conduct a systematic review and meta-analysis of epidemiologic studies examining how legislations that ban smoking in indoor public places impact the risk of acute coronary events. Methods We searched MEDLINE, EMBASE, and relevant bibliographies including previous systematic reviews for studies that evaluated changes in acute coronary events, following implementation of smoke-free legislations. Studies were identified through December 2013. We pooled relative risk (RR) estimates for acute coronary events comparing post-vs. prelegislation using inverse-variance weighted random-effects models.
Journal of Trauma and Acute Care Surgery, 2014
Recent studies have found that unconscious biases may influence physicians&am... more Recent studies have found that unconscious biases may influence physicians' clinical decision making. The objective of our study was to determine, using clinical vignettes, if unconscious race and class biases exist specifically among trauma/acute care surgeons and, if so, whether those biases impact surgeons' clinical decision making. A prospective Web-based survey was administered to active members of the Eastern Association for the Surgery of Trauma. Participants completed nine clinical vignettes, each with three trauma/acute care surgery management questions. Race Implicit Association Test (IAT) and social class IAT assessments were completed by each participant. Multivariable, ordered logistic regression analysis was then used to determine whether implicit biases reflected on the IAT tests were associated with vignette responses. In total, 248 members of the Eastern Association for the Surgery of Trauma participated. Of these, 79% explicitly stated that they had no race preferences and 55% stated they had no social class preferences. However, 73.5% of the participants had IAT scores demonstrating an unconscious preference toward white persons; 90.7% demonstrated an implicit preference toward upper social class persons. Only 2 of 27 vignette-based clinical decisions were associated with patient race or social class on univariate analyses. Multivariable analyses revealed no relationship between IAT scores and vignette-based clinical assessments. Unconscious preferences for white and upper-class persons are prevalent among trauma and acute care surgeons. In this study, these biases were not statistically significantly associated with clinical decision making. Further study of the factors that may prevent implicit biases from influencing patient management is warranted. Epidemiologic study, level II.
The Journal of emergency medicine, Jan 2, 2015
Catastrophic antiphospholipid syndrome (CAPS) is a rare disease that causes rapid vascular occlus... more Catastrophic antiphospholipid syndrome (CAPS) is a rare disease that causes rapid vascular occlusion in multiple organ systems. Initial presentation varies depending on the organs affected. Although headache is a common complaint in the emergency department (ED), it is a very rare presentation of CAPS. A 43-year-old previously healthy woman presented to the ED with severe headache. Subarachnoid hemorrhage was excluded and she was discharged home. She returned 36 h later with diabetic ketoacidosis, hyperthyroidism, and thrombosis in her cerebral venous sinus, aorta and splenic artery. She was treated with heparin, steroids, plasmapharesis, and i.v. immunoglobulin, after which she improved. This constellation of symptoms is highly suggestive of CAPS initiated by a polyglandular autoimmune syndrome, despite negative serology. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although a rare cause of headache, CAPS is a potentially fatal disease that requires early identification and...
Journal of the American College of Surgeons, 2012