Erik Anderson, MD

All Publications

• Continuum of Care for HCV Among Patients Diagnosed in the Emergency Department Setting. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Anderson, E. S., Galbraith, J. W., Deering, L. J., Pfeil, S. K., Todorovic, T., Rodgers, J. B., Forsythe, J. M., Franco, R., Wang, H., Wang, N. E., White, D. A. 2017

  View details for DOI 10.1093/cid/cix163

  View details for PubMedID 28207069

• Addressing Social Determinants of Health from the Emergency Department through Social Emergency Medicine. The western journal of emergency medicine Anderson, E. S., Lippert, S., Newberry, J., Bernstein, E., Alter, H. J., Wang, N. E. 2016; 17 (4): 487-489

  View details for DOI 10.5811/westjem.2016.5.30240

  View details for PubMedID 27429706

• High-impact hepatitis C virus testing for injection drug users in an urban ED AMERICAN JOURNAL OF EMERGENCY MEDICINE Anderson, E. S., Pfeil, S. K., Deering, L. J., Todorovic, T., Lippert, S., White, D. A. 2016; 34 (6): 1108-1111

  Abstract

  We implemented the "High-Impact Testing for Injection Drug Users", or the "HIT IDU" initiative, an emergency physician (EP)-based hepatitis C virus (HCV) testing program. The objective of this study was to evaluate the outcomes of this clinical protocol.This was a prospective observational pilot study. The HIT IDU initiative encouraged EPs to integrate targeted HCV testing into care, with an emphasis on screening all people who inject drugs (PWID). Physicians selected the primary indication for HCV testing from a drop-down menu integrated into the electronic ordering process. The primary outcome was the absolute number and overall proportion of EP-based HCV antibody positive tests, further stratified by the indication for testing.Over the 3-month study period, 14,253 unique patients were evaluated, and EPs tested 155 patients for HCV (1.1%; 95% confidence interval [CI], 0.9%-1.2%), of which 40 (26%, 95% CI, 19%-33%) were HCV antibody positive. The proportion of HCV antibody positivity by testing indication was as follows: PWID 47% (34/73; 95% CI, 35%-59%), patient requested test 10% (4/40; 95% CI, 3%-24%), confirm patient report 67% (2/3; 95% CI, 9%-99%), liver disease of uncertain etiology 0% (0/3; 95% CI, 0%-71%), and other 0% (0/36; 95% CI, 0%-10%). There were 22 patients chronically infected, 19 had a follow-up appointment arranged, 3 attended their follow-up appointment, and 1 patient was treated at 1 year of follow-up.Although the overall number of EP-based HCV tests performed was low, high rates of infection were identified, particularly among PWID. There were significant challenges with linkage to care.

  View details for DOI 10.1016/j.ajem.2016.03.004

  View details for Web of Science ID 000377338700032

  View details for PubMedID 27037135

• Patient Understanding of HIV and Hepatitis C Testing in an Emergency Department with an Integrated Program. Journal of the International Association of Providers of AIDS Care Anderson, E. S., Pfeil, S. K., Alter, H. J., White, D. A. 2016; 15 (3): 184-188

  Abstract

  We implemented triage nurse rapid HIV and hepatitis C virus (HCV) screening, in parallel with physician diagnostic testing, in our urban emergency department (ED).A 2-month cross-sectional survey was performed to determine the proportion of patients who correctly reported being tested for HIV and HCV.A total of 492 patients were surveyed. Fifty-one (70%) of the 73 patients who reported being HIV tested and 372 (89%) of the 419 patients who reported not being HIV tested were correct. Thirty (60%) of the 50 patients who reported being HCV tested and 416 (94%) of the 442 patients who reported not being HCV tested were correct.Although most ED patients correctly reported whether testing was performed, there were many who did not. Although ED screening programs for HIV and HCV serve as an important venue for screening, strategies to improve communication require attention.

  View details for DOI 10.1177/2325957416629551

  View details for PubMedID 26858313

• DIFFERENCES BETWEEN EMERGENCY NURSE PERCEPTION AND PATIENT REPORTED EXPERIENCE WITH AN ED HIV AND HEPATITIS C VIRUS SCREENING PROGRAM JOURNAL OF EMERGENCY NURSING White, D. A., Anderson, E. S., Pfeil, S. K., Graffman, S. E., Trivedi, T. K. 2016; 42 (2): 139-145

  Abstract

  Nontargeted human immunodeficiency virus (HIV) screening and targeted hepatitis C virus (HCV) screening for selected high-risk patients (those born between 1945 and 1965 and those who report injection drug use) was integrated into our ED triage process and carried out by nurses. Determining whether emergency nurses accurately perceive what patients experience is important to know because staff misperceptions may pose a barrier to program adherence and sustainability.We performed a cross-sectional survey study of emergency nurses and patients to assess the accuracy of emergency nurses' perception of patient experience with the HIV/HCV screening program. Respondents evaluated their level of agreement using a 5-item Likert scale for 9 statements across 4 domains related to the patient experience with the screening process (satisfaction, sense of autonomy, sense of privacy, and comfort level).Surveys were completed by 65 of the 153 eligible emergency nurses (42%). Of the 1040 patients approached, 610 (59%) were eligible, and 491 of the 610 eligible patients (80%) completed surveys. Across all domains, statistically significant differences were found between emergency nurse perception and patient report, P < .001. Emergency nurses perceived patients to be less satisfied with the screening program, more uncomfortable with being asked screening questions, more concerned about privacy issues, and less likely to feel that the decision to decline screening was autonomous than were patients.Emergency nurses not only frequently misperceive how patients experience ED-based HIV/HCV screening, but these misperceptions are skewed toward the negative, representing a type of staff bias. Further research is recommended to determine if such misperceptions adversely affect implementation of screening.

  View details for DOI 10.1016/j.jen.2015.09.010

  View details for Web of Science ID 000372370800012

  View details for PubMedID 26547573

• Hepatitis C Virus Screening and Emergency Department Length of Stay. PloS one White, D. A., Anderson, E. S., Pfeil, S. K., Deering, L. J., Todorovic, T., Trivedi, T. K. 2016; 11 (10)

  Abstract

  Recent studies demonstrate high rates of previously undiagnosed hepatitis C virus (HCV) infection among patients screened in urban emergency departments (ED). Experts caution, however, that public health interventions, such as screening for infectious diseases, must not interfere with the primary mission of EDs to provide timely acute care. Increases in ED length of stay (LOS) have been associated with decreased quality of ED care.In this study, we assess the influence of an integrated HCV screening protocol on ED LOS.This was a retrospective cohort study analyzing timestamp data for all discharged patients over a 1-year period. The primary outcome compared the median LOS in minutes between patients who completed HCV screening and those who did not. Further analysis compared LOS for HCV screening by whether or not complete blood count (CBC) testing was conducted.Of 69,639 visits, 2,864 (4%) had HCV screening tests completed and 272 (9.5%) were antibody positive. The median LOS for visits that included HCV screening was greater than visits that did not include screening (151 versus 119 minutes, P < 0.001). Among the subset of visits in which CBC testing was conducted, there was no significant difference in median LOS between visits that also included HCV screening and those that did not (240 versus 242 minutes, P = 0.68).Integrated HCV screening modestly prolongs ED LOS. However, among patients undergoing other blood tests, screening had no effect on LOS. Programs may consider routinely offering HCV screening to patients who are undergoing laboratory testing.

  View details for DOI 10.1371/journal.pone.0164831

  View details for PubMedID 27760176

• Social Emergency Medicine: Embracing the Dual Role of the Emergency Department in Acute Care and Population Health. Annals of emergency medicine Anderson, E. S., Hsieh, D., Alter, H. J. 2016

  View details for DOI 10.1016/j.annemergmed.2016.01.005

  View details for PubMedID 26921967

• Substance Abuse and Mental Health Visits Among Adolescents Presenting to US Emergency Departments PEDIATRIC EMERGENCY CARE Fahimi, J., Aurrecoechea, A., Anderson, E., Herring, A., Alter, H. 2015; 31 (5): 331-338

  Abstract

  The objectives of the study were to identify factors associated with adolescent emergency department (ED) visits for substance abuse, including those complicated by mental health (dual diagnosis), and to analyze their effect on ED length of stay (LOS) and disposition.We performed a secondary analysis of ED visits by adolescents (age, 11-24) using the National Hospital Ambulatory Medical Care Survey (1997-2010) to identify visits for mental health, substance use, and dual diagnosis. Univariate and multivariate statistics were used to analyze demographic and visit-level factors, factors associated with substance use and dual diagnosis visits, as well as the effects of substance use and mental health conditions on ED LOS and disposition.Substance use and mental health accounted for 2.1% and 4.3% of all adolescent visits, respectively, with 20.9% (95% confidence interval [CI], 18.3%-23.5%) of substance abuse visits complicated by mental health. The factors significantly associated with substance use include the following: male sex, urban location, West region, ambulance arrival, night and weekend shift, anxiety disorders, mood disorders, and psychotic disorders. Additional LOS was 89.77 minutes for mental health, 71.33 minutes for substance use, and 139.97 minutes for dual diagnosis visits, as compared with visits where these conditions were not present. Both mental health and substance use were associated with admission/transfer as compared with other dispositions as follows: mental health odds ratio (OR), 5.93 (95% CI, 5.14-6.84); illicit drug use OR, 3.56 (95% CI 2.72-4.64); and dual diagnosis OR, 6.86 (95% CI, 4.67-10.09).Substance abuse and dual diagnosis are common among adolescent ED visits and are strongly associated with increased use of prehospital resources, ED LOS, and need for hospitalization.

  View details for Web of Science ID 000353930300004

  View details for PubMedID 25875990

• The first 500: initial experience with widespread use of low-dose ketamine for acute pain management in the ED Annual Pain Medicine Meeting of the American-Society-of-Regional-Anesthesia-and-Pain-Medicine Ahern, T. L., Herring, A. A., Anderson, E. S., Madia, V. A., Fahimi, J., Frazee, B. W. W B SAUNDERS CO-ELSEVIER INC. 2015: 197–201

  Abstract

  The objective of this study is to describe the clinical use and safety profile of low-dose ketamine (LDK) (0.1-0.3 mg/kg) for pain management in the emergency department (ED).This was a retrospective case series of consecutive patients given LDK for pain at a single urban ED between 2012 and 2013. Using a standardized data abstraction form, 2 physicians reviewed patient records to determine demographics, indication, dose, route, disposition, and occurrence of adverse events. Adverse events were categorized as minor (emesis, psychomimetic or dysphoric reaction, and transient hypoxia) and serious (apnea, laryngospasm, hypertensive emergency, and cardiac arrest). Additional parameters measured were heart rate and systolic blood pressure.Five hundred thirty patients received LDK in the ED over a 2-year period. Indications for LDK were diverse. Median patient age was 41 years, 55% were women, and 63% were discharged. Route of administration was intravenous in 93% and intramuscular in 7%. Most patients (92%) received a dose of 10 to 15 mg. Comorbid diseases included hypertension (26%), psychiatric disorder (12%), obstructive airway disease (11%), and coronary artery disease (4%). There was no significant change in heart rate or systolic blood pressure. Thirty patients (6%) met our criteria for adverse events. Eighteen patients (3.5%) experienced psychomimetic or dysphoric reactions. Seven patients (1.5%) developed transient hypoxia. Five patients (1%) had emesis. There were no cases of serious adverse events. Agreement between abstractors was almost perfect.Use of LDK as an analgesic in a diverse ED patient population appears to be safe and feasible for the treatment of many types of pain.

  View details for DOI 10.1016/j.ajem.2014.11.010

  View details for Web of Science ID 000350447900012

  View details for PubMedID 25488336

• Results of a Rapid Hepatitis C Virus Screening and Diagnostic Testing Program in an Urban Emergency Department. Annals of emergency medicine White, D. A., Anderson, E. S., Pfeil, S. K., Trivedi, T. K., Alter, H. J. 2015

  Abstract

  We describe the results of an emergency department (ED) hepatitis C virus testing program that integrated birth cohort screening and screening of patients with a history of injection drug use, as well as physician diagnostic testing, according to national guidelines.We conducted a retrospective cohort study using data collected as part of clinical care. The primary outcome was the hepatitis C virus prevalence among tested patients. We evaluated factors associated with testing positive with logistic regression.Of the 26,639 unique adults aged 18 years or older and presenting to the ED during the 6-month study, 2,581 (9.7%) completed hepatitis C virus screening (2,028) or diagnostic testing (553), of whom 267 were antibody positive (10.3% prevalence). Factors associated with testing positive for hepatitis C virus included injection drug use (38.4% prevalence; odds ratio [OR] 10.8; 95% confidence interval [CI] 7.5 to 15.5), homeless (25.5% prevalence; OR 3.1; 95% CI 1.5 to 6.8), diagnostic testing (14.8% prevalence; OR 2.6; 95% CI 1.7 to 3.9), birth cohort (13.7% prevalence; OR 3.6; 95% CI 2.4 to 5.3), and male sex (12.4% prevalence; OR 1.4; 95% CI 1.0 to 2.0). Of the 267 patients testing positive for hepatitis C virus antibody, 137 (51%) had documentation of result disclosure and 180 (67%) had confirmatory ribonucleic acid testing performed, of whom 126 (70%) had a positive result. Follow-up appointments at the hepatitis C virus clinic were arranged for 57 of the 126 (45%) patients with confirmed positive results, of which 30 attended.This ED screening and diagnostic testing program found a high prevalence of hepatitis C virus antibody positivity across all groups. Challenges encountered with hepatitis C virus screening included result disclosure, confirmatory testing, and linkage to care. Our results warrant continued efforts to develop and evaluate policies for ED-based hepatitis C virus screening.

  View details for DOI 10.1016/j.annemergmed.2015.06.023

  View details for PubMedID 26253712

• Hepatitis C Virus Antibody Testing: Result Availability at Time of Discharge for Emergency Department Patients. Journal of acquired immune deficiency syndromes (1999) White, D. A., Anderson, E. S., Pfeil, S. K., Trivedi, T. K. 2015

  View details for DOI 10.1097/QAI.0000000000000887

  View details for PubMedID 26536320

• Long-term mortality of patients surviving firearm violence. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention Fahimi, J., Larimer, E., Hamud-Ahmed, W., Anderson, E., Schnorr, C. D., Yen, I., Alter, H. J. 2015

  Abstract

  We aim to calculate the 5-year mortality after surviving to hospital discharge after a firearm injury and estimate the association of firearm injury with later mortality.We performed a retrospective cohort study of patients from an urban emergency department (ED) and trauma centre in Oakland, California, USA, in 2007. We created three cohorts of patients presenting for (1) gunshot wound (GSW), (2) MVC and (3) assault without a firearm. Demographic and clinical information was obtained from the clinical chart, and the California Department of Public Health Vital Statistics and Social Security Death Master File (2007-2012) were queried to identify patients who died.We analysed 516 GSW patients, 992 MVC patients and 695 non-GSW assault patients. Of the GSW patients, 86.4% were alive at 5 years. All-cause 5-year mortality among GSW victims surviving to discharge after injury was 5.1%. Compared with MVC patients, both GSW and non-GSW assault patients have higher risk of death at 5 years (HR 2.54 (95% CI 1.41 to 4.59) and HR 1.64 (95% CI 1.01 to 2.68), respectively), adjusting for age, sex and race. Risk of death was higher in the first year for the GSW cohort (HR 6.14 (95% CI 2.35 to 16.08) and HR 5.06 (95% CI 1.88 to 13.63) as compared with MVC and non-GSW assault cohorts, respectively). Homicide was the cause of death in 79.2% of GSW patients who died after surviving the index injury.Among individuals presenting to the ED after injury or assault and surviving to discharge, firearm injury exposure is an important predictor of death within 5 years and most pronounced in the first year after injury.

  View details for DOI 10.1136/injuryprev-2015-041710

  View details for PubMedID 26506959

• Pilot study of ultrasound-guided corticosteroid hip injections by emergency physicians. The western journal of emergency medicine Anderson, E. S., Hodell, E., Mantuani, D., Fahimi, J., Pampalone, I., Nagdev, A. 2014; 15 (7): 919-924

  Abstract

  Our objective was to assess the efficacy of ultrasound-guided hip injections performed by emergency physicians (EPs) for the treatment of chronic hip pain in an outpatient clinic setting.Patients were identified on a referral basis from the orthopedic chronic pain clinic. The patient population was either identified as having osteoarthritis of the hip, osteonecrosis of varying etiologies, post-traumatic osteoarthritis of the hip, or other non-infectious causes of chronic hip pain. Patients had an ultrasound-guided hip injection of 4 ml of 0.5% bupivacaine and 1 ml of triamcinolone acetate (40 mg/1 ml). Emergency medicine resident physicians under the supervision of an attending EP performed all injections. Pain scores were collected using a Likert pain scale from patients prior to the procedure, and 10 minutes post procedure and at short-term follow-up of one week and one month. The primary outcome was patient-reported pain score on a Likert pain scale at one week.We performed a total of 47 ultrasound-guided intra-articular hip injections on 44 subjects who met inclusion criteria. Three subjects received bilateral injections. Follow-up data were available for 42/47 (89.4%) hip injections at one week and 40/47 (85.1%) at one month. The greatest improvement was at 10 minutes after injection with a mean decrease in Likert pain score from pre-injection baseline of 5.57 (95% CI, 4.76-6.39). For the primary outcome at one week, we found a mean decrease in Likert pain score from pre-injection baseline of 3.85 (95% CI, 2.94-4.75). At one month we found a mean decrease in Likert pain score of 1.8 (95% CI, 1.12-2.53). There were no significant adverse outcomes reported.Under the supervision of an attending EP, junior emergency medicine resident physicians can safely and effectively inject hips for chronic pain relief in an outpatient clinical setting using ultrasound guidance.

  View details for DOI 10.5811/westjem.2014.9.20575

  View details for PubMedID 25493154

• Lack of improved outcomes with increased use of targeted temperature management following out-of-hospital cardiac arrest: A multicenter retrospective cohort study RESUSCITATION Mark, D. G., Vinson, D. R., Hung, Y., Anderson, E. S., Escobar, G. J., Carr, B. G., Abella, B. S., Ballard, D. W. 2014; 85 (11): 1549-1556

  Abstract

  To assess whether increased use of targeted temperature management (TTM) within an integrated healthcare delivery system resulted in improved rates of good neurologic outcome at hospital discharge (Cerebral Performance Category score of 1 or 2).Retrospective cohort study of patients with OHCA admitted to 21 medical centers between January 2007 and December 2012. A standardized TTM protocol and educational program were introduced throughout the system in early 2009. Comatose patients eligible for treatment with TTM were included. Adjusted odds of good neurologic outcome at hospital discharge and survival to hospital discharge were assessed using multivariate logistic regression.A total of 1119 patients were admitted post-OHCA with coma, 59.1% (661 of 1119) of which were eligible for TTM. The percentage of patients treated with TTM markedly increased during the study period: 10.5% in the years preceding (2007-2008) vs. 85.1% in the years following (2011-2012) implementation of the practice improvement initiative. However, unadjusted in-hospital survival (37.3% vs. 39.0%, p=0.77) and good neurologic outcome at hospital discharge (26.3% vs. 26.6%, p=1.0) did not change. The adjusted odds of survival to hospital discharge (AOR 1.0, 95% CI 0.85-1.17) or a good neurologic outcome (AOR 0.94, 95% CI 0.79-1.11) were likewise non-significant.Despite a marked increase in TTM rates across hospitals in an integrated delivery system, there was no appreciable change in the crude or adjusted odds of in-hospital survival or good neurologic outcomes at hospital discharge among eligible post-arrest patients.

  View details for DOI 10.1016/j.resuscitation.2014.08.014

  View details for Web of Science ID 000343827100028

  View details for PubMedID 25180922

• Ultrasound-guided Intraarticular Hip Injection for Osteoarthritis Pain in the Emergency Department. The western journal of emergency medicine Anderson, E. S., Herring, A. A., Bailey, C., Mantuani, D., Nagdev, A. D. 2013; 14 (5): 505-508

  Abstract

  Ultrasound-guided intraarticular hip corticosteroid injections may be useful for emergency care providers treating patients with painful exacerbations of osteoarthritis of the hip. Corticosteroid injection is widely recommended as a first-line treatment for painful osteoarthritis of the hip. Bedside ultrasound is readily available in most emergency departments; however, using ultrasound to guide therapeutic hip injections has not yet been described in emergency practice. Herein, we present the first description of a successful emergency physician-performed ultrasound-guided hip injection of local anesthetic and corticosteroid for pain control in a patient with an acute exacerbation of osteoarthritis.

  View details for DOI 10.5811/westjem.2013.2.13966

  View details for PubMedID 24106550

• Cusco reflections: poverty, health, and the physician's duty. Minnesota medicine Anderson, E. 2012; 95 (5): 60-?

  View details for PubMedID 22712140