The ‘Art’ of Research in the Emergency Department

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Dr. Art Pancioli at a Research Experience hosted by the American Heart Association /American Stroke Association and UCMC. Photo by Cindy Starr / Mayfield Clinic.

When patients are brought into the emergency department, stricken by a stroke, epileptic seizure or other acute illness, they don’t want their doctors guessing about what to do next. But for doctors to be certain of what is best in life-threatening situations, they need data to back them up. And that means research must be conducted in the Emergency Department.

The difficulty in accomplishing this, Art Pancioli, MD, said Wednesday night during a presentation at the Vontz Center for Molecular Studies, is not a matter of asking the right questions. The problem lies in figuring out how to answer them in an environment defined by urgency and the unexpected. “It’s not the what if,” he said. “It’s the how.”

Dr. Pancioli is the Richard C. Levy Professor and Chairman of Emergency Medicine at UC and a member of the UC Stroke Team at the UC Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health. Addressing supporters of the American Heart Association / American Stroke Association and the UC Medical Center, he showed a picture that spoke a thousand words about why research in the Emergency Department might be a little bit challenging.


“This is our world,” he said. “This is our reality. It is chaos incarnate. It is abject panic. How do you do research in this?”

Furthermore, to enroll a patient in a clinical trial that might help scientists understand whether treatment A is better than treatment B, a consent form typically must be signed. Dr. Pancioli described a situation in which he asked a family he had known for only 7 minutes whether they would consent for their loved one’s inclusion in a clinical trial. He described “the level of trust that families must have to be willing to participate in research and the great appreciation and sense of duty to that patient and family that clinical researchers feel having received such trust.”

Despite these hurdles, UC’s Department of Emergency Medicine is a national leader in research that tests new therapies and protocols for patients whose lives hang in the balance. And its expertise in the treatment of acute stroke played an important role in the UC Medical Center’s certification, announced yesterday, as an advanced comprehensive stroke center.

The department, which includes 50 faculty members:

•    Produced 90-peer-reviewed publications in 2012, twice the number of the second most prolific research institution;

•    Is the leading enroller of study participants in the national coalition known as the Neurological Emergency Treatment Trials, a permanent research framework led by 22 large university medical centers throughout the United States;

•    Played an important role in the RAMPART study – named study of the year by the Society of Clinical Trials – which determined that an injection of antiepileptic medication in the muscle by paramedics was superior to delivery of the medication by IV;

•    Is currently participating in two additional NETT trials: POINT, which is assessing a treatment for patients who have suffered a minor stroke or transient ischemic attack; and SHINE, which seeks to provide safety data on the use of insulin-infusion therapy for glucose control in patients who have suffered an acute stroke and whose blood sugar is out of control.

•    Played an integral role with the UC Stroke Team in additional NIH-funded studies related ischemic and bleeding stroke, including those under the umbrella of SPOTRIAS, a global network of centers that perform research and share data in an effort to develop new therapies for stroke.

Irene Ewing, RN, BSN, discusses an Emergency Department study with a guest at last Wednesday’s event at the Vontz on the UC Academic Health Center campus.

The UC Department of Emergency Medicine has a long history of excellence and leadership. It developed the very first residency training program in the United States, graduating its first trainee in 1970; it was the first emergency department in the United States to become involved in acute stroke research; and it became the first stroke and neurocritical care training program for emergency physicians in the United States in 2008.

Dr. Pancioli, one of the first emergency medicine specialists on the UC Stroke Team, vividly remembers his first stroke patient. “It was 1991, and we did nothing for her,” he said. “There was nothing we could do.”

Today, there is much Dr. Pancioli and his team do for patients who have suffered a stroke. And there is still much more to be done. “There are not enough hours in the day to answer all the good questions we have,” Dr. Pancioli said, “even with all the good people we have.”

Dr. Pancioli concluded by thanking those in attendance for their support. Without donors and tax dollars, he noted, research cannot move forward for the betterment of humankind.

— Cindy Starr

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