Tadahiro Goto
Harvard University
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Publication
Featured researches published by Tadahiro Goto.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | 2015
Tadahiro Goto; Koichiro Gibo; Yusuke Hagiwara; Hiroshi Morita; David Fm Brown; Calvin A. Brown; Kohei Hasegawa
BackgroundAlthough the international guidelines emphasize early and systematic use of rescue intubation techniques, there is little evidence to support this notion. We aimed to test the hypothesis that preceding multiple failed intubation attempts are associated with a decreased success rate on the first rescue intubation in emergency departments (EDs).MethodsWe analysed data from two multicentre prospective registries designed to characterize current ED airway management in Japan between April 2010 and June 2013. All patients who underwent a rescue intubation after a failed attempt or a series of failed attempts were included for the analysis. Multiple failed intubation attempts were defined as ≥2 consecutive failed intubation attempts before a rescue intubation. Primary outcome measure was success rate on the first rescue intubation attempt.ResultsOf 6,273 consecutive patients, 1,151 underwent a rescue intubation. The success rate on the first rescue intubation attempt declined as the number of preceding failed intubation attempts increased (81% [95% CI, 79%-84%] after one failed attempt; 71% [95% CI, 66%-76%] after two failed attempts; 67% [95% CI, 55%-78%] after three or more failed attempts; Ptrend <0.001). In the multivariable analysis adjusting for age, sex, principal indication, change in methods, devices, and intubator specialty, and clustering of patients within EDs, success rate on the first rescue intubation after two failed attempts was significantly lower (OR, 0.56; 95% CI, 0.41-0.77) compared to that after one failed attempt. Similarly, success rate on the first rescue intubation attempt after three or more failed attempts was significantly lower (OR, 0.49; 95% CI, 0.25-0.94) compared to that after one failed attempt.ConclusionPreceding multiple failed intubation attempts was independently associated with a decreased success rate on the first rescue intubation in the ED.
American Journal of Emergency Medicine | 2015
Yusuke Hagiwara; Hiroko Watase; Hiroshi Okamoto; Tadahiro Goto; Kohei Hasegawa
BACKGROUND Evidence to predict difficult intubation remains scarce in the emergency department (ED) setting. A previously defined clinical decision rule, the modified LEMON criteria, may provide a reliable and reproducible means of identifying difficult intubations. We aimed to prospectively evaluate the external validity of the modified LEMON criteria in the EDs. METHODS We conducted a 13-center prospective observational study, the second Japanese Emergency Airway Network study. We prospectively collected data on all patients undergoing intubations in the ED from February 2012 through September 2014. The primary outcomes were sensitivity, specificity, and predictive values of the modified LEMON criteria for predicting difficult intubation (≥2 attempts by emergency attending physicians or anesthesiologists). RESULTS The database recorded a total of 4034 encounters (capture rate, 96%) in the EDs. Of these, 3313 patients (84%) underwent the intubation attempt with a direct laryngoscope and 610 patients (16%) with a video laryngoscope. The proportion of difficult intubation was 5.4% (95% confidence interval [CI], 4.7%-6.2%) in the direct laryngoscope group and 7.4% (95% CI, 5.6%-9.7%) in the video laryngoscope group. The sensitivity was 85.7% (95% CI, 79.3%-90.4%) with direct laryngoscope and 94.9% (95% CI, 83.5%-98.6%) with video laryngoscope. The specificity was 47.6% (95% CI, 47.2%-47.9%) and 40.3% (95% CI, 39.4%-40.6%), respectively. The negative predictive value was 98.2% (95% CI, 97.5%-98.8%) and 99.0% (95% CI, 96.6%-99.7%), respectively. CONCLUSIONS In this multicenter prospective study, we found a high sensitivity and a negative predictive value of the modified LEMON criteria for predicting difficult intubation. The modified LEMON might assist ED providers in better identifying difficult intubations.
Journal of the American Geriatrics Society | 2016
Tadahiro Goto; Kazuki Yoshida; Yusuke Tsugawa; Carlos A. Camargo; Kohei Hasegawa
To investigate the frequency of infectious disease (ID)‐related emergency department (ED) visits of elderly adults in the United States.
The Journal of Rheumatology | 2016
Sadao Jinno; Kohei Hasegawa; Tuhina Neogi; Tadahiro Goto; Maureen Dubreuil
Objective. To examine temporal trends in the rate of gout emergency department (ED) visits and charges in the United States between 2006 and 2012. Methods. A serial cross-sectional analysis of the Nationwide Emergency Department Sample. Results. The rate of ED visits for gout in adults overall increased from 75.0 to 85.4 per 100,000 persons over the study period (14% increase, p < 0.001), and increased 29% for those aged 45–54 years. Nationwide ED charges increased from
Emergency Medicine Journal | 2015
Tadahiro Goto; Hiroko Watase; Hiroshi Morita; Hideya Nagai; Calvin A. Brown; David F.M. Brown; Kohei Hasegawa
156 million to
Resuscitation | 2017
Yukari Goto; Tadahiro Goto; Yusuke Hagiwara; Yusuke Tsugawa; Hiroko Watase; Hiroshi Okamoto; Kohei Hasegawa
281 million (80% increase, p < 0.001). Conclusion. Between 2006 and 2012, the rate of gout ED visits increased among US adults, most notably in those aged 45–54 years.
Chest | 2017
Tadahiro Goto; Yusuke Tsugawa; Mohammad Kamal Faridi; Carlos A. Camargo; Kohei Hasegawa
Objective To determine whether the success rate of repeated attempts at tracheal intubation by a single intubator was lower than those by alternate intubators in the emergency department (ED). Methods An analysis of data from a multicentre prospective registry (Japanese Emergency Airway Network Registry) of 13 academic and community EDs in Japan between April 2010 and August 2012. We included all adult and paediatric patients who underwent repeated attempts at tracheal intubation in the ED. We compared the intubation success rates at the second and third attempts between attempts at intubation by a single intubator who performed the previous attempts, and the attempts by alternate intubators. Results We recorded 4094 patients (capture rate, 96%); 1289 patients with repeated attempts at tracheal intubation were eligible for this study. Among these, 871 patients (68%) had a second attempt at intubation by single intubators. At the second attempt, tracheal intubation by a single intubator was associated with a decreased success rate (adjusted odds ratio or AOR, 0.50; 95% CI 0.36 to 0.71), compared with alternate intubators. At the third attempt, intubation by a single intubator was also associated with a decreased success rate (58% vs 70%; unadjusted OR, 0.58; 95% CI 0.38 to 0.89). However, after adjustment for potential confounders, the association lost statistical significance (AOR, 0.89; 95% CI 0.52 to 1.56). Conclusions In this large multicentre study of ED patients undergoing tracheal intubation, second attempts at intubation by a single intubator, compared with those by alternate intubators, were independently associated with a decreased success rate.
Western Journal of Emergency Medicine | 2016
Tadahiro Goto; Koichiro Gibo; Yusuke Hagiwara; Masashi Okubo; David F.M. Brown; Calvin A. Brown; Kohei Hasegawa
OBJECTIVES Continuous surveillance of emergency airway management practice is imperative in improving quality of care and patient safety. We aimed to investigate the changes in the practice of emergency airway management and the related outcomes in the emergency departments (EDs) in Japan. METHODS We conducted an analysis of the data from two prospective, observational, multicentre registries of emergency airway management-the Japanese Emergency Airway Network (JEAN)-1 and -2 Registries from April 2010 through May 2016. RESULTS We recorded 10,927 ED intubations (capture rate, 96%); 10,875 paediatric and adult patients were eligible for our analysis. The rate of rapid sequence intubation (RSI) use as the initial intubation method significantly increased from 28% in 2010 to 53% in 2016 (Ptrend=0.03). Likewise, the rate of video laryngoscope (VL) use as the first intubation device increased significantly from 2% in 2010 to 40% in 2016 (Ptrend<0.001), with a significant decrease in the rate of direct laryngoscope use from 97% in 2010 to 58% in 2016 (Ptrend<0.001). Concurrent with these changes, the overall first-attempt success rate also increased from 68% in 2010 to 74% in 2016 (Ptrend=0.02). By contrast, the rate of adverse events did not change significantly over time (Ptrend=0.06). CONCLUSION By using data from two large, multicentre, prospective registries, we characterised the current emergency airway management practice, and identified their changes in Japan. The data demonstrated significant increases in the rate of RSI and VL use on the first attempt and the first-attempt success rate over the 6-year study period.
BMJ Open | 2014
Tadahiro Goto; Yasuaki Koyama; Takashiro Kondo; Yusuke Tsugawa; Kohei Hasegawa
BACKGROUND Obesity is common among individuals with COPD and associated with increased COPD morbidities. However, little is known about the impact of weight reduction on COPD‐related outcomes in patients who are obese. METHODS Using the population‐based ED and inpatient sample in three US states (California, Florida, and Nebraska), we performed a self‐controlled case series study of 481 adults who were obese (40‐65 years of age) with COPD who underwent bariatric surgery. The primary outcome was an ED visit or hospitalization for acute exacerbation of COPD (AECOPD) from 2005 through 2011. We compared each patient’s risk of the outcome during sequential 12‐month periods using presurgery months 13 through 24 as the reference period. RESULTS During the 13 to 24 months before bariatric surgery (ie, reference period), 28% (95% CI, 24%‐32%) of patients had an ED visit or hospitalization for AECOPD. In the subsequent 12‐month presurgery period, the risk did not change materially (31%; 95% CI, 27%‐35%), with an adjusted OR (aOR) of 1.16 (95% CI, 0.88‐1.53; P = .29). By contrast, during the first 12 months after bariatric surgery, the risk declined significantly (12%; 95% CI, 9%‐15%; aOR, 0.35; 95% CI, 0.25‐0.49; P < .001). Likewise, in the subsequent period of 13 to 24 months after bariatric surgery, the risk remained significantly low (13%; 95% CI, 11%‐17%; aOR, 0.39; 95% CI, 0.28‐0.55; P < .001). CONCLUSIONS The risk of an ED visit or hospitalization for AECOPD substantially decreased after bariatric surgery in patients who are obese. This observation suggests the effectiveness of substantial weight reduction on COPD morbidity.
JAMA Internal Medicine | 2018
Giorgio Costantino; Martin H. Ruwald; James Quinn; Carlos A. Camargo; Frederik Dalgaard; Gunnar H. Gislason; Tadahiro Goto; Kohei Hasegawa; Padma Kaul; Nicola Montano; Anna Karin Numé; Antonio Russo; Robert S. Sheldon; Monica Solbiati; Benjamin Sun; Giovanni Casazza
Introduction The objective of this study was to investigate the factors associated with first-pass success in pediatric intubation in the emergency department (ED). Methods We analyzed the data from two multicenter prospective studies of ED intubation in 17 EDs between April 2010 and September 2014. The studies prospectively measured patient’s age, sex, principal indication for intubation, methods (e.g., rapid sequence intubation [RSI]), devices, and intubator’s level of training and specialty. To evaluate independent predictors of first-pass success, we fit logistic regression model with generalized estimating equations. In the sensitivity analysis, we repeated the analysis in children <10 years. Results A total of 293 children aged ≤18 years who underwent ED intubation were eligible for the analysis. The overall first-pass success rate was 60% (95%CI [54%–66%]). In the multivariable model, age ≥10 years (adjusted odds ratio [aOR], 2.45; 95% CI [1.23–4.87]), use of RSI (aOR, 2.17; 95% CI [1.31–3.57]), and intubation attempt by an emergency physician (aOR, 3.21; 95% CI [1.78–5.83]) were significantly associated with a higher chance of first-pass success. Likewise, in the sensitivity analysis, the use of RSI (aOR, 3.05; 95% CI [1.63–5.70]), and intubation attempt by an emergency physician (aOR, 4.08; 95% CI [1.92–8.63]) were significantly associated with a higher chance of first-pass success. Conclusion Based on two large multicenter prospective studies of ED airway management, we found that older age, use of RSI, and intubation by emergency physicians were the independent predictors of a higher chance of first-pass success in children. Our findings should facilitate investigations to develop optimal airway management strategies in critically-ill children in the ED.