Jeffrey A. Kline

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https://hdl.handle.net/1805/6677

Facial Expression as a Diagnostic Tool for Pulmonary Embolism

Jeffrey Kline studies blood clots, the people they affect, and the providers who care for those people. His diagnostic research interests focus on human affect analysis, pretest probability, and novel breath-based instruments to reduce medical imaging. His human treatment research includes randomized trials of fibrinolysis and inhaled nitric oxide to reduce heart damage from blood clots in the lungs. He derived and validated a decision rule to help emergency physicians reduce unnecessary diagnostic tests for low-risk patients with symptoms of blood clots in the lungs.

Dr. Kline’s current work focuses on using the human face as a diagnostic instrument to further help doctors make informed decisions about diagnostic testing for blood clots. His laboratory work focuses on mechanisms and treatment of acute pulmonary hypertension from pulmonary embolism (PE), animal models of pulmonary embolism, and a nanoparticle-delivered enzyme, plasmin, to promote clot lysis without increasing risk. He helped set up an advanced hospital treatment program to treat patients with severe PE, and he also created and runs a clinic specifically to allow patients diagnosed with blood clots in the emergency department to treat themselves at home, rather than in the hospital.

Dr. Kline’s work using the human face as a diagnostic instrument is another example of how IUPUI’s faculty members are TRANSLATING their RESEARCH INTO PRACTICE.

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Pulmonary Dysfunction in Patients with Femoral Shaft Fracture Treated with Intramedullary Nailing
(2001-08) Norris, Brent L; Patton, W Christopher; Rudd, Joseph N Jr; Schmitt, Colleen M; Kline, Jeffrey A.
Background: This study was undertaken to determine whether alveolar dead space increases during intramedullary nailing of femoral shaft fractures and whether alveolar dead space predicts postoperative pulmonary dysfunction in patients undergoing intramedullary nailing of a femoral shaft fracture. Methods: All patients with a femoral shaft fracture were prospectively enrolled in the study unless there was evidence of acute myocardial infarction, shock, or heart failure. Arterial blood gases were measured at three consecutive time-periods after induction of general anesthesia: before intramedullary nailing and ten and thirty minutes after intramedullary nailing. The end-tidal carbon-dioxide level, minute ventilation, positive end‐expiratory pressure, and percent of inspired and expired inhalation agent were recorded simultaneously with the blood-gas measurement. Postoperatively, all subjects were monitored for evidence of pulmonary dysfunction, defined as the need for mechanical ventilation or supplemental oxygen (at a fraction of inspired oxygen of >40%) in the presence of clinical signs of a respiratory rate of >20 breaths/min or the use of accessory muscles of respiration. Results: Seventy‐four patients with a total of eighty femoral shaft fractures completed the study. Fifty fractures (62.5%) underwent nailing after reaming, and thirty fractures (37.5%) underwent nailing with minimal or no reaming. The mean alveolar dead-space measurements before canal opening and at ten and thirty minutes after canal opening were 14.5%, 15.8%, and 15.2% in the total series of seventy‐four patients (general linear model, p = 0.2) and 20.5%, 22.7%, and 24.2% in the twenty patients with postoperative pulmonary dysfunction (general linear model, p = 0.05). Of the twenty‐one patients with an alveolar dead-space measurement of >20% thirty minutes after nailing, sixteen had postoperative pulmonary dysfunction. According to univariate and multivariate analysis, the alveolar dead-space measurement was strongly associated with postoperative pulmonary dysfunction. Conclusions: According to our data, intramedullary nailing of femoral shaft fractures did not significantly increase alveolar dead space, and the amount of alveolar dead space can predict which patients will have pulmonary dysfunction postoperatively.
Disposable Hand-Held Device for Collection of Exhaled Breath Condensate
(2004-07) Kline, Jeffrey A.
A breath condensate collection apparatus comprising a central chamber, a breath input assembly, a plunger assembly and a breath condensate collection port. The central chamber has inner and outer side walls with a coolant material sealed in between. The breath input assembly is disposed on the side of the central chamber in fluid communication with the chamber interior. The plunger assembly has a piston, slidably disposed in the chamber, and a handle extending from a first end of the chamber. The collection port is disposed at the second end of the central chamber in fluid communication with the interior of the chamber. Obstructive structures may be arranged in the chamber interior for increasing the surface area on which condensate may form. The apparatus may also include an outlet assembly that may be removed and replaced with a sampling well into which the condensate may be washed with a buffer solution.
Device and Method for Collection of Exhaled Alveolar Breath Condensate
(2004-08) Kline, Jeffrey A.
A diagnosis method for respiratory disease based on the separation of the expired airway phase in an exhaled breath from the alveolar phase, and a device to accomplish the method. The device includes a cartridge assembly and a disposable condensing chamber carried in a substantially enclosed housing. The cartridge assembly includes a disposable cartridge and a reusable control system that monitors a characteristic of gas passing through the cartridge to determine when to divert the exhaled breath to an exhaust outlet and when to divert the exhaled breath to the condensing chamber. The characteristic is selected as being representative of the transition from the expired airway phase to the alveolar phase. Also included are a refrigeration system, an auxiliary monitoring system for determining when a sufficient volume of gas has been produced, and a built-in analyzer.
Prospective study of clinician-entered research data in the Emergency Department using an Internet-based system after the HIPAA Privacy Rule
(2004-10) Kline, Jeffrey A.; Johnson, Charles L; Webb, William B; Runyon, Michael S
Background Design and test the reliability of a web-based system for multicenter, real-time collection of data in the emergency department (ED), under waiver of authorization, in compliance with HIPAA. Methods This was a phase I, two-hospital study of patients undergoing evaluation for possible pulmonary embolism. Data were collected by on-duty clinicians on an HTML data collection form (prospective e-form), populated using either a personal digital assistant (PDA) or personal computer (PC). Data forms were uploaded to a central, offsite server using secure socket protocol transfer. Each form was assigned a unique identifier, and all PHI data were encrypted, but were password-accessible by authorized research personnel to complete a follow-up e-form. Results From April 15, 2003-April 15 2004, 1022 prospective e-forms and 605 follow-up e-forms were uploaded. Complexities of PDA use compelled clinicians to use PCs in the ED for data entry for most forms. No data were lost and server log query revealed no unauthorized entry. Prospectively obtained PHI data, encrypted upon server upload, were successfully decrypted using password-protected access to allow follow-up without difficulty in 605 cases. Non-PHI data from prospective and follow-up forms were available to the study investigators via standard file transfer protocol. Conclusions Data can be accurately collected from on-duty clinicians in the ED using real-time, PC-Internet data entry in compliance with the Privacy Rule. Deidentification-reidentification of PHI was successfully accomplished by a password-protected encryption-deencryption mechanism to permit follow-up by approved research personnel.
NON-INVASIVE DEVICE AND METHOD FOR THE DIAGNOSIS OF PULMONARY VASCULAR OCCLUSIONS
(2005-04-19) Kline, Jeffrey A.
The invention involves a device and method for ascertaining the functioning of the respiratory system and determining whether a pulmonary embolism is present. The device comprises an apparatus containing sensors which measure the amount of a particular gas expired from a patient's lungs, including a non-ambient gas which is previously provided to the patent. From this data, a processor computes the concentration of expired gas as a function of expired volume and displays the results on a screen. By comparing the results to predetermined values from afflicted and healthy patient populations, an accurate determination can be made regarding the presence of a pulmonary embolism.
Pretest probability assessment derived from attribute matching
(2005-08) Kline, Jeffrey A.; Johnson, Charles L; Pollack, Charles V Jr; Diercks, Deborah B; Hollander, Judd E; Newgard, Craig D; Garvey, J Lee
Background Pretest probability (PTP) assessment plays a central role in diagnosis. This report compares a novel attribute-matching method to generate a PTP for acute coronary syndrome (ACS). We compare the new method with a validated logistic regression equation (LRE). Methods Eight clinical variables (attributes) were chosen by classification and regression tree analysis of a prospectively collected reference database of 14,796 emergency department (ED) patients evaluated for possible ACS. For attribute matching, a computer program identifies patients within the database who have the exact profile defined by clinician input of the eight attributes. The novel method was compared with the LRE for ability to produce PTP estimation <2% in a validation set of 8,120 patients evaluated for possible ACS and did not have ST segment elevation on ECG. 1,061 patients were excluded prior to validation analysis because of ST-segment elevation (713), missing data (77) or being lost to follow-up (271). Results In the validation set, attribute matching produced 267 unique PTP estimates [median PTP value 6%, 1st–3rd quartile 1–10%] compared with the LRE, which produced 96 unique PTP estimates [median 24%, 1st–3rd quartile 10–30%]. The areas under the receiver operating characteristic curves were 0.74 (95% CI 0.65 to 0.82) for the attribute matching curve and 0.68 (95% CI 0.62 to 0.77) for LRE. The attribute matching system categorized 1,670 (24%, 95% CI = 23–25%) patients as having a PTP < 2.0%; 28 developed ACS (1.7% 95% CI = 1.1–2.4%). The LRE categorized 244 (4%, 95% CI = 3–4%) with PTP < 2.0%; four developed ACS (1.6%, 95% CI = 0.4–4.1%). Conclusion Attribute matching estimated a very low PTP for ACS in a significantly larger proportion of ED patients compared with a validated LRE.
USE OF FREE HEMOGLOBIN AND ITS SURROGATE MARKERS TO DETECT AND MONITOR PULMONARY HYPERTENSION
(2005-09-08) Kline, Jeffrey A.; Zagorski, John
A method for diagnosing and monitoring pulmonary hypertension using free hemoglobin, as well as surrogates for free hemoglobin, as markers for pulmonary hypertension. Bodily fluids, such as blood, serum, plasma, urine and/or breathe condensate may be collected and analyzed to determine the concentration of free hemoglobin or surrogates of free hemoglobin. The concentration indicates the presence or absence of pulmonary hypertension.
End expiratory oxygen concentrations to predict central venous oxygen saturation: an observational pilot study
(2006-09) Jones, Alan E; Kuehne, Karl; Steuerwald, Michael; Kline, Jeffrey A.
Background A non-invasive surrogate measurement for central venous oxygen saturation (ScVO2) would be useful in the ED for assessing therapeutic interventions in critically ill patients. We hypothesized that either linear or nonlinear mathematical manipulation of the partial pressure of oxygen in breath at end expiration (EtO2) would accurately predict ScVO2. Methods Prospective observational study of a convenience sample of hemodialysis patients age > 17 years with existing upper extremity central venous catheters were enrolled. Using a portable respiratory device, we collected both tidal breathing and end expiratory oxygen and carbon dioxide concentrations, volume and flow on each patient. Simultaneous ScVO2 measurements were obtained via blood samples collected from the hemodialysis catheter. Two models were used to predict ScVO2: 1) Best-fit multivariate linear regression equation incorporating all respiratory variables; 2) MathCAD to model the decay curve of EtO2 versus expiratory volume using the least squares method to estimate the pO2 that would occur at <20% of total lung capacity. Results From 21 patients, the correlation between EtO2 and measured ScVO2 yielded R2 = 0.11. The best fit multivariate equation included EtCO2 and EtO2 and when solved for ScVO2, the equation yielded a mean absolute difference from the measured ScVO2 of 8 ± 6% (range -18 to +17%). The predicted ScVO2 value was within 10% of the actual value for 57% of the patients. Modeling of the EtO2 curve did not accurately predict ScVO2 at any lung volume. Conclusion We found no significant correlation between EtO2 and ScVO2. A linear equation incorporating EtCO2 and EtO2 had at best modest predictive accuracy for ScVO2.
SYSTEM AND METHOD FOR DETERMINING THE DEGREE OF ABNORMALITY OF A PATIENT'S VITAL SIGNS
(2006-11-16) Kline, Jeffrey A.
A system and method for determining the degree of abnormality of a vital sign of a patient by obtaining the clinical profile of said patient and determining the statistical difference between the vital sign of the patient and the vital signs of previously evaluated patients having similar clinical profiles. The vital signs of previously evaluated patients having similar clinical profiles are determined based on matching the attributes of the patent's clinical profile to the clinical profiles of previously evaluated patients. The statistical difference, and the patent's clinical profile may be exported to an electronic medical record system or printed in hard copy for inclusion in the patient's medial file.
SYSTEM AND METHOD FOR DETERMINING AIRWAY OBSTRUCTION
(2007-05-31) Kline, Jeffrey A.
A method and system for detecting the presence of restriction to expired airflow in humans or animals by analyzing the expired capnogram and oxygram, as well as the geometric analysis of the real-time plot of the waveform that depicts the instantaneous ratio of CO2 to O2 (the carboxygram ratio). Airway obstructions causes an increase in the Q-angle between the slope of phase 11 and slope of phase III in the expired carboxygram. The diagnostic accuracy of the detection of airways obstruction is further enhanced by measuring the ratio of time spent in exhalation (Te) versus inhalation (Ti). The system uses the combination of an increased carboxygram Q-angle, and a prolonged Te/Ti to detect presence of airways obstruction.

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