IntroductionThis study investigated factors that influence emergency medicine (EM) patients’ decisions to participate in clinical trials and whether the impact of these factors differs from those of other medical specialties.MethodsA survey was distributed in EM, family medicine (FM), infectious disease (ID), and obstetrics/gynecology (OB/GYN) outpatient waiting areas. Eligibility criteria included those who were 18 years of age or older, active patients on the day of the survey, and able to complete the survey without assistance. We used the Kruskal-Wallis test and ordinal logistic regression analyses to identify differences in participants’ responses.ResultsA total of 2,893 eligible subjects were approached, and we included 1,841 surveys in the final analysis. Statistically significant differences (p≤0.009) were found for eight of the ten motivating factors between EM and one or more of the other specialties. Regardless of a patient’s gender, race, and education, the relationship with their doctor was more motivating to patients seen in other specialties than to EM patients (FM [odds ratio {OR}:1.752, 95% confidence interval {CI}{1.285–2.389}], ID [OR:3.281, 95% CI{2.293–4.695}], and OB/GYN [OR:2.408, 95% CI{1.741–3.330}]). EM’s rankings of “how well the research was explained” and whether “the knowledge learned would benefit others” as their top two motivating factors were similar across other specialties. All nine barriers showed statistically significant differences (p≤0.008) between EM and one or more other specialties. Participants from all specialties indicated “risk of unknown side effects” as their strongest barrier. Regardless of the patients’ race, “time commitment” was considered to be more of a barrier to other specialties when compared to EM (FM [OR:1.613, 95% CI{1.218–2.136}], ID [OR:1.340, 95% CI{1.006–1.784}], or OB/GYN [OR:1.901, 95% CI{1.431–2.526}]). Among the six resources assessed that help patients decide whether to participate in a clinical trial, only one scored statistically significantly different for EM (p<0.001). EM patients ranked “having all material provided in my own language” as the most helpful resource.ConclusionThere are significant differences between EM patients and those of other specialties in the factors that influence their participation in clinical trials. Providing material in the patient’s own language, explaining the study well, and elucidating how their participation might benefit others in the future may help to improve enrollment in EM-based clinical trials.

Background: Near infrared spectroscopy is a noninvasive method for assessing regional tissue oxygenation (StO2), a parameter influenced by microvascular perfusion. Normal StO2 values recorded from the thenar eminance are 87% ± 6%. In critically ill patients, low StO2 levels (<70%) have been associated with a poor prognosis. We evaluated the prognostic significance of StO2 in patients undergoing therapeutic hypothermia (TH) after cardiac arrest (CA). Hypothesis: After resuscitation from CA, an initial StO2 ≥70%, or an initial StO2 <70% followed by an upward trend, is associated with a good neurologic outcome. Methods: We conducted a retrospective analysis of CA patients who underwent TH between August, 2005 and June, 2013. StO2 levels at the thenar eminence were collected at the onset and hourly during TH. Neurological outcome was assessed by the Cerebral Performance Category (CPC) at hospital discharge. Good outcome was defined as survival to hospital discharge with a CPC ≤2. Univariate and multivariate analyses were performed. Results: Among 160 patients, 18% (n=29) survived with a CPC ≤2. Survival with a CPC ≤2 was associated with witnessed CA (p=0.04; OR 11.6; 95% CI 1.1-118.0), shockable rhythm (p=0.02; OR 3.4; 95% CI 1.2-9.3), time to return of spontaneous circulation (ROSC) ≤15 minutes (p=0.02; OR 4.5; 95% CI 1.2-16.6) and age <65 (p=0.001; OR 7.6; 95% CI 2.3-25.5). However, an initial StO2 ≥70% was not associated with a CPC ≤2 (P=0.7; OR 0.82; 95% CI 0.29-2.2). For patients with an initial St02 <70%, there was no difference in outcome between those with an upward trend vs downward trend in St02 (p=0.98). Conclusions: Similar to previous trials documenting the value of TH witnessed CA, shockable rhythm, short time to ROSC, and younger age were associated with a good neurologic outcome. StO2 levels recorded from the thenar eminence were not associated with neurologic outcome. These StO2 levels are influenced by regional perfusion and tissue oxygenation but may not reflect cerebral microvascular perfusion. Identifying alternative technologies to assess cerebral microvascular perfusion may help determine patients for whom a good neurologic outcome can be predicted.