Dr. Jeffrey A. Kline

 Director of Research

Department of Emergency Medicine

    
                             Carolinas Medical Center                       

   Phone:

jkline@carolinas.org

General Information

Research Interests

Pulmonary embolism:

Since 1999, my work has focused on screening, risk stratifying, and treatment of pulmonary embolism. I have focused on PE because of its importance to society, and also because of the fascinating physiology that occurs with PE. I have investigated the role of using the alveolar deadspace (estimated using capnometry and arterial PaCO2) plus a whole-blood D-dimer to screen for PE. At Carolinas Medical Center (CMC), we use a combination of a decision rule that I derived and the deadspace/D-dimer in what we term the “PE rule out” procedure. We use this procedure approximately three times each day in the ED as part of real practice. To advance my ideas, together with my business partner, Mr. Michael Sinsheimer, I co-founded BreathQuant Medical Systems, a company dedicated to noninvasive diagnosis (see www.breathquant.com). Our company has patented and tested a breath-based device and signal processing algorithm that uses expired CO2 and O2 to estimate alveolar deadspace from PE (US patent issued). The proprietary name of this device is the CarboximeterTM (US trademark pending). We have acquired $6MM in private funding to build an FDA-approved carboximeter for the evaluation of dyspneic patients. Additionally, we developed and are marketing a novel method of assessing pretest probability of PE that uses a technique that I invented known as computer-assisted, database-derived attribute matching (US patent pending). I have an NIH R42 grant designed to advance this technology. In follow-up to my published work on the use of an ECG scoring system and pulse oximetry, I have a funded NIH RO1 grant designed to provide clinicians with simple clinical criteria to predict right ventricular strain on echocardiography and long-term cardiopulmonary disability after PE. To help discover mechanisms of persistent pulmonary hypertension after PE, we are examining the impact of nonmalignant thrombophilia on the prognosis of PE. In the laboratory, I have developed rat models of PE to allow us to measure the role of inflammation on vascular reactivity during and pulmonary vascular remodeling during pulmonary vascular occlusion. We hope to link the inflammatory response to the presence of persistent pulmonary hypertension in treated PE in rats and in humans. We are currently using 2-D electrophoresis to resolve plasma proteins in effort to discover a protein liberated in the alveolar epithelial fluid and in the blood under conditions of lung ischemia.

Education

  • Bachelor of Science, Major: Biochemistry, Minor: English

  • Virginia Polytechnic Institute and State University

  • Blacksburg, Virginia, 1982-1986 

  • Doctor of Medicine

  • Medical College of Virginia

  • Richmond, Virginia, 1986-1990

Selected Recent Publications

1. Custalow CB, , Thornton LR, Omalley P, Barbee RW, Grattan RM, Lopaschuk GD, Watts JA, Kline JA. Role of fatty acids in the recovery of heart function during resuscitation from hemorrhagic shock. Shock, 15:231-238, 2001.

2. Heffner AC, Kline JA. Role of the peripheral intravenous catheter in false-positive D-dimer testing.  Academic Emergency Medicine, 8: 103-106, 2001.

3. Courtney DM, Sasser H, Pinkus C, Kline JA.  Pulseless electrical activity with witnessed arrest as a predictor of sudden death from pulmonary embolism in outpatients. Resuscitation, 49:265-272, 2001.

4. Norris BL, Patton WC, Rudd JN, Schmitt CM, Kline JA. Pulmonary dysfunction in patients with femoral shaft fractures treated with intramedullary nailing. Journal of Bone and Joint Surgery, 83:1162-1168, 2001.

5. Sullivan DM, Watts JA, Kline JA. Biventricular dysfunction after acute pulmonary embolism in the rat. Journal of Applied Physiology 90:1648-1656, 2001.

6. Kline JA, Israel EG, Michelson EA, O’Neil BJ, Plewa MC, Portelli DC. Diagnostic accuracy of a bedside D-dimer and alveolar deadspace measurement for rapid exclusion of pulmonary embolism (a multicenter study), JAMA 285:761-798 [See correspondence, below. Paper featured in The Charlotte Observer local section March 14,2001]

7. Daniel KR, Courtney DM, Kline JA. Assessment of cardiac stress from massive pulmonary embolism with 12-lead electrocardiography. Chest. 120:474-481, 2001.

8. Watts JA, Grattan RM, Whitlow BS, Kline JA. Activation of Poly (ADP-ribose) in severe hemorrhagic shock and resuscitation. American Journal of Physiology – Gastrointestinal & Liver Physiology. 281(2):G498-506, 2001.

9. DeBehnke D, Kline JA, Shih R. Research Fundamentals: Choosing and appropriate journal, manuscript preparation, and interaction with editors. Academic Emergency Medicine 8:844-850, 2001.

10. Courtney DM, Kline JA. Identification of pre-arrest clinical characteristics of fatal Pulmonary Embolism. Academic Emergency Medicine.8:1136-1142, 2001.

11. Kline JA, Nelson  RD,  Jackson RE, Courtney DM. Criteria for the safe use of D-dimer testing in emergency department patients with suspected pulmonary embolism: A multicenter United States study. Annals of Emergency Medicine. 37:144-152, 2002.

12. Moore CL, Rose  GA, Arrowood JA. Sullivan DM, Tayal VS, Kline JA. Determination of left ventricular function in hypotensive emergency department patients by emergency physician echocardiography. Academic Emergency Medicine. 9:186-193, 2002.

13. Courtney DM, Watts JA, Kline JA. End Tidal CO2 is reduced during hypotension and cardiac arrest in a rat model of massive pulmonary embolism. Resuscitation. 53:83-91,2002

14. Custalow CB, Kline JA, Marx JA, Baylor MR. Emergency department resuscitative procedures: animal laboratory training improves procedural competency and speed Academic Emergency Medicine 9:575-596, 2002.

15. Fesmire FM, Kline JA, Wolf SJ. Clinical Policy: Critical issues in the evaluation and management of adult patients presenting with suspected pulmonary embolism. Annals of

Emergency Medicine, 41 (2):257-269, 2002.

16. Roshon MR, Kline JA, Thornton LR, Watts JA. Cardiac UCP2 Expression and myocardial oxidative metabolism during acute septic shock in the rat. Shock, 19(6):570-576, 2003

17. Richman PB, Wood J, Kasper DM, Collins JM, Petri RW, Field AG, Cowles DN, Kline JA. Contribution of indirect computed tomography venography to computed tomography angiography of the chest for the diagnosis of thromboembolic disease in two  U.S. emergency departments.  Journal of Thrombosis and Haemostasis, 1(4):652-657, 2003

18. Jones A, Watts JA, Younger JG, Kline JA,.  Inhibition of Prostaglandin Synthesis During Experimental Massive Pulmonary Embolism in the Rat. American Journal of Physiology 284: L1072-L1081, 2003

19. Kline JA, Wells PS. Methodology for a Rapid Protocol to Rule-Out Pulmonary Embolism in the Emergency Department. Annals of Emergency Medicine, 42(2):266-275, 2003.

20. Watts JA, Kline JA. From Bench to Bedside: the role of mitochondrial medicine in the pathogenesis and treatment of cellular injury. Academic Emergency Medicine 10(9): 985-997, 2003.

21. Wilson JS, Rushing GR, Johnson BL, Kline JA, Back MR, Bandyk DF.

Dichloroacetate Increases Skeletal Muscle Pyruvate Dehydrogenase Activity During Acute Limb Ischemia.  Journal of Vascular and Endovascular Surgery 37(3):T1-5, 2003

22. Wilson, JS, Rushing, G, Johnson, BL, Kline JA, Parker, JL, Bowser, AN, Bandyk, DF. The Effects of Dichloroacetate in a Rabbit Model of Acute Hind Limb Ischemia and

Reperfusion.  Journal of American College of Surgeons,  197(4)591-5, 2003

23. Kline JA, Cowles DN, Courtney DM, Newgard CE, Jackson RE. Use of Pulse Oximetry to Predict Short-term Mortality in Hemodynamically Stable Patients with Pulmonary Embolism in the Emergency Department. American Journal of Medicine, 115(3):203-208, 2003

24. Jones AE, Tayal VS, Kline JA.  Focused Training of Emergency Medicine Residents in Goal-Directed Echocardiography: A Prospective Study.  Academic Emergency Medicine, 10(10):1054-1058, 2003

25.  Jones AE, Kline JA.  Availability of technology to evaluate for pulmonary Embolism in Academic Emergency Departments in the United States.  Journal  of Thrombosis Haemostasis, 1(10)2240-2, 2003

26. Brown MD, Kline JA, Nelson RD, Lau J. Turbidimetric D-dimer in the diagnosis of pulmonary embolism: A Meta-Analysis. Clinical Chemistry, 49:1846-1853, 2003

27. Zagorski J, Debelak J, Gellar M, Watts JA, Kline JA.  Chemokines Accumulate in the Lungs of Rats with Severe Pulmonary Embolism Induced By Polystyrene Microspheres. Journal of Immunology  (Inflammation) 171(10):5529-36, 2003

28.  Jones AE, Stiell IA, Spaite DW, Nesbit L, Hasan N, Watts B, Kline JA. Non-traumatic pre-hospital hypotension predicts in hospital mortality. Annals of Emergency Medicine, 43:106-113, 2004

29. Watts JA, Kline JA, Thornton LR, Grattan RM, Brar SS. Metabolic dysfunction and depletion of mitochondria in hearts of septic rats. Journal of Molecular Cellular Cardiology 36:141-150, 2004.

30. Richman PB, Courtney DM, Friese J, Matthews J, Field A, Petri R, Kline JA.  Prevalence and significance of non-thromboembolic findings on chest computerized tomography angiography performed to rule-out pulmonary embolism-A multi-center study of 1025 emergency department patients. Academic Emergency Medicine, 11: 642-647, 2004

31. Jones AE, Tayal VS, Sullivan DM, Kline JA. Randomized controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Critical Care Medicine, 32:1703-1708, 2004.

32. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J. Thrombosis Haemostasis, 2:1247-1255, 2004. [see commentary]

33. Kline JA, Johnson CL, Webb WB, Runyon MS. Prospective study of clinician-entered research data in the Emergency Department using an Internet-based system after the HIPAA Privacy Rule BMC Medical Informatics and Decision Making 2004, 4:17

34. Kline JA, Webb WB, Jones AE, Hernandez J. Impact of a rapid rule-out protocol for pulmonary embolism on the rate of screening, missed cases, and pulmonary vascular imaging in an urban U.S. emergency department. Annals of Emergency Medicine, 44:490-503, 2004.

35. Jones AE, Fitch M, Kline JA. Severity of emergency department hypotension predicts adverse hospital outcome. Shock 22(5):410-4, 2004

36. Brown MD, Vance SJ, Kline JA. An emergency department guideline for the diagnosis of pulmonary embolism: An outcome study. Academic Emergency Medicine, 12:20-25, 2005.

37. Engoren M, Plewa MC, O’Hara D, Kline JA Evaluation of capnography using a genetic algorithm to predict arterial partial pressure of carbon dioxide. Chest 127: 579-584, 2005.

38. Kline JA, Novobilski AJ, Kabrhel C, Richman PB, Courtney DM, Derivation and validation of a Bayesian network for the diagnosis of pulmonary embolism. Ann Emerg Med 45:282-290, 2005.

39. Courtney DM, Kline JA. Prospective use of a prediction rule to identify pulmonary embolism as likely cause of outpatient cardiac arrest. Resuscitation 65(1):57-64, 2005.

| Biology Faculty | Biology Home | UNCC Home |