About

Shahram Lotfipour is a Professor of Emergency Medicine at the University of California, Irvine, with additional appointments in the School of Medicine and the Department of Public Health in the Joe C. Wen School of Population & Public Health. He earned his M.D. from the University of Iowa College of Medicine in 1995 and completed a Master of Public Health at the University of California, Los Angeles, in 2006. His educational background also includes a B.S. in Chemistry from Drake University in 1991. His research interests focus on medical student education, screening and brief intervention for alcohol use, and older driver fitness. Throughout his career, he has contributed to emergency medicine through numerous publications, addressing topics such as trauma care, pedestrian injuries, alcohol-related crashes, and emergency medical education. His work has influenced clinical guidelines and public health policies, notably contributing to revisions in the American Heart Association guidelines regarding drug use in atrial fibrillation management.

Research topics

• Medicine
• Internal medicine
• Emergency medicine
• Medical emergency
• Psychiatry

Selected publications

• Case-control studies conducted in emergency departments: a methodological consideration

  Revista de Educaci�n e Investigaci�n en Emergencias · 2026-02-17

  articleOpen access
  PublisherOA PDFDOI

• Arm Pain

  Cambridge University Press eBooks · 2026-05-21

  book-chapter1st authorCorresponding
  PublisherDOI

• Feasibility of an Emergency Department-based Food Insecurity Screening and Referral Program

  Western Journal of Emergency Medicine · 2025-03-15

  articleOpen access

  INTRODUCTION: Food insecurity (FI) remains a pervasive issue in the United States, affecting over 12.8% of households. Marginalized populations, particularly those in urban areas, are disproportionately impacted. The emergency department (ED) holds potential as a vital outreach hub, given its diverse patient population and extensive service coverage. In this study we explore the feasibility of implementing an ED-based FI screening and referral program at an urban, academic teaching hospital. We aimed to assess the prevalence of FI among ED patients and evaluate the feasibility of a three- and six-week follow-up to assess patients' FI and related barriers to resource referral utilization. METHODS: This single-center, observational study was conducted at an urban, academic ED from 2018-2024. Initial FI screening was performed using a validated two-question survey adapted from the Hunger Vital Sign screening tool. Participants who screened positive were enrolled and completed the 10-item US Department of Agriculture Adult Food Security survey, received a food assistance guide, and were followed up at three- and six-week intervals to assess changes in FI status. RESULTS: Among 6,339 participants, 1,069 (16.9%) experienced FI, with the highest rates among Black non-Hispanic (24.7%) and Spanish-speaking participants (28.7%). Of the 1,069 participants who screened positive for FI, 630 (59.0%) were enrolled in the study. Of the enrolled participants, 161 (25.6%) completed the three-week follow-up phone calls, and 48 (7.6%) completed the six-week follow-up. The mean FI score for these 48 participants decreased from 6.67 (SD 2.68) at enrollment to 4.75 (SD 2.85) at the three-week follow-up (P < 0.001), and to 4.25 (SD 3.48) by the six-week follow-up (P < 0.001). Barriers to using the food resource guide, such as time constraints, transportation, and misplacement of resources, limited many participants' engagement. CONCLUSION: This study demonstrated the feasibility and effectiveness of an ED-based food insecurity screening and resource referral program, associated with a significant reduction in food insecurity scores among participants. However, barriers such as time constraints, transportation issues, and misplacement of referral materials limited engagement. Addressing these barriers through tailored follow-up and systematic support systems, including universal screening during ED intake and personalized assistance, can enhance the program's accessibility and impact.

  PublisherOA PDFDOI

• The Proposed 48-Month Emergency Medicine Residency Requirement Demands Immediate Scrutiny

  Western Journal of Emergency Medicine · 2025-06-24

  articleOpen access1st authorCorresponding

  The Accreditation Council for Graduate Medical Education's (ACGME) proposal to mandate 48-month training for all emergency medicine residency programs represents a significant departure from the current system where both 36- and 48-month formats successfully coexist.The ACGME's justification relies on a methodologically flawed survey that never directly asked program directors about optimal training duration. Instead, it calculated totals by summing individual rotation estimates without considering integrated curricula or practical constraints. Even if these results were to be accepted, directors of three-year programs reported a mean desired duration of only 41.6 months-hardly justifying a universal 48-month mandate.Current evidence contradicts the ACGME's rationale. Three-year graduates achieve higher board pass rates (93.1% vs 90.8%) and demonstrate equivalent clinical performance to four-year graduates. The mandate would impose substantial financial burdens on trainees-an opportunity cost exceeding $200,000-$250,000-while potentially deterring qualified applicants and discouraging fellowship training.We urge the ACGME to pause implementation and provide compelling evidence that a 48-month mandate is necessary and demonstrably superior to the current model.

  PublisherOA PDFDOI

• Comparative Effectiveness of Telesimulation Versus In-Person Training for Teaching Tourniquet Application for Life-Threatening Hemorrhage: A Prospective Randomized Controlled Study

  Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · 2025-09-29

  articleSenior author

  INTRODUCTION: Hemorrhage continues to be the leading cause of preventable death in trauma, and tourniquet application has been associated with survival. The purpose of our study was to evaluate the efficacy of telesimulation (TeleSIM) versus in-person training (SIM) for teaching tourniquet application for life-threatening hemorrhage control. METHODS: We performed a prospective randomized study of participants enrolled in a Stop The Bleed course at a university medical school. The TeleSIM group completed the course with an instructor streaming live from an off-site location. The SIM group completed the course in the standard fashion with a live instructor present. The primary endpoint was the successful application of a combat application tourniquet to a bleeding extremity in a simulation scenario. We also evaluated the time for successful tourniquet application according to training modality. Participants' thoughts, feelings, and attitudes pertaining to their experience in the course were obtained via a postcourse survey. RESULTS: Ninety-four of 97 (96.9%) eligible subjects participated in the study. There was no difference in the proportion of participants in each group who successfully applied a combat application tourniquet during their simulation scenario: TeleSIM group, 100% (95% CI, 92.5-100.0); SIM group, 100% (95% CI, 92.7-100.0). We also observed no significant difference in the mean time it took the participants to apply a tourniquet regardless of their training modality. Both groups reported their learning modality as an effective way to learn hemorrhage control. CONCLUSION: A telesimulation-based instructional delivery design is an effective way to teach tourniquet application for hemorrhage control.

  PublisherDOI

• Trends in Substance Use Disorder–Related Emergency Department Visits in California: An Analysis of 46 Million Visits From 2006 to 2011

  The Permanente Journal · 2024-07-19

  articleOpen access

  These findings advocate for tailored public health strategies, addressing the underlying disparities to combat the opioid epidemic effectively.

  PublisherOA PDFDOI

• Comparison of Emergency Department Disposition Times in Adult Level I and Level II Trauma Centers

  Western Journal of Emergency Medicine · 2024-10-22 · 4 citations

  articleOpen access

  Introduction: The efficient utilization of resources is a crucial aspect of healthcare, particularly in both Level I and Level II American College of Surgeons (ACS)-verified trauma centers. The effect of resource allocation on emergency department length of stay (ED-LOS) of trauma patients has remained under-investigated. As ED crowding has become more prevalent, especially at quaternary care centers, an evaluation of the potential disparities in ED-LOS between Level I and Level II trauma centers is warranted. We hypothesized a longer ED-LOS at Level I centers compared to Level II centers. Methods: We queried the 2017–2021 Trauma Quality Improvement Process (TQIP) database for trauma patients ≥18 years of age presenting to either a Level-I or -II center. The TQIP defines ED-LOS as the time from arrival until the time an ED disposition (admission or discharge) order is written. We excluded transferred patients and those with missing data regarding ACS trauma center verification level. We performed bivariate analyses, as well as subgroup analyses based on location of disposition. Results: Of 2,225,067 trauma patients, 59.3% (1,318,497) received treatment at Level I centers. No significant differences were found in Injury Severity Scores between patients admitted to the operating room or non-intensive care unit (ICU) locations, or discharged home from Level-I and -II centers (all P &amp;lt; 0.05). The ED-LOS for trauma patients was longer at Level-I centers for all patient categories: overall (198 vs 145 minutes [min], P &amp;lt; 0.001), discharged home (286 vs 160 min, P &amp;lt; 0.001), non-ICU admissions (234 vs 164 min, P &amp;lt; 0.001), and those requiring surgery (126 vs 101 min, P &amp;lt; 0.001). Conclusion: Even when treating patients with similar injury severity, trauma patients at Level I trauma centers had longer ED-LOS compared to Level II centers, irrespective of the patients’ final disposition (surgery, non-ICU admission, or discharge). To optimize resource utilization and alleviate ED saturation, further research must delve into the underlying causes of these discrepancies to identify best practices and solutions.

  PublisherOA PDFDOI

• Drowning Among Children 1–4 Years of Age in California, 2017–2021

  Western Journal of Emergency Medicine · 2024-09-09

  articleOpen accessSenior author

  Background and Objectives: Drowning, the leading cause of unintentional injury death among California children less than five years of age, averaged 49 annual fatalities for the years 2010-2021. The California Pool Safety Act aims to reduce fatalities by requiring safety measures around residential pools. This study was designed to analyze annual fatality rates and drowning incidents in California among children 1-4 years of age from 2017-2021. Methods: We identified fatalities, injury hospitalizations, and emergency department (ED) visits from California state vital statistics death data and state hospital and ED discharge data using the EpiCenter California Injury Data Online website. Results: = 0.88). Location-based analysis of the 234 fatal drowning incidents revealed that pools were the most common injury site, accounting for 65% of the cases. Conclusion: Drowning remains the leading cause of unintentional, injury-related death among California children 1-4 years of age, as the annual rate of fatality over the five-year study period did not decline. While the EpiCenter California Injury Data Online website is excellent for analyzing annual rates of drowning incidents among California residents over time, it is limited in providing insight into modifiable risk factors and event circumstances that can further inform prevention. The development of robust integrated fatal and non-fatal local, state, and national systematic data collection systems could aid in moving the needle in decreasing pool fatalities among young children.

  PublisherOA PDFDOI

• Impact of adherence to procalcitonin antibiotic prescribing guideline recommendations for low procalcitonin levels on antibiotic use

  BMC Infectious Diseases · 2023-01-19 · 2 citations

  articleOpen access

  BACKGROUND: The Procalcitonin Antibiotic Consensus Trial (ProACT) found provision of a procalcitonin antibiotic prescribing guideline to hospital-based clinicians did not reduce antibiotic use. Possible reasons include clinician reluctance to follow the guideline, with an observed 64.8% adherence rate. In this study we sought to determine the threshold adherence rate for reduction in antibiotic use, and to explore opportunities to increase adherence. METHODS: This study is a retrospective analysis of ProACT data. ProACT randomized 1656 patients presenting to 14 U.S. hospitals with suspected lower respiratory tract infection to usual care or provision of procalcitonin assay results and an antibiotic prescribing guideline to the treating clinicians. We simulated varying adherence to guideline recommendations for low procalcitonin levels and determined which threshold adherence rate could have resulted in rejection of the null hypothesis of no difference between groups at alpha = 0.05. We also performed sensitivity analyses within specific clinical settings and grouped patients initially prescribed antibiotics despite low procalcitonin into low, medium, and high risk of illness severity or bacterial infection. RESULTS: Our primary outcome was number of antibiotic-days by day 30 using an intention-to-treat approach and a null hypothesis of no difference in antibiotic use. We determined that an 84% adherence rate in the hospital setting (emergency department and inpatient) for low procalcitonin could have allowed rejection of the null hypothesis (3.7 vs 4.3 antibiotic-days, p = 0.048). The threshold adherence rate was 76% for continued guideline adherence after discharge. Even 100% adherence in the emergency department alone failed to reduce antibiotic-days. Of the 218 patients prescribed antibiotics in the emergency department despite low procalcitonin, 153 (70.2%) were categorized as low or medium risk. CONCLUSIONS: High adherence in the hospital setting to a procalcitonin antibiotic prescribing guideline is necessary to reduce antibiotic use in suspected lower respiratory tract infection. Continued guideline adherence after discharge and withholding of antibiotics in low and medium risk patients with low procalcitonin may offer impactful potential opportunities for antibiotic reduction. Trial registration Procalcitonin Antibiotic Consensus Trial (ProACT), ClinicalTrials.gov Identifier: NCT02130986. First posted May 6, 2014.

  PublisherOA PDFDOI

• A randomized study to compare oral potassium binders in the treatment of acute hyperkalemia

  BMC Nephrology · 2023 · 20 citations

  • Medicine
  • Internal medicine

  BACKGROUND: Binders in Emergency Room and hospitalized patients) clinical trial is the first head-to-head evaluation of oral potassium binders (cation-exchange resins) for acute hyperkalemia therapy. METHODS: Emergency room and hospitalized patients with a blood potassium level ≥ 5.5 mEq/L are randomized to one of four study groups: potassium binder drug (sodium polystyrene sulfonate, patiromer, or sodium zirconium cyclosilicate) or nonspecific laxative (polyethylene glycol). Exclusion criteria include recent bowel surgery, ileus, diabetic ketoacidosis, or anticipated dialysis treatment within 4 h of treatment drug. Primary endpoints include change in potassium level at 2 and 4 h after treatment drug. Length of hospital stay, next-morning potassium level, gastrointestinal side effects and palatability will also be analyzed. We are aiming for a final cohort of 80 patients with complete data endpoints (20 per group) for comparative statistics including multivariate adjustment for kidney function, diabetes mellitus, congestive heart failure, metabolic acidosis, renin-angiotensin-aldosterone system inhibitor prescription, and treatment with other agents to lower potassium (insulin, albuterol, loop diuretics). DISCUSSION: The findings from our study will inform decision-making guidelines on the role of oral potassium binders in the treatment of acute hyperkalemia. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04585542 . Registered 14 October 2020.

  PublisherOA PDFDOI

Frequent coauthors

• Bharath Chakravarthy

  Thai Red Cross Society

  140 shared

• Craig L. Anderson

  60 shared

• Wirachin Hoonpongsimanont

  Eisenhower Medical Center

  59 shared

• Faried Banimahd

  University of California, Irvine

  37 shared

• Omeed Ahadiat

  Southern California University for Professional Studies

  36 shared

• Manish Amin

  Kern Medical Center

  36 shared

• Mark I. Langdorf

  University of California, Irvine

  36 shared

• Tricia Loo

  University of California, San Francisco

  36 shared

Education

• B.S., Chemistry

  Drake University

  1991

• M.D., Medicine

  University of Iowa College of Medicine

  1995

• Other, Community Health Sciences

  University of California, Los Angeles

  2006