Faculty Profile: Aris Garro, MD, MPH

Aris Garro
Aris Garro, MD, MPH
Assistant Professor of Emergency Medicine and Pediatrics
Emergency Medicine, Division of Pediatrics
Dr. Garro's is a clinical researcher in the Hasbro Children's Hospital emergency department. He investigates preventive interventions after an ED visit for children with asthma to improve disease management. He has also studied decision-making to identify children with undifferentiated aseptic meningitis vs. children with Lyme meningitis. In addition, Dr. Garro is the site investigator at Hasbro Children's Hospital for the PECARN Fluid Therapy in DKA study, and is performing ancillary work on biomarkers of cerebral injury in DKA.

Biography

Dr. Garro is a researcher affiliated with the Warren Alpert Medical School of Brown University and Rhode Island Hospital. His clinical affiliation is as an attending in the Hasbro Children's Hospital Emergency Department. His research expertise includes interventions to improve disease management in children presenting to the emergency department with asthma, biomarkers of cerebral injury, and clinical management of Lyme meningitis.

Research Description

Dr. Garro's research focuses on preventive interventions after an ED visit for children with asthma to improve disease management, and Lyme meningitis. He is currently funded on several research grants, notably as the principal investigator on an American Lung Association / Chest Foundation grant, and as a co-investigator on CMS, AHRQ, and CDC sponsored grants. Dr. Garro is also a member of the Children's Asthma Research Program (CARP), a multi-disciplinary group of researchers at Brown.

Current studies include an ALA funded project, "Optimizing Use of Inhaled Corticosteroids after Emergency Department Visits for Children with Uncontrolled Asthma". In addition Dr. Garro is collaborating on the "Adaptation of the Pediatric Asthma Control and Communication Instrument (PACCI) in the Emergency Department". This project is a collaboration with pulmonologists at Johns Hopkins University, who originally developed the PACCI, which enables clinicians to quickly identify children who have poor asthma control.

Dr. Garro has also published two studies on Lyme meningitis, focusing on decision-making to identify children with undifferentiated aseptic meningitis vs. children with Lyme meningitis. "Prospective Validation of a Clinical Prediction Model for Lyme Meningitis in Children" validated the clinical prediction rule derived by Avery, et al., and also resulted in the rule of 7's (< 7 days of headache, < 70% mononuclear cells, and no cranial nerve 7 palsy) to identify chidren at low risk of Lyme meningitis. A second manuscript, "Prevalence of Lyme meningitis in children with aseptic meningitis in a Lyme disease-endemic region" established that at least 13% of children in Lyme-endemic regions presenting with undifferentiated aseptic meningitis in the summer and fall actually have Lyme meningitis.

Recently Dr. Garro has collaborated with neuroscientists at Brown University to evaluate the use of serum biomarkers to identify children with incomplete recovery after concussions. This preliminary work has also lead to an interest in the use of serum biomarkers for other diseases with CNS involvement, including Lyme meningitis and DKA.

Grants and Awards

1998 – 2001 Microbes and Defense Society, Vanderbilt's honor society for excellence in immunology, microbiology and virology

2004 Pediatric Resident Teaching Award, Cincinnati Children's Hospital Medical Center, June 2004

2011 Dean's Excellence in Teaching Award, The Warren Alpert Medical School of Brown University, June 2011

Affiliations

2006 – Present Rhode Island Public Health Association

2007 – Present American College of Emergency Physicians, Section of Pediatrics

2008 – Present Society for Academic Emergency Medicine, Section of Pediatrics

2008 – Present Academic Pediatric Association

2008 – Present Rhode Island Medical Society

2010 – Present Project HARP (Home Asthma Response Plan) steering committee member. This collaboraton between the Centers for Disease Control, Rhode Island Department of Health, and Hasbro Children's Hospital uses home-based interventions to improve disease management after children visit the emergency department for an asthma exacerbation.

2011 - The Pediatric Emergency Care Applied Research Network site investigator for the Fluid Therapy and Cerebral Injury in Pediatric Diabetic Ketoacidosis.

Funded Research

1. Diagnosing Asthma in Young Children: Parents' Perceptions of Barriers. University Emergency Medicine Foundation Junior Faculty Research Development Grant (PI Garro), $31,478 FY 2009, role: Principal Investigator

Grant description: The goal of this study was to identify the expectations that caregivers have during the diagnostic process, and provide guidance to clinicians on how to incorporate these expectations in caregiver education. We addressed these research goals using thematic analysis of caregiver focus groups that occurred within one year of a child's asthma diagnosis.

2. Rhode Island Department of Health Asthma Control Program: Addressing Asthma from a Public Health Perspective, Rhode Island Department of Health CAP Contract: Emergency Department Diversion Project (PI: Klein / McQuaid) 2011 to present, $70,000 FY 2011, role: Sub-contracted Investigator

Grant description: The CDC is funding the health department in Rhode Island to conduct asthma surveillance, maintain and expand partnerships, implement statewide comprehensive asthma plans, implement interventions to reduce the burden of asthma, and develop and implement an evaluation plan.

3. Improving Pediatric Resuscitation: A Simulation Program for the Community ED. Agency for Health Research and Quality R18 (PI Brown), 2011 to present, $243,101 (all years), role: Consultant on Qualitative Methods

Grant description: This study proposes to utilize high-fidelity in situ medical simulation to assess Rhode Island's community emergency departments' ability to perform pediatric resuscitations. The study also aims to develop a simulation-enhanced educational intervention to assist Rhode Island's community emergency departments and staff members in improving their skills and optimizing the systems required to effectively perform pediatric resuscitations

4. Optimizing Use of Inhaled Corticosteroids after Emergency Department Visits for Children with Uncontrolled Asthma. American Lung Association / Chest Foundation Grants Program (PI Garro) 2012-2014, $76,980 (all years), role: Principal Investigator
Grant description: The objectives of the project are to develop a systematized method to prescribe inhaled corticosteroids to children with uncontrolled asthma after an emergency department visit, and to identify factors associated with medication adherence to develop an educational component to accompany prescriptions.

5. New England Asthma Innovations Collaborative. Center for Medicaid & Medicare Services / Health Resources in Action, Health Care Initiative Challenge Award (PI: Chacker), 2012 to 2015, $4,040,657 (all years), role Sub-contracted Investigator
Grant description: This program is a multi-state, multi-sector partnership that includes health care providers, payers, and policy makers aimed at creating an innovative Asthma Marketplace in New England that will increase the supply and demand for high-quality, cost-effective health care services. Over the three year funding period, services will be delivered to over 1400 children ages 2-17 with persistent asthma to lower costs of asthma care by delivering cost-effective prevention oriented care in clinics and at home to reduce preventable pediatric-related emergency visits and hospital admissions with estimated savings of over $4 million.

6. Fluid Therapy and Cerebral Injury in Pediatric Diabetic Ketoacidosis. NICHD U01HD062417 (PIs: Kupperman/Glaser), 2011 to 2016, $600,784 FY 2012, Role: Clinical Center Investigator
Grant description: This is a multi-center factorial-design randomized controlled trial comparing four fluid treatment protocols for pediatric DKA to determine the optimal fluid therapy for reducing the incidence of cerebral injury in pediatric diabetic ketoacidosis.

7. Vital Signs: A Quality Improvement Project to Improve Patient Outcomes and Reduce Return Visits in the Pediatric ED. Lifespan Risk Management Grant (PI: Jacobs), 2012, $17,893 FY 2012, role: Co-investigator.
Grant description: The objectives of this 12 month project are to gather data regarding baseline documentation of and response to vital signs in the pediatric emergency department, to describe behaviors of clinicians regarding potential barriers to documentation and follow-up of abnormal vital signs, to identify strategies for educational and system-based interventions to improve documentation and recognition of and response to abnormal vital signs, and to institute interventions, through PDSA cycles, to achieve improved documentation of vital signs in the Pediatric ED.

Teaching Experience

Dr. Garro is the co-director of the Epidemiology Course at the Warren Alpert School of Medicine of Brown University that is part of the second year medical student curriculum. Clinical teaching occurs in the Hasbro Children's Hospital Emergency Department, where he is an instructor for the Doctoring course (1st and 2nd year med students). He also teaches emergency medicine, pediatric, and family practice residents as well as medical students during his clinical shifts.

Courses Taught

  • Epidemiology (Biol 3662 and 3664)

Selected Publications

  • McQuaid, EL, Garro, AC, Seifer, R., Hammond, SK, & Borrelli, B. Integrating asthma education and smoking cessation for parents: Estimating financial return on investment. Pediatr Pulmonol 2012;47(10):950-5. (2012)
  • Canino G, Garro AC, Alvarez MM, Colón-Semidey A, Esteban C, Fritz G, Koinis-Mitchell D, Kopel SJ, Ortega AN, Seifer R, McQuaid EL. Factors Associated with Disparities in ED Use among Latino Children with Asthma. Annals of Allergy, Asthma & Immunology 2012;108(4):266-70. (2012)
  • Garro AC, Jandasek B, Fleming J, Turcotte-Benedict F, Rosen R, McQuaid E. Caregiver satisfaction with the asthma diagnostic process in young children: thematic analysis of caregiver focus groups. J of Asthma 2012;49(7):703-11. (2012)
  • Pearlman DN, Jackson TL, Gjelsvik A, Viner-Brown S, GarroA. The impact of the 2007–2009 US recession on the health of children with asthma: evidence from the National Child Asthma Call-Back Survey. Medicine and Health RI 2012; 95(12): 394-6. (2012)
  • Garro AC, Rutman M, Simonsen K, Jaeger J, Chapin K, Lockhart G. Prevalence of Lyme meningitis in children with aseptic meningitis in a Lyme disease-endemic region. Pediatr Infect Dis J November 2011, in press. (2011)
  • Garro AC, Asnis L, Merchant R, McQuaid E. Frequency of Prescription of Inhaled Corticosteroids to Children with Asthma from US Emergency Departments. Acad Emerg Med 2011,18 (7): 767–770. (2011)
  • Garro AC, Fearon D, Koinis-Mitchell D, McQuaid EL. Does Pre-hospital Telephone Communication with a Clinician result in more appropriate Medication Administration by Parents during Childhood Asthma Exacerbations?; Journal of Asthma 2009; 46(9): 916-20. (2009)
  • Garro AC, Rutman M, Simonsen K, Jaeger J, Lockhart G. Prospective Validation of a Clinical Prediction Model for Lyme Meningitis in Children; Pediatrics 2009; 123: e829-34. (2009)
  • Garro AC, Klein RB. Asthma Management: The Interplay between Pulmonary Function and Quality of Life; Disease Management and Health Outcomes 2008; 16: 297-303. (2008)
  • Bond GR, Garro AC, Gilbert DL. Dyskinesias Associated with Atomoxetine in Combination with other Psychoactive Drugs. Clinical Toxicology. 2007; 45(2): 182-5. (2007)
  • Garro AC, Chun T. Trauma Emergencies, Book Chapter in Practical Guide to the Care of the Pediatric Patient. Alario A - author, Elsevier - 2007 (2007)
  • Garro AC, Linakis J. Umbilical Vessel Catheterization Book Chapter in Textbook of Pediatric Emergency Procedures, King & Henritig - editors, Lippincott Williams & Wilkins - 2007 (2007)