multiple trauma

This study investigates the clinical predictors of chest CT scan findings in patients with chest trauma presenting to the emergency department of Khatam-Al-Anbia Hospital in Zahedan in 2023.

A cross-sectional study was conducted on 460 patients with multiple traumas. Data were collected from CT scan reports and analyzed using SPSS 22 software, employing independent t-tests, correlation coefficients,and chi-square tests.

The mean age of the patients was 40.2 ± 20.36 years (range: 16–97). Gender distribution included 28.7% women and 71.3% men. Significant differences in CT scan findings were observed based on gender (P = 0.032), trauma mechanism (P = 0.029), and clinical complaint type (P = 0.017). Patients under 20 years old exhibited more normal findings, whereas those over 40 had a higher prevalence of rib and thoracic vertebra fractures. Traffic accidents and collisions frequently resulted in rib and thoracic vertebra fractures, while altercations were more commonly associated with pneumothorax. Clinical complaints of chest pain and deformity were frequently linked to pneumothorax and rib fractures.

These findings underscore the importance of age, trauma mechanism, and clinical complaints in diagnosing chest trauma, facilitating more informed decision-making and diagnosis.

This study aimed to identify strategies for enhancing the quality of home care for trauma patients. Using a conventional qualitative content analysis approach, this study was conducted from September 2023 to September 2024 in Hamadan, located in northwest Iran. A total of 18 participants, including home care managers, nurses, trauma patients, and the family members of trauma patients, were selected through purposive sampling. Data were collected using semi-structured interviews and analyzed using Graneheim and Lundman’s method with the assistance of MAXQDA software (version 20). Analysis of the data yielded 430 initial codes, which were categorized into 36 subcategories and 6 main categories: patient-centered care, safe care provision, spiritual care, effective educational program development, service effectiveness enhancement, and dynamic service delivery. The study results showed that nurses employed various strategies to improve the quality of home care services for trauma patients. Key strategies included adhering to the principle of patient-centered care, providing safe care for trauma patients, providing spiritual care, developing effective educational programs, enhancing service effectiveness, and ensuring dynamism in service delivery. Implementing these strategies could guide policymakers and home care nurses to improve care quality for trauma patients and increase satisfaction. The findings of the present study can enhance the planning and implementation of home care services, facilitating the transition from hospital to home for trauma patients.

Multiple trauma can cause an increase in creatine phosphokinase (CPK) and subsequently rhabdomyolysis and acute kidney injury (AKI). This study was designed to evaluate the effect of vitamin D3 on the serum CPK level and the incidence of rhabdomyolysis-induced AKI in patients with multiple trauma. Patients with serum CPK levels <1000 IU/L were followed as the control 1 group. Subjects with serum CPK levels ≥1000 IU/L were randomly allocated to the control 2 or intervention group at Imam Hossein Medical Center, Tehran, Iran in 2020. Patients in the intervention group received a single dose of vitamin D3 (300,000 units) on the recruitment day. The serum level of CPK was recorded every 3 days for 14 days. Parametric and non-parametric tests were used to compare the CPK values between groups. Forty-six patients, consisting of 16, 15, and 15 in control 1, control 2, and intervention arms of the study were recruited, respectively. Unlike control groups, the significant steadily decreasing trend was seen only in the intervention group (P<0.001). This significant decrease in the intervention arm was observed on days 5 to 7 (P=0.001) and on days 8 to 10 (P<0.001) compared to the baseline.Patients in the intervention group had a lower number of AKI or need for dialysis (P=0.869 and P=0.670 for AKI and dialysis, respectively) than control group 2, although the differences were not significant.  The current study revealed that vitamin D3, could prevent the increasing trend of CPK during the first days and accelerate the normalization of CPK in patients with elevated CPK due to multiple trauma.Trial registration number: IRCT20120703010178N23.

Tension pneumothorax (TPT) in trauma patients is an uncommon disorder caused by the progressive accumulation of air in the pleural cavity. In pre-hospital and emergencies, if it is not diagnosed and treated on time, it endangers the lives of patients. In this study, we report a patient who developed tension pneumothorax and extensive subcutaneous emphysema due to mild trauma and not going to the hospital in the early hours, which caused an anaphylactic appearance on the patient's face.

Transfusion of packed red blood cells (PRBCs) following severe bleeding from multiple trauma can reduce mortality. The present study aimed to compare the accuracy of eight different scoring systems for predicting the need for blood transfusion in such patients. The present diagnostic accuracy study was conducted at the emergency department of Shohadaye Tajrish Hospital in Tehran, From March to September 2023. Medical records of multiple trauma patients admitted to the emergency department were reviewed. The predictive performances of eight scoring systems including Glasgow coma scale (GCS), revised trauma score (RTS), trauma associated severe hemorrhage (TASH), Prince of Wales hospital score (PWH), emergency transfusion score (ETS), base deficit, assessment of blood consumption (ABC), and the Shock index in predicting the need for PRBC transfusion were assessed. The area under the ROC curve of TASH in predicting PRBC transfusion was calculated 0.959, significantly higher than the area under the ROC curves for PWH, GCS, Shock index, Base deficit, ETS, RTS, and ABC (0.902, 0.899, 0.882, 0.857, 0.846, 0.824, and 0.810 respectively; p < 0.001). Sensitivity and specificity of TASH at the optimal cut-off were 98.72% and 51.56% respectively. A new score, the MTTP (Multiple Trauma Transfusion Predictor), developed by evaluating the association of clinical and laboratory variables with PRBC transfusion in the ED, showed an AUC of 0.964, not significantly higher than the AUC of TASH (p=0.804). The sensitivity and specificity of MTTP at the optimal cut-off were 93.59% and 91.84%, respectively. Among the evaluated scores, TASH was the most accurate for predicting PRBC transfusion in multiple trauma patients in the ED. Furthermore, among the pre-hospital scores, the Shock index was identified as the most accurate predictor for PRBC transfusion. This score is recommended for use in the ED due to its simplicity, rapid calculation and high prediction accuracy. The MTTP, the newly developed scoring system in this study, outperformed all the other scores.

During the past few decades, many scoring systems have been developed to evaluate the severity of injury and predict the outcome in trauma patients. This study aimed to assess the capacity of three common trauma scoring systems: injury severity score (ISS), Glasgow coma scale (GCS), and revised trauma score (RTS) in predicting in-hospital mortality and ICU admission in patients with traumatic injury. 

This is a multicenter study of the hospital-based national trauma registry of Iran (NTRI), an ongoing registry-based trauma database. This study included trauma cases from 12 major trauma centers throughout the country admitted between July 2016 and November 2023. The inclusion criteria were all patients admitted to the emergency department due to trauma, hospitalized for at least 24 hours, deceased within the first 24 hours of admission, and patients transferred from the intensive care unit  (ICU)s of other hospitals. 

A total of 50,458 traumatic patients, with 38,740 (76.9%) being male, were included in this study. After adjustment for confounders, head, face, and neck injuries were associated with the highest odds of death (OR: 7.51, P-value<0.001), whereas abdominal injuries were associated with the highest odds of ICU admission (OR: 4.58, P-value<0.001). Each Unit increase in RTS score was accompanied by a 61% decrease in odds of death (OR: 0.39, P-value<0.001). The area under the ROC curve for predicting in-hospital mortality was 0.81 (0.79 to 0.82) in ISS, 0.78 (0.77 to 0.80) in GCS, and 0.75 (0.73 to 0.76) in RTS. There was a significant difference between RTS and GCS, as well as RTS and ISS for in-hospital mortality prediction (P-values< 0.001). The area under the ROC curve for the prediction of ICU admission was 0.75 (0.74 to 0.75) in ISS, 0.63 (0.62 to 0.63) in GCS, and 0.62 (0.61 to 0.63) in RTS. There was a statistically significant difference between ISS and GCS, as well as ISS and RTS, for ICU admission prediction (P-value<0.001). 

ISS is the best predictor of in-hospital mortality and ICU admission, compared to GCS and RTS.

Electrolyte imbalance is one of the influential causes in determining the outcome of traumatic patients. One of the electrolytes that get less attention from healthcare providers is magnesium. Therefore, this study investigated the frequency of hypomagnesemia in trauma patients hospitalized in the intensive care unit.

The descriptive-cross-sectional study was conducted after approval at Zahedan University of Medical Sciences on 118 patients with multiple traumas from 2021 to 2022. Patients were selected by convenience sampling method according to the inclusion criteria. Age, sex, weight, body mass index, level of consciousness, and level of blood serum electrolytes were measured and recorded on the first and fifth days after hospitalization. The data were analyzed and compared using descriptive statistics, chi-square, and independent t-test.

Of 118 patients studied, 81 (68.6%) were male, and 38 (31.4%) were female. On the fifth day after hospitalization, the mean serum magnesium level of the patients was 1.4 ± 0.81 mg/dL. 87 patients (73.7%) had normal magnesium serum levels, 27 patients (29.9%) had hypomagnesemia, and 4 patients (3.4%) had severe hypomagnesemia. No statistically significant relationship existed between hypomagnesemia and gender, age group, and comorbidity diseases. The level of other blood serum electrolytes on the fifth day after hospitalization, age, weight, body mass index, and status of consciousness was not statistically significant between the two groups of patients with hypomagnesemia and without hypomagnesemia.

Trauma and the subsequent treatment measures lead to decreased magnesium serum levels in intensive care patients. Therefore, the normal serum level of other electrolytes should not be considered a diagnostic indicator for the normality of magnesium serum level. Magnesium should be measured along with other electrolytes to make a timely decision to replace magnesium supplements in a patient with hypomagnesemia.

Trauma is a leading cause of morbidity and mortality worldwide. The frequency of trauma-related deaths depends on various factors such as the severity and mechanism of the trauma. This study aimed to determine the frequency, causes, and outcomes of trauma in patients referred to the emergency department of Ali Ibn Abitaleb Hospital, Rafsanjan, Iran, in 2021. A case-series study was conducted, examining the medical files of 4689 trauma patients referred to the emergency department of Ali Ibn Abitaleb Hospital in 2021. Data on age, gender, marital status, place of residence, mode of transportation to the hospital, reasons for admission (extremity trauma, head and neck trauma, thorax trauma, abdominal trauma, spine trauma, multiple trauma), type of trauma (blunt or penetrating), and mechanisms of trauma (traffic accidents, falls, fights, burns, electrocutions, work-related accidents) were recorded. The mortality rate and factors influencing it were also evaluated. Among 4,689 trauma patients, the most common reasons for admission were organ trauma (46.4%), multiple trauma (23.5%), and cervical spine trauma (21.7%). The most common mechanisms of trauma were traffic accidents (68.3%) and fights (17.2%). Most patients (3506, 74.8%) had penetrating trauma. A total of 68 patients (1.5%) died from trauma. Significant factors related to mortality included old age (p<0.001), male gender (p=0.028), transportation by ambulance (p<0.001), initial admission to the trauma emergency department (p<0.001), hospitalization in the emergency or orthopedics department (p<0.001), and cause of trauma (extremity trauma, head and neck trauma, multiple trauma) (p=0.002). The findings of the present study showed that 1.5% of all deaths was due to trauma. Significant factors related to mortality included old age, male gender, transportation by ambulance, admission and hospitalization in the emergency department, and the cause of trauma. Although traffic accidents and fights were the most common mechanisms of trauma and car accidents caused the highest mortality rate, these findings were not significantly correlated with death.

This study aimed to evaluate the relationship between clavicular fracture and associated injuries in multi-traumatic patients. In this prospective cohort study, 185 multi-traumatic patients referred to the Emergency Department of Imam Reza (AS) Hospital of Tabriz University of Medical Sciences were selected between August 2019 and September 2021. The census sampling method was used until the required sample size was achieved. The following patient information was recorded and studied: mechanism of trauma, age, gender, Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), the presence of clavicular fracture, concomitant injuries, hospital outcome, duration ofhospitalization, and severity of trauma. The participants were divided into two groups based on the presence of a clavicular fracture. Data were analyzed using SPSS software. Of all 185 patients, 51 had clavicular fractures. The mean age of the patients was 34.72±12.99. Of all patients, 27.6% had clavicular fractures. There was no statistically significant difference in GCS scores between the two groups (P=0.927). The highest percentage of injuries associated with clavicular traumas was traumatic brain injuries, with rates of 22.4% and 19.6% in the study and control groups, respectively. There were statistically significant differences inconcomitant injuries between the two groups (P

It is of prime importance to manage trauma patients in the early hours and use easy trauma severity scoring systems to make decisions and evaluate patient prognosis.

The present study aimed to design a predictive model of the mortality of multi-trauma patients due to traffic accidents.

This cross-sectional analytical study was performed on 600 patients who suffered from multi-trauma caused by traffic accidents from December 2019 to September 2021. Collected data included age, sex, vital signs, trauma mechanism, involved vehicle in the accident, accident location, and hospital outcome.

In this study, 600 multi-trauma cases caused by traffic accidents were evaluated. Among the significant variables included in the regression model, age, Mean Arterial Pressure (MAP), Glasgow Coma Scale (GCS), AVPU (Alert, Verbal response, Pain response, Unresponsive), and vehicle versus fixed objects (in Vehicle 2) in the presence of other variables in the model, significantly predictedpatient outcomes. Therefore, with the other variables being constant, one unit increase in the age variable increases the probability of death by 1.04 times, one unit increase in the score of the two variables of MAP and GCS, and also the transfer of trauma mechanism from the fixed object to the vehicle reduces death by 0.92, 0.62, and 0.10 times, respectively. In the AVPU variable, the transition from Alert to Verbal, the transition from Verbal to Pain, and the transition from Pain to Unresponsive increases the probability of death by 32, 104, and 567, respectively.

In this study, AVPU, age, MAP, primary GCS, and trauma mechanism due to hitting a vehicle with a fixed object had significantly the highest predictive power of hospital mortality in patients with multiple trauma due to traffic accidents, respectively. It is suggested that further studies be performed to replace the AVPU variable with GCS in the newly designed formulas for calculating the severity of trauma to simplify these scores.

Altered immune responses, in particular neutrophil changes, are perceived to play a key role in immuneresponses to trauma. This study aimed to evaluate the association of neutrophil changes with patients’ survival in severetrauma cases.

The current retrospective cohort study was conducted using data from patients admitted in theintensive care unit (ICU) of a trauma center in Shiraz, Iran, between 2016 and 2021. Patients were divided into threegroups (i.e., normal, neutropenia, and neutrophilia) based on neutrophil count at the time of ICU admission, and theassociation of neutrophil count with in-hospital mortality was analyzed.

2176 patients with the mean age of37.90 ± 18.57 years were evaluated (84.04% male). The median trauma severity based on injury severity score (ISS) in thisseries was 9 (4 -17). Patients were divided in to three groups of neutrophilia (n = 1805), normal (n = 357), and neutropenia(n = 14). There were not any significant differences between groups regarding age distribution (p = 0.634), gender (p =0.544), and trauma severity (p = 0.197). The median survival times for the normal, neutropenia, and neutrophilia groupswere 49 (IQR: 33 -47) days, 51 (IQR: 8- 51) days, and 38 (IQR: 26 - 52) days, respectively (p = 0.346). The log-rank testshowed a statistically significant difference between the three groups adjustment for ISS (p≤0.001). For each unitincrease in ISS, the hazard ratio increased by 2%. In ISS 9-17, the hazard ratio increased by 11% compared to ISS<4. Also,in ISS>17, the hazard ratio increased by 76% compared to ISS<4 in ICU-hospitalized patients.

In general,the findings of the present study showed that the survival rate of patients in the normal group after ISS adjustment washigher than the other two groups. Also, the Cox model showed that the mortality risk ratio in the neutropenia group was15 times higher than the normal group.

Emergency Trauma Score (EMTRAS), Revised Trauma Score (RTS) and Glasgow Age Pressure (GAP) are used to determine the patient status, and to predict the intervention and prognosis. The aim of the present study was to evaluate the association between mortality and trauma severity scores (EMTRAS, RTS, and GAP) in multiple trauma patients. In this study, patients who had referred to the Emergency Department of Mustafa Kemal University Hospital due to multiple trauma within a one-year period were evaluated retrospectively. The hospital is located in the central district of Hatay, Antakya in the Republic of Turkey, 680 km from the capital, on the Syrian border. Its population is 1,5 million. Antakya is located as the central district of Hatay with population of 400,000. Demographic data, trauma type, nationality, vital parameters [pulse, peripheral oxygen saturation (SO2), respiratory count, systolic blood pressure (SBP), diastolic blood pressure (DBP)], physiological scoring systems (GCS, RTS, GAP and EMTRAS), and mortality states of the patients were reviewed. Data were analysed by SPSS 21, and the effect of current parameters on short-term (in the emergency service) and long-term (30 days) mortality was examined. Three hundred and thirty-three multi-trauma patients were enrolled into the study. The median age of the patients was 31 (IQR: 22) years; 88.3% (294) of the patients were male. The exitus rate was detected as 7.8% in the emergency service and 26.4% within one month. GCS, RTS and GAP values of the patients who have died in the emergency service and within one month were significantly lower; however, the EMTRAS level was significantly higher in these patients (p<0.05). RTS and EMTRAS were detected as short- and long-term independent variables for mortality (p<0.05). After Receiver Operating Characteristic (ROC) analysis, the areas under the curve (AUC) of GCS, GAP, RTS and EMTRAS for short-term mortality were 0.861cm2, 0.876 cm2, 0.901cm2 and 0,917cm2, respectively; the AUC of such parameters for long-term mortality was detected 0.896cm2, 0.904 cm2, 0.914cm2and 0.899cm2, respectively. EMTRAS values were detected more significant parameters for short-term mortality whereas RTS was more significant for long-term mortality in multiple trauma patients. Such two scores may be useful to predict the patient prognosis along with GCS or solely.

Intrusion is the most severe luxation injury, resulting in soft and hard tissue damage. Treatment depends on the root development stage and tooth intrusion degree. Lateral luxation describes tooth displacement in any direction other than axial. The prognosis of luxated teeth depends on the emergency treatment and elapsed time. This paper reports an 11-year-old boy who sustained displacement of central and lateral incisors into the nasal cavity, and his left canine had lateral luxation. Surgical repositioning was undertaken for intruded teeth, and a splint was placed. The canine could not be repositioned due to the delay, but its position improved toward the force of the cheek after several sessions. This study contains the data obtained from a one-year follow-up.

Early assessment of the severity and prognosis of multiple trauma injuries is crucial for the improvement of prognosis. Therefore, defining the parameters related to mortality and severity of multiple trauma injuries needs to be considered. The current study aims to investigate the serum lactate level and prognosis of these patients.

This is a cross‑sectional study conducted on 150 motor‑vehicle‑induced multiple trauma patients who were admitted to the Babol Trauma Center for 15 months. The serum lactate level was measured at the time of admission, 24 h, and 72 h after admission. The outcome of the patients was evaluated as death, hospitalization, or discharge.

Overall, 150 motor vehicle‑induced trauma patients were enrolled in the study. Hyperlactatemia was seen in 33 (22%) patients in 24 h and 78 (52%) patients in 72 h after admission (P < 0.001). There was a clinically significant correlation between lactate level at the time of admission and the outcome of the patients (5.22 ± 3.41 expired, 2.69 ± 1.67 hospitalized, and 1.83 ± 1.09 discharged, P < 0.00). There was a clinically significant correlation between the serum lactate level at 24 h after admission and the outcome of the patients (6.81 ± 3.51 expired, 1.35 ± 0.79 hospitalized, and 0.83 ± 0.23 discharged, P < 0.001). There was also a clinically significant correlation between the outcome of the patients (discharge or hospitalization, or death) and the serum lactate level at the time of the admission and 24 h after the admission (P = 0.035).

The baseline lactate, the lactate level at 24 h after admission, and the difference between these two can be used as a prognostic factor in the evaluation of multiple trauma patients. It is suggested to check the difference between the serum lactate level at the time of admission and 24 h later in trauma centers.

To evaluate the spiral chest computed tomography (CT) scan findings in patients with multipletrauma during the COVID-19 pandemic. This retrospective study was performed on multiple trauma patients admitted to a tertiary hospital inthe north of Iran in 2020. All patients with multiple trauma who had undergone a chest spiral CT were includedin this study. Furthermore, the data analysis was performed through descriptive and analytical statistics usingSPSS software. A total of 600 patients were included over the study period. The mean age of patients was 48.2±20.3years. Of the total, 496 (65.3%) patients had blunt chest injuries, and 104 (34.7%) had penetrating chest injuries.Falling was the most common mechanical cause of chest trauma in 270 patients (45%). Surgical interventionswere performed in 110 (18.3%) patients. A total of 276 (46%) patients had chest injuries identified by CTscans. Many patients (15.6%) had ground-glass lung opacity in the CT scan reports. Lung consolidation,pneumothorax, lung contusion, hemothorax, and rib fractures were the most common. Due to the high frequency of typical findings in spiral CT scan examinations, obtaining a reliablehistory of trauma severity, injury mechanism, and a detailed physical examination is recommended beforeprescribing a CT scan for patients.

This case report described a 10-year-old girl injured during a sports accident. Clinical examinations disclosed the extrusion, crown fracture, and subluxation of the anterior teeth of each jaw. At the same time, dental fragments were embedded within the lower lip soft tissue - the projected procedures concerned maintaining pulp vitality and periodontal stability of the fractured teeth with an 18-month follow-up.

Traumatic injuries have become a health problem worldwide, especially in low‑ to middle‑income countries. Therefore, this study was conducted to identify predicting factors of death in adult severe multiple trauma patients.

This retrospective cross‑sectional study was performed on 1397 adult multiple trauma patients referred to the emergency department(ED) of Poursina Hospital between June 2019 and August 2021. The demographic characteristics, on admission clinical parameters, laboratory tests, the need for packed red blood cell transfusion, and the need for endotracheal intubation were recorded. The revised trauma score (RTS) was calculated according to the physiological variables collected on admission to ED. The primary outcome was 1‑day mortality after admission.

The mean age of subjects was 37.12 ± 13.61 (18–60) years, and 1250 (89.5%) subjects were male. The 1‑day mortality was 339 patients (24.3%). Initial RTS score and the mean Glasgow coma scale (GCS) scores were significantly higher in the survived group than in the nonsurvived group (6.6 ± 1.2 vs. 4.9 ± 1.0, 10.2 ± 3.7 vs. 4.9 ± 2.4, P < 0.001). The multivariate analysis resulted in low GCS (odds ratio [OR] = 1.527, 95%CI 1.434–1625, P < 0.001), low O2 saturation (OR = 1.023, 95%CI 1.003–1.043, P = 0.022), and need for intubation in the ED (OR = 0.696, 95%CI 0.488–0.993, P = 0.046) as predictors of 1‑day mortality. The area under the curves receiver operating characteristics of RTS and GCS scores to predict mortality were 0.853 (95% CI: 0.831–0.874) and 0.866 (95% CI: 0.846–0.887), respectively.

Multiple factors associated with 1‑day mortality were reduced GCS score, decreased oxygen saturation, and need for intubation in the ED. The RTS and GCS scores are good predictors of mortality survival in multiple trauma patients.

Trauma is a worldwide problem that affects healthy people. Several scales such as Injury Severity Score (ISS) and New ISS (NISS) are used to evaluate trauma patients. This study aimed at evaluating the predictive values of ISS and NISS in predicting the possible mortality rate of trauma patients referred to the emergency department.

This historical cohort study was conducted on multiple trauma patients admitted to the Emergency Department of Imam Reza Hospital in Tabriz, Iran, from January to March 2021. Pearson’s regression, Spearman’s correlation, and the receiver operating characteristic curve were used to analyze the data. ISS and NISS values were also calculated.

In NISS evaluation with the cutoff point of 24, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 93.65%, 82.33%, 51.3%, and 98.49%, respectively. Furthermore, positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 3.5 and 0.08, respectively. In ISS evaluation with the cutoff point of 21, the sensitivity, specificity, PPV, and NPV were 88.89%, 82.02%, 49.56%, and 97.38%, respectively. In addition, PLR and NLR were 4.94 and 0.14, respectively.

Both ISS and NISS are useful in predicting outcomes in trauma patients, but NISS is more useful and better than ISS and has a higher sensitivity. Due to high sensitivity and a high NPV of NISS, using the high Abbreviated Injury Scale without considering the area of injury can be better and more effective. Therefore, the NISS value works better for patient evaluation and outcome prediction in the emergency department.