Trauma Monthly
Volume:24 Issue: 4, Jul-Aug2019

The hand and wrist are functionally the most important parts of the body that are also very prone to traumatic injuries. Clinical examinations have inherent shortcomings in accurate diagnosis of tendon injuries. This makes diagnostic surgical exploration mandatory in the setting of questionable clinical findings. It is valuable to have an adjunctive diagnostic modality on hand to complement clinical findings and obviate the need for unnecessary surgery.

The primary purpose of this article was to investigate the overall accuracy of point of care ultrasound performed by emergency physicians for the diagnosis of tendon lacerations.

One hundred and twelve patients with penetrating trauma to the volar aspect of hand or wrist and questionable clinical findings took part in this prospective study. All patients were candidates for exploratory surgery and underwent diagnostic ultrasonography to evaluate tendon rupture before surgery. Ultrasound results were compared with surgical evaluation results as the standard test.

This research found a specificity of 99.4% and sensitivity of 100% for POCUS in the diagnosis of tendon rupture in traumas to the volar aspect of the hand and wrist.

The POCUS can be a reliable modality to evaluate tendon injuries in patients with suspicious clinical findings. Using this modality may obviate the need for a mere diagnostic surgical exploration.

To reduce mortality in patients with multiple-trauma, rapid diagnosis for blood transfusion is of great importance.

The current study aimed at investigating the predictive role of red cell distribution width (RDW) in comparison with other multivariate systems to determine the need for blood transfusions in patients with trauma referred to hospital.

The follow-up study was conducted on patients with multiple-trauma aged ≥ 18 years with an injury severity score (ISS) ≥ 16 referred to the emergency department within the study period. All patients were evaluated based on the ATLS (the advanced trauma life support) guideline; then, blood samples were taken at arrival and 24 hours later to measure RDW. According to the questionnaire, age, gender, ISS, RTS (the revised trauma score), and TASH (the trauma-associated severe hemorrhage) score were recorded by a senior emergency medicine resident.

Finally, 200 patients were enrolled in the study, of which 87 (43.5%) received blood transfusion. In the univariate analysis, there was a significant association between the first-day RDW, ∆ RDW (RDW on arrival - the first-day RDW), ISS, RTS, and TASH score, and blood transfusion. However, in the multivariate analysis, only TASH had a significant relationship with the need for blood transfusion (P < 0.0001).

Inmultiple trauma patients, rapid diagnosis of hemorrhage and the need for blood transfusion is crucial. Monitoring the patients based on the RDW test is not helpful in predicting the need for blood transfusion. Multivariate systems such as TASH score are more valuable in determining the need for blood transfusion.

The aim of the current study was to assess the prevalence and causes of maxillofacial fractures in a five-year period among patients referring to Taleghani Hospital, Tehran, Iran.

This retrospective study was conducted on patients with maxillofacial fractures from the beginning of 2013 until the end of 2017. Demographic factors, fracture site, fracture type, the cause of fracture, and performed treatment were recorded.

There were 708 patients with maxillofacial fractures; most cases were in men (85.2%) and in the second and third decades of life (53.8%). The majority of the fractures were in the mandible with the incidence rate of 64.7%. In addition, the causes of maxillofacial fractures were due to car accident (CA) (29.4%), motor vehicle accident (MVA) (28.7%), and falling down (FD) (21%). No significant difference was observed in the type of fracture between the sex and age (P > 0.05).

Maxillofacial fractures were associated with serious health problems, specifically in young males following CA and MVA.

Spinal cord injury (SCI) is a disorder that causes several adverse effects on all aspects of the individual’s life and disrupts the normal routine of life.

The present study aimed at evaluating the prevalence of depression and pain among patients with SCI.

The present systematic review was conducted using the Iranian literature. The study population included all articles available in Iranian and international databases as well as Google Scholar search engine. For this purpose, databases including SID, Magiran, IranMedex, IranDoc, Scopus, PubMed, ScienceDirect, Web of Science, and ProQuest were searched. The quality of published articles was assessed by two highly qualified researchers; the primary search was also performed separately. The data were analyzed with comprehensive meta-analyses (CMA) statistical package.

According to the findings, the prevalence of mild depression in the studied patients was 22.6% (95% confidence interval (CI): 17.50 - 28.8), moderate depression 19.6% (95% CI: 14.7% - 25.7%), and severe depression was 12.1% (95% CI: 8.3% - 17.3%); in addition, 46.5% of the patients had no depression (95% CI: 26.7% - 67.6%), and 65.9% of the subjects complained of pain (95% CI: 53.9% - 76.1%).

Because of high prevalence of pain and depression among patients with SCI, it is essential to take appropriate measures to prevent depression and pain in such patients in order to improve their health status and quality of life.

The prehospital care system depends on many factors. If all factors contributing to prehospital care are handled correctly, many fatalities occurring in this phase will be prevented.

We aimed to identify root causes and factors contributing to preventable deaths in the prehospital phase of road traffic injuries.Data Sources: In this study, a systematic review was performed on the Web of Science, Scopus, and PubMed databases, as well as Google Scholar Search Engine, using keywords “preventable mortality/fatality”, “road traffic injuries”, “prehospital” and a combination of them to find papers published from May 10, 2018, to August 30, 2018. The quality of the finally retrieved papers was investigated by two researchers independently and in the case of any disparities, a third researcher explored the papers. The PRISMA checklist was used to analyze the quality of the papers.

All documents and papers were included in the initial investigation regardless of the type of the paper. If a paper dealt with preventable fatalities of road traffic injuries in both prehospital and hospital phases, only were the prehospital phase results analyzed.

Based on the findings, 14 articles and records were included in the review. The precise assessment of the papers using content analysis resulted in the emergence of three themes, six subthemes, and 45 codes. The main themes including “systemic deficiencies, human errors, and patient’s clinical condition,” and the subthemes including “educational deficiencies, managerial deficiencies, errors/delay in diagnosis, therapeutic deficiencies, technical deficiencies, and trauma types” were extracted.

Various factors were rendered effective in preventable fatalities of road traffic injuries in the prehospital phase. The identification of these factors and resolving the identified problems can reduce the fatalities of road traffic injuries.

Patients requiring invasive mechanical ventilation in the intensive care unit (ICU) are at risk for ventilator-associated pneumonia (VAP).

To summarize the results of published, randomized, clinical trials (RCTs), a meta-analysis was performed to examine the effect of subglottic secretion drainage (SSD) on the prevalence and outcomes of VAP in adult patients undergoing mechanical ventilation.

A comprehensive search based on specific terms was performed as a systematic review and meta-analysis by a computerized database search in the national and international databases including MagIran, SID, Scopus, PubMed, ISI Web of Knowledge, ScienceDirect, Google Scholar, Cochrane Central, and IRCT as well as references from 1990 to 2018 in English and Persian languages. RCTsof SSDwere considered as common careof adultpatientsundergoingmechanical ventilationin the currentmeta-analysis. Data analysis was carried out through the random and fixed effects model, and the heterogeneity was investigated by I2 and Q-Cochrane index. The data were analyzed using STATA 11.

A total of 24 eligible RCTs with 2434 patients were identified. The overall risk ratio for VAP was 14.7 (95% confidence interval (CI): 11.1 - 18.4); mortality 25.8 (95% CI: 17.3 - 34.3); length of ICU stay 13.4 (95% CI: 7.8 - 18.9) and hospital stay 23.2 (95% CI: 12.5 - 33.9); ventilation days 14.9 (95% CI: 7.3 - 22.6); airway secretion 10.2 (95% CI: 4.9 - 15.5); and APACHEII 19.5 (95% CI: 14.6 - 24.3).

SSD is recommended to prevent VAP, and reduce mortality rate and the ICU LOS, especially in the high-risk patients undergoing mechanical ventilation for a long period of time.

Distal radius fracture (DRF) is one of the most common upper limb fractures, which is associated with osteoporosis and vitamin D deficiency, especially in old adults.

The aimof this studywas to evaluate the effectof supplementary vitaminDongrip strength, pinchpower, painintensity, and DASH score in post-menopausal females after distal radius fractures.

Fifty-two post-menopausal women with distal radius fractures were enrolled in a randomized single-blinded multicenter trial from January 2015 to January 2016 (IRCT registration number: IRCT20160830029603N7). Patients with pre-operative serum vitamin D level of 30 to 100 ng/mL were enrolled in the study. Patients were divided into two randomized groups including groups with and without supplementation of vitamin D [25 women in intervention group (50,000 IU supplementary vitamin D, every 4 weeks for 6 months) and 27 women in placebo group]. Grip strength, pinch power, pain intensity, and DASH score pre-operatively and at three and six months after the surgery were measured; the obtained data were analyzed using SPSS version 16.

The subjects’ mean age in vitamin D supplemented and placebo group was 57.98 ± 7.15 and 59.15 ± 8.03, respectively. The mean grip strength of patients in vitamin D supplemented group was significantly higher than the placebo group on both the third and sixth months (P = 0.011 and P = 0.003, respectively). The pinch power was significantly increased on the sixth month compared to the third month in patients with revised vitamin D supplementation (1.32 ± 2.14 and 0.67 ± 0.96 respectively, P = 0.0001). There was no statistically significant difference between the two groups in terms of mean VAS and DASH scores at the end of the study (P = 241, P = 0.665, respectively).

Vitamin D supplementation was significantly helpful in improving grip strength recovery in post-menopausal women after distal radius fracture, however, no significant differences were observed in supplementation of vitamin D on pinchpower and pain intensity after distal radius fractures.