Trauma Monthly
Volume:23 Issue: 6, Nov-Dec2018

Two systems exist for evaluating the abilities of trauma centers: the American College of Surgeons’ (ACS) verification and the State’s designation. Given criteria variations between the two systems, we studied clinical outcome variations of the same.

The National Trauma Databank was queried from 2002 - 2009, 2013 & 2014 for all patients admitted to a State designated (SI) or ACS verified (AI) trauma facility. Centers that were exclusively state or ACS designated were used for analysis. Patient demographics, facility information and physiological variables were obtained. Outcome variables included length of stay, no of patients with complications and mortality. Multivariate logistic or linear regression analyses were employed for assessing outcome variations.

Of the 12,581,375 trauma admissions, 1,504,848 (12%) met the inclusion criteria with 15 AI and 94 SI exclusive facilities identified. Patient demographics were 66% male, 62 - 63% white and 81% blunt injury. Higher length of stay, mortality, and complications were noted in SI vs. AI centers.

Our results indicate ACS verified level I trauma centers have better clinical outcomes than State designated level I trauma centers. This study warrants future prospective studies to determine the impact of level of designation on clinical outcomes.

Trauma related disorder is a common disorder in warfare victims. The present study investigated the effectiveness of mindfulness-based therapy and pharmacotherapy improving the clinical symptoms of warfare victims suffering from the disorder.

This experimental study was carried out in 2016 on 28 warfare victims with a trauma related disorder. They were randomly assigned into two groups (mindfulness therapy and pharmacotherapy). The study gathered combat-related trauma related disorder data and analyzed it via repeated measures ANOVA.

The results showed that a significant (P < 0.001) decrease in the psychological symptoms of mindfulness therapy group was noted in the post-test and follow-up test.

The results showed the effectiveness of mindfulness-based therapy improved the psychological symptoms of warfare victims with trauma related disorders. Mindfulness-based therapy can reduce the psychological symptoms of individuals with trauma related disorders.

This case report describes a rare case of intralenticular foreign body subsequent to a penetrating eye injury that was asymptomatic for six months. While early surgical intervention is preferred in these cases, the conservative approach may be an alternative approach.

Proximal humeral fracture (PHF) is a common orthopedic injury that constitutes 4% - 5% of all fractures. An appropriate treatment for PHF is very challenging. Minimally invasive surgery (MIS) techniques are presented to reduce soft tissue damage and save biological tissues at the fracture site. The current study aimed at investigating the clinical, functional, and the radiographic results, as well as complications of the surgical treatment of PHF with minimally invasive plate osteosynthesis (MIPO).

24 patients with proximal humeral fracture, classified according to Neer classification, aged over 18 years, from 2013 to 2014, with closed and displaced pattern underwent surgery by MIPO technique. In the follow-up period, patients were clinically evaluated using the criteria for the arm, shoulder, and hand disabilities (DASH score) and visual analogue scale (VAS). All complications related to the surgery and fracture healing were recorded.

Data regarding the 24 studied patients with themean age of 57.6±4.11 years were analyzed. In the current study, one patient presented superficial wound infection. Three patients had axillary nerve injury (12.5 %). In two cases subacromial impingement (SAI) due to greater tuberosity avulsion was observed. The motion range of forward flexion, abduction, and external rotation were 141 ± 39, 129±31, and 28±22 degrees, respectively. In the final visit, the averageDASH and VAS scores were 3.6±2.21 and 3.1±1, respectively.

Considering the reasonable functional and radiological results, low pain intensity, and finally low incidence of complications after surgery, the MIPO technique can be properly employed to treat proximal humeral fractures.

Diagnostic Peritoneal Lavage (DPL) is a routine method for evaluating internal organ damage in patients with blunt
or penetrating torso trauma. Internal organ damage can lead to elevated alkaline phosphatase (ALP) levels in the DPL fluid. In this
study, the researchers aimed to assess the prognostic value of elevated alkaline phosphatase levels and the need for laparotomy.

In this study, the researchers evaluated 42 patients with torso trauma (18 penetrating and 24 blunt traumas). The ALP was
positive for all the patients in DPL (2 IU/mL <). The hemodynamic status was stable, and there were no other positive findings in
their DPL. All the patients underwent diagnostic laparoscopy to evaluate the Positive Predictive Value (PPV) of ALP in DPL.

There were only three patients with significant laparoscopic findings, none of which required laparotomy. The PPV of ALP
in DPL fluid for the diagnosis of internal organ damage was 7.1%.

Elevated DPL alkaline phosphatase levels have no predictive value to warrant for further laparotomy in hemodynamically
stable patients, who had torso trauma, which had no other positive finding in their DPL.

There is an increasing trend of traffic accidents in the world in recent years. Road traffic injuries in Iran, caused 17994 deaths in 2012 - 13. Among these accidents, the most terrible one occurred on September 9, 2012 at 22:48 hour GMT, when two approaching buses had a head-on collision on 28-kilometer Tehran-Qom highway, killing 44 passengers on board and leaving 47 injurers.

This study aimed to assess factors, causes, and lessons learned from the two bus collision on the Tehran-Qom highway in Iran.

This case study adopted qualitative approach, to explore the different scenarios of the crash focusing on content analysis. Focus Group Discussion, semi-structured individual interviews and review of documentations and evidence were the data sources. Data and evidence gathered from people’s experience and perceptions, such as officials and staffs of rescue teams, were analyzed.

After repeated analysis and comparison of data, three categories were explored (agent/host/environment causes, victims’ search and rescue, and psychosocial support). Inadequate bus supervision and driver’s behavior, lack of fire extinguishers, and rescue tools such as hammers in buses, and blocked doors contributed to increased casualties. Effective field assessment for incidence and decentralizing stand-by hospitals would help reduce casualties. Lack of effective coordination, lack of psychosocial support services for victims and participation of ‘lay people’ the scene, were key findings.

Lessons learned: controlling per-second speed, improving vehicle manufacturing quality, re-training courses for drivers and the empowerment of rescuing people should help reduce human casualties during accidents. Lack of fire stations and fire extinguishing agent along the road outside cities are major problems. Common dispatch center with national emergency number is explicitly recommended for faster and more coordinated rescue services to reach the accidents scene. We also suggested instruction of psychosocial support for victims, survivors, and even rescuers during and after rescue process. Finally, persistent merge of existing rescue organizations, leading to the development of a national emergency management organization (NEMO) and national data collection system are highly recommended.

Head trauma is associated with high morbidity and mortality. A common complication of head trauma is the intracranial hemorrhage (ICH). This study was performed to evaluate the association between early discharge and long-term outcomes of patients with traumatic ICH.

In this prospective cohort, patients with traumatic ICH referring to the emergency departments (EDs) of two teaching hospitals were investigated. Demographic and clinical characteristics of the patients were recorded in the checklists and then a radiologic assessment was done. According to the time of discharge, the patients were divided into two groups: early discharge (≤ 24 hours) and late discharge (> 24 hours). The collected data were analyzed using SPSS-24.

A total of 28 patients (84.8%) in the early discharge group and 36 patients (81.8%) in the late discharge group completed the study. The age distribution was similar in the two groups. The most common clinical symptoms after discharge were a headache in the first group and a headache plus vertigo in the second group (n = 7, 25.0% vs. n = 4, 11.1%; P = 0.020). At the end of the follow-up, in the first group, 28 patients (100%) had a GOS of 5 and in the second group, 33 patients (91.7%) had a GOS of 5 and 3 patients (8.3%) had a GOS of 4, showing no statistically significant differences (P = 0.118).

The results of this study showed that traumatic ICH patients with early discharge had fairly similar outcomes to patients with late discharge.

Anesthesiology plays a major role in developing preoperative patient care. As the field of anesthesiology improves, the options to apply better anesthetic procedures emerge. Furthermore, Neuraxial anesthesia increases the chances of better outcome for the patients. However, neuraxial anesthesia has not become yet the favorite choice of anesthesia method by all physicians and patients.

The aim of present study was to assess elective orthopedic trauma patient’s preference on the choice of anesthesia method and their primary reasons for their choices.

Overall, 170 adult patients underwent elective orthopedic surgery after encountering various orthopedic traumas. It is important to note that the patients entered the study in a prospective cross sectional manner during a period of six months. A structured questionnaire consisting of two parts was used to interview the patients. The first part included the demographic data and the preferred anesthesia technique and the reasons for supporting these techniques. The second part was designed to assess the level of knowledge regarding the anesthesia methods.

Amongst 171 patients, 104 (60.8%) chose regional anesthesia (RA) in comparison to 67 (39.2%), who preferred general anesthesia (GA). The correlation between age and choice of anesthesia was significant (P = 0.001). Level of education did not affect the preferred choice of anesthesia (P = 0.651) nor the satisfaction score (P = 0.363). The satisfaction score with respect to received anesthesia was 9.29 ± 1.03 in the RA group and 8.7 ± 1.29 in the GA patients (P = 0.004).

The current findings suggested that regional anesthesia was the most preferred satisfactory technique among orthopedic patients, especially older patients.

Hydrogen peroxide poisoning can cause death. The chemical reactions in the body will produce complications, such as stroke, perforation of the gut, and embolism. These complications are most likely seen with high concentrations.

The patient was a 55-year-old female, who tried to commit suicide by ingestion of approximately 150 cc of hydrogen peroxide. She was brought to the emergency room for medical treatment. During the physical examination, the patient had air in the neck and mediastinum, which is a strong indication of acute mediastinitis. The patient was treated with esophagectomy and feeding jejunostomy. The pathology reported first degree burns of the esophagus without perforation. The patient underwent reconstructive surgery and treatment for eight weeks, yet she died during surgery as a result of low ejection fraction (EF).

In this case, the patient intentionally ingested a low concentration (15%) of hydrogen peroxide and as a result experienced first degree burns in the esophagus. The patient did not require surgery for treatment. The presence of white mucus and air around the esophagus and stomach was thought to be indicative of acute mediastinitis and mistakenly exposed the patient to major surgery.

Every year, millions of people die or are injured due to road traffic accidents worldwide. Investigating the epidemiology of these accidents could help reduce their frequency.

This study aimed to evaluate the epidemiological characteristics of non-fatal traffic accidents in Babol, northern Iran, over a seven-year period.

Between 2010 and 2016, all of the orthopedic patients with road traffic accidents hospitalized at Shahid Beheshti hospital of Babol were enrolled in this cross-sectional study. The patients’ information, including details of the accidents and demographic characteristics, was collected using predesigned checklists.

The majority of 3649 subjects (2748, 75.3%) were male. The age range was from 1 to 86 years old, with an average of 30.5±15.4 years. Traffic accidents were mostly seen in the age group of 19 - 40 years (58.7%) and in those who were drivers (52.7%). The accidents were highest in 2016 (19.9%), and on interurban roads (32.9%), on sunny days (73.4%), asphalt roads (74.3%), and in the morning (42.8%). November (12.7%) was associated with the highest monthly rate, followed by August (11.9%) and March (11.2%). Fractures were observed mostly in the leg (n = 960), followed by the forearm (n = 773).

The results showed that road traffic accidents have increased in recent years. It is recommended to improve the traffic safety with the improvement of the geometric design of the roads, especially in roads with a high probability of accident risk.

Renal traumas are quite commonly encountered in emergency departments. Low-energy traumas are often considered non-significant, but the presence of a pre-existing renal lesion predisposes the kidneys to more severe damage in the setting of even minor traumas, which may be accompanied by devastating results, should they remain unattended.

Here we report an incidental diagnosis of bilateral ureteropelvic junction obstruction in a patient who presented with unexpected shattered kidney following a low-energy flank injury.

Patients with a pre-existing renal lesion are vulnerable to severe traumatic renal injuries, even after minor trauma. The severity of renal injuries may be much more than expected, making the clinical and imaging findings complex and confusing in these patients.

Considering the role of Intracranial Pressure Amplitude [AMP(ICP)] in evaluating the rate of craniospinal compliance (CC) and intracranial pressure (ICP) and in estimating the degree of brain damage, the aim of the present study was to evaluate the correlation of AMP(ICP) with the degree of brain damage in patients with traumatic brain injury (TBI).

Thirty-four patients were enrolled in the present study. Patients underwent intraventricular ICP monitoring. During the first 24 hours, AMP(ICP) was recorded every hour, and its total mean was calculated. Correlation of AMP(ICP) and Glasgow outcome scale (GOS) was analyzed.

There was a negative correlation between mean AMP(ICP) within 24 hours and GOS values on the first, third, and sixth month (r = -0.476, -0.563, and -0.627, respectively).

The findings of the present study suggest that AMP(ICP) index can determine GOS in patients with TBI.

Penetrating ocular injuries associated with intraocular foreign body (IOFB) can lead to severe visual loss and despite improvement in microsurgical techniques, IOFB removal is one of the most challenging procedures in ophthalmology.

The aim of this study was to evaluate the treatment outcomes of 23-gauge (23-G) pars plana vitrectomy (PPV) and intraocular SF6 gas tamponade for the management of patients with intraocular foreign body and attached retina with superior full thickness retinal breaks.

In this prospective study, 23-G PPV was performed to manage patients with IOFB and attached retina and with full thickness retinal breaks. In patients with traumatic cataract and ruptured anterior and posterior lens capsule, IOFB was removed through limbal incision, yet in cases with intact lens capsule or without cataract, IOFB was removed through extended sclerotomy. Careful intraoperative barrier laser was performed and the vitreous cavity was filled with SF6 gas. All patients were followed-up for at least six months.

Ten eyes of ten patients were included in this study. The IOFB was removed through limbal incision in five eyes and through extended sclerotomy in five eyes. Lensectomy was done in eight eyes, in which primary intraocular lens (IOL) was implanted in seven eyes and secondary IOL (iris claw IOL) was implanted in one eye threemonths later. Visual acuity improved from 1.22±0.36 to 0.26± 0.18 logMAR (P = 0.007). No major intra-operative or post-operative complication, such as retinal detachment or endophthalmitis, occurred.

The 23-G PPV with intraocular SF6 gas tamponade was an effective and safe treatment modality for the management of eyes with small IOFBs and attached retina with full thickness retinal break