Trauma Monthly
Volume:23 Issue: 1, Jan-Feb2018

Traffic events are among the greatest health problems which are ignored among other health issues. The treatments related to these events can involve individuals for a long period of time.

This study aimed to predict the mortality resulting from car accidents in injured individuals referring to Shiraz Shahid Rajaee hospital.

This study was conducted on all the patients hospitalized in Shahid Rajaee hospital due to traffic events during 2010 to 2016. The best models of various instruments including auto correlation function (ACF), partial auto correlation function (PACF), and Akaike information criterion (AIC) statistics were used for identification and fitting. Moreover, normality and statistics were taken into consideration in order to determine the validation of residual diagram’s pattern. Then, the best model was selected and analyzed using ITSM, SPSS 19, and Excel software.

Mortality followed an ascending trend in this study. Among male patients, mortality trend was relatively fixed, but showed an increasing slope in some months of the year. However, this trend increased continuously in females. Considering different age groups, mortality followed a relatively fixed trend in below-30-year-old individuals, an increasing trend among the individuals between 30 and 45 years of age, and a steeper slope among above-45-year-old ones. Moreover, the prediction models indicated that the majority of the accidents had taken place during spring and summer.

The mortality resulting from car accidents followed an increasing trend. This can be attributed to the increasing number of cars in Shiraz, economic changes in Iran, and the country’s movement towards development which lead to a decrease in motorcycle events and an increase in the car accidents. Moreover, the majority of accidents leading to death had taken place in May and September. This can be related to tourist attraction of this province during these months.

Although perilunate fracture-dislocation usually extremely alters the inter-carpal relationships, it is frequently misinterpreted during initial evaluations. We report two 30-year-old males with a very rare transradial styloid perilunate fracture-dislocation treated by closed reduction and percutaneous K-wire fixation. They regained the range of motion (ROM) of their wrists and furthermore, the mid-term outcome turned out to be satisfactory

The use of patient-controlled analgesia (PCA) has increased in recent years. Data regarding PCA’s usefulness following anorectal surgery are equivocal, and it still needs to be further studied and discussed. Therefore, the current study was conducted to compare PCA with pudendal nerve block (PNB) for pain management in patients undergoing anorectal surgery.

Patients candidate for elective anorectal surgery under general anaesthesia were considered eligible. Prior to the surgery, the patients were divided into PCA and PNB groups. PNB was performed at the end of the surgery just before extubation. PCA was initiated in the recovery room. The patients’ pain scores were recorded based on an 11-point numerical rating scale (NRS) at 2, 6, 12, and 24 hours into the post-operative period. The total dose of morphine sulfate consumed, the overall satisfaction, and any side effects were recorded.

100 patients with a mean age of 44.55 ± 11.45 years were enrolled (71% male). Both methods resulted in effective pain control. The difference in the consumed doses of morphine was not statistically significant (P = 0.2). The PNB group patients were more satisfied than those in the PCA group (8.6 ± 1.9 vs. 7.3 ± 2.2; P = 0.037). The recorded side effects were significantly higher in the PCA group (P < 0.001).

Although both morphine-contained PCA and PNB with Marcaine resulted in effective pain control following anorectal surgery, it is likely that local anaesthesia with Marcaine is accompanied by fewer side effects and more satisfaction.

In recent years traumatic injuries and their related mortality have become a major public health issue in Iran. This study aimed to assess injuries and mortality rate in southern Iran.

In this cross-sectional study, all trauma cases aged above 14 years, who were referred to Rajaee hospital, Shiraz, Iran from January 2010 to December 2014, were enrolled. Age, gender, cause of injury, and in-patient hospital mortality were extracted from the hospital information system and analyzed.

The study participants included 41,182 patients, among whom 32,219 (78.2%) were male and 8,963 (21.8%) were female. The frequency of all injuries was higher in males. In the current study, fatality rate was 2.65%, male and female fatality rates were 2.70% and 2.45%, respectively. Even though admission had an ascending trend from 2010 to 2014, a noticeable reduction in the trend of fatality rate was seen 4.5 % and 3% in pedestrian-related injuries and gunshot -related injuries.

In the light of medical advances in trauma management, allocating budget is necessary for prevention and implementation of vehicles’ safety protocols and developing educational programs to reduce mortality

Atypical femoral fracture (AFF) is a tensile fracture with unique radiographic and clinical features that differ from ordinary osteoporotic femoral fractures. Denosumab is a novel agent that inhibits osteoclastic activity, reducing bone resorption. Within the past few years, several case reports indicated that patients on denosumab prescription are at risk of AFF. The purpose of this review was to discuss the current evidence regarding this association and draw recommendations for clinicians about the use of denosumab in osteoporotic patients, until such evidence is established in future studies.

A computer search of Medline (through PubMed and OVID search) engines was conducted using the following keywords: "Denosumab" and "atypical femoral fractures". Furthermore, we reviewed the reference list of included studies for further citations.

We identified 9 case reports, 5 clinical trials, and 1 prospective observational study that have reported data regarding the incidence of AFF in patients on denosumab prescription.

Denosumab is an effective treatment for osteoporosis; however, there is a growing number of reports regarding its association with AFF. Causality needs verification in future observational and interventional studies; meanwhile, screening for AFF in patients receiving denosumab and reevaluating the optimal antiresorptive therapy in osteoporotic patients is recommended.

Heavy workload is one of the main problems of nurses working in intensive care units (ICUs). It not only decreases the quality and safety of patient care, but also increases human errors in health care, rate of hospitalization, and risk of mortality in patients. Workload evaluation and surveillance of patients enable authorities to allocate adequate staff to ICUs, leading to improved quality of patient care and treatment.

The present study aimed to evaluate nurses’ workload and efficiency of nursing staff allocation in a trauma ICU of Shahid Rajaee hospital, affiliated to Shiraz University of Medical Sciences.

In this cross sectional study, we evaluated nurses’ workload in a trauma ICU. The evaluation was based on the nursing activities score (NAS) system and was performed in the morning, evening, and night shifts for 1 month. In this period, all nursing care activities provided for 36 patients in this unit were monitored and recorded. Additionally, the number of nurses required per shift was estimated, based on the required and available time for care. Efficiency of nursing staff allocation was evaluated accordingly.

The mean age of the patients was 40.17 ± 22.30 years, and the length of ICU stay was 9.79 days on average. Based on the findings, the mean NAS score was 65.3 ± 23.19%. Moreover, the number of nurses in the morning and evening shifts was less than the required number, except for days 3 and 7. On the other hand, the number of nurses in the night shifts was proportional to the required number.

The results indicated a heavy nursing workload in the ICU. Our findings also suggest that the quality of patient care can be improved by balanced distribution of workforce relative to workload in different shifts.

This case report presents an open subtrochanteric fracture in a premature low birth weight newborn, which was treated with intramedullary Kirschner wire.

A neonate with left open subtrochanteric fracture was referred to the orthopedics department of the current study. Pavlik harness was applied yet treatment failed; therefore, an intramedullary Kirschner wire was applied.

The pin wasmaintained for 6 weeks and fracture healing was confirmed by a radiograph. Follow up after 18months showed complete healing, no limb length discrepancy, and normal gait.

In some patients, traditional methods, such as traction, cast, and Pavlik harness cannot be used. Intramedullary Kirschner wire insertion could be an alternative treatment option.

Treatment of multi-drug-resistant strains of pneumonia with common antibiotics in renal patients is ineffective and physicians are compelled to use Colistin for such cases.

This study was conducted to assess the mortality, length of stay, and renal damages in the treatment of multi-drugresistant pneumonia with Colistin among multiple trauma patients admitted to the emergency department and transferred to the ICU.

This retrospective cohort study was conducted between 2011 and 2016. 102 multiple trauma (MT) patients with multidrug-resistant strains of hospital-acquired pneumonia (HAP) admitted to the emergency department then transferred to the ICU were assessed. All patients received Colistin according to their weight. Renal damage was evaluated according to the RIFLE criteria. The mortality and the length of stay were assessed. In order to statistically analyze the data, SPSS version 23 software was used to conduct t-test and chi-square test.

Out of 102 patients, 55 (54%) died and 50 (49.1%) developed acute renal failure; 64 cases had no hypertension. Patients according to the RIFLE index were assessed: Risk (11.01%), Injury (14%), Failure (18%), Loss (6%), and End-stage renal disease. The prevalence and prognosis of acute kidney injury in multiple trauma patients treated with Colistin were significantly correlated with drug dosage, body mass index, and use of corticosteroids (when assessed using relevant scoring systems, P < 0.05).

The use of a scoring system in the intensive care unit, determining those patients requiring Colistin, and adjusting the dosage of this drug for treatment of MT patients with multi-drug resistant strains of HAP are vital. Creatinine levels must be carefully monitored.

Randomized controlled trials (RCTs) have a major role in making the evidence-based decisions on healthcare. Therefore, the assessment of the quality of RCTs is important to properly apply the evidence-based healthcare. The current study aimed at assessing the quality of RCT reports published in Trauma Monthly Journal. Evidence Acquisition: The quality assessment of each report was performed using a checklist based on the CONSORT (consolidated standards of reporting trials) Statement and Jadad criteria.

Fifteen RCTs were published from 2011 to 2015 in Trauma Monthly journal out of which 5 (33.3%) reported the pain outcomes, 7 (46.6%) reports included surgical interventions, and 3 (33.3%) reports included patients with different types of fractures. According to the CONSORT checklist, the best report belonged to the definition of interventions for each group with sufficient details. The mean score of Jadad was 2.27 (45.4% of maximum possible total score). According to both scales, there was an increase in the periods of time in the quality of reporting.

The results showed a moderate quality score in RCTs and an improvement over the years. Training courses for researchers, managing reporting standard tools presented by editors (CONSORT checklist) and employing methodologists and statistical experts can improve the quality of published RCTs.

There is a lack of epidemiological data on emergency Medical service (EMS) missions for accidents in Iran. The present study aimed at obtaining representative data on the epidemiology of emergency Medical service missions for accidents in Tehran.

Active EMS stations in Tehran were selected through stratified random sampling in different regions of the city during a twelve-month period from March 2012 to March 2013. Data was collected through a questionnaire on demographic information, which extracted from events recorded on dispatch electronic forms in EMS. Data was analyzed by Excel using descriptive statistics.

Based on the type of accidents, Road Traffic Accidents (RTA) and downfall in the North, stab wound in the East, burning in the West, and poisoning with CO in the East region of Tehran megacity had the highest rates compared to other areas. The most common of all were Road Traffic Accidents (RTA) (77.9%) stab wound (11.1%), falling down (4.6%), burns (2.1%), and Carbon Monoxide (CO) poisoning (1.5%). Most accidents occurred in males and 20- to 40-year-old age group (45.51%), and the western district had the first rank in Tehran.

According to demographic and geographical rate of accidents, It is recommended to develop preparedness programs and response plan according to epidemiological information of accidents. This programs includes EMS staff trainings and community educations.

The scientific literature highlighted the relevance of psychopathological symptoms and psychiatric disorders among the victims of accidents. The research that focused on non-fatal injuries has paid limited attention to mental disorders in adolescent victims of motor vehicle collisions (MVCs). However, adolescents’ emotional-behavioural functioning and psychopathological risk can be related to their likability of being victims of road accidents.

This study aimed to synthesize data gathered in an Italian emergency department, specifically focusing on adolescents attending the service for the physical consequences of a motor vehicle collision.

An ad hoc anamnestic self-report questionnaire was administered to 410 adolescents involved in MVCs. Results and

This preliminary report shows that non-fatal injuries are very common among adolescents, being particularly related to poor mental health.

Field hospitals are health care institutions with mobile or fixed structures. Although there have been numerous models and indicators for assessing the performance of public hospitals, there is no model to evaluate the performance of field hospitals.

This study was aimed at determining key performance indicators in field hospital appraisal.

In this study, we conducted a systematic review of publications in English or Persian language indexed by PubMed, Scopus, Emerald, Elsevier, Ovid, Google Scholar, Springer, ProQuest, WHO and Word Bank databases. PICO strategy was used for searching databases. Quality assessment of the publications were carried out using CASP checklist. Similarly, the preferred reporting items for PRISMA checklist were used to assess systematic reviews. The PRISMA checklist was used to guide the reporting of the systematic review. A descriptive summary with data tables was produced to summarize the literature. Following the results of our search, 592 publications were retrieved and 352 citations were excluded because of irrelevance or duplication. After excluding the duplicate and irrelevant items we screened 240 titles and abstracts. Two independent reviewers evaluated 240 potentially relevant studies, and 15 records met the criteria to be included in this review.

We found 13 criteria on the assessment of field hospital in the literature. We classified all the retrieved indicators according to the system approach. The results of this study showed that input indicators included 4 indicators, process indicators included 2 indicators, output indicators consisted of 4 indicators and outcome indicators involved 3 indicators.

This study highlights the most important performance measurement indicators in field hospitals with a system approach. There was no model to assess the field hospitals; however, a systematic approach in assessment can improve the quality of services.

Occupational injuries are considered as important factors in the loss of active human resources and useful working time; these injuries also constitute an important part of the global burden of disease. However, few studies have been performed on factors influencing the occurrence of occupational injuries. Besides, most studies have focused on the frequency of occupational injuries.

The present study aimed to identify the risk factors associated with mortality, occupational injuries, and length of hospital stay and to recognize the clinical pattern in patients with occupational injuries, depending on the type and severity of injuries with the purpose of designing effective preventive interventions.

This cross-sectional study was conducted on 365 participants in the second half of 2015. The study sample consisted of victims suffering from occupational injuries in Shahid Rajaee Hospital, Shiraz, Iran. The data were collected, using a questionnaire through face-to-face interviews. The injury severity score (ISS), as well as demographic and clinical variables, was evaluated in the subjects. Then, the data were analyzed, using logistic, ordinal, and multinomial regression models.

Out of 365 patients, 34 (9.3%) were female and 331 (90.7%) were male. Additionally, the mean age of the subjects was 34.26 ± 13.63 years. The results showed a significant reverse relationship between mortality and limb injury (P = 0.016) and type of fraction and dislocation (P = 0.02). Also, length of hospital stay had a significant relationship with abdominal injury (P = 0.008) and fraction and dislocation (P < 0.001). ISS within the range of 11 - 26 or≥ 27 was significantly associated with mortality (P < 0.00). Moreover, age ≥ 56 years was directly related to severe abbreviated injury scale (AIS) (P = 0.009). In addition, limb injury had a significant reverse relationship with critical AIS (P = 0.001). Chest (P = 0.013) and limb (P = 0.006) injuries also showed a significant reverse relationship with ISS. Furthermore, abdominal injury was directly related to ISS (P = 0.023), and fracture and dislocation were directly related to AIS (P < 0.001) and ISS (P < 0.001).

By the evaluation of patients’ ISS, fracture, dislocation, abdominal injury, and length of hospital stay, we can identify high-risk groups and develop necessary care and training programs in order to prevent the occurrence of injuries and decrease the length of hospital stay

Linear frontal bone fractures are common injuries in road traffic accidents. Pneumocephalus and CSF (cerebrospinal fluid) leak are both factors influencing their outcome. Persistent pneumocephalus and CSF leak are main indications for surgical treatment.

Surgical indications are rarely discussed in linear frontal bone fractures. We report results on patients with linear frontal bone fractures, clinical data, management, surgical indications and outcome.

From 2011 to 2015, 121 patients were admitted to our institution with a diagnosis of frontal bone fractures (compound depressed fractures excluded). Fractures were classified into three types, Type A: fracture involving anterior wall of the frontal sinus; Type B: fracture involving posterior wall of the frontal sinus and Type C: fracture of frontobasal region without involving the frontal sinus. All patients were followed for more than 6 months.

A total of 112 patients were conservatively treated with standard pneumocephalus protocol. Nine patients underwent surgical intervention. The indications for surgery were the presence of persistent pneumocephalus in CT scan and persistent CSF leak. The presence of pneumocephalus or CSF leak in Type B patients sinus cranialisation with repair of the defect were the variables mainly influencing the outcome (P < 0.001).

Frontal bone fracture needs careful attention to prevent its complications such as a CSF leak and meningitis. Patients need clinical and radiological evaluation. Patients with persistent CSF leak or pneumocephalus should always be treated surgically and others should be managed conservatively