Trauma Monthly
Volume:22 Issue: 2, Mar-Apr 2017

Motor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Road traffic fatality is high in Iran; about 28,000 individuals die from road traffic accidents annually. Previous studies on trauma care in Iran have mainly focused on pre-hospital trauma care. This paper deals with the rate and the related factors of traffic injury deaths in hospitals.

The objectives of the present study were to investigate the predictors of survival rates of 2-wheel vehicle and pedestrian traffic injuries in hospitals of Tabriz, Iran. Patients and

This longitudinal study reviewed 15,331 injuries in 21 hospitals in the city of Tabriz from March 2012 to March 2013. The required data on motorcycle, bicycle and pedestrian (MBP) traffic injuries were collected from hospital information systems (HISs). Operation codes were extracted according to the 2010 California Billing Code and the data were analyzed using the STATA 13 statistical software package.

The total number of deaths due to traffic injuries was 266. Of these deaths, 184 were among inpatient traffic injuries 166 were MBP inpatients and 82 were outpatients. Young MBP patients (20 to 40 years of age) experienced a higher injury rate than older ones (48.4%, P < 0.05). Of all traffic injuries, 26% were pedestrian, 32% were motorcyclist, 4.6% were bicyclist, and 37.1% were nonMBPs. Most of the 266 deaths (251 deaths; 94.3) happened in public teaching hospitals. Fourteen deaths (5.3%) happened in other public hospitals and 1 death (0.4%) occurred in a private hospital. The difference, using the Fisher’s exact test, was significant (P < 0.01). The hazard ratio for the death of victims referred to public teaching hospitals was 5.8 times more than other hospitals (RR = 5.7, 95% CI: 3.4 - 9.6). The likelihood of admission for victims transported by emergency medical services (EMS) was 1.13 times more than for victims not transported by EMS (RR = 1.13 - 1.22, 95% CI: 1.05 - 1.2). Of the 266 deaths, 265 (99.62%) occurred in grade 1 hospitals and 1 (0.38%) occurred in a grade 2 hospital.

Close attention to these predictors may aid officials in planning effective training programs and prevention measures. These predictors can also be used in the legislation of traffic laws and regulations and managerial plans of hospitals.

Although forefoot fractures are of the most common orthopedic injuries, there are limited studies regarding the outcomes of nonoperative treatment of these fractures. In the current randomized clinical trial, for the first time, we evaluated the outcomes of nonoperative treatment of metatarsal bone fractures using off-loading shoes compared with casting.

In this study, there were 60 patients with metatarsal fractures without indications for surgical management who were assigned to the two equal groups: casting (group C) and off-loading shoe (group OS). The rate of fracture union was investigated. Also, the pain severity and patient satisfaction were measured based on visual analogue scale (VAS). Patients were followed for six months. In the last examination, American foot and ankle score (AOFAS) was completed. Finally, the outcomes were compared between two groups.

Clinical and radiological unions were achieved in all of the fractures. In the last examination, the pain intensity (1.2 ± 0.8 in group C versus 1.8 ± 1 in group OS; P = 0.149) and AOFAS (91.7 ± 15.1 in group C versus 93.2 ± 12.9 in group OS; P = 0.407) were similar. Patients in group OS were significantly more satisfied (7.5 ± 1.1 and 9.2 ± 1.3; P < 0.001). Complications of casting including skin problems, symptoms of deep venous thrombosis, and reflex sympathetic dystrophy developed in four patients.

Off-loading shoes are suitable modalities to treat forefoot fractures. Although no statistically significant difference was found between the groups, but due to the comparable outcomes, high patient satisfaction, and lack of complications, nonoperative treatment of forefoot fractures using off-loading shoes is recommended.

Fatal road accidents are among the most important causes of mortality in the world; Iran has one of the world’s highest accident fatality rates. Therefore, it is important to have efficient pre-hospital emergency services.

The main aim of this study was to assess the road emergency sites (RECs) in Iran.

Provincial data were used for this purpose. Concentration index, concentration curve, Lorenz curve, and the Gini coefficient were calculated to assess the distribution of RECs.

The results of this study showed that the distribution of RECs was in favor of provinces with higher road fatalities, but it was equal to the need for RECs. The results of the Poisson regression showed that RECs were not distributed by population density, but rather were distributed according to road injuries, needs and average yearly rainfall.

While the distribution of RECs is equal with regard to the need, the number of RECs is still inadequate.

Open abdomen occurs most often after damage-control surgery following trauma. This condition is a temporary abdominal closure of the abdominal cavity which is left open.

This study aims to describe the experience and management in open abdomen trauma patients at a level 1 trauma center in Thailand. Patients and

A retrospective review was performed of all adult trauma patients who had open abdomen after laparotomy between January 2011 and December 2012. Patients who had open abdomen but did not survive in the operating room were excluded. The data were collected from the trauma registry and medical records.

After 157 trauma laparotomies, 35 (22%) were open abdomen cases with an average injury severity score was 35. Ninety-four percent of open abdomens occurred after damage-control surgery. Temporary vacuum-assisted closure was applied in all patients. The fascial closure rate was 40%. In patients who failed to achieve a standard fascial closure, the skin closure technique alone was used. Deep surgical site infection was the most common complication after the abdominal cavities were closed. No enterocutaneous fistulae were reported.

Vacuum-assisted abdominal closure is a good technique for temporary abdominal closure. In patients who are unable to achieve fascial closure, skin closure alone is safe.

Open abdomen occurs most often after damage-control surgery following trauma. This condition is a temporary abdominal closure of the abdominal cavity which is left open.

This study aims to describe the experience and management in open abdomen trauma patients at a level 1 trauma center in Thailand. Patients and

A retrospective review was performed of all adult trauma patients who had open abdomen after laparotomy between January 2011 and December 2012. Patients who had open abdomen but did not survive in the operating room were excluded. The data were collected from the trauma registry and medical records.

After 157 trauma laparotomies, 35 (22%) were open abdomen cases with an average injury severity score was 35. Ninety-four percent of open abdomens occurred after damage-control surgery. Temporary vacuum-assisted closure was applied in all patients. The fascial closure rate was 40%. In patients who failed to achieve a standard fascial closure, the skin closure technique alone was used. Deep surgical site infection was the most common complication after the abdominal cavities were closed. No enterocutaneous fistulae were reported.

Vacuum-assisted abdominal closure is a good technique for temporary abdominal closure. In patients who are unable to achieve fascial closure, skin closure alone is safe.

When disasters strike, hospitals are among the first units whose efficient and timely services can be crucial and decisive in reducing mortality and rescuing the injured. Non-structural components are among domains that need to be considered in any assessment of hospital readiness.

Given that Azerbaijan, and especially the metropolis of Tabriz, is located in the world’s earthquake belt, this study aimed to evaluate the non-structural vulnerability of hospitals involved in the 2012 Azerbaijan earthquake.

In a cross-sectional study, eight public, social security, military, and private earthquake-stricken hospitals in Azerbaijan were assessed from nine different aspects using the standard checklist issued by the WHO/HSI (hospital safety index).

The lowest level of performance was observed in communication and electrical systems. The hospitals surveyed had appropriate levels of performance in terms of water supply systems, medical gas systems, and emergency fuel. Although in the overall assessment, approximately 60% of hospitals surveyed had an acceptable performance in their non-structural elements, key sectors such as emergency, ICU, radiology, and laboratories had rather low to moderate levels of safety in all hospitals.

Overall, two hospitals had high levels of readiness in the assessment (above 80%). Given that Iran, and particularly its neighbor Azerbaijan, is a crisis-prone country, adherence to non-structural security protocols of the WHO has had a significant effect on the non-structural readiness and safety of hospitals.

Arterial cannulation and intra-arterial (IA) fluid and blood resuscitation in the patients with severe shock is an easier approach compared with the intravenous (IV) access if concerns regarding the efficiency and safety of this approach are addressed.

We hypothesized that IA fluid resuscitation is more effective than IV resuscitation in restoring cardiac contractions (CC) of cardiac-arrested mice following severe hemorrhagic shock.

Mice (N = 22) were anesthetized using ketamine/xylazine. Arterial and venous systems accessed through cannulation of the carotid artery and the Jugular vein, respectively. As much blood as possible was aspirated from the carotid artery access. Mice were observed until the complete cessation of chest wall motions. Following 30 seconds delay, IV (N = 5) and IA access (N = 6) were used for fluid resuscitation using Ringer Lactate (RL) in a similar volume to the aspirated blood. Mice were observed for restoration of chest wall motions. In phase-IIof the study, after cessation of chest motions, mice (N = 11) underwent a thoracotomy and CCs were observed. In three mice, IV RL Infusion after cardiac arrest failed to restore CCs and was followed by IA RL infusion. In eight mice, following cardiac arrest intermittent IA RL infusion was performed.

While IV RL Infusion failed to restore chestmotion inmice (N = 5), IA RL infusion restored chestmotion in allmice examined (N = 6) (P = 0.0067). In three mice, IV RL infusion after cardiac arrest showed no effect on CC. After failure of venous infusion, IA RL infusion was performed which resulted in restoration of CC for 13.33 ± 1.76 minutes. In eight mice, intermittent IA infusion of RL after cardiac arrest, sustained CC for 31.43 ± 10.9 minutes (P = 0.017).

IA fluid resuscitation is superior to IV resuscitation in hemorrhagic shock induced cardiac arrest.

A hospital emergency incident command system is one of the most reliable and popular organizational methods for disaster and emergency management.

The aim of the present study was to assess the level of disaster preparedness in the emergency department and other selected units of a military hospital in Tehran.

This cross-sectional study was conducted in 2013 and involved 97medical staffmembers from various departments: emergency, management, discharge and transport, camp (security and staff), information and communication technology, training, reception, and human resources. Three instruments were used for data collection: a self-reported questionnaire, unit evaluation checklist, and maneuver evaluation checklist.

The overall mean score for the maneuver checklist was 55.5%. The mean (±standard deviation) score for the questionnaire was 42.02±8.62. The unit evaluation checklist had a score of 165 from a total of 244 possible points and amean percentage of 67.62%. After conducting the maneuver, the hospital staff was reported to have weak performance in evaluating and prioritizing patients for quick release and tracking their conditions.

The present study shows that the selected hospital had a moderate level of preparedness, which is in line with the previous studies. It is recommended that future studies evaluate the effect of education on the disaster preparedness of hospital units

Occupational injuries are considered to be of great concern in all workplaces and industries, especially in the construction field.

The purpose of this study was to determine and analyze the factors contributing to occupational injuries by means of confirmatory factor analysis (CFA).

This developmental analytical study was implemented based on occupational accidents that occurred within a five-year time frame (2009 to 2013) in 13 large Iranian construction workplaces. Modeling and data analysis were conducted by implementing the structural equations model (SEM) and CFA approaches with the use of statistical software IBM SPSS AMOS version 22.0.

The results show that the individual and demographic factor (IDF), organizational factor (OF), H & S training factor (TF), workplace-human factor (WHF), factor related to type of accident occurrence (TAF), H & S risk management system factor (RMSF), and accident time factor (ATF) were considered to be effective and significant independent latent factors in occupational injuries.

Analytical modeling of structural equations with respect to the CFA approach has shown that occupational injuries are due to the combination of underlying indicator variables and different groups of latent factors. Hence, to determine and analyze such injuries, the role of each factor, its underlying components, and its relation with others should be considered, which will make it possible to develop a more structured approach that considers all relevant factors in order to prevent occupational injuries.

Sulfur mustard (SM) has been used as a chemical weapon in some conflicts, and many veterans and civilians have been injured thereby. Pulmonary, cutaneous, and ocular effects of SM have been frequently reported, although it seems that other organs such as the cardiovascular system are probably also affected. There are a number of studies evaluating the cardiovascular impacts of SM. However, these are dispersed and unfocused. In this paper, these studies have been reviewed to draw conclusions about the cardiovascular effects of SM. It seems that there is a probable relationship between SM exposure and cardiovascular toxicity in the long term. It appears that coronary artery diseases especially coronary ectasia and diastolic dysfunction are among the significant cardiovascular abnormalities frequently seen in these patients. Abnormal coronary arteries may occur due to direct endothelial injury by SM, sustained inflammatory status in patients with chronic lung disease, and abnormal mediators of tissue injury and repair or oxidative stressors.

Femoroacetabular Impingement (FAI) means pathological impact between the femoral head-neck junction and the acetabular rim.

The aim of this retrospective study was to analyze Femoroacetabular Impingement (FAI) signs, which can lead to idiopathic hip osteoarthritis, from preoperative radiographs of patients indicated for total hip replacement as compared to radiographs of patients without this indication.

We examined the preoperative anteroposterior (AP) pelvic radiograph, the pincer and cam FAI signs of patients between 45 and 60 years, who had undergone total hip replacement. We examined in the same group, the operated side and the non-operated hips with osteoarthritis (patients group). In the control group we examined the pelvic radiograph of patients without symptoms between 45 and 60 years old (control, group).

In the patient group (215 patients, 313 hips) we noted the signs of FAI in 88% while in the control group (112 patients 224 hips) these signs were found in 8.8% of cases.

In 88% of primary osteoarthritis cases we found FAI morphology on the AP pelvic radiograph, similarly to those found in the bibliography, and we considered naming primary osteoarthritis, secondary osteoarthritis caused by FAI. In the majority of cases, early diagnosis with simple, cheap and easily accessible AP pelvic radiograph with low dose of radiationmay also be warranted

Road traffic injuries (RTIs) impose a significant social and economic burden.

The objective of this study was to estimate the medical costs and economic burden caused by RTI in Iran

The major components included in this study were medical costs, lost output, and indirect costs. Cost components and their values in 2011 were obtained using previous data collected during the study. A general approach that included a consideration of capital was used to calculate the cost of RTIs.

The economic burden of RTIs was estimated to be more than 111,000 billion Iranian rials (IRR) ($4.44 billion USD) in 2011. This cost relates only to the health sector and does not include components such as vehicle damage, lost time in accidents, and the administrative costs of insurance and police services. The estimated cost of RTIs to the health sector was about 2.18% of Iran’s total GDP in 2011.

The medical costs and economic burden caused by RTIs in Iran clearly indicate that injuries should be a significant concern for health policymakers and medical planners.

Strategic planning and objectives at the provincial and local levels should be consistent with the requirements, obligations, and official standards.

In the present study, we sought to assess the health system’s informative documents on disaster management used by the decision- makers.

This was a qualitative research, which utilized content analysis. Seven national documents were selected from 9 national documents on disaster management. Valid checklists and data extraction forms were used for data collection.

Based on the United Nations disaster preparedness (UNDP) protocol, preparedness and mitigation strategies were investigated in national documents. We identified 52 strategies in disaster preparedness and 19 in disaster mitigation. The most mentioned strategies were related to organizational structure, resource planning mobilization, and strategies on evaluation, vulnerability assessment, and disaster response mechanisms.

According to the findings of the present study, more attention should be paid to the mission and vision of the organizations in disaster preparedness. To improve the disaster preparedness measures, more emphasis should be placed on other disaster preparedness strategies such as response mechanisms and information systems.