Trauma Monthly
Volume:22 Issue: 1, Jan-Feb2017

The functional independence measure (FIM) is a practical tool for the evaluation of motor and cognitive independence, which has been validated in different languages; its Persian version has not been studied so far.

In this cross-sectional study, the validity, reliability, and replicability of FIM for Iranian patients with traumatic brain injuries (TBIs) were determined. Patients and

Forty patients with acute TBI that were hospitalized in emergency ward for evaluation of inter-rater reliability for the test replicability and 185 sub-acute TBI patients that were in the neurosurgery ward of Poursina educational hospital in Rasht were selected in the assessment of other psychometric indices by the consecutive sampling method. The tests used include the FIM for measuring motor and cognitive functioning, the Barthel Index for measuring physical disability, the mini mental state examination (MMSE), and questions on the physical dimension of quality of life in the short form health survey (SF-36) were used. Statistical analyses were performed using Intraclass correlation coefficient (ICC), Cronbach’s Alpha and Pearson correlation coefficients, independent t-tests, and hierarchical regression analyses.

The inter-rater reliability was acceptable on admission and at discharge (ICC = 0.779 to 0.895). The internal consistency of FIM and its subscales were excellent (α ≥ 0.97). The results for criterion validity by adjusting the values of GCS on admission and at discharge showed that the FIM motor dimension could predict a significant proportion of the variance of Barthel index scores; and the physical health components of quality of life and overall physical component of SF-36 (PCS) and FIM cognitive dimension could predict a significant proportion of the variance of MMSE scores (all P < 0.05). FIM and its subscales were correlated with the above variables in expected directions (all P < 0.01). In known-groups validity, patients with physical trauma and cognitive impairment obtained lower motor (t = 2.09, P = 0.038) and cognitive (t = 3.36, P < 0.0001) FIM scores compared to the groups with no physical trauma or cognitive impairment.

This Persian version of the FIM can be used as a valid, reliable, and replicable instrument for research and rehabilitation purposes in TBI patients

Using subjective tools for pain assessment is essential, but may confuse healthcare professionals in some clinical situations. It is also useful to assess pain severity objectively. Several observational pain scales have been developed, but they are mostly for intensive care units and not for the emergency department (ED).

The purpose of the present study was to compare the verbal rating scale (VRS) and Nonverbal Rating Scale (NVRS) in the determination of pain severity in patients with limb trauma, in the ED of a general hospital in Kashan, Iran, in 2014.

This observational, prospective study was conducted on 450 traumatic patients admitted to the trauma ED of Shahid Beheshti Hospital in 2014. The tool used in this study consisted of three parts: demographic data, VRS, and NVRS scores at 7 time points, from arrival until 4 hours. The statistical analysis was conducted using the two-tailed Student’s t-test, Mann-Whitney U test, Pearson correlations, and repeated measures. The data analysis was conducted using SPSS software, version 16.

The average age of the participants was 35.2 years, and the extremities were the most common painful area (66.2%). The mean VRS and NVRS pain intensity ratings upon arrival were 6.16 (± 2.63) and 3.06 (± 2.17), respectively. The estimation of pain was lower in the NVRS when compared to the VRS, and the scores in these two tools showed a significant correlation. One-hundred and seventy-two of the patients received interventions for pain relief; 60 patients received analgesics and 112 patients (24.8%) received non-pharmacological interventions, such as stabilization of the injured extremity.

This study indicated that the modified version of the adult NVPS in step with the VRS is a useful tool for pain intensity assessment in the ED.

Lung herniation following blunt chest trauma is extremely rare and only a few hundred cases of this pathology have been reported in the English language medical literature. This type of lung hernia is divided into intercostal, parasternal, or supraclavicular subtypes based on the exact location of the chest wall defect. Traumatic intercostal lung hernia is even more uncommon. Delayed presentation of a traumatic lung hernia has been reported in two cases in the medical literature where cases had a delayed presentation of 2-29 days.

We present a case of 72-year-old white male who had a delayed presentation of an intercostal post traumatic lung hernia (PTLH) 50 years after severe blunt chest trauma.

This is a rare case of a delayed presentation of a traumatic intercostal lung hernia. Based on our literature search, this case seems to be the first reported case with such a long delay prior to presentation. We suggest that in patients with even a remote history of blunt chest trauma, a physical examination and preoperative evaluation including assessment for possible PTLH be considered before patients undergo positive pressure ventilation. We also suggest that PTLD be considered in the differential diagnosis for patients with blunt traumatic chest injuries and rib fractures.

Major trauma is a leading cause of death, particularly amongst young patients. New strategies in management are needed to improve the poor outcome of severe trauma. We report our initial experience with extracorporeal life support (ECLS) as a rescue therapy in severe multiple trauma patients with refractory cardiopulmonary failure.

The purpose of this study was to identify the pre-ECLS patient characteristics predicting appropriateness ECLS treatment.

From December 2008 to May 2013, 420 multiple trauma patients were treated at our tertiary level referral trauma center. Our ECLS team was alerted on 35 and applied ECLS in 20 adult trauma patients. In 16 patients with cardiopulmonary failure with refractory shock, we adopted a veno-arterial ECLS; in 4 patients with isolated refractory acute respiratory failure, we used venovenous ECLS.

ECLS was initiated at a mean of 324.15 ± 197.8 (110 - 950) min from initial trauma. In 4 patients, ECLS treatment failed due to an incapability to maintain adequate ECLS flow and patient perfusion. In the other 16 patients efficiently supported by ECLS, the Cardiac Index, mean arterial pressure, lactate concentration, PaO2, PaCO2, and pH showed significant improvement with normal values reached at 3.2 ± 1.5 hours. Seven (43.7%) patients in the ECLS-Success Group donated organs, 2 patients (22.2%) died due to septic multi organ failure (MOF), and 7 (77.7%) patients were discharged from the hospital. ECLS was suitable and successful in patients with a significantly lower injury severity score, lower blood lactate level, lower number of blood units given, and significantly higher pH and Hb.

From our data, ECLS seems to be a valuable option to resuscitate severe trauma patients when conventional therapies are insufficient: it is safe, feasible and effective in providing hemodynamic support and blood gas exchange. Our data permitted us to identify strong predictors of ECLS non-suitability and success in multiple trauma patients; these might be helpful in deciding whether ECLS should be used or not. Future improvements in materials and techniques are expected to make ECLS even easier and safer to manage, leading to a further extension of its use in disastrously injured patients

Fatigue may lead to occupational physical trauma among the workforce.

This study was designed to explore the relationship between work-related physical trauma and fatigue in the copper extraction industry.

This cross-sectional study was conducted among 453 male workers employed in the copper extraction industry in Kerman, Iran. The validated Persian version of the Piper Chronic Fatigue Scale was used for the data collection. An additional self-administrated questionnaire was prepared to obtain demographic and occupational data, including age, work experience, smoking, and history of physical trauma in the workplace.

The results showed that 28.5% of the participants had experienced work-related physical trauma during the past three years. Severe fatigue was most commonly reported on the subscale for life and emotions (14.79%). A higher rate of work-related fatigue was associated with physically strenuous activities and an inappropriate work place. The mean fatigue scores for subjects both with and without physical trauma experiences were 3.75 ± 0.98 and 2.86 ± 0.79, respectively (P = 0.005).

General fatigue and its subscales had a significant relationship with workplace physical trauma amongminers. Workplace physical trauma can be reduced bymanaging fatigue with different programs, including decreasing the workload, scheduling rest breaks at the facilities, and possibly providing welfare and entertainment opportunities for the workers.

This study was performed to evaluate the results of finger lengthening following traumatic amputation or congenitally short phalanges, metacarpal bones, ormetatarsal bones using a new callus distraction device. The device is simple, light, cheap, reliable, and easy to use.

The study group consisted of 246 patients (108 females and 138 males) who had short bones in their hands or feet. The mean (± SD) age of the patients was 23 ± 8 years (4 - 37 years). In the study group, 68.2% of the patients had previously undergone traumatic amputation of fingers or toes. The mean follow-up time of the patients was 7 ± 1.5 years.

The mean metacarpal, phalangeal, and metatarsal length before surgery was 28 mm (19 - 35 mm). The mean lengthening after surgery was 18mm (13 - 29mm; more than 64% lengthening). Themean healing index ratio (HIR) was 3.88mm/d. No bone grafts were required after bone lengthening. Complications included pin tract infection in 5 (2%) cases, scar formation in the dorsum of the finger in 19 (7.7%) cases, neuronal damage in 3 (1.2%) cases, reversible joint stiffness in 23 (9.3%) cases, and bone malalignment pain in 29 (11.7%) cases.

Callus distraction is an effective and reliable method for lengthening short phalangeal, metacarpal, and metatarsal bones. It also preserves periosteal tissue. Our distractor is reliable, cheap, lightweight, user friendly, and highly effective for callotasis

Zygomatic arch fractures are common injuries in the maxillofacial injuries. Sometimes it is necessary to fix the unstable fragments of the zygomatic arch.

We introduce a combination of transconjunctival and lateral canthotomy for open reduction and percutaneous access for rigid fixation of the arch in the zygomatic maxillary complex (ZMC) fracture in a 44-year-old man.

This approach may be an appropriate approach to the zygomatic arch in the ZMC fractures and eliminates the use of the coronal flap.

Occupational accidents represent one of the major problems in developing and developed countries. Deaths caused by occupational accidents result in loss of life, lost working hours, and related costs. These accidents create a lot of waste for the community and labor organizations. Moreover, they result in socioeconomic losses such as disability, loss of work time, and increased medical care expenses.

Despite the existence of extensive studies, a practical method for calculating the cost of accidents is still not clear; consequently, the aim of the present study is to provide a new framework for the calculation of the (direct and indirect) costs of accidents in construction.

In this paper, the cost of accidents in the construction industry in Tehran, Iran in 2013 were calculated using a new, structured, six-step approach. First, the results were classified into five groups according to the intensity of accident, as follows: 1, short-term absences; 2, long-term absence; 3, small inability; 4, total disability; and 5, death. Moreover, the six following groups of imposed costs were identified: 1, production disturbance costs; 2, human capital costs; 3, medical costs; 4, administrative costs; 5, transfer costs; and 6. other costs. These groups were classified according to the direct or indirect costs resulting from the incident and the costs imposed on workers, employers, and society. Finally, the data were analyzed using statistical tests.

Significant proportions of the cost of construction accidents involve production disturbance costs, human capital costs, medical costs, administrative costs, transfer costs, and other costs. The highest cost is imposed on the community and employee, with the least being imposed on employers. Much of the cost of accidents relates to total disability ($ 4,260,000) and partial disability ($ 3,270,000); meanwhile, the lowest costs are associated with death ($ 1,800,000), long-term absences ($ 1,960,000), and short-term absences ($ 840,000). A significant difference was seen between the type of cost (e.g., production disturbance cost, human capital costs; P = 0.0001). Statistical analysis of the direct and indirect costs of accidents indicated a significant difference (P = 0.019). Moreover, a significant difference was seen between the cost of accidents resulting (P = 0.005).

Accidents resulting in death, total disability, and partial disability impose a huge cost burden on society, whereas the employer will bear a relatively low cost. This is because of society’s health, treatment, and welfare systems available for treatment and rehabilitation of injured employees and their families.

Femoral neck fractures (FNF) are a challenging orthopedic problem, and their appropriate treatment remains controversial. Nowadays, bipolar hemiarthroplasty (BHA) is increasingly used to treat FNF.

In the current retrospective study, we investigated the outcomes of treating FNF with BHA.

There were 55 patients with FNF enrolled in the current retrospective study. The variables measured were mortality in the first postoperative year, returning to the pre-injury activity level, the harris hip score (HHS) and pain intensity based on a visual analogue scale (VAS) at the last visit. The correlation between a delay in surgery, and mortality and HHS were investigated.

Sixteen patients died within the first postoperative year (29%). HHS and VAS averaged 83.5±15.5 and 0.7±0.9, respectively. Patients who achieved good or excellent outcomes were 72% and 74% returned to their previous activity level. Of the study group, 95% of patients ambulated with or without using assistive devices. Although we found no significant correlation between delay in surgery, and mortality or HHS, HHS decreased with increased time interval between injury and surgery.

The rate of mortality in the first postoperative year was high; however, functional outcomes were satisfactory. Most of the patients could return to their previous activity levels. In the current study, we found no significant correlation between delay in surgery, and mortality at the first postoperative year and HHS.