Bulletin of Emergency And Trauma
Volume:8 Issue: 4, Oct 2020

This study aims to review systematically the association of social determinants of health (SDH) and road traffic deaths (RTD) within scientific literature.

A search strategy was designed and run in EMBASE, PubMed via MEDLINE, Scopus, Web of Science, and Cochrane library. Through title, abstract, and full-text screening, all English original papers (except ecological studies) which studied social determinants of health and fatal injuries were included. Papers which studied association between RTD and the education, income, rural settlement, and marital status were evaluated and the related data was extracted from the full-texts.

Eleven articles out of 7,897 primary results were selected to be included in the study. Among eight papers studied education, seven confirmed a negative association between years of schooling and RTD. Two out of three articles reported no association between income leveland RTD. Among three papers studied rural settlement, two approved a positive relationship between this determinant and RTD. Both articles studied marital status, confirmed an association between this determinant and RTD.

A few papers studied association of social determinants of health (SDH) and RTD. There was an inverse relationship between education and RTD. The evidence for such an association between income, rural settlement, and marital state was scarce. Further investigations are recommended through original research.

The present study aimed at codifying a native model of civil-military coordination (CIMIC) in natural disasters in Iran.

This manuscript is a part of a larger study. The present cross-sectional study was conducted in 2019 using a two-stage Delphi technique. The factors confirmed by the technique were prioritized via a pairwise questionnaire. In doing so, 24 elites and experts in civil-military coordination were presented with the indicators in the course of classic Delphi technique and pairwise comparison. At the end, the nationalized model was finalized by sending the model to ten experts and asking their ideas.

The results obtained from the two rounds of Delphi indicated that 36 coordination factors could be classified into three primary classes of staff, stuff, and system. All factors were confirmed by the experts. Considering the weight of each class, “staff” and “stuff” classes were considered to be the highest and lowest priorities, respectively.

Application of the coordination factors in the context of military and civil organizations leads to a better response to natural disasters. The organizations in charge of responding to disasters should be obliged to apply this model in the highest organizational commitment level as the final goals of disaster management. The results of the present study can be applied for codification of a comprehensive plan for assessing the civil-military coordination in natural disasters.

To compare the differences in the clinical course of acute appendicitis between early elderly (60-79 years) and late elderly patients (≥80 years).

The sample consisted of 177 patients aged over 60 that underwent surgery at the emergency service with the diagnosis of acute appendicitis between January 2010 and May 2018. Patients’ data were retrospectively obtained from electronic records. Patients that had undergone appendectomy or negative appendectomy or had an appendix tumor were excluded from the study. The patients were divided into two groups by age; early elderly (60-79 years) and late elderly (≥80 years).

Of the 177 patients included in the study, 162(91%) were 60-79 years old and 15 (9%) were over 80. A statistically significant difference was found between the early and late elderly groups in terms of perforation, requirement for intensive care (p =0.001), red cell distribution width (p =0.025), the Clavien-Dindo classification (p =0.020), and the Charlson comorbidity index (p =0.005). The mean hospital stay was four and 11 days for early and late elderly groups, respectively. Multivariate analysis revealed that age alone was an independent factor with a statistically significant effect on mortality (OR=Odds Ratio: 53, 95% CI: 16.91-166.08; (p <0.001)).

In particular, in the elderly patients over 80 years old, the clinical manifestation of acute appendicitis at hospital admission is in the form of perforation. Therefore, in this age group, a careful, precise and prompt diagnosis is crucial.

Pedestrians are road users vulnerable to traffic injuries and fatalities. This study aimed to develop and validate a pedestrian behavior questionnaire to be used in Iran.

In this cross-sectional study, the initial questionnaire was designed based on the evaluation of previous studies conducted world-wide or in Iran. The initial pack included 127 items. After the assuring the face validity of the questionnaire, 27 experts’ opinions in the field of traffic was obtained for assessing/improving the content validity. To test the reliability of the questionnaire, the test-retest method and internal consistency assessment were used. To evaluate the structural validity, the Exploratory Factor Analysis (EFA) using the principal component and the Varimax rotation was applied.

After completing the face validity and after summarizing the experts’ suggestions, 12 questions were deleted. By calculating the content validity ratio and coefficient, 20 and 17 were removed. Also, the average content validity coefficient regarding relevancy, clarity and overall average were 0.86, 0.88, and 0.87, respectively. The Cronbach’s alpha coefficient was 0.84. In the last stage and according to the results of the factor analysis, five factors violations, distraction, positive behaviors (group1), positive behaviors (group2) and Aggressive behaviors) were identified from the 29-items questionnaire, which explained 98% of the total variance.

Considering the necessity of using a verified and validated tool for planning and evaluating effective interventions for pedestrians is inevitable. The tool designed in the study was found to be valid and reliable for use to measure pedestrian’s behavior and planning to modify high-risk behaviors and enhance safe pedestrian behaviors.

The aim of the present study was identifying factors associated with h delayed initiation of post-exposure prophylaxis (PEP) among animal bite victims.

This cross-sectional study assessed biting patterns among 3032 cases that were referred to Tabriz Rabies Center. The delay was described as the initiation of PEP more than 48 hours (h) after possible exposure to the rabies virus. Determinants of delay in initiating PEP were recognizing by a decision tree model.

Totally, 8.5% of the victims who were bitten by an animal had a delay of more than 48 h in the initiation of PEP. The relative frequency of delay more than 48 h in females was higher than the males (12.9% compared to 8.5%) (p-value= 0.004). Relative frequency of delay more of 48 h from carnivorous (dog, jackal, fox) was significantly less than others (p -value< 0.001). Of the decision tree, the overall classification accuracy was 89.5%, with 44.1% sensitivity and 92.3% specificity. The identified variables included gender,biting place (rural, urban), and type of animal.

Based on the study findings on various variables that affect the delayed initiation of PEP, particularly being female, and rural residents were the major factors associated with a delay in the initiation of PEP for rabies prevention. We found relatively low rates of vaccine completion. Our findings indicate that provider training and patient education are required to ensure the completion of appropriate treatment.

This study investigated the existence of anxiety and depression mediating effect on the relationship between PTSD and aggression in the hope of providing more comprehensive and effective trauma treatment in motor vehicle accident.

The studied population of the study consisted of motor vehicles with posttraumatic stress disorder in Kashan. Three questionnaires of post-traumatic stress disorder, Hospital Anxiety and Depression Scale (HADS) and Aggression Questionnaire (Buss & Perry, 1992) were used for data collection. In order to analyze the mediating effects of anxiety and depression on the relationship between PTSD and aggression, structural equation modeling(SEM) was performed with the maximum likelihoodratio as the method of estimation.

Evaluation of the research hypothesis model using fitness indices showed that the hypothetical model fits with the measurement model.  NFI=0.96, CFI =0.95, RMSEA=0.06 and the results showed that PTSD had indirect exacerbating effects on aggression. The results also confirmed the mediating role of anxiety and depression in the relationship between post-traumatic stress disorder and aggression in motor vehicle accident.  

The findings demonstrate that anxiety mediates the relationship between PTSD and aggression. Therefore, this finding can help to prioritize therapeutic goals and determine therapeutic focus for mental health professionals. It is possible to reduce one's aggression by focusing on his anxiety and increasing his/her ability to handle and manage it.

Pancreatic injury in paediatrics is a rare condition and can be difficult to diagnose. The diagnostic challenge is due to its symptom of vague abdominal pain which usually results in late presentation. Elevated biochemical markers such as amylase and lipase can aid in the evaluation of pancreatic injury, however, it is not specific and is only evident after several hours of trauma. Ultrasound is commonly used as a primary modality to evaluate abdominal organ injuries, but its role in detecting pancreatic injury is limited due to low sensitivity. High index of suspicion is needed to avoid undiagnosed pancreatic injury which could be lethal to children. We herein report a case of delayed presentation of isolated pancreatic tail injury in a child who was sufficiently diagnosed with ultrasound and treated conservatively. Proper initial assessment and diagnosis will allow appropriate management of pancreatic injury. Conservative management should include serial imaging to look at the evolution of pancreatic injury and detect complications such as pseudocyst or abscess formation.