Bulletin of emergency and trauma最新文献

Objective: This study explored the underlying reasons for non-compliance with seatbelt usage among rear-seat passengers in Iran.

Methods: This qualitative study was conducted in 2023 with a diverse group of participants, including driving instructors, drivers, psychologists, rear-seat passengers, and experts in the field of traffic accidents and driving from Tehran, Khuzestan, and Golestan (n=39 persons). Data were collected through semi-structured interviews and focus group discussions and analyzed using conventional content analysis. The interviews, which lasted between 40 and 90 minutes, were recorded using two digital recorders, transcribed verbatim, and analyzed following the conventional qualitative content analysis method.

Results: The findings revealed several factors contributing to the non-use of rear seatbelts, including lack of sufficient awareness of laws and regulations, incorrect behavioral and cultural attitudes, socio-economic influences factors, inadequate law enforcement and related organizations, and poor quality of seatbelts. Based on these findings, potential solutions were proposed, such as continuous education and awareness campaigns, improvements in seatbelt quality, and enhanced collaboration among relevant organizations to promote traffic safety culture. Education on the importance of seatbelt use should begin comprehensively in early childhood and continue into adulthood, with families playing a pivotal role in fostering this awareness.

Conclusion: This study identified key factors influencing the non-use of rear seatbelts, including awareness of laws, cultural attitudes, socio-economic influences, and seatbelt quality issues. To address these challenges, the study recommended prioritizing ongoing education on seatbelt use, improving the quality of seatbelts, and fostering collaboration among traffic police, media, and educational institutions. These measures aimed to enhance traffic safety, increase compliance with seatbelt laws, and ultimately reduce fatalities and injuries resulting from road accidents.

Objective: This study aimed to investigate the incidence and risk factors for surgical site infection (SSI) following appendectomy.

Methods: This retrospective cohort study examined the records of 180 patients who underwent appendectomy in Emam Khomeini Hospital from January 2021 to December 2022. The research tool included a demographic profile form and a research checklist. After obtaining the ethical approval from the university, the researcher visited the hospital and extracted the required data from the patient's clinical file (in accordance with the research checklist). Then, the collected data were entered into SPSS software (version 21) for data analysis.

Results: Of the 180 patient records included in the study, 28 (15.6%) developed SSI. The descriptive analysis revealed that among the patients with SSI, 19 patients were men (67.9%), 18 (64.3%) had a low BMI, 8 (28.6%) had blood type A^-, and 19 (67.9%) patients had a fever below 38 °C. Regarding clinical symptoms, 1 (3.6%) patient had gangrenous appendicitis, and 22 (78.6%) required urgent surgery. Notably, no significant risk factors for SSI were identified. There was no association between SSI status and demographic variables, clinical symptoms, or underlying conditions (p>0.05).

Conclusion: The incidence of SSI following appendectomy was relatively higher than in previous studies, though no significant risk factors were identified. Given this, standardization and adherence to evidence-based infection control practices, such as an appropriate preoperative antiseptic preparation, timely administration of prophylactic antibiotics, and the use of laparoscopic techniques when feasible, might help reduce SSI risk.

Objectives: This randomized controlled trial aimed to evaluate the effect of pre-extubation intravenous lidocaine (1 mg/Kg) on the incidence of airway complications and hemodynamic stability in patients undergoing emergency laparoscopic cholecystectomy, while accounting for age differences.

Methods: The study was a prospective, single-center, randomized controlled trial conducted from 2021 to 2023 at Imam Khomeini Hospital, Ilam, Iran. Ninety patients undergoing emergency laparoscopic cholecystectomy were classified into two age groups (<50 and ≥50 years) and randomly assigned to receive either intravenous lidocaine (1 mg/Kg) or a standard extubation protocol. The primary outcomes included post-extubation airway complications, such as laryngospasm, cough, and sore throat, and the secondary outcomes included hemodynamic and respiratory parameters.

Results: Lidocaine produced hemodynamic effects that differed by age group. In patients <50 years, systolic blood pressure (SBP) increased from 129.2±16.4 mmHg to 133.1±23.1 mmHg, while diastolic blood pressure (DBP) rose from 83.9±14.4 mmHg to 92.3±19.4 mmHg (both p<0.001). Conversely, in patients ≥50 years old, SBP decreased from 160.5±26.7 mmHg to 145.2±19.7 mmHg, and DBP decreased from 107.9±19.5 mmHg to 99.0±16.1 mmHg (both p<0.001). Airway complications exhibited non-significant tendencies, with a decreased incidence of cough in the older age group (15.6% vs. 31.8%) and an absence of laryngospasm in this age group. There were no serious adverse events (e.g., bronchospasm, arrhythmias).

Conclusion: Intravenous lidocaine was safe and demonstrated a trend toward reducing airway complications at extubation in patients undergoing emergency laparoscopic cholecystectomy, particularly in elderly patients. However, this trend did not reach statistical significance, most likely due to insufficient statistical power.

Marin-Amat syndrome is a rare form of facial synkinesis resulting from aberrant connections between the trigeminal and facial nerves. This condition manifests as involuntary eyelid closure upon voluntary jaw movement. It is distinct from the more common Marcus Gunn jaw-winking syndrome (MGJWS), which involves upper eyelid elevation during mastication. Here, we reported a case of a 64-year-old woman who developed this syndrome following combat-related maxillofacial trauma to the lateral mandible, which resulted in a left facial nerve injury. After her mandibular fractures were stabilized using 2 mm plates, her medical history was notable only for hypothyroidism. Six months post-injury, and following an attempted free fibula flap procedure, the patient began experiencing involuntary facial movements. These symptoms caused significant social discomfort and difficulty with eating. Treatment options, including botulinum toxin and surgery, were discussed; however, the patient opted for a conservative management approach.

Objective: The primary outcome was the management of acute agitation, as measured by the Richmond Agitation-Sedation Scale (RASS). Secondary outcomes included the incidence of adverse effects and the time to onset of the therapeutic effect.

Methods: This randomized clinical trial was conducted between March 2021 and March 2022. Participants were recruited from patients presenting with acute agitation who required pharmacological intervention at Emam Reza and Shahid Hasheminejad hospitals (Mashhad, Iran). Eligible participants were adults aged 18 to 65 years. Using a block randomization method with a block size of four, patients were assigned to receive either 5 mg of intravenous (IV) haloperidol or 2 mg/Kg of IV ketamine. Data were analyzed using SPSS software (version 22).

Results: A total of 120 participants were randomized. The majority were male, comprising 43 (73%) in the haloperidol group and 45 (75%) in the ketamine group. The mean age was 45.42±16.65 in the ketamine group and 48.28±16.75 years in the haloperidol group (p=0.34). In the haloperidol group, the mean admission RASS score was 1.73±0.75, which decreased to 0.07±1.25 post-intervention. In the ketamine group, the mean admission RASS score was 1.58±0.61, which improved to -0.92±1.19 following treatment.

Conclusion: Ketamine demonstrated a faster onset of action in managing acute agitation than haloperidol. These findings suggested that ketamine might represent a viable first-line therapeutic option for acutely agitated patients, particularly in clinical scenarios where rapid symptom control is critical.

Objectives: Intertrochanteric femur fractures are prevalent injuries among the elderly, significantly affecting their quality of life (QOL) and functional status. This study aimed to evaluate functional outcomes and QOL in elderly patients one year after sustaining an intertrochanteric femur fracture.

Methods: This retrospective observational study was conducted at Shahid Beheshti Hospital in Kashan, Iran. The functional status and QOL of 79 elderly patients with intertrochanteric femur fractures, who were at least one year post-injury were assessed between February 2020 to February 2021.Data were collected from patient's records, which included sociodemographic and clinical information at the time of admission. Functional status was evaluated using the Barthel Index, and QOL was assessed using the shortened form of the SF-36 questionnaire.

Results: The study population comprised 60.8% women, with a mean age of 79.81±7.07 years. The mean of the Barthel index score was 11.49±2.22, indicating that participants achieved approximately 60% of the maximum functional score. The mean overall QOL score was 50.59±9.54, suggesting that patients attained approximately 51% of the maximum QOL score. A final linear regression model indicated that increased age was significantly associated with declines in both functional abilities (R²=0.53, p<0.001) and QOL (R²=0.39, p<0.001). Additionally, patients who received physiotherapy demonstrated significantly better functional outcomes than those who did not.

Conclusion: This study highlighted the significant impact of intertrochanteric femur fractures on the functional status and QOL of older adults. The findings emphasized the critical role of rehabilitation services, such as physiotherapy, in improving patient outcomes. Further research is warranted to explore the influence of comorbidities and optimize interventions for this vulnerable population.

Objectives: This study aimed to systematically review and quantify the association between D-dimer levels and injury outcomes in trauma patients through a meta-analysis.

Methods: A systematic literature search of PubMed, MEDLINE/PubMed, and Web of Science was conducted from 2011 to 2023, supplemented by manual reference list searches. Two independent reviewers assessed the risk of bias using the Newcastle-Ottawa Scale. The primary outcomes were mortality and deep vein thrombosis (DVT).

Results: Of 84 identified articles, 17 were eligible for full-text assessment, and 12 were included in the final analysis. A random-effects model was used to pool the study results. The analysis revealed a statistically significant difference in mean D-dimer levels between patients with poor outcomes and those without poor outcomes (p=0.0003). The standardized mean difference (SMD) was 0.51 (95% confidence interval [CI]:0.24 to 0.79). Furthermore, a significant difference in mean D-dimer levels was observed between survivors and non-survivors (p=0.03, SMD:0.42, 95% CI:0.04-0.79) and between patients with DVT and those without DVT (p=0.0008, SMD:0.79, 95% CI:0.32-1.25).

Conclusion: This meta-analysis indicated that elevated D-dimer levels upon admission could be a valuable prognostic marker in trauma patients and might help predict poor outcomes.

Suicidal cut-throat injuries are rare in Indian society, as reported by the National Crime Records Bureau (NCRB). However, during the COVID-19 pandemic, a significant rise in unemployment among Indian youth led to increased psychological distress and depression, contributing to a surge in suicide cases, including those presenting with cutthroat injuries in emergency departments. This study reported two distinct cases of suicidal cutthroat injuries, both involving young individuals who were unemployed during the pandemic and suffered from underlying psychiatric disorders. Both patients presented with severe neck injuries, requiring immediate and complex intervention. Their conditions were further complicated by the psychological trauma associated with their mental health disorders. The management of these cases required a multidisciplinary approach, involving emergency medical care, surgical intervention, and psychiatric support. Both patients received prompt attention and stabilization, followed by psychological counseling and long-term psychiatric care. Their recovery was closely monitored, with a focus on addressing the root causes of their distress. These cases highlighted the increasing incidence of suicidal cutthroat injuries during the COVID-19 pandemic and emphasized the need for a comprehensive, multidisciplinary approach to managing both the physical and psychological aspects of such critical situations. This report underscored greater attention to mental health, particularly among the unemployed youth during crises.

Objectives: Severe burns often result in significant intravascular albumin loss, leading to hypoalbuminemia. This study aimed to evaluate the association between serum albumin levels and clinical outcomes in burn patients.

Methods: A retrospective, single-center study was conducted at Velayat Hospital (Rasht, Iran), including burn patients aged ≥16 years, who were admitted between April 2019 and March 2020. Serum albumin levels were recorded on day 1, day 7, and at discharge. The main variables analyzed included albumin levels, length of hospital stay, skin graft rate, need for mechanical ventilation, and mortality.

Results: Among the 74 patients included in the study, 14 (18.9%) died, while 60 (81.1%) survived. The mean serum albumin levels on days 1, 7, and at discharge were significantly higher in survivors (3.09±0.22, 3.12±0.23, and 3.18±0.28 g/dL, respectively) than non-survivors (2.22±0.29, 2.74±0.29, and 2.07±0.69 g/dL, respectively) at all time points (p<0.001). The serum albumin level measured on day 1 was significantly lower in patients who required mechanical ventilation than in those who did not (2.86±0.47 vs.3.09±0.13, p=0.03). Additionally, a significant inverse relationship was observed between serum albumin levels and both total body surface area burned (TBSA) and graft extent (day 1: r_s=-0.76, day 7: r_s=-0.74, discharge: r_s=-0.62; p<0.001 for TBSA; and day 1: r_s=-0.59, day 7: r_s=-0.58, discharge: r_s=-0.50; p<0.001 for graft extent).

Conclusion: Hypoalbuminemia was associated with poor clinical outcomes in patients with severe burns. Serum albumin levels might serve as a specific marker of burn severity and a predictor of mortality.

Objective: Allergic respiratory and pulmonary emergencies, though uncommon, represent a potentially lethal risk in dentistry, and anaphylaxis is the cause of a significant percentage of perioperative allergic reactions. If left uncorrected, it increases the mortality rate.

Methods: Systematic review according to PRISMA guidelines with a literature search in PubMed, Scopus, Web of Science, Cochrane Library, and Embase (2000-2025). 47 studies were considered for analyzing allergens, treatment protocols, and preventive interventions. Data synthesis and extraction were conducted, and study quality was assessed using standardized tools.

Results: Local anesthetics (such as lidocaine), latex, antiseptics (such as chlorhexidine), and dental materials (such as methacrylates) were identified by the review to be the most common allergens responsible for respiratory allergic emergencies. IgE-mediated reactions (such as anaphylaxis) were demarcated from non-IgE-mediated reactions, and epinephrine was revealed to be the drug of choice for first-line use in anaphylaxis. Preoperative allergy screening, premedications, and material substitution were proven to be preventive measures. Reasonable gaps in the training and preparedness of dental personnel to manage allergic emergencies were identified.

Conclusion: Even though there are effective emergency protocols available, widespread implementation of universally standardized response procedures, mandatory simulation training, and enhanced preoperative risk assessment is overdue if patient safety is to evolve.