Bulletin of emergency and trauma最新文献

Spontaneous heterotopic pregnancy is a potentially life-threatening condition rarely considered when a patient with an intrauterine pregnancy is asymptomatic or presents with complaints such as abdominal pain. An advanced abdominal pregnancy is even more unusual as the form of the ectopic component outside the context of assisted reproduction and is difficult in diagnosis with very few cases reported in the literature. We report such a case in a 31-year-old primigravida with heterotopic pregnancy which is a fetus in the uterine cavity and the other in the abdominal cavity. Her pregnancy was initially misdiagnosed and managed as a di-amniotic di-chorionic gestation. The correct diagnosis was only made after term delivery of the intrauterine pregnancy. The patient was complicated with severe bleeding which led to disseminated intravascular coagulopathy and massive transfusion. Two other operations were imposed on the patient because of bleeding. The clinical risk factor for ectopic pregnancy was only previous pelvic inflammatory disease in this woman.

Objective: To investigate the quality of life (QOL) of injured motorcyclists and associated factors in a period of three months after the accident.

Methods: In the present study, we were included 190 injured motorcyclists who admitted to two referral specialized hospitals (Emam Reza and Shohada) in Tabriz, between June 2018 and January 2019. All injured motorcyclists were contacted through the telephone one and 171 of them (90%) three months after their accident to complete an EQ-5D-3L questionnaire. The baseline measurements were gathered by using face to face interviews in the hospitals. The QOL score could vary between 1 and 3. The higher score showed a lower QOL.

Results: The injured motorcyclist's QOL score was relatively better in three months after the accident (mean±Standard Deviation (SD): 1.78±0.51) in comparison with their status a month after the accident (2.15±0.65) (p<0.001). The multivariable model showed that individuals with pelvis injuries (Coef: 0.29, (95% CI: 0.16, 0.42), p=0.001) and knee injuries (Coef: 0.26, (95% CI: 0.10, 0.42), p=0.001), experienced a higher QOL score. Also, those whose accident had happened in rainy weather experienced higher QOL score (Coef: 0.33, (95% CI: 0.12, 0.53), p=0.001). The patients who were in an accident with a vehicle were experienced a better QOL than others (Coef: -0.26, (95% CI: -0.43, -0.09), p=0.002).

Conclusion: The assessment of three-months post-accident showed that the QOL score of the motorcyclists was reduced. It is recommended that the QOL of patients should be improved in hospital discharge victims.

Objective: To investigate the prevalence of chemical burns among the patients admitted to Shiraz burn treatment centers.

Methods: It is a descriptive study that was conducted on 62 patients with chemical burns who were admitted between 2008 and 2018. The patients' records were used in the research using the census sampling process. A questionnaire with questions about age, sex, the extent of the burn, the cause of the burn, duration of hospital stay, level of education, incident location, and clinical outcome was used to collect data (survival-death). The data was analyzed by using descriptive statistical methods.

Results: The prevalence of chemical burns was 1% during 2008-2018. Acid and alkali burns were accounted for 93.5% and 6.5% of burns, respectively. 77.4% of patients were male, and 22.6% were female. The mean age of patients was 27 years. The average burn percentage was 16%. 70.6% of patients were illiterate or had primary education. Burns occurred at the workplace and home in 12.9% and 66.1% of cases, respectively. Moreover, Burns occurred due to accident (61%), acid attack (29%), and self-immolation (10%). The average length of hospital stay was 20 days. One patient (1.6%) died from burns.

Conclusion: The study's findings revealed that chemical burns were more common in men than women, and the majority of chemical burns occurred at home. To minimize the occurrence of chemical burns and acid attacks, teaching methods of preventing burns is important at home and work, as well as restricting non-specialists' access to chemicals.

Objective: To review the cost-effectiveness of multifactorial interventions to prevent falls in elderly people.

Methods: In this systematic review, the databases including PubMed via MEDLINE, Web of Science, Embase, Scopus, Cochrane Library and Google Scholar (from 1st January 2000 to 30^th February) were used. All pre-reviewed articles related to cost-effectiveness analysis of multifactorial interventions to prevent falls in elderly were included in this paper and congresses abstracts were excluded. Descriptive statistics were used for quantitative data and content-analysis method to analyze qualitative data.

Results: Out of the 456 articles, 19 were finally included in the study. Eighteen articles were conducted in High-Income Countries (HICs) and 16 were at the community level. Medical visits consultation and education were the most common interventions. Most studies were cost-effectiveness and using the Randomized Control Trial (RCT) methods. A fall of prevention costs ranged from $ 272 to $ 987. Incremental Cost-Effectiveness Ratio (ICER) interventions also ranged from the US $ 120,667 to the US $ 4280.9.

Conclusion: The results show that despite the high effectiveness of multifactorial interventions to prevent elderly falls, the cost of the interventions are high and they are not very cost-effective. It would be better to design and implement multifactorial interventions with low cost and high effectiveness that are appropriate for each country.

Objective: To investigate the radiological and clinical outcomes of different surgical approaches in cervical spinal trauma in northeastern of Iran.

Methods: The present study was conducted retrospectively from January 2011 to December 2017 in Mashhad, Iran. The demographic characteristics, hospitalization duration, and patient's surgery detail data were extracted from the patients' medical records. The follow-up period was at least six months after surgery.

Results: This study was conducted on 72 patients and the majority (n=51; 70.8 %) of them were male. Moreover, the participants; mean age was determined at 40.7±16.5 years. In total, 33 (45.8%), 13(18.1%), and 11 patients (15.3%) were operated using the anterior, posterior, and combined approaches in one round, respectively. It should be mentioned that 15 (20.8%) patients underwent the combined approach in two rounds. Early mortality was observed in 22 (30.6%) patients in the admission period. According to the follow-up X-ray results, the type of approach showed no relationship with non-fusion, malalignment, cage subside, and adjacent disk narrowing (p>0.05).

Conclusion: According to the obtained results, there was no significant association between neurological and radiological outcomes among approaches. A high mortality rate was noted in combined surgery at one round, and the posterior approach is the best option when our goal is to correct lordosis.

Objective: To assess the patient's satisfaction rate during two distinct registry procedures in the emergency department.

Methods: A cross-sectional study was conducted in educational hospitals with a high volume of patient's admission in Tabriz-Iran and Erzurum-Turkey. In this study, we used a Press Ganey questionnaire as a data collection tool that was filled out with patients or their companions before discharging or referred to other areas (wards). Finally, data were analyzed by using SPSS software version 16.

Results: The included patients were from three-admission time courses includes morning, evening, and night shifts. The present study results indicated that the total satisfaction score was two scores higher than the classic one (p<0.001) in the model registry system. Furthermore, the findings of the current study interestingly showed a correlation between satisfaction rate and education level as well as patient's location. Thus, patients with moderate education levels had a higher satisfaction rate in urban regions when compared with rural regions and higher/lower education levels (p=0.03).

Conclusion: Patients' satisfaction rate with multiple variables can be improved by designing an appropriate registry procedure.

Objective: To investigate in how the current COVID-19 pandemic affects patient's perceptions of emergency physician empathy and communication.

Methods: Patients cared for by Emergency Department physicians with the lowest satisfaction scores were surveyed within one week of discharge via phone. Using questions from the Consultation and Relational Empathy (CARE) survey, patients rated their satisfaction with their Emergency provider's empathy and communication on a scale of 1 to 5 and provided feedback on how the patient-provider interaction could be improved. Demographic data and patient responses to CARE survey questions were compared between pre-COVID-19 and during COVID-19 time. Patient's open-ended responses were analyzed for themes related to the impact of COVID-19 on the patient-provider relationship.

Results: Patient median quantitative scores were 5 (4-5) across all five questions of pre-COVID-19 and 5 (4-5) during COVID-19 for all questions except two (showing care and compassion), median 5(5-5). Female patients rated provider empathy and communication lower than mens. There was no differences across age strata. A shift in provider focuses to COVID-19 only care (N=3), and an understanding of the stress on healthcare processes (N=13) from open-ended responses themes emerged of patients who want to minimize interactions within the emergency department (N=3).

Conclusions: The external factor of the current pandemic did not negatively impact patient's satisfaction scores. Many patients express leniency and gratitude for emergency providers during this challenging time. Their responses seem to mirror current societal views of frontline healthcare workers.

Objective: To evaluate the maternal and fetal outcomes of COVID-19 up to three months after the delivery in pregnant women.

Methods: This case series study was conducted on all pregnant women with COVID-19 hospitalized in Hazrat -E- Rasoul Akram Hospital, Tehran, Iran from March 8, 2020 to December 28, 2020. Data were included maternal age and gestational age (GA) which presenting signs and symptoms were collected at hospital admission. To confirm COVID-19 diagnosis, high-resolution computed tomography (HRCT) or reverse transcription-polymerase chain reaction (RT-PCR) tests were conducted. Both the mothers and the newborns were followed up to three months after delivery.

Results: Fourteen pregnant women with the median age of 31.5 were enrolled. HRCT was done in twelve mothers (85.7%), and eleven mothers (78.6%) were evaluated via RT-PCR; four of them (36.36%) were positive. Two mothers (14.28%) were admitted to ICU. The cesarean section (C/S) was done following fetal distress in only three mothers due to their concerns of vertical transmission. Two mothers were admitted to the intensive care unit (ICU), and one of them died of pneumomediastinum. Fortunately, no neonatal death was reported three months after the delivery.

Conclusion: COVID-19 affects mothers more in the last trimester of the pregnancy. Although no fetal death was reported in the recent study, physicians should closely monitor pregnant women to reduce the adverse event .