Bulletin of emergency and trauma最新文献

Objective: To compare the ketamine efficacy at a sub-dissociative morphine dose to reduce pain in isolated limb traumatic injuries.

Methods: A double-blind randomized clinical trial study was carried out on patients referred to emergency departments (EDs) due to isolated limb traumatic injuries. Eligible patients were divided into two groups which one group received 0.1 mg/kg ketamine and the other group received 0.05 mg/kg morphine, intravenously. An observed side effect includes pain scores and vital signs were recorded at baseline of every 5 minutes for 30 minutes.

Results: Totally, 73 patients with the mean age of 32.9±10.4 were enrolled of whom 59 (80.8%) individuals were men. The baseline characteristics difference of the two study groups was not statistically significant. The results showed that the change of mean pain score was -6.2 (95% CI: -5.72 to -6.69) points in the group receiving ketamine compared to -5.8 (95%CI: -5.15 to - 6.48) in the group who were administered morphine. At all assessed checkpoints, the pain mean score was lower in the ketamine group than in the morphine group (p<0.05); the mean of total pain reduction was greater in the ketamine group during the observation period compared with patients who received morphine (p=0.002).

Conclusion: The study findings suggest that the sub-dissociative ketamine efficacy in controlling of the acute pain is not lower than morphine sulfate in patients with isolated limb trauma in ED's. Thus, it can be considered as a safe and effective alternative approach.

Meckel's diverticulum is the most common gastrointestinal congenital defect, which, although asymptomatic in adults, may present symptoms in obstruction, inflammation, bleeding and foreign body perforation. There are only 8 reported cases of Meckel's diverticulum perforation by chicken bone. We report a case of a 24-year-old man presenting a 2-day-history of periumbilical pain that shifted to the right lower quadrant in 24 hours. Clinical and laboratory findings led to an appendicitis diagnosis, followed by laparotomy. Normal appendix was found intraoperatively along with an incidental finding of an inflamed and perforated Meckel's diverticulum by chicken bone. Diverticulectomy and enteroanastomosis were performed and the patient had a successful recovery, being discharged after 5 days. Although rare, its clinical presentation might be similar to acute appendicitis, which restate the importance of collecting a detailed clinical history and examining the small bowel in order to investigate a possible Meckel's diverticulum complication in the differential diagnosis.

Objective: To assess the possible factors associated with increasing risk of COVID-19 among EMTs.

Methods: This study was a case-control study conducted in Tehran, Iran. Case group was consisted of confirmed COVID-19 EMTs based on the results of reverse transcriptase polymerase chain reaction and/or lung computed tomography scan. Healthy EMTs were randomly selected as control group. Patients were asked to fill out a checklist including demographic data, data related to the work situation (such as number of missions and type of mask and cloth) and PPE precautions.

Results: Sixty-eight patients and 148 healthy persons took part in this study as case and control group, respectively. Having two EMTs involved directly in taking care of patients (p<0.001) and working with a confirmed case teammate (p<0.001), considering the precautions such as seal check after wearing the mask (p=0.015), covering the hair with a medical hat (p<0.001), not using personal items despite protective clothing (p<0.001), and avoiding contact with the outer surface of clothing while removing (p<0.001) had significant difference in two groups.

Conclusion: We found that the type and method of use of PPE were correlated with the increasing risk of COVID-19 in EMTs. Also, we found that when two EMTs were involved directly in taking care of the patients, and those who worked with a confirmed case teammate, more frequently affected.

Objective: To investigate and understand the current status of inter-organizational management in relief organizations as well as the relief organizations personnel behavior when facing mass traffic incidents (MCTI). The inter-organizational barriers and facilitators are also discussed in response to MCTI management and in order to help direct future actions to improve pre-hospital emergency services.

Methods: The current qualitative study was performed through face-to-face, semi-structured interviews with 31 individuals from pre-hospital emergency services authorities and personnel, Red Crescent and Yazd, Kohgiluyeh and Boyer-Ahmad, Fars, and Qom provinces police. These provinces were selected by purposive sampling in 2018-2019. The conventional content analysis method was applied to analyze the data in this research.

Results: Three main categories and 14 subcategories were determined. The categories are including relief organizations coordination (having four subcategories: independent relief organizations, interdepartmental services integration, insufficient knowledge of organizations about one other, and performance based on job descriptions), resource and infrastructure management (having four subcategories: adverse information management, proper information management, lack of medical resources and capacities considered, and upgrading of medical resources and capacities considered), and response management of relief organizations (having six subcategories: incomplete assessment, improving the quality of assessment, weakness in establishing scene security, scene security management, poor response, and cooperation in response).

Conclusion: Relief organizations need to perform under a unified command. It has inter-organizational cooperation and provide integration of interdepartmental services in order to manage responsiveness at the scene. It also prevents an independent, chaos, and inability of the injured to properly understand and needs in MCTI.

Objective: To describe the restructuring in-hospital systems of care at a Level -1 trauma center in India and to analyze an injury volume and patterns for future preparedness as well as to establish a specific injuries preventive measures during health emergencies like COVID-19.

Methods: Data was extracted from a prospectively managed trauma registry at level-1 trauma center in India. We have compared the data in lockdown period with the same day's number from the pre-lockdown period. Patients were categorized according to age, gender, injury cause, injury place, injury severity, and injury outcome to compare the statistical analysis between two periods.

Results: Total emergency department (ED) trauma footfall decreased significantly by 73% during lockdown period. The injuries result increased significantly due to blunt forces. There was a significant decrease in the major injury of the patient's percentage. The road traffic injuries (RTIs) in individuals were less than the reported falls number, which increased significantly during lockdown. The less number of patients significantly presented without receiving primary care. Majority of the patients had been transferred by using private cars, police vehicle, and two wheelers during lockdown; however, patients' less number were transferred significantly by three wheelers as expected. The comparative analysis between quantitative data points shows significant differences in median Injury Severity Score (ISS) and length of stay during lockdown.

Conclusion: This study highlighted that the preparedness should not focus solely on the response to treat infectious disease during health emergencies but also on ensuring access and provision of reasonable quality of care for non-infectious illnesses especially acute conditions like trauma.

Objective: To investigate the factors affecting the hospital costs in the road traffic injuries.

Methods: This applied study examined the information of patients presenting to Yazd Trauma Center in 2018. The data were extracted from Comprehensive Traffic Injuries System affiliated to the center, which were described with frequency, percentage, mean, and SD, and then analyzed using independent t-test and one-way ANOVA.

Results: Most injuries (%66.4) are caused by motorcycle and pertained to head region (%61.8). Some significant correlations were found among gender, type of injury, patient's final status, site of road accident, patient's nationality, type of vehicle used at the time of accident, length of stay (hospital stay), patient's age, and hospital costs (p<0.05). Moreover, the costs were higher in men, and in those with head and neck injuries, dead casualties, suburban high-way accidents, motor cyclists, hospital stay longer than three days, and older patients.

Conclusion: Given the significant correlations between demographic and social variables under study, the results may be used in planning and designing strategies for controlling road traffic injuries and reducing the related hospitalization costs.

Objective: To assess the preparedness of Iranian hospitals against earthquake.

Methods: In this systematic review, a query was carried out on PubMed, Scopus, Web of Sciences, Sid, Irandoc, Google scholar, and Magiran databases for articles published between 2000-2019. Statistical analysis was performed using Chi-square and I2 tests at a confidence interval of 95%. Finally, out of 7458 studies, 10 related articles were analyzed.

Results: As evidenced by the obtained results, the highest readiness was obtained at 0.709 (95% CI: 0.49-0.88) in "disaster plan", while the lowest readiness was reported at 0.455 (95% CI: 0.23-0.68) in "structural safety". The overall earthquake preparedness of these hospitals was calculated at 0.47 (95% CI: 0.37-0.56).

Conclusion: The results of the present study pointed to the moderate level of earthquake preparedness in Iranian hospitals. This finding highlights the necessity of a training plan and implementation of a national program in all hospitals of the country to increase earthquake preparedness.

Objective: To determine the sensitivity, specificity and accuracy of ultrasound to diagnose the patients with tendon rupture of upper extremity referred to Taleghani Hospital's center of Kermanshah in 2019.

Methods: This was a diagnostic value study which performed on 113 patients with non-fracture penetrating hand trauma. In the first stage, all patients have been diagnosed with tendon injury by a first-year resident and then ultrasound was performed by a trained 2^nd year resident in emergency medicine ward and the results were recorded in a checklist. Further examination of the tendon was performed as well as exploring the site for the patients after the patient was transferred to the orthopaedic service. Final result was recorded in the checklist. Data were analysed by SPSS software and sensitivity and specificity of ultrasound have been calculated.

Results: Results showed that ultrasound was able to identify 73 patients of 77 individuals with tendon injury. Of the patients with complete rupture, 45 individuals were correctly diagnosed based on the results of surgery in ultrasound test. Ultrasound and surgical findings were significantly different. Of the 36 individuals without confirmed rupture in surgery, 10 cases were diagnosed with tendon rupture by ultrasound. Of 52 cases of complete rupture based on surgical findings, 45 individuals were correctly diagnosed based on the results of surgery. Twenty-one patients were correctly diagnosed based on ultrasound out of 25 cases of partial rupture based on surgical findings.

Conclusion: Overall, the results of the present study show that ultrasound is not very sensitive and specific in diagnosing of upper extremity tendon rupture and cannot be used as a reliable alternative in diagnosing of upper exteremity rupture; however, further studies is essential according to the limitations of this research. The limitations were low sample size in subgroups analysis based on the presence of complete or partial rupture and performing the ultrasound by an emergency medicine resident who is less experienced rather than radiologists.

Objective: To investigate the patients transferred by helicopters, as well as an emergent medical services that were performed for them.

Methods: In this retrospective cross-sectional study, all patients who were transferred by Fars province of Helicopter Emergency Medical Services (HEMS) to Shiraz hospitals, southern Iran (March 2017-March 2019) were investigated. Patients' information was collected and analyzed includes age, gender, dispatch reason, trauma mechanisms, take hold of emergent medical services, as well as the air transportation time, time between dispatch from the origin hospital and starting the procedures, and patients' outcome.

Results: Eighty-three patients were enrolled with the mean±SD age of 36.9±19.47 years that 75.9% had trauma (p<0.0001). Mental status deterioration (25.3%) was the most dispatched indications. The mortality rate was 13.25% totally (11.11% in traumatic vs. 10% in non-traumatic). The mean±SD of air transportation time was significantly lower than ground transportation in both traumatic (p=0.0013) and non-traumatic (p<0.0001) patients. Also, the mean±SD of time between dispatch from the origin hospital and starting the procedures was statistically lower in air transportation in both traumatic (p=0.0028) and non-traumatic (p=0.0017) patients.

Conclusion: Most of the patients transferred by HEMS were traumatic. The air transportation time as well as the time between dispatches from the origin hospital to the starting of the procedures were significantly lower in HEMS in comparison with ground transportation for both traumatic and non-traumatic patients.