Bulletin of emergency and trauma最新文献

Objective: This systematic review and meta-analysis aimed to evaluate the impact of albumin administration on mortality and total resuscitation volume in burn patients.

Methods: We systematically searched ScienceDirect, Cochrane, PubMed, MEDLINE, Scopus, and ProQuest in June 2025 using the terms "Burns," "Resuscitation," and "Albumin." Studies were included if they investigated albumin as part of burn resuscitation in adult patients and reported on mortality and total resuscitation volume. Pediatric studies, studies using albumin for other purposes, and those using other colloids were excluded. Reviewers independently extracted data on study characteristics, patient demographics, and outcomes. The risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-randomized studies (NRCTs). Pooled analyses were performed using Review Manager 9.3.0, applying random-effects models.

Results: Eleven of the 7,365 identified articles were included. Albumin administration did not significantly affect mortality (OR=1.19 [0.62-2.28], p=0.57) or total resuscitation volume (OR=0.69 [-0.93-2.31], p=0.34). However, albumin use was associated with a reduced incidence of sepsis (OR=1.18 [1.02-1.38], p=0.03) and ARDS (OR=2.64 [1.43-4.86], p=0.02).

Conclusion: The administration of albumin did not significantly impact mortality or resuscitation volume in burn patients. While there is some evidence of potential benefits in reducing complications, this is limited by heterogeneity, underscoring the need for further high-quality RCTs.

Objective: The study aimed to explore experts' perspectives on the factors contributing to accidents involving the elderly in Guilan, Iran.

Methods: This qualitative study employed conventional content analysis with an inductive approach in 2024. Fourteen experts from Guilan (Iran) were purposefully selected. Data were collected through individual face-to-face interviews using a semi-structured interview guide containing open-ended questions, which was developed through an expert panel discussion. All stages of data analysis were performed manually following the Graneheim and Lundman's approach.

Results: Three main categories, 10 subcategories, and 29 key codes were identified. The "Individual Factors" category had six subcategories: physical abilities, psychological factors, traffic literacy, cultural attitudes, and Individual needs. The "Environmental Factors" had two subcategories: road and traffic infrastructure, and weather conditions. The "Policy-making" category consisted of three sub-categories: transportation safety, healthcare system, and public education.

Conclusion: To reduce damages from elderly-related accidents, preventive measures should focus on improving health services, enhancing traffic education, and addressing specific behavioral and cultural factors. Additionally, enhancing infrastructure, designing age-appropriate vehicles, and implementing targeted policies could significantly mitigate accident risks among this population.

Objectives: This study aimed to determine the prevalence of dental trauma (DT) in pediatrics and adolescents in Ilam.

Methods: This retrospective study was conducted in Ilam (Iran) on a group of pediatric and adolescent patients with DT between 2017 and 2021. The researchers reviewed patient records from hospital-based specialty clinics providing DT treatment. Using a predefined checklist, they extracted the relevant data from the patients' medical files.

Results: In this study, 246 pediatrics and adolescents were examined, including 144 (58.5%) boys and 102 (41.5%) girls. Regarding age distribution, 104 (42.3%) patients were in the pediatric age group (mean age: 7.1±3.2 years) and 142 (57.7%) were adolescents (14.8±5.1 years). A significant relationship was found between place of occurrence with sex (OR=0.77; 95% CI=0.64-0.93; p=0.008) and age group (OR=0.73; 95% CI=0.6-0.89; p=0.002). Additionally, the type of trauma showed a significant association with sex (OR=1.24; 95% CI=1.08-1.43; p=0.002), while the treatment provided was significantly associated with school type (OR=0.79; 95% CI=0.65-0.96; p=0.02). In addition, there was no significant relationship between the demographic variables and dental injury-related factors (p>0.05).

Conclusion: The present study found a higher prevalence of DT in boys than in girls. However, this trend reversed in the adolescent age group. In addition, public schools had a higher rate of DT, which influenced the types of treatments provided.

Objective: Dental injury is a significant issue in children due to their immature physical, cognitive, and physiological development. These factors often result in heightened fear and behavioral challenges during their first visit following trauma, which can compromise the quality of treatment and lead to a poor prognosis for the affected tooth. Silver Diamine Fluoride (SDF), a colorless solution approved by the US FDA for treating dental hypersensitivity and caries, offers a simple, painless, and non-invasive treatment option. Its application involves a paint-on technique with a powerful fluoride formulation, making it an ideal choice for the initial management of enamel and dentin fractures in primary teeth, particularly in uncooperative young children.

Case description: This case series described four cases in which SDF was successfully used as the primary treatment for Ellis Class IX anterior tooth trauma in very young children with negative behavior responses in the dental setting. The procedure required minimal armamentarium and was well-tolerated by all patients.

Conclusion: In each case, the use of SDF yielded successful and satisfactory outcomes, with a favorable prognosis for the affected teeth. Additionally, the treatment contributed to a positive shift in the children's attitudes toward dental care.

Objectives: This study aimed to compare the effectiveness of Trauma and Injury Severity Scores (TRISS) and Madras Head Injury Prognostic Scale (MHIPS) in assessing the prognosis of head trauma patients in the emergency department.

Methods: In this descriptive-analytical (predictive) study, 140 head trauma patients admitted to the emergency department of Shahid Beheshti Hospital (Sabzevar, Iran), were included from January to November 2023. Participants were selected via convenience sampling method and based on the inclusion criteria. Data were collected using a demographic questionnaire, the TRISS, and the MHIPS scale, and analyzed using Stata software (version 17).

Results: The mean age of the injured patients was 39.72±19.86 years, and 102 (73%) patients were male. For intensive care unit (ICU) hospitalization prediction, the MHIPS tool showed a sensitivity of 92%, specificity of 86%, positive predictive value (PPV) of 60%, and negative predictive value (NPV) of 98%. For mortality prediction, the MHIPS tool had a sensitivity of 89%, specificity of 86%, PPV of 27%, and NPV of 99% in predicting death. The TRISS tool demonstrated a sensitivity of 81%, a specificity of 96%, a PPV of 81%, and an NPV of 95% for ICU hospitalization, and a sensitivity of 75%, specificity of 87%, PPV of 26%, and NPV of 98% for mortality. No significant difference was observed between TRISS and MHIPS in predicting the probability of ICU admission and mortality (p=0.797).

Conclusion: Both TRISS and MHIPS demonstrated satisfactory predictive value for head trauma outcomes, with neither tool being superior to the other.

Objectives: This study aimed to investigate the prognostic role of lactate clearance in predicting outcomes among trauma patients admitted to the emergency department.

Methods: This retrospective cohort study was conducted on patients referred to the Emergency Department. Serum lactate levels were measured at admission and 2 hours later. The patients were followed up for 72 hours to assess outcomes, including discharge, hospitalization in other wards, and mortality.

Results: The results showed a significant difference between the mean age, Glasgow Coma Scale (GCS), systolic blood pressure (SBP), pulse rate (PR), and oxygen saturation (O₂ Sat) of the trauma patients in relation to mortality prognosis (p<0.05). Additionally, significant differences were found in primary lactate, lactate levels two hours post-admission, and lactate clearance levels based on the patient's prognosis (p<0.01). Multivariate logistic regression analysis revealed that lactate clearance was associated with a reduced mortality rate among trauma patients (OR=0.907, p<0.05).

Conclusion: The findings of this study showed that lactate clearance, as an independent predictive factor, was associated with poorer prognosis and increased mortality rates in trauma patients.

Objectives: Ankle joint injuries are among the most common orthopedic injuries and are associated with significant healthcare costs. To reduce unnecessary radiographic screening, diagnostic tools such as the widely accepted Ottawa Ankle Rules (OARs) have been developed. However, the accuracy of OARs in excluding fractures remains uncertain. Recently, a new diagnostic test, the Shetty Test (ST), has been introduced. This prospective comparative study aimed to evaluate the diagnostic accuracy of the "ST" in comparison to the "OARs" for detecting ankle and foot fractures.

Methods: A total of 112 consecutive adult patients (>18 years old) were included in the study. They were presented to the Emergency Department of a University Hospital in Alexandroupolis due to an ankle or foot injury. Data were collected over 6 months, from November 2022 to May 2023.

Results: The sensitivity of the ST was 68.4%, specificity was 76.3%, positive predictive value (PPV) was 37.1%, and negative predictive value (NPV) was 92.2%. For the OARs, sensitivity was 94.7%, specificity was 15%, PPV was 18.5%, and NPV was 93.3%. When at least one of the tests was positive, the sensitivity and NPV increased to 100%.

Conclusion: The ST was found to be reliable; however, it did not outperform the OARs in this study. Nevertheless, when used in conjunction, the two tests significantly improved sensitivity and the NPV. Due to its simplicity and reproducibility, the ST could be a valuable tool in daily clinical practice, particularly for non-orthopedic emergency department personnel.

Objectives: This systematic review explored gene expression and DNA methylation patterns to identify key pathways and molecular targets associated with post-traumatic stress disorder (PTSD), particularly its war-related subtype.

Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted using keywords related to PTSD, gene expression, and DNA methylation. Studies published between 2000 to 2024 involving adult military personnel with confirmed PTSD based on the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria were included. Animal studies, psychological interventions, and pharmacological research were excluded. Only cross-sectional, case-control, or cohort studies utilizing blood, saliva, or brain tissue samples were considered. Data from 28 studies were extracted using a predefined framework, focusing on population characteristics, study design, and identified hub genes.

Results: Key findings revealed the upregulation of immune-related genes (e.g., CCL4, NF-κB) and hypomethylation of inflammation-related genes. Downregulation of neurodevelopmental genes, such as Brain-Derived Neurotropic Factor (BDNF) and Down syndrome cell adhesion molecule (DSCAM), highlighted disruptions in synaptic plasticity. The identified pathways suggested potential biomarkers and therapeutic targets for precision medicine approaches.

Conclusion: This review highlighted the role of gene expression alterations in war-related PTSD. The identified genes might serve as candidates for personalized therapies. Further research is required to validate these findings and develop targeted interventions.

Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of urine alkalinization in preventing acute kidney injury (AKI) and the need for dialysis in patients with rhabdomyolysis.

Methods: This study was conducted in accordance with the PRISMA guideline. A systematic literature search of MEDLINE/ PubMed, Scopus, Web of Science, and Embase databases was conducted. No time or language restrictions were applied to maximize the scope of the results. After removing duplicates, the remaining articles were screened by title, abstract, and study criteria. Two researchers independently assessed the full texts of the remaining studies, with any discrepancies resolved through discussion. The risk of bias was assessed using the ROBINS-I tool, and studies with a critical risk of bias were excluded from the final analysis.

Results: Out of 9,230 initially identified articles, five studies met the inclusion criteria for the meta-analysis. The analysis revealed that urine alkalinization was not significantly effective in preventing AKI (OR: 2.11; 95% CI: 0.09-47.72; p=0.3), preventing acute renal failure (OR: 1.26; 95% CI: 0.86-1.84; p=0.36), or reducing the need for dialysis (OR: 4.25; 95% CI: 0-3.8e⁺⁰⁷; p=0.25).

Conclusion: The addition of sodium bicarbonate to fluid therapy solution did not appear to provide significant protection against AKI, acute renal failure, or the need for dialysis in patients with rhabdomyolysis. Further insight should be sought through controlled randomized clinical trials with larger sample sizes.