Bulletin of emergency and trauma最新文献

Objective: This study aimed to assess the potential of the Systemic Inflammatory Response Index (SIRI) for diagnosing AA, its possible advantages over current methods, and its utility in distinguishing uncomplicated from complicated appendicitis.

Methods: In this cross-sectional study, 240 patients scheduled for appendectomy with a diagnosis of AA were enrolled. Demographic information, clinical and paraclinical findings, including complete blood count (CBC), Alvarado score, SIRI, sonography findings, and pathology results, were documented. Data were analyzed using SPSS software version 26.

Results: Of the 240 patients, 106 (44.2%) were men, and 134 (55.8%) were women, with a mean age of 37.49±15.55 years. Final pathology reports identified 26 (10.8%) cases of a normal appendix, 176 (73.3%) with uncomplicated appendicitis, 23 (9.6%) with complicated appendicitis, and 15 (6.3%) with reactive lymphoid hyperplasia. SIRI demonstrated significant differences across the pathology groups (P<0.0001). It showed notable discrimination between normal and complicated appendicitis (P=0.005), normal and combined appendicitis (P=0.008), and suggestive differences for normal versus uncomplicated (P=0.021) and uncomplicated versus complicated cases (P=0.044). Similarly, Alvarado scores showed significant differences, particularly between the normal and complicated appendicitis groups.

Conclusion: The SIRI and Alvarado scoring systems showed significant potential for diagnosing appendicitis with acceptable sensitivity and specificity. They might also assist in differentiating between uncomplicated and complicated appendicitis.

Objectives: Chevron osteotomy could be fixed using various techniques, each yielding different outcomes. This study aimed to determine the complications and outcomes caused by Chevron osteotomy fixed with tension band wire in distal humeral fractures.

Methods: In this prospective study, patients with distal intra-articular humerus fractures treated by Chevron osteotomy at Shahid Rajaei and Shahid Chamran Hospitals (Shiraz, Iran) from October 2018 to October 2023 were enrolled. Osteotomy fusion was evaluated radiographically using the Picture Archiving and Communication System (PACS). Additional complications were assessed during periodic patient follow-ups.

Results: The study included 60 patients with a mean age of 44.6±18.14 years, including 23 (38.3%) women. All cases demonstrated complete union of the olecranon osteotomy, with no cases of infection or fixation failure. In three cases, the applied pins and wires were removed. Hardware-related irritation was observed in 22 patients (36.7%).

Conclusion: The tension band wiring (TBW) method demonstrated acceptable clinical outcomes. Despite frequent hardwire irritation, this technique achieved high rates of bony union. However, future comparative studies evaluating multiple fixation techniques within a single center are warranted.

Objectives: This qualitative study aimed to identify the key challenges associated with managing patients affected by biological emergencies in Iran.

Methods: This study was part of grounded theory research using the constant comparative analysis method proposed by Corbin (2014). Data were gathered through semi-structured interviews with 25 individuals with expertise or experience in managing biological emergencies. Purposive sampling, followed by theoretical sampling, was employed until theoretical saturation was reached. Data collection was conducted between April and November 2023, and MAXQDA software (2020) was used for data analysis.

Results: After several rounds of data analysis and summarization, considering similarities and differences, four main categories and 14 subcategories were identified. The main categories included: 1) lack of a comprehensive risk communication strategy, 2) inefficiencies in patient flow mismanagement, 3) systemic political and governance challenges, and 4) deficiencies in resource allocation and utilization.

Conclusion: This study highlighted the challenges faced by Iran's Healthcare system in managing affected individuals in biological emergencies. Key issues included mismanagement of patient flow and systemic inefficiencies. Addressing these challenges is essential for enhancing the effectiveness and sustainability of Iran's Healthcare system. Further research is recommended to provide practical strategies for managing biological emergencies in the future.

Objectives: This study aimed to identify factors influencing helmet usage behavior among motorcyclists.

Methods: A cross-sectional study of injured motorcyclists was conducted at Shahid Rajaee Hospital (Shiraz, Iran), using the convenience sampling method. Data were collected via a structured medical form, and logistic regression with the "Backward" technique was applied to identify risk factors associated with helmet use.

Results: Among 147 patients, 139 (94.55%) were un-helmeted, and 8 (5.45%) were helmeted. The mean age of helmeted riders was 41.46±17.44 years, compared to 29.21±12.23 years for un-helmeted riders. After data balancing, key predictors of helmet use included riding before noon (OR=10.164, 95% CI [4.543, 22.738]), crashes in urban areas (OR=21.740, 95% CI [5.535, 85.383]), absence of head/neck injuries (OR=4.549, 95% CI [2.075, 9.970]), absence of facial injuries (OR=5.108, 95% CI [1.587, 8.694]).

Conclusion: These findings could assist policymakers in understanding helmet usage behavior and increasing helmet usage rates. They also support evidence-based strategies to reduce traffic crashes. Addressing helmet-related discomfort and enhancing public awareness of helmet benefits could significantly reduce motorcycle-related trauma.

Objectives: This study aimed to determine the survival rate and identify associated risk factors in mechanically ventilated (MV) burn patients.

Methods: This cross-sectional analytical study was conducted at Velayat Hospital, a burn and plastic surgery referral center affiliated with Guilan University of Medical Sciences, between March 2011, and September 2020. Data were retrieved from electronic medical records and analyzed using SPSS software (version 24.0). Patients discharged alive or lost to follow-up were treated as censored observations in a time-to-event analysis.

Results: The mean age of survivors was 19.03±30.21 years, compared to 42.54±19.30 years in the non-survivors. Men comprised 78.9% (n=30) of survivors and 64.9% (n=155) of non-survivors. The mean intensive care unit (ICU) survival time was 18.33±1.36 days (median=12±1.24 days). There were significant differences between survivor and non-survivor groups in terms of age, length of stay, presence of comorbidities, inhalation injury, sepsis, acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI) (p<0.05). The Kaplan-Meier analysis demonstrated a significant difference in survival probability between MV and non-MV groups (p=0.028), with a higher survival probability observed in non-MV patients.

Conclusion: Age, length of stay, renal failure, ARDS, and sepsis were associated with increased mortality risk in MV burn patients. While these findings highlighted critical prognostic factors, causal inferences require further investigation through longitudinal or interventional studies to guide targeted therapeutic strategies.

A 19-year-old male presented with a three-day history of worsening epigastric pain, persistent vomiting, abdominal distension, and obstipation. His medical history included high-fall trauma in 2022, resulting in a parietal bone fracture, scalp swelling, and an epidural hematoma. Physical examination revealed epigastric tenderness, abdominal distension, and diminished bowel sounds. Imaging revealed a 7 cm left diaphragmatic defect with herniation of the stomach, colon, and mesentery into the thoracic cavity, confirming a diagnosis of gastric volvulus with a diaphragmatic hernia. An exploratory laparotomy confirmed herniation of the stomach, transverse colon, spleen, and pancreas. The procedure involved derotation of the gastric volvulus, reduction of the herniated organs, and repair of the diaphragmatic tear; a fundoplication was also performed to prevent recurrence. The patient's recovery was uneventful, and he was discharged on the fifth postoperative day. He remained asymptomatic at the six-month follow-up. This case underscored the importance of considering gastric volvulus and diaphragmatic hernia in trauma patients presenting with gastrointestinal symptoms, highlighting the necessity of early diagnosis and prompt surgical intervention.

Objectives: This study aimed to explore experts' perspectives on the factors influencing pedestrian traffic collisions in Iran.

Methods: This qualitative study was conducted using conventional content analysis with an inductive approach from September 2023 to March 2024. Twenty-six experts were purposefully selected from across Iran. Data were collected through individual face-to-face interviews, guided by a semi-structured interview, developed by a panel of experts and contained open-ended questions. Data analysis was performed manually using the Graneheim and Lundman approach (2004). To ensure trustworthiness, four strategies proposed by Lincoln and Guba were employed.

Results: The results revealed two main categories: direct factors and underlying factors, comprising nine subcategories. Direct factors included five subcategories: driver, pedestrian, roads and streets, vehicle, and geographic factors. Underlying factors included four subcategories: governance factors, social determinants, cultural conditions, and economic status.

Conclusion: The study identified key risk factors associated with pedestrian collisions according to experts' experiences. We recommend further qualitative studies to explore high-risk behaviors among pedestrians and drivers in depth. Additionally, systematic reviews should examine strategies employed by developing and successful countries to prevent or reduce pedestrian collisions.

Objectives: This study aimed to identify strategies for enhancing the quality of home care for trauma patients.

Methods: Using a conventional qualitative content analysis approach, this study was conducted from September 2023 to September 2024 in Hamadan, located in northwest Iran. A total of 18 participants, including home care managers, nurses, trauma patients, and the family members of trauma patients, were selected through purposive sampling. Data were collected using semi-structured interviews and analyzed using Graneheim and Lundman's method with the assistance of MAXQDA software (version 20).

Results: Analysis of the data yielded 430 initial codes, which were categorized into 36 subcategories and 6 main categories: patient-centered care, safe care provision, spiritual care, effective educational program development, service effectiveness enhancement, and dynamic service delivery.

Conclusion: The study results showed that nurses employed various strategies to improve the quality of home care services for trauma patients. Key strategies included adhering to the principle of patient-centered care, providing safe care for trauma patients, providing spiritual care, developing effective educational programs, enhancing service effectiveness, and ensuring dynamism in service delivery. Implementing these strategies could guide policymakers and home care nurses to improve care quality for trauma patients and increase satisfaction. The findings of the present study can enhance the planning and implementation of home care services, facilitating the transition from hospital to home for trauma patients.