Bulletin of emergency and trauma最新文献

Objective: This study aimed to evaluate the outcome and risk factors in operative and non-operative management of splenic injury.

Methods: This cross-sectional study was conducted on patients with traumatic splenic injuries who were hospitalized in Kashani Hospital (Isfahan, Iran) from 2017 to 2019. The studied variables were extracted from the medical records of the enrolled participants. The outcomes such as mortality complications and risk factors were compared based on treatment methods.

Results: A total of 240 patients were investigated. The mean age of the patients was 29.8±12.2, with 180 (77.5%) patients being men. 154 (64.2%) patients underwent operative treatment. The mortality rate was 18.9% and 4.6% among operative and non-operative groups (p<0.001). Complications were observed in 11.5% and 46.1% of non-operative and operative groups, respectively (p<0.001). Operative treatment inversely correlated with mortality (p<0.001) and complications (p<0.05). Splenic injury severity was correlated positively with mortality (p<0.001) and negatively with complications (p<0.001). Unstable hemodynamic status was positively correlated with complications (p<0.001). Age had a positive correlation with mortality (p<0.001) and complications (p<0.001). Male sex had a negative correlation with complications (p<0.001). GCS score and admission were positively correlated with mortality (p<0.001). There was no statistically significant correlation between correlated injuries and outcomes (p≥0.05).

Conclusion: Patients who received surgery had higher rates of mortality and complications. However, after controlling for confounders, operative treatment was found to be inversely correlated with mortality and complications.

Objective: Recently, different serum markers have been used for the diagnosis and prognosis of acute heart diseases in emergency departments. To determine such a role, the present study was designed and conducted.

Methods: This is an analytical cross-sectional study conducted on patients with syncope complaints. The patients enrolled in the study based on the inclusion and exclusion criteria and underwent initial evaluations, including collecting a history, physical examination, ECG, blood sugar measurement, and, if necessary, brain CT scan, Doppler echocardiography, and CTA.

Results: This study included 100 participants who complained of syncope. The results showed that 19% and 81% of the subjects suffered from cardiac and non-cardiac syncope, respectively. The average Pro BNP of the studied individuals was 196.06±128.45 pg/mL. According to the results, age and length of hospitalization had a positive and significant relationship with the average Pro BNP (p<0.01). Individuals with positive TPI, cardiac syncope, and abnormal ECG or Doppler findings had significantly higher average Pro BNP levels (p<0.01). The results of the diagnostic value of Pro BNP in diagnosing cardiac syncope also showed that its sensitivity and specificity were 94.73% and 56.79%, respectively.

Conclusion: The results of this study showed that the increase in the Pro BNP values was associated with age, length of hospitalization, and ECG abnormalities. In addition, as an independent marker, Pro BNP had optimal acceptability in identifying cardiac syncope cases.

Airgun injuries are prevalent in the pediatric population. The present study described a case of air gun pellet injury to the left carotid artery and its successful management. A 25-year-old man presented to the emergency department complaining that his son had accidentally injured him with an air gun pellet while playing. The X-ray cervical spine revealed a single foreign body (pellet) located directly anterior to the C5-C6 vertebra. A CT angiography of the neck showed a spherical hyperdense object just anterior to the C6 vertebral body on the left side, 3 mm posteromedial to the left common carotid artery, which was most likely a pellet foreign body. The patient was sent to operation theatre (OT) for exploration. There was a rent in the internal carotid artery with active bleeding. After exerting both proximal and distal control, the rent was closed. Close air gun injury could result in gunshot wounds, as in the present case. Plain X-rays in AP and lateral view are required. Nonoperative management could be employed in a restricted group of patients with satisfactory outcomes. Those who have vascular involvement will require surgical intervention.

Objective: This study aimed to evaluate the Iranian ophthalmologists' knowledge of prescribing prophylactic antibiotics to patients with open globe injury (OGI) in Iran.

Methods: In this cross-sectional study, we utilized a questionnaire to evaluate the ophthalmologists' knowledge about prescribing antibiotics as prophylaxis. This survey was conducted in Tehran and its suburbs. The questionnaire included demographic information as well as ophthalmologists' knowledge levels. Cronbach's alpha was used to determine its validity and reliability. The obtained data were analyzed using SPSS 24.0.

Results: Of 192 subjects, 111 (35 women, 76 men) were included. About 65 (58.6%) specialists and 45 (41.4%) subspecialists with different orientations completed the questionnaires. The total knowledge score was 13.04±2.96. The following are the results of ophthalmologists' responses to questions regarding the cornea/scleral injury (1.09±1.72), prophylactic antibiotics administration (2.79±1.11), the infectious agents in eye surgeries (3.21±1.49), diagnosis and treatment (2.84±0.944), and the effects of ocular antibiotics as well as their proper dosage (2.96±2.35). There was no significant relationship between some demographic information such as sex, working hours, workplace, and the number of studied articles (p>0.05). In addition, ophthalmologists with less work experience had significantly higher levels of knowledge than those with more work experience.

Conclusion: The findings indicated that the majority of ophthalmologists had a basic knowledge of prescribing prophylactic antibiotics in OGI.

Objective: Emergency medical technicians (EMTs) are at risk of developing post-traumatic stress disorder (PTSD) as a result of seeing painful events involving suspected COVID-19 patients and being concerned about potentially infecting themselves and their families. Therefore, screening for these disorders is essential in the post-Corona era. This study aimed to investigate the prevalence of PTSD among EMTs and its relationship with occupational stress and depression when dealing with patients with suspected COVID-19.

Methods: This cross-sectional study was conducted on EMTs at Zanjan University of Medical Sciences using a convenience sampling method. Data were collected using a demographic information questionnaire, PTSD checklist, occupational stress questionnaire, and the Goldberg depression scale. The data were analyzed using SPSS software. Statistical tests such as Pearson correlation and logistic regression analysis were used to evaluate the data.

Result: 205 EMTs participated in this cross-sectional study. The mean and standard deviation of PTSD was 37.13±12.93 (17-85), and according to the cut-off (45), the prevalence of PTSD was 30.7%. There was a direct and significant association between the total PTSD and depression scores (r=0.435, p=0.001). Some occupational stress domains, such as demand (r=0.306, p=0.001), colleague support (r=0.149, p=0.033), and communication (r=0.293, p=0.001) had a significant association with PTSD. The domains of sadness in depression (OR=1.074, p=0.027) and demands in occupational stress (OR=1.872, p=0.029) were the most important predictors of PTSD. Among demographic variables, employment status was the most important protective factor for PTSD (OR=0.378, p=0.038).

Conclusion: PTSD affected one-third of EMTs, and it had a significant relationship with various dimensions of depression and occupational stress. Due to the chronic nature of these diseases, policymakers are advised to prioritize psychological screening of EMTs as part of the post-Corona policy.

Objective: To design and conduct the effectiveness of Ketamine vs Dexmedetomidine in children's sedation at emergency department (ED).

Methods: This randomized clinical trial study was carried out at the two trauma centers in Mashhad, Iran. The patients were divided into two groups by means of a random numbers table to be treated with Ketamine (N=20) or Dexmedetomidine (N=20). Their demographic information and sedation times of drugs were collected and analyzed.

Results: In general, sedation time was significantly higher in the ketamine group, 14.35 minutes (IQR:9.82-19) than in the dexmedetomidine group, 9.7 minutes (8.35-14.23) (p=0.023). Time of injection to complete anesthesia was 45.25 (IQR:30-58) and 72 (IQR:60.25-82) minutes in ketamine and dexmedetomidine groups, respectively (p<0.01). In the case of recovery, grade 4 of the Ramsey scale was statistically more prevalent in dexmedetomidine (45%) than in the ketamine group (p=0.0001).

Conclusion: This study demonstrated that dexmedetomidine could be used in cases where a shorter sedation time is vital. Ketamine could be a better choice where full recovery time (from injection) matters most. Clinical Trial registration code: IR.MUMS.fm.REC.1396.534.

Objective: This study aimed to comprehensively determine the factors that affect the hospitals' functional preparedness in response to disasters.

Methods: A systematic review of studies published in English and Persian up to the end of 2022 was performed by searching PubMed Central, Web of Science, Scopus, ProQuest, SID, and Elmnet databases. Articles that assessed hospitals' functional preparedness were searched by using a combination of medical subject heading terms and keywords including disaster, emergency, preparedness, hospital preparedness, health care facilities preparedness, hospital functional preparedness, health care facilities functional preparedness, readiness, and effective factors. Additionally, journals and gray literature were manually searched. Two independent reviewers screened the eligible papers. The inclusion criteria were the full text should be published up to the end of 2022, in both Persian and English, and focus on hospital preparedness. The extracted data were manually analyzed, summarized, and reported using the content analysis method.

Results: Of the 3465 articles, 105 studies were eventually included in the final analysis. Eighty-two influential factors were identified and classified into seven categories: government, coordination, control, and commanding (7 factors), existing guidelines and preparedness plans (12 factors), regulations (6 factors), supplying of resources (37 factors), education and training (8 factors), multi-layered information management and communication systems (8 factors), and contextual factors (4 factors).

Conclusion: There are different dimensions of hospital preparedness for disasters, each of which is influenced by several independent factors. Addressing these factors will enhance the actual functional preparedness of hospitals encountering disasters.

Objective: To identify the distinctive features of acutely injured patients who were presented to the emergency department (ED) and their association with mortality and surgical intervention outcomes.

Methods: This cross-sectional study was conducted on all trauma patients resuscitated in the ED of Shahid Rajaee (Emtiaz) Trauma Hospital (Shiraz, Iran) from May 2018 to June 2019. Demographic information, the mechanism of trauma, trauma type, injured body regions, criteria of abbreviated injury scale (AIS) score, injury severity score (ISS), and surgical intervention were all taken into consideration. The items related to the mortality and surgical performance outcomes among the patients were analyzed.

Results: Of all 1281 cases, 82.9% were men, and the mean age of the patients was 37.9±19.1 years. The most common mechanism of injury was a car accident, and the thorax was the most prevalent injured area of the body. The majority of the patients had moderate blunt trauma. The mechanism of trauma, ISS, and the severity of head trauma were all significantly correlated with operation interventions. Moreover, age, the mechanism and type of trauma, ISS, and the necessity for the surgery were significantly associated with death occurrence. Additionally, head, thorax, and abdomen trauma were significantly related to a high mortality rate.

Conclusion: Age, trauma mechanism and type, ISS, and the necessity for surgery were significantly associated with the mortality rate of injured patients. The severity of the trauma, particularly head injuries and the mechanism of damage were important determinants in concern for surgery the necessity.

Objective: This study aimed to investigate the death trend and years of life lost (YLL) caused by social harm in Ilam province.

Methods: This cross-sectional study was conducted in Ilam province from 2009 to 2019. To estimate YLL, all deaths caused by suicide, homicide, and addiction were included in the study. The data were collected from the Forensic Medicine Organization. The analysis was carried out using SPSS software (version 23.0). A p-value of <0.05 was considered statistically significant.

Results: Between 2009 and 2019, there were 1712 occurrences of suicide, homicide, and addiction, which resulted in a total of 62,605 years of lost life (53,934 per 100,000 people). The highest frequency was related to the age group of 15-29 years, while the lowest was related to the age group of 0-14 years (p<0.001). During the studied period, men were more likely than women to commit suicide, homicide, and addiction in Ilam (p>0.439). Between 2009 and 2019, the number of suicides and homicides in Ilam province started a decreasing trend for both sexes, while the number of deaths caused by addiction was increasing.

Conclusion: The results of this study indicated that the age groups of 15-29 years had the highest rate of YLL caused by suicide, homicide, and addiction for both sexes. Furthermore, the findings showed that YLL decreased for suicide and homicide, but increased for addiction.