Bulletin of emergency and trauma最新文献

Objective: This study emphasized the importance of providing equal access to rescue and emergency services for all individuals involved in road accidents, regardless of their geographical location or socioeconomic status.

Methods: This study involved gathering data on the number of Iranian Red Crescent Society (IRCS) and Emergency Medical Services (EMS) stations in 31 provinces of Iran. It entailed calculating the Gini coefficient and creating the Lorenz curve to assess the station distribution. To present road traffic injuries (RTIs) mortality, Disability-Adjusted Life Years (DALYs), and prevalence in Iran from 1990 to 2019, the Global Burden of Disease (GBD) 2019 estimates were utilized.

Results: The findings revealed that Tehran, Khorasan Razavi, Isfahan, Fars, and Khuzestan provinces were equipped with the most stations; whereas, Ilam, Semnan, and Kohgiluyeh and Boyer Ahmad had the fewest. The Gini coefficient for the distribution of RCS and EMS stations was found to be 0.23 and 0.38, respectively. Additionally, the study examined the prevalence, DALYs, and mortalities caused by road injuries across the 31 provinces and presented the findings in the form of a geographical representation.

Conclusion: The results of this study highlighted the importance of ongoing efforts to ensure the equitable allocation of RCS and emergency services, with a particular emphasis on road accidents and disaster management scenarios.

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.

Leech therapy (Hirudotherapy) is a method used in the treatment of many diseases since ancient times. Although many complications have been reported following the use of this method, no systemic life-threatening bleeding has yet been described. A-43-year-old male patient was diagnosed with upper gastrointestinal bleeding following leech application that he had received for infertility one week earlier. The complications of hirudotherapy typically spontaneously improve due to the local effects of this treatment. The most frequently reported complications are local infections, and less commonly allergies and prolonged local bleeding can occur. However, in this case report, we describe a life-threatening upper gastrointestinal bleeding as a new complication. Gastrointestinal bleeding appearing a week after leech therapy does not necessarily mean that leeches caused gastrointestinal bleeding in this case. Nevertheless, considering the development time of gastrointestinal bleeding, it can be deduced that it was possibly due to hirudotherapy. Patients should be informed about alarming symptoms that can indicate complications following leech application.

Objective: Ventilator-associated pneumonia is the common cause of morbidity and mortality in the intensive care unit. Due to the antimicrobial effect of chlorhexidine, and the long-lasting result of mucoadhesive drugs, this study aimed to determine the effect of chlorhexidine mucoadhesive gel on the prevention of ventilator-associated pneumonia in critical patients.

Method: In this clinical trial, 64 ventilated patients were selected and randomly allocated into two groups. The first group received 0.2% chlorhexidine mucoadhesive gel and the second group received 0.2% chlorhexidine solution as a mouthwash. Every three days, the incidence of ventilator-associated pneumonia was evaluated by the clinical score of pulmonary infection. The data were analyzed by SPSS statistical software version 20.

Results: There was no statistically significant difference in demographic characteristics between the two groups. In the control group, 25% of the patients had ventilator-associated pneumonia, while it was only 15.6% in the intervention group; however, the incidence of ventilator-associated pneumonia revealed no significant difference between the two groups (HR ratio, 0.86; 95% confidence interval, 0.49 to 1.83 p =0.356).In addition, there was no statistically significant difference between the number of days connected to the ventilator (p =0.854), the number of days hospitalized in the intensive care unit (p =0.423), and the death rate (p =0.634) between the two groups.

Conclusion: Although no significant statistical difference was detected between chlorhexidine mucoadhesive gel and chlorhexidine solution in the prevention of ventilator-associated pneumonia, the incidence of pneumonia in the mucoadhesive gel group was clinically less than in the control group. It is better to repeat the study with a larger statistical population.