Bulletin of emergency and trauma最新文献

Objective: This study aimed to investigate blood glucose levels in patients with brain injury caused by mild traumatic brain injury (TBI) as a foundation for determining whether these patients need a brain CT scan or not.

Methods: This cross-sectional study was conducted on patients with mild TBI, who were referred to the emergency department from March 1, 2022, to September 1, 2022. After the confirmation of mild TBI by an emergency medicine specialist, blood samples were taken from the patients to measure blood glucose levels. Then a brain CT scan was performed, and blood glucose levels were compared between patients with and without CT indications of brain injury. A checklist was used to collect data, and the data were analyzed using SPSS software (version 23).

Results: In the CT scans of the 157 patients included in the study, 30 patients (19.2%) had a brain injury in the CT scan. The mean blood glucose level was significantly higher in patients with brain injury, especially in the presence of vertigo and ataxia, than patients without brain injury in the CT scan (p<0.0001). There was a significant positive correlation between age and blood glucose level (r=0.315, p<0.0001).

Conclusion: Patients with mild TBI who had signs of brain injury in the CT scan had significantly higher blood glucose levels than patients with normal CT scan findings. Although indications for performing a brain CT scan are usually based on clinical criteria, blood glucose levels can be helpful in determining the requirement for a brain CT scan in patients with mild TBI.

Objective: This study aimed to evaluate the radiologic and clinical outcomes of TKA with non-stemmed tibial components in relation to their body mass index (BMI).

Methods: In this retrospective cohort study, the outcome of TKA with non-stemmed tibial components based on their BMI was evaluated (BMI<30 vs. BMI≥30). The patients' function was assessed using the International Knee Documentation Committee (IKDC) and Lysholm knee questionnaires. Radiologic evaluation for probable signs of loosening was performed using two quantitative scoring systems by Ewald and Bach et al. Moreover, we reviewed the current literature on the application of non-stemmed tibial components in obese patients.

Results: Twenty-one patients (two men and 19 women) with BMI≥30 and a mean age of 65.1±9.5 years, and 22 patients (three men and 19 women) with BMI<30 and a mean age of 63.6±8.5 years were studied. The mean follow-up periods with BMI≥30 (47.0±19.8 months) and BMI<30 (49.2±18.7 months) were comparable (p=0.618). No patients in either group experienced clinical loosening. Besides, none of the patients had any kind of revision surgery. The patients in both BMI groups had comparable IKDC scores (both the total score and its sub-scores; p>0.05). Furthermore, the total Lysholm knee scores were similar in both groups (p=0.122). Using both scoring systems, the peri-prosthetic bone radiolucency near the tibial components was similar in both groups (p>0.999).

Conclusion: The present study found no significant difference in the radiologic or clinical outcome of non-stemmed TKA in patients with BMIs under and over 30.

Objective: To investigate the use of prognostic markers such as C-reactive protein (CRP) and D-dimer for clinical outcomes in patients with mild traumatic brain injury (TBI).

Methods: This cross-sectional study was conducted on patients with mild head trauma who were admitted to the Emergency Department of Imam Khomeini Hospital (Sari, Iran). Data were collected from 2018 to 2019. Age, sex, the time of injury hospitalization, length of hospitalization, length of unconsciousness, blood pressure, heart rate, respiratory rate, and concomitant symptoms were all recorded using a pre-designed checklist. The patient's Glasgow Coma Scale (GCS), CRP, and D-dimer were also measured. Moreover, all patients underwent CT scan.

Results: This study included 74 patients with TBI. The mean age of the participants was 36.92±3.54. The mean CRP and D-dimer values were 5.69±0.77 and 0.58±0.11 in these patients, respectively. At the cut-off point of 11.50 for CRP, the sensitivity and specificity to detect the pathological lesions in CT scan were 75% and 95.50%, respectively (p<0.001). Additionally, with a D-dimer cut-off point of 0.90, the sensitivity and specificity for diagnosing pathological lesions in CT scan were 100% and 98.50%, respectively (p<0.001).

Conclusion: In general, the CRP and D-dimer levels of patients with mild TBI (GCS≥13) can be assessed to protect against CT-induced radiation exposure and subsequent disorders; if they do not exhibit clinical signs to increase the risk of adverse brain damage, such as reduced level of consciousness, drowsiness, and prolonged periods of unconsciousness.

Objective: To estimate the rate of driving hazard perception (HP), explicate the content of HP and determine its components.

Methods: The present study is a systematic review and a meta-analysis which is carried out to gather data, to search Science Direct, PubMed, Scopus, PROQUEST, web of knowledge databases, Google scholar search engine and also to search manually from January 2000 to September 2021 with using related keywords. EndNote X20 software was used to manage and screening studies. Stata16 was used for meta-analysis. Thematic content analysis was used to analyze the findings. The entire review process was conducted by two authors, and disputes were referred to a third person.

Results: Out of the 1167 founded articles, 50 were finally included in the study. According to 10 imported papers for meta-analysis includes 2770 sample size, general HP of drivers is estimated 3.33 [4.04-2.62 with CI 95, I2=89.72]. Also, HP for experienced and beginner drivers is estimated 3.26 [2.23-4.26 with CI 95, I2=89.47] and 3.42 [2.41-4.43 with CI 95, I2=89.68], respectively. Also, in the data meta-synthesis, 28 definitions of HP and 6 main components are identified to evaluate HP using thematic content analysis.

Conclusion: In this study, obtained results show that all people need constant and gradual training at all levels. A factor that can be effective to improve drivers' HP is to make drivers to take training courses and to pass standard tests at the time of obtaining driving license.

Objective: This study aimed to compare the outcomes of fixing scapholunate with pins and screws in parallel, convergent, and divergent orientations.

Materials and methods: In this computer simulation study, the CT scan images of a healthy subject were used to construct a 3D model of the wrist joint using MIMICS software. The imposed force to scaphoid and 3D model lunate bones, as well as the scapholunate angle and distance, were compared in different surgical techniques using parallel, divergent, and convergent pins and screws.

Results: In the absence of external force, the imposed stress applied to the scaphoid and lunate bones in cases of parallel pins and screws were 7.5MPa, 5.08MPa (pins), 1.134MPa, and 1.151MPa (screws), and 10.90MPa, 10.90MPa (pins), 9.7MPa, and 34.1MPa (screws) for 50N flexion force. The imposed stress in this approach is significantly lower compared to other interventions. Better outcomes were seen regarding scapholunate angle and scapholunate distance in using parallel pins or screws as well.

Conclusion: In conclusion, implementing parallel pins and screws for scapholunate fixation had better results in terms of achieving carpal stability in scapholunate dissociation. However, fixation with pins and screws showed a statistically significant difference. Furthermore, a wide range of motion exercises with no additional forces can be used in the rehabilitation of patients undergoing this surgery.

Objective: This study aimed to evaluate epidemiological aspects of fatal injuries in Georgia.

Methods: This was a retrospective, descriptive study that included all traumatic injury deaths in Georgia from January 1 to December 31, 2018. The National Center for Disease Control and Public Health of Georgia's Electronic Death Register database was utilized in this research.

Results: Of the study fatal injuries, 74% (n=1489) were males. 74% (n=1480) of all fatal injuries were caused by unintentional injuries. Road traffic accidents (25%, n=511) and falls (16%, n=322) were the primary causes of mortality. During the research year, the number of Years of life lost (YLL) was associated with injuries and was increased to 58172 for both sexes (rate per 1000 population: 15.6). Most of the years were lost in the age group of 25-29 years (7515.37). Road traffic deaths accounted for 30% (17613.50) of YLL.

Conclusion: Injuries are still a major public health problem in Georgia. In 2018, 2012 individuals died from injuries across the country. However, mortality and YLL rates of injury varied by age and cause of injury. To prevent injury-related mortality, it is crucial to conduct ongoing research on high-risk populations.

Objective: To compare the ability of quantitative trauma severity assessment methods based on Glasgow coma scale, age, and arterial pressure (GAP), revised trauma score (RTS), and injury severity score (ISS) criteria in determining the prognosis of accidental patients.

Methods: This cross-sectional study was performed on random patients referred to Imam Khomeini Hospital in Urmia from March 20, 2020 to September 21, 2020. The data were obtained by using a checklist includes items such as age, sex, respiration rate, oxygen saturation level, pulse rate, primary blood pressure, initial Glascow coma scale (GCS), patient outcome and injury to different parts of body. After collecting the data, it was entered into SPSS 18 and analyzed with the descriptive and analytical statistics include an independent t-test and receiver operating characteristic curve (ROC) curves.

Results: Out of 1930 studied patients, 365 (18.9%) were women and 1565 (81.1%) were men. The mean age of patients was 37.05±17.11 years and women were significantly older than men. The mortality rate was 4.8% and was significantly more in men compared to women. The mean blood pressure, GCS and oxygen saturation level were lower in deceased patients. The mean GAP, ISS and RTS values were 23.13±2.69, 4.07±3.82, 7.72±0.52, respectively. The mean values of GAP and RTS were significantly low in deceased patients whereas the mean ISS value was significantly high in the deceased patients. The Area under the curve (AUS) for ISS was greater than the other two scoring systems.

Conclusion: The findings of the current study showed that all three systems were adequately efficient to prognoses the final outcome in multi-trauma patients but the ISS measure was better than the other two criteria.

Objective: To evaluate the efficacy of chest x-ray (CXR) in blunt traumatic aortic injury (BTAI) as a primary imaging tool in trauma patients.

Methods: We retrospectively reviewed our hospital records for blunt thoracic aortic injury patients who had a therapeutic intervention from January 2015 to February 2021. Patients' characteristics, initial chest x-rays, and computed tomography (CT) scan were extracted and re-evaluated.

Results: Eighteen patients matched the criteria of our research. The mean age and the injury severity score (ISS) was 29.8±11.2 and 38.4±14.4, respectively. Seven patients (38.9%) underwent thoracic endovascular aortic repair (TEVAR), and 11 (61.1%) had open surgery. The TEVAR group had significantly lower mean intensive care unit stay days (6.6±3.9 vs. 10.8±6.9 in open aortic repair (OAR), p<0.05). The percentile of patients requiring blood transfusion was significantly lower in the TEVAR group (57% vs. 100% in OAR, p<0.05). Mediastinal widening (66.7%) was the most common finding during the evaluation of initial chest x-rays. Interestingly, 22.2% of the initial x-rays were not remarkable for BTAI.

Conclusion: TEVAR is an advantageous choice in the management of BTAI. However, open aortic repair is the optimal decision in certain situations. It is suggested that the Interventional management of the BTAI must be performed by experienced vascular surgeons in a medical center capable of both OAR and TEVAR.

Objective: To evaluate the effect of COVID-19 pandemic on the incidence and mortality rate of road traffic injuries in Shiraz, Iran.

Methods: This cross-sectional study was performed on the data of patients who admitted by road traffic accidents 18 months before the outbreak of COVID-19 and 18 months after COVID-19 in the largest provider of trauma level 1 care services in southern Iran. SPSS 19 software was used to analyze the data.

Results: A significant decrease of 12.8% was observed in the number of patients admitted by road traffic accidents during the COVID-19 pandemic period compared to the same period before the pandemic (p<0.0001). But the death toll from road traffic accidents has increased significantly during the COVID-19 pandemic period compared to the same period before the pandemic (p=0.01).

Conclusion: Due to the COVID-19 restrictions, it seems that factors such as restrictions on suburban travel, closure of public and recreational spaces, reduction of intra-city traffic, people staying at home and a significant reduction in injuries caused by traffic accidents, is reasonable. On the other hand, these restrictions, quarantines, and COVID disease itself can lead to confusion, anxiety, fear of infection, and thus avoid or delay the search for health care and increase mortality. Therefore, planning and policy-making is essential in order to prepare the correct guidance for seeking treatment.

Traumatic cervical translational injury is a notably rare and highly unstable subtype of type C sub-axial cervical spine injury with high morbidity and mortality rates. Hereby, we report a 41-years-old man who was a case of multiple trauma due to car rollover. He was completely conscious, complaining of cervical pain, with a GCS score of 15/15. His neurological examination was unremarkable. The cervical CT scan revealed a vertical translation at the C6-C7 level (roughly 11 mm) and bilateral facet joint diastases which are highly unstable injuries. A two-stage combined anterior and posterior fixation operation was performed. First, an anterior cervical discectomy and fusion with autologous graft and plate fixation, and then a posterior approach with lateral mass screw fixation was performed. Disruption of the anterior longitudinal ligament, annulus fibrosis, facet capsules, and severe strain of ligamentum flavum was noted intraoperatively. He had no early and late complications within 2 years of follow-up.