Bulletin of emergency and trauma最新文献

Objective: This study aims to characterize the demographic, clinical, and radiological features of gunshot wound (GSW) patients as well as identify predictors of prolonged hospitalization.

Methods: In this retrospective study, a consecutive sampling method was used, including all patients with GSWs in any anatomical region. Data collection included demographic and clinical information, radiological findings, treatment specifics, and outcome variables, such as hospitalization length of stay (LOS) as the primary outcome. To identify predictive factors associated with prolonged LOS, logistic regression analysis was used.

Results: We studied 212 GSW cases, including 95.8% were men and 4.2% were women. The mean age of the studied group was 30.17±7.80 years. GSWs occurred in extremities (80.2%), abdomen (9.0%), thorax (4.7%), and head or neck (5.2%). Two patients (0.9%) had both abdominal and thoracic GSWs. The most prevalent radiological study was an X-ray (83.0%). Patients with head and neck GSWs had the longest emergency department stay, while patients with abdominal GSW patients had the shortest (p=0.068). The highest rates of blood product transfusion were observed in abdominal GSWs (63.2%), emergency surgery (63.2%), and ICU admission (42.1%). Head and neck GSWs had the longest hospitalization LOS (7.5 days). Longer LOS was significantly associated with abnormalities in radiological findings, receiving blood products, and ICU admission (p≤0.001). Significant predictors of prolonged LOS were major abnormalities in radiological findings [odds ratio (OR)=5.3; 95% confidence interval (CI):2.8-10.2], head and neck GSWs (OR=6.1; 95% CI:1.2-31.9), and blood product transfusion (OR=4.1; 95% CI: 1.0-16.3).

Conclusion: This study provides insights into factors influencing prolonged hospitalization in GSW patients, highlighting the importance of radiological findings, head and neck injuries, and blood product transfusion.

Objective: This study evaluated the occupational burnout (OB) and spiritual well-being (SWB) of emergency nurses as well as the associations between these variables.

Method: This cross-sectional study was conducted in six hospitals and emergency medical centers affiliated with Ardebil University of Medical Sciences (Ardebil, Iran), in 2020. Data were collected via socio-demographic, Spiritual Well-Being Scale (SWBS), and Maslach Burnout Inventory (MBI) questionnaires.

Results: This study included 239 emergency department nurses. The mean age of the participants was 34.4±6.4 years. The mean of existential well-being and religious well-being was 40.3±8.7 and 41.0±9.2, respectively. The results indicated that moderate (P=0.007) and severe (P<0.001) personal accomplishment was a positive and significant predictor of the SWB in emergency department nurses.

Conclusion: Proper planning and provision of suitable educational programs in the dimension of the SWB of nurses prevent the creation and continuation of OB and increase the self-efficacy and job satisfaction of emergency medical staff, resulting in better patient care.

Thoracic ossification of the posterior longitudinal ligament (OPLL) is a rare condition that is mainly accompanied by cervical OPLL or ossification of thoracic ligamentum flavum. In case of causing neurological manifestations, it is preferred to treat the condition surgically. Several surgical procedures were introduced, including anterior, posterior, or combined approaches. Laminectomy with instrumented fusion is the most popular procedure utilized via the posterior approach. A 32-year-old obese woman, who suffered from back pain and weakness in both lower extremities for one month, was referred to our spine outpatient clinic. Imaging revealed lower thoracic OPLL (T7/T8 & T8/T9 & T9/T10). The posterior longitudinal ligament had a mixed ossification pattern (beaked and continuing cylindrical). To maintain thoracic spine stability and prevent future kyphosis, we performed laminectomy and long segment fixation (T7 to T12). The post-operative neurological examination revealed a considerable increase in muscle strength and significant pain relief.

Objective: Breaking bad news (BBN) is a critical aspect of healthcare delivery that can have significant implications for patients' outcomes. Inadequate and inappropriate delivery of bad news can result in detrimental psychological and emotional effects. This study aimed to compare the performance of emergency department (ED) personnel and patients' preferences in BBN.

Methods: This descriptive-analytical study was conducted in 2022, and 135 patients who were admitted to the ED were included using quota sampling. Data were collected using a demographic questionnaire, a researcher-made questionnaire, and a standard questionnaire on attitudes toward the methods of BBN in the ED. The data were analyzed using SPSS software (version 16), and a p-value<0.05 was considered statistically significant.

Results: The results showed that the majority of patients (69.6%) received bad news from nurses. Based on the conditions mentioned in the standard questionnaire, the overall performance of personnel was 6.08±4.22 out of 19, while the overall attitude score (59.66±7.66 out of 76) revealed patients' high tendency to receive bad news. There was a statistically significant difference between the total score of personnel performances and the total score of patients' attitudes (p=0.001).

Conclusion: The performance of ED personnel concerning patients' attitudes toward the method of BBN in the emergency department was not optimal. Therefore, it is recommended to implement appropriate training programs for medical professionals, especially physicians, and nurses, to enhance their communication skills and reduce the detrimental effects of inappropriate delivery of bad news in medical settings.

Objective: To determine the causal relationship between aging and nighttime driving and the odds of injury among elderly drivers.

Methods: In this cross-sectional study, 5460 car accidents were investigated from 2015 to 2016. The data were extracted from the Iranian Integrated Road Traffic Injury Registry System. Pedestrian accidents, motorcycle crashes, and fatalities were excluded from the study. To account for major confounders, Bayesian-LASSO, and treatment-effect cutting-edge approaches were used.

Results: Overall, 801 injuries (14.67%) were evaluated. The results of the univariable analysis indicated that aging and nighttime had adverse effects on the odds of road traffic injuries (RTIs), even after adjusting for the effect of other variables, these effects remained statistically significant. According to a newly developed approach, the overall effects of aging and nighttime were significantly and directly correlated with the odds of being injured for older adults (both p<0.001). Our findings indicated that drivers over 75 years old experienced 23% higher injury odds (OR=1.23, 95% CI:1.11 to 1.39; p<0.001), while driving at night increased the odds by 1.78 times (OR=1.78, 95% CI:1.51 to 1.83; p<0.001).

Conclusion: Aging and nighttime driving are significant risk factors for RTIs among elderly drivers. This highlights the importance of implementing targeted interventions to enhance road safety for this vulnerable population. Furthermore, the use of advanced Bayesian-LASSO and treatment-effect statistical methods highlights the importance of utilizing sophisticated methodologies in epidemiological research to effectively capture and adjust for potential confounding factors.

Objective: To evaluate the spiral chest computed tomography (CT) scan findings in patients with multiple trauma during the COVID-19 pandemic.

Methods: This retrospective study was performed on multiple trauma patients admitted to a tertiary hospital in the north of Iran in 2020. All patients with multiple trauma who had undergone a chest spiral CT were included in this study. Furthermore, the data analysis was performed through descriptive and analytical statistics using SPSS software.

Results: A total of 600 patients were included over the study period. The mean age of patients was 48.2±20.3 years. Of the total, 496 (65.3%) patients had blunt chest injuries, and 104 (34.7%) had penetrating chest injuries. Falling was the most common mechanical cause of chest trauma in 270 patients (45%). Surgical interventions were performed in 110 (18.3%) patients. A total of 276 (46%) patients had chest injuries identified by CT scans. Many patients (15.6%) had ground-glass lung opacity in the CT scan reports. Lung consolidation, pneumothorax, lung contusion, hemothorax, and rib fractures were the most common.

Conclusion: Due to the high frequency of typical findings in spiral CT scan examinations, obtaining a reliable history of trauma severity, injury mechanism, and a detailed physical examination is recommended before prescribing a CT scan for patients.

Objective: The present study was conducted to evaluate previous studies on hazard perception among road users.

Methods: A comprehensive search was conducted using electronic databases and search engines including Science Direct, PubMed, Scopus, Embase, Web of Science, Iranmedex, SID, Irandoc, and Google Scholar from January 2000 to September 2021. The search was performed using a combination of medical subject heading terms and keywords. Endnote software version 20.0 (Clarivate, Philadelphia, PA, USA) was used to organize the included articles. Thematic content analysis was used to analyze the findings. The entire review process was conducted by two authors, and unresolved challenges were discussed with other researchers.

Results: Findings of the study show that all of the tests could discriminate between inexperienced and experienced drivers. The use of dynamic hazard perception tests was more common than static tests, and in some cases, simulators were used. Moreover, the results indicated a weak correlation between the results of dynamic and static tests. Therefore, it could be claimed that both dynamic and static methods measured certain dimensions of hazard perception.

Conclusion: Regarding the importance of hazard perception, the findings of this study can provide further progress in designing hazard perception tests. The hazard perception tests can be sensitive to cultural or legal differences. It should also be noted that in developing tools for measuring drivers' hazard perception, different dimensions of hazard perception must be considered, so that the level of drivers' hazard perception can be reported accurately.

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.