Bulletin of emergency and trauma最新文献

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.

Nowadays, the use of central venous catheter insertion (CVC), has abundantly increased. It is a common technique in critically ill patients who are admitted to intensive care and emergency departments in order to hemodynamic monitoring and fluid and medication administration. In this report, we express a 28-year-old man who has multiple trauma with decreased level of consciousness during a car accident three months ago and needs intensive care and monitoring by central venous catheter placing. A missed guide wire remaining inside the venous system after peripherally inserted in femoral vein that was incidentally diagnosed by taking a chest X-ray after three months. Although, guide wires are often retrieved by snaring catheter under fluoroscopic guidance and an interventional cardiologist, we have successfully extracted the lost wire through vascular surgery. Eventually, this report is supposed to increase awareness of this rare and preventable complication and to provide a solution to prevent this complication. Finally, the purpose of this report is to emphasize that surgical extracting is the best intervention to remove the missed guide wire (after 3 months) and this option could be developed, introduced and standardized in appropriate and controlled conditions.

Objective: To evaluate the clinical and radiographic findings of long head biceps tendon (LHBT) transfer in traumatic proximal humeral fractures with the biceps groove breakage or comminution.

Methods: In this interventional study, subjects surveyed in terms of shoulder function, clinical signs of LHBT tendinitis, radiographic signs of transferred biceps as a possible depressor of the shoulder, and mechanical changes of the scapula. Data were analyzed in SPSS version 21.

Results: Fifteen patients were included in the case group (tendon transfer to the conjoined tendon), and 10 patients were evaluated in the control group (non-transfer or non-manipulation of the exposed tendon in the fracture callus of biceps groove). The mean age of the study population was 46.56±14.31 years, and the majority of patients (14.56%) were men. The differences between two groups were not significant in terms of the American Society of Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score, and constant shoulder score (CSS) (p=0.535, p=0.419, and p=0.266, respectively). Also, there was no significant differences between the case and control groups regarding the biceps muscle involvement (Popeye sign: p=1.00; tenderness: p=0.477; pain: p=1.00; speed test: p=1.00; Yergason's test: p=1.00).

Conclusion: LHBT transfer to the conjoined tendon in proximal humerus fractures with cleavage or comminution at the bicipital groove showed no advantages.