Hospital management of abdominal trauma in Tehran, Iran: a review of 228 patients

Objective: Today, trauma is a major public health problem in some countries. Abdominal trauma is the source of significant mortality and morbidity with both blunt and penetrating injuries. We performed an epidemiological study of abdominal trauma (AT) in Tehran, Iran. We used all our sources to describe the epidemiology and outcome of patients with AT.Methods: This study was done in Tehran. The study population included trauma patients admitted to the emergency department of six general hospitals in Tehran during one year. The data were collected through a questionnaire that was completed by a trained physician at the trauma center. The statistical analysis was performed using the SPSS software (version 11.5 for Windows). The statistical analysis was conducted using the chi-square and P＜0.05 was accepted as being statistically significant.Results: Two hundred and twenty-eight (2.8%) out of 8 000 patients were referred to the above mentioned centers with abdominal trauma. One hundred and twenty-five (54.9%)of the patients were in their 2nd and 3rd decades of life and 189 (83%) of our patients were male. Road traffic accidents (RTA) were the leading cause of AT with 119 (52.2%) patients. Spleen was the commonly injured organ with 51 cases. Following the analysis of injury severity, 159 (69.7%) patients had mild injuries (ISS＜16) and 69 (30.3%) patients had severe injuries (ISS= 16). The overall mortality rate was 46 (20.2%).Conclusions: Blunt abdominal trauma is more common than penetrating abdominal trauma. Road traffic accidents and stab wound are the most common causes of blunt and penetrating trauma, respectively. Spleen is the most commonly injured organ in these patients. The mortality rate is higher in blunt trauma than penetrating one.     

Assessment of mechanism, type and severity of injury in multiple trauma patients: A cross sectional study of a trauma center in Iran

Purpose: To accurately assess the mechanism, type and severity of injury in Iranian multiple trauma patients of a trauma center. Methods: Patients with multiple traumas referring to the emergency department of Hasheminejad University Hospital in Mashhad, Iran, entered this cross sectional study from March 2013 to December 2013. All the patients with injury severity score (ISS) > 9 were included in this study. Data analysis was performed by SPSS software (Version 11.5) and P values less than 0.05 were considered as significant differences. Results: Among the 6306 hospitalized trauma patients during this period, 148 had ISS>9. The male female ratio was 80%. The mean age of the patients was (33.5 ± 19.3) years. And 71% of the patients were younger than 44 years old. There were 19 (13%) deaths from which 68.5% were older than 44 years old. The mean transfer time from the injury scene to hospital was (55 ± 26) minutes. The most frequent mechanisms of injury were motorcycle crashes and falling from height, which together included 66.2% of all the injuries. A total of 84% of hospital deaths occurred after the first 24 h of hospitalization. Head and neck were the most common body injured areas with a prevalence of 111 cases (75%). Conclusion: Motorcycle crashes have high frequency in Iran. Since most victims are young males, injury prevention strategies should be considered to reduce the burden of injuries.     

Comparing epidemiologic features,outcomes, and diagnostic and therapeutic procedures of traumatic patients before and during COVID-19 pandemic: Data from the National Trauma Registry of Iran

PurposeTo prepare for future possible communicable disease epidemics/pandemics, health care providers should know how the COVID-19 pandemic influenced injured patients. This study aimed to compare epidemiologic features, outcomes, and diagnostic and therapeutic procedures of trauma patients admitted to a university-affiliated hospital before and during the pandemic.MethodsThis retrospective study was performed on data from the National Trauma Registry of Iran. All injured patients admitted to the hospital from July 25, 2016 to March 10, 2021 were included in the study. The patients were excluded if they had hospital length of stay less than 24 h. The injury outcomes, trauma mechanisms, and therapeutic and diagnostic procedures of the 2 periods: before (from July 25, 2016 to February 18, 2020) and during (from February 19, 2020 to March 10, 2021) COVID-19 pandemic were compared. All analyses were performed using STATA version 14.0 software (Stata Corporation, College Station, TX).ResultsTotally, 5014 patients were included in the registry. Of them, 773 (15.4%) were registered after the beginning of the COVID-19 pandemic on February 19, 2020, while 4241 were registered before that. Gender, education level, and cause of injury were significantly different among the patients before and after the beginning of the pandemic (p < 0.001). In the ≤ 15 years and ≥ 65 years age groups, injuries decreased significantly during the COVID-19 pandemic (p < 0.001). The frequency of intensive care unit (ICU) admission decreased from 694 (16.4%) to 88 (11.4%) (p < 0.001). The mean length of stay at the hospital (days) and at the ICU (days) declined as follow: 8.3 (SD = 17.2) vs. 5.5 (SD = 6.1), p < 0.001 and 7.5 (SD = 11.5) vs. 4.5 (SD = 6.3), p < 0.022. The frequency of diagnostic and therapeutic procedures before and during the pandemic was as follows, respectively: ultrasonography 905 (21.3%) vs. 417 (53.9%) (p < 0.001), echocardiography 313 (7.4%) vs. 107 (13.8%) (p < 0.001), angiography 1597 (37.7%) vs. 534 (69.1%) (p < 0.001), MRI 166 (3.9%) vs. 51 (6.6%) (p < 0.001), surgery 3407 (80.3%) vs. 654 (84.6%) (p < 0.001), and internal/external fixation 1215 (28.6%) vs. 336 (43.5%) (p < 0.001).ConclusionThe pandemic affected the epidemiology of traumatic patients in terms of gender, age, educational level, and trauma mechanism. It changed the outcomes of injured patients: ICU admission, length of stay at the hospital and ICU decreased. The patients received more diagnostic and therapeutic procedures during the pandemic. To be more precise, more research is needed on the details.     

Hospital management of abdominal trauma in Tehran, Iran: a review of 228 patients

Objective: Today, trauma is a major public health problem in some countries. Abdominal trauma is the source of significant mortality and morbidity with both blunt and penetrating injuries. We performed an epidemiological study of abdominal trauma (AT) in Tehran, Iran. We used all our sources to describe the epidemiology and outcome of patients with AT.Methods: This study was done in Tehran. The study population included trauma patients admitted to the emergency department of six general hospitals in Tehran during one year. The data were collected through a questionnaire that was completed by a trained physician at the trauma center. The statistical analysis was performed using the SPSS software (version 11.5 for Windows). The statistical analysis was conducted using the chi-square and P＜0.05 was accepted as being statistically significant.Results: Two hundred and twenty-eight (2.8%) out of 8 000 patients were referred to the above mentioned centers with abdominal trauma. One hundred and twenty-five (54.9%)of the patients were in their 2nd and 3rd decades of life and 189 (83%) of our patients were male. Road traffic accidents (RTA) were the leading cause of AT with 119 (52.2%) patients. Spleen was the commonly injured organ with 51 cases. Following the analysis of injury severity, 159 (69.7%) patients had mild injuries (ISS＜16) and 69 (30.3%) patients had severe injuries (ISS= 16). The overall mortality rate was 46 (20.2%).Conclusions: Blunt abdominal trauma is more common than penetrating abdominal trauma. Road traffic accidents and stab wound are the most common causes of blunt and penetrating trauma, respectively. Spleen is the most commonly injured organ in these patients. The mortality rate is higher in blunt trauma than penetrating one.     

Epidemiology of livestock-related injuries in a major trauma center in Kashan, Iran

Objective:Livestock-related injuries are one of the important factors causing morbidity and mortality in patients admitted to hospital.Treatment of these patients is still a major problem in health car...     

Epidemiological investigation on Wenchuan earthquake-struck trauma patients admitted to two hospitals of Chongqing

Objective： To study epidemiological characteristics and influential factors of in-hospital patients struck by the Wenchuan earthquake disaster. Methods： The clinical data of 196 cases were collected from 2 hospitals of Chongqing city, including age, sex, occupation, injury site, dwelling and injury severity score. Results： In this series, 31.63% victims＇ age was over 60 years, and 54.08% were farmers. Multiple trauma accounted for 35.71%, and lower limb injury for 33.67%. There was no significant difference on injury severity score between city dwellers and rural ones （P〉0.05）. Conclusion： The earthquake injury is influenced by many factors. More attention should be paid to the treatment at first 5 days after injury and high risk population.     

Comparison of the new injury severity score and the injury severity score in multiple trauma patients

Objective： To assess whether these characteristics of less misclassification and greater area under receiver operator characteristic （ROC） curve of the new injury severity score （NISS） are better than the injury severity score （ISS） as applying it to our multiple trauma patients registered into the emergency intensive care unit （EICU）.
Methods： This was a retrospective review of registry data from 2 286 multiple trauma patients consecutively registered into the EICU from January 1,1997 to December 31, 2006 in the Second Affiliated Hospital, Medical School of Zhejiang University in China. Comparisons between ISS and NISS were made using misclassification rates, ROC curve analysis, and the H-L statistics by univariate and multivariate logistic progression model.
Results： Among the 2 286 patients, 176 （7.7%） were excluded because of deaths on arrival or patients less than 16 years of age. The study population therefore comprised 2 1 10 patients. Mean EICU length of stay （LOS） was 7.8 days ± 2.4 days. Compared with the blunt injury group, the penetrating injury group had a higher percentage of male, lower mean EICU LOS and age. The most frequently injured body regions were extremities and head/neck, followed by thorax, face and abdomen in the blunt injury group; whereas, thorax and abdomen were more frequently seen in the penetrating injury group. The minimum misclassification rate for NISS was slightly less than ISS in all groups （4.01% versus 4.49%）. However, NISS had more tendency to misclassify in the penetrating injury group. This, we noted, was attributed mainly to a higher false-positive rate （21.04% versus 15.55% for IS S, t=-3.310, P〈0.001）, resulting in an overall misclassification rate of 23.57% for NISS versus 18.79% for ISS （t=3.290, P〈0.001）. In the whole sample, NISS presented equivalent discrimination （area under ROC curve： NISS=0.938 versus ISS=0.943）. The H-L statistics showed poorer calibration （48.64 versus 32.11, t=3.305, P〈0.001） in     

Epidemiology of patients admitted to a major trauma centre in northern India

Objective： Trauma in India is an increasingly significant problem, particularly in light of rapid development and increasing motorization. Social changes are resulting in alterations in the epidemiology of trauma. The aim of the study was to assess the various epidemiological parameters that influence the cause of injury in the patients admitted to a major trauma centre in northem India. Methods： An observational study of 748 patients chosen by random assortment was carried out over a peri- od of 1 year （August 2008 to July 2009）. Age, sex, injury type and pattern were noted. Injury mode of upper and lower limbs was also noted. Results： Injuries occur predominately in the age group of 15-30 years. Males incurred more injury with male to female ratio of 6：1. The most vulnerable group was motorcycle users. Among the injured, farmers were the most commonly involved. Blunt injuries （94.92%） were much more common than penetrating injuries. Among patients with head injury, two wheelers related accidents were the most common （40.3%）. Most spinal cord injuries were caused by falls from height （51.09%）. Most lower limb fractures were simple type. Compound fractures of the lower limb were more common than up- per limb fractures. Conclusion： Strict enforcement of traffic rules, combined with improved infrastructure and behavior change can decrease the burden of road traffic accidents in India and other developing countries. This study could assist in raising the profile of road traffic accidents as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and plan- ning appropriate interventions for this major challenge. Preventive strategies should be made on the basis of these epidemiological trends.     

Factors determining the severity of ski injuries

We investigated the relationship between the severity of ski injuries (n=895) classified according to the abbreviated injury score (AIS; based on objective criteria for judging the severity of injuries) and the following factors: sex, site and mode of injury, skill level, speed at the time of injury, binding release, gradient, type of snow, surface conditions, weather, visibility, and the month and day of the week on which the injury was sustained. Age, sex, mode and site of injury, speed at the time of injury, binding release, visibility, and the month and day of the week on which the injury was sustained were associated with the severity of injuries, but the skill level, gradient, type of snow, surface conditions, and weather were not. Injuries with an AIS of 4 or higher accounted for only 4.6% of injuries (AIS scores range from 1; e.g., mild sprains, to a maximum of 6; injuries with scores of 4 and above are regarded as life-threatening). Given that patients with very severe injuries tend to be taken to our facility, the actual incidence of severe ski injuries may be even lower. However, measures to protect against severe injuries are needed to ensure greater safety for skiers.     

烧创伤相关肺损伤系统控制技术的研究与转化

Burns and traumas are common injuries during both peacetime and wartime.Lung is the earliest organ subjected to dysfunction and the incidence is highest.The systemic protective technology for the burn ...     

Demographics,mechanism of injury,and associated injuries of 25,615 patients with talus fractures in the National Trauma Data Bank

BackgroundExtensive research has been conducted concerning the epidemiology of fractures of the calcaneus and ankle. However, less work has characterized the population sustaining talus fractures, necessitating the analysis of a large, national sample to assess the presentation of this important injury.MethodsThe current study included adult patients from the 2011 through 2015 National Trauma Data Bank (NTDB) who had talus fractures. Modified Charlson Comorbidity Index (CCI), mechanism of injury (MOI), Injury Severity Score (ISS), and associated injuries were evaluated.ResultsOut of 25,615 talus fracture patients, 15,607 (61%) were males. The age distribution showed a general decline in frequency as age increased after a peak incidence at 21 years of age. As expected, CCI increased as age increased. The mechanism of injury analysis showed a decline in motor vehicle accidents (MVAs) and an increase in falls as age increased. ISS was generally higher for MVAs compared to falls and other injuries.Overall, 89% of patients with a talus fracture had an associated injury. Among associated bony injuries, non-talus lower extremity fractures were common, with ankle fractures (noted in 42.7%) and calcaneus fractures (noted in 27.8%) being the most notable. The most common associated internal organ injuries were lung (noted in 19.0%) and intracranial injuries (noted in 14.9%).ConclusionThis large cohort of patients with talus fractures defined the demographics of those who sustain this injury and demonstrated ankle and calcaneus fractures to be the most commonly associated injuries. Other associated orthopaedic and non-orthopaedic injuries were also defined. In fact, the incidence of associated lumbar spine fracture was similar to that seen for calcaneus fractures (14%) and nearly 1 in 5 patients had a thoracic organ injury. Clinicians need to maintain a high suspicion for such associated injuries for those who present with talus fractures.Level of EvidenceLevel II, retrospective study     

Frequency of fall-related injuries of female patients referred to the trauma center in the city of Kashan from years 2005 to 2008

Objective:Falls are one of the life events leading to injury and in serious cases cause high morbidity and mortality.This research was conducted to determine the fall incidence among female population ...     

Early mobilization of trauma patients admitted to intensive care units: A systematic review and meta-analyses

ObjectiveTo determine the effect of early mobilization (EM) in trauma patients admitted to the ICU. Outcomes of interest included mortality, hospital and ICU length of stay (LOS), and duration of mechanical ventilation.MethodsWe performed a systematic review of 4 electronic databases (Ovid MEDLINE, Embase, CINAHL, Cochrane Library) and the grey literature. Eligible study designs included randomized control trials, prospective cohorts, or retrospective cohorts. Studies must have compared EM to usual care (i.e., delayed or no mobilization) in trauma patients admitted to ICU. Overall, there were 2982 articles screened and 9 were included in the analysis. Two authors independently performed data extraction using a standardized form. Pertinent study design and population characteristics were recorded, as were prespecified outcome measures. Meta-analyses were performed using random effects models. Study quality was assessed using the Newcastle-Ottawa Scale.ResultsStudy cohorts ranged from 15 to 1132 patients (median 63) and varied in their inclusion criteria. Most studies utilized a progressive mobility protocol as their intervention. Mortality was reported in 5 studies, of which 3 observed a lower rate with EM; however, meta-analysis showed no difference in mortality between patients mobilized early and those receiving usual care. Eight studies reported on LOS (in-hospital and ICU); although all 8 studies found EM reduced LOS, the difference in LOS was not significant on meta-analysis. Finally, 3 studies reported on ventilator days, all of which observed a reduction in the EM group. On meta-analysis, duration of mechanical ventilation was significantly lower with EM (mean difference −1.18 days, 95% CI, −2.17 – −0.19).ConclusionsFew studies have investigated the effects of EM in trauma ICU patients. The available evidence suggests that patients who receive EM require fewer days of mechanical ventilation, but have similar mortality and LOS compared to those receiving usual care.     

Epidemiology of road traffic mortality and injuries in Yazd, Iran during 2003-2008

Objective: Road traffic crashes (RTCs) are considered to be the second highest cause of mortality in Iran. The purpose of this study was to describe the morbidity and mortality of RTC during 2003-2008.Methods: Data were got from national health sources of Iran. These data included population, the number of RTCs,consequent fatalities, cause and place of death from 2003 to 2008.Results: RTC incidence rate increased from 868.5 per 100 000 population in the year 2003 to 1 643.6 in 2008. A total of 2 565 deaths from RTC were recorded in Yazd from 2003 to 2008. RTC mortality rate increased from 46.1 per 100 000 population in 2003 to 46.9 in 2006, then declined to 38.8 in 2008. During this time period, overall traffic injury incidence per 100 000 population increased from 368.8 in 2003 to 647.9 in 2006, then declined to 527.9 in 2008. Head injuries were the most common cause of road traffic-related mortality from 2003 to 2008. Following road traffic accidents, most of the deaths occurred before arriving hospital.Conclusions: Road traffic crash-related mortality and morbidity in Yazd in the recent six years are increased, but decreased in the last two years. This decline is most probably the result of a variety of interventions, including laws,police enforcement, improvements in traffic and transport,health care resources and media and public education.     

两种损伤严重程度评分对腹部闭合性损伤病人死亡率预测价值的对比分析

目的探讨新损伤严重程度评分(new injury severity score,NISS)与损伤严重程度评分(injury severity score,ISS)对腹部损伤病人预后预测价值的差异。方法自2010年1月至2015年5月,按照连续采样的方法收集就诊的腹部损伤病人的临床资料,根据病人是否死亡将所有病人分为死亡组和生存组。比较组间病人年龄、性别、入院时脉搏、收缩压、NISS、ISS以及受伤机制的差异,多元回归分析法判定腹部损伤病人死亡的相关危险因素,并绘制相关危险因素预测病人死亡的ROC曲线,以比较两种评价体系对病人预后预测价值的差异,并确定相关危险因素预测病人死亡的临界值。结果组间病人入院情况相比,生存组病人入院时平均脉搏相对较慢,收缩压相对较高,ISS、NISS评分相对较低,就病人致伤因素分布情况来看,死亡组病人交通事故伤病人比例相对较高,以上组间相比差异均有统计学意义(P均0.05)。病人死亡危险因素的多元回归分析结果显示,病人入院时收缩压、ISS、NISS评分是腹部损伤病人死亡的独立危险因素(OR值均1.0,P值均0.05)。ISS、NISS预测病人死亡的对比分析结果显示,NISS[曲线下面积(AUC)=0.96,95%置信区间(CI):0.57~1.93,P0.001]预测病人死亡风险的AUC较ISS(AUC=0.75,95%CI:0.92~1.00,P=0.003)相对较大,准确性相对较高,在NISS=14时,其预测腹部损伤病人死亡的敏感性和特异性分别为90.2%和88.6%。结论 ISS、NISS两种评分体系均是腹部闭合性损伤病人死亡风险的独立危险因素,但在病人死亡风险预测上,NISS评分的预测价值相对较大,值得临床进一步研究证实。     

Mortality pattern according to autopsy findings among traffic accident victims in Yazd, Iran

Objective： To describe mortality pattern and to determine undiagnosed fatal injuries according to autopsy findings among road traffic accident victims in Yazd, Iran.
Methods： In this retrospective study, 251 victims of road traffic accidents who were admitted to a tertiary trauma hospital over a two-year period （2006 and 2007） and received medical cares were included. Hospital records were reviewed to gather demographic characteristics, road user type, and medical data. Autopsy records were also reviewed to determine actual causes of death and possible undiagnosed injuries occurred in the initial assessment of the emergency unit or during hospitalization.
Results： There were 202 males （80.5%） and 49 females （19.5%）. The mean （＋SD） age of fatalities was 34.1 （＋21.5） years. Pedestrian-vehicle accidents were the most common cause of trauma （100 cases, 39.8%）. The most common cause of death was central nervous system injury （146 cases, 58.1%）. The other causes were skull base fractures （10%）, internalbleeding （8%）, lower limb hemorrhage （8%）, skull vault fractures （4%）, cervical spinal cord injury （3.6%）, airway compromise （3.2%）, and multifactor cases （5.1%）, respectively. Thirty-six fatal injuries in 30 victims （12%） mainly contributed to death according to autopsy, but were not diagnosed in initial assessments. The head （72.2%） and cervical spine （13.8%） regions were the two most common sites for undi- agnosed injuries.
Conclusion： Training courses for emergency unit medical staff with regard to interpreting radiological findings of head and neck and high clinical suspicion for cervical spine injuries are essential to improve the quality of early hospital care and reduce the mortality and morbidity of traffic accident patients.