Situation analysis of trauma based on Arizona trauma center standards in university hospitals of Tehran, Iran

Objective: Injuries are common and important problem in Tehran, capital of Iran. Although therapeutic centers are not essentially established following the constructional principles of developed countries, the present opportunities and equipments have to be used properly. We should recognize and reduce the deficits based on the global standards.This study deliberates the trauma resources and capacities in university hospitals of Tehran based on Arizona trauma center standards, which are suitable for the assessment of trauma centers.Methods: Forty-one university hospitals in Tehran were evaluated for their conformity with "Arizona trauma center standards" in 2008. A structured interview was arranged with the "Educational Supervisor" of all hospitals regarding their institutional organization, departments, clini-cal capabilities, clinical qualifications, facilities and resources, rehabilitation services, performance improvement, continuing education, prevention, research and additional requirements for pediatric trauma patients. Relative frequencies and percentages were calculated and Student's t test was used to compare the mean values.Results: Forty-one hospitals had the average of 77.7 (50.7%) standards from 153 Arizona trauma center standards and these standards were present in 97.5 out of 153 (63.7%) in 17 general hospitals. Based on the subgroups of the standards, 64.8% items of hospital resources and capabilities were considered as a subgroup with the maximum criteria, and 17.7% items of research section as another subgroup with the minimum standards.Conclusions: On the basis of our findings, no hospital meet all the Arizona trauma center standards completely. The hospitals as trauma centers at different levels must be promoted to manage trauma patients desirably.     

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...     

Education and training of the future trauma surgeon in acute care surgery: trauma, critical care, and emergency surgery

BACKGROUND: Trauma surgery as a specialty in the United States is at a crossroads. Currently, less than 100 residents per year pursue additional specialty training in trauma and surgical critical care. Many forces have converged to place serious challenges and obstacles to the training of future trauma surgeons. In order for the field to flourish, the training of future trauma surgeons must be modified to compensate for these changes. DATA SOURCES: Recent medical literature regarding the training of trauma surgeons and report of the Future of Trauma Surgery/Trauma Specialization Committee of the American Association for the Surgery of Trauma. CONCLUSIONS: The new post-graduate trauma training fellowship of the future should be built on a foundation of general surgery. The goal of this program will be to train a surgeon with broad expertise in trauma, critical care, and emergency general surgery. This new emphasis on non-trauma emergency surgery required an image change and thus a new name; Acute Care Surgery: Trauma, Critical Care, and Emergency Surgery.     

Prevalence of Spinal Cord Injury in Tehran,Iran

Abstract

Background/Objective: To determine the prevalence of traumatic spinal cord injury (SCI) in Tehran, Iran.

Methods: A population-based study was performed. In a random cluster sampling, 100 addresses were selected as the starting point of the survey for each cluster consisting of 25 households. To expand the geographic dimension of each cluster, the interviewers skipped 3 of 4 houses in gathering data for each study unit. Each person with traumatic SCI was evaluated initially by a nurse and then by a neurosurgeon by physical examination and spinal imaging at the hospital or at home.

Results: Ninety-seven percent of all surveyed agreed to participate in the study (2,425 households, or 9,006 persons). Four cases of SCI were identified. The point prevalence of SCI was 4.4 [95% CI = 1.2-11.4] per 10,000 people. Over the 5-year period from January 2003 through January 2008, the reported incidence rate of SCI was 2.2 (95% Cl = 0.27-8.00) per 10,000 people.

Conclusions: In this, the first published population-based study from Iran, the prevalence of traumatic SCI in Tehran ranged from 1.2 to 11.4 per 10,000 people. More research is required to determine the patterns and causes of SCI. Development of a nationwide SCI registry or surveillance system is fundamental to an understanding of the epidemiology, and hence the prevention, of this costly health problem.     

Prevalence of Spinal Cord Injury in Tehran,Iran

Background/Objective:

To determine the prevalence of traumatic spinal cord injury (SCI) in Tehran, Iran.

Methods:

A population-based study was performed. In a random cluster sampling, 100 addresses were selected as the starting point of the survey for each cluster consisting of 25 households. To expand the geographic dimension of each cluster, the interviewers skipped 3 of 4 houses in gathering data for each study unit. Each person with traumatic SCI was evaluated initially by a nurse and then by a neurosurgeon by physical examination and spinal imaging at the hospital or at home.

Results:

Ninety-seven percent of all surveyed agreed to participate in the study (2,425 households, or 9,006 persons). Four cases of SCI were identified. The point prevalence of SCI was 4.4 [95% CI  =  1.2–11.4] per 10,000 people. Over the 5-year period from January 2003 through January 2008, the reported incidence rate of SCI was 2.2 (95% CI  =  0.27–8.00) per 10,000 people.

Conclusions:

In this, the first published population-based study from Iran, the prevalence of traumatic SCI in Tehran ranged from 1.2 to 11.4 per 10,000 people. More research is required to determine the patterns and causes of SCI. Development of a nationwide SCI registry or surveillance system is fundamental to an understanding of the epidemiology, and hence the prevention, of this costly health problem.     

The effect of trauma center verification level on traumatic brain injury outcome after implementation of the Orange Book

BackgroundPrevious literature demonstrates mortality discrepancies at Level II vs. Level I centers in patients with isolated Traumatic Brain Injury (TBI). Our hypothesis is that the implementation of the 2014 version of the resources manual (“the Orange Book”) is associated with an elimination of this outcome disparity.MethodsUtilizing the Trauma Quality Program Participant Use File for 2017, we compared TBI outcomes at ACS Level I vs. Level II centers.Results39,764 records met inclusion criteria where 25,382 (63.8%) were admitted to a Level I center. Level I patients were younger (56.4 vs.59.1 years, p < 0.001) and less likely to have been injured in a single level fall (39.5%vs.45.5%, p < 0.001). The incidence of severe TBI (11.3%vs.10.3%, p < 0.001) was more common. Adjusted mortality at a Level II vs. Level I center were similar [7.8% vs. 8.4%, 0.669].ConclusionsImplementation of 2014 version of the ACS resources manual is associated with improved TBI associated mortality in ACS Level II centers relative to their Level I counterparts.     

创伤中心对提升严重多发伤患者救治效果的初步探索

目的:探讨创伤中心建设对严重多发伤患者救治效果的影响。方法:采用回顾性队列研究分析南华大学附属第二医院2015年10月至2019年9月收治的严重多发伤患者资料。以创伤中心建设后（2017年10月至2019年9月）救治的102例患者为研究组,创伤中心建设前（2015年10月至2017年9月）救治的126例患者为对照组,比...     

Evolution, not revolution: splenic salvage for blunt trauma in a statewide voluntary trauma system--a 10-year experience

BACKGROUND: State-legislated trauma systems have been enacted in an attempt to improve trauma care. Blunt splenic injury incidence without a legislated trauma system was examined for changes in care with a hypothesis that a voluntary system may perform equally with a legislated system. METHODS: Data from a statewide discharge database for the years 1993 to 2002 were examined. RESULTS: There were 276,425 trauma admissions overall, with blunt splenic injury occurring in 1.76%. Average Injury Severity Score (ISS) increased in trauma centers and decreased in the community. Trauma centers (TC) had more multisystem injuries. Splenic injury diagnosis increased 44% in TC between the early and late periods but only 7% in community facilities. Splenectomies increased 16% in TC but declined 16% in community hospital. Splenic salvage rate improved at both types of facilities. CONCLUSIONS: Splenic salvage rates improved over time in hospitals with no formal trauma system. Community hospitals cared for more than 50% of splenic injuries but transferred complex multisystem injuries, including splenic injuries, suggesting evolving care. Non-invasive imaging has increased the recognition of splenic injuries in both community hospitals and TC. Splenectomies are performed less, but have increased in TC with increasing ISS scores.     

Measuring trauma outcomes in India: an analysis based on TRISS methodology in a Mumbai university hospital

BACKGROUND: In this prospective study, the TRISS methodology is used to compare trauma care at a university hospital (Lokmanya Tilak Municipal General (LTMG) Hospital) in Mumbai, India, with the standards reported in the Major Trauma Outcome Study (MTOS). METHODS: Between 1 August 2001 and 31 May 2002, 1074 severely injured patients were included in the study. Survival analysis was completed for 98.3% of the patients. RESULTS: The majority of the patients were men (84%) and the average age was 31 years. 90.4% were blunt injuries, with road traffic crashes (39.2%) being the most common cause. The predicted mortality was 10.89% and the observed mortality was 21.26%. The mean Revised Trauma Score (RTS) was 6.61 +/- 1.65 and the mean Injury Severity Score (ISS) was 16.7 +/- 10.67. The average probability of survival (Ps) was 89.14. The M and Z statistics were 0.84 and -14.1593, respectively. CONCLUSION: The injured in India were found to be older, the injuries more severe and with poorer outcomes, than in the MTOS study.     

Breast self-examination: knowledge,attitudes, and practices among female health care workers in Tehran,Iran

A cross-sectional study was conducted to examine the knowledge of breast cancer, attitudes toward breast self-examination (BSE), and practice of BSE among a sample of female health care workers in Tehran, Iran. Using a purposed questionnaire, a total of 410 women from seven health centers completed the questionnaire. The mean age of the respondents was 32.9 years (SD = 9.5), most (58%) were married, and family history of breast cancer was reported by 11%. Seventy-five percent of the women knew about breast cancer prevalence, but only 27% knew that breast pain is not a symptom of breast cancer. Although 73% of women did know that contact with a relative with breast cancer could not lead to development of breast cancer, the respondents' knowledge of risk factors of breast cancer was not satisfactory. With regard to women's attitudes toward BSE, the majority believed that it is not difficult and time consuming or troublesome (63% and 72%, respectively). Sixty-three percent of the respondents claimed that they know how to examine their breasts, but only 6% performed BSE monthly. The practice of BSE was significantly associated with age ( p = 0.01), the level of education ( p < 0.0001), personal history of breast problems ( p < 0.0001), and knowledge of how to examine the breasts ( p < 0.0001). The study findings suggest that the knowledge and behaviors of female health care workers concerning breast cancer is relatively poor and it needs to be improved. Considering the role that health care workers may play in communicating health behaviors to the general public, planning health education interventions for this group of females is essential.     

Traffic crash accidents in Tehran, Iran: Its relation with circadian rhythm of sleepiness

Purpose: Road traffic accidents are one of main problems in Iran. Multiple factors cause traffic accidents and the most important one is sleepiness. This factor, however, is given less attention in our country. Road traffic accidents relevant to sleepiness are studied. Methods: In this cross-sectional study, all road traffic accidents relevant to sleepiness, which were reported by police, were studied in Tehran province in 2009. Results: The risk of road traffic accidents due to sleepiness was increased by more than sevenfold (odds ratio=7.33) in low alertness hours (0:00-6:00) compared to other time of day. The risk of road traffic accidents due to sleepiness was decreased by 0.15-fold (odds ratio=0.15) in hours with maximum of alertness (18:00-22:00) of circadian rhythm compared to other time of day. Conclusion: The occurrence of road traffic accidents due to sleepiness has significant statistical relations with driving during lowest point of alertness of circadian rhythm.     

Incidence and pattern of traumatic spine injury in a single level I trauma center of southern Iran

PurposeSpine injury is one of the leading causes of death and mortality worldwide. The objective of this study was to determine the incidence, pattern and outcome of trauma patients with spine injury referred to the largest trauma center in southern Iran during the last 3 years.MethodsThis is a cross-sectional study conducted between March 2018 and June 2021 in the largest trauma center in the southern Iran. The data collection form included the age, sex, injury location (cervical, thoracic, and lumbar), cause of injury (traffic accidents, falls, and assaults), length of hospital stay, injured segment of spine injury, severity of injury, and outcome. Statistical analyzes were performed using SPSS software version 24.ResultsTotally 776 cases of spine injury were identified. The spine injury rate was 17.0%, and the mortality rate was 15.5%. Cervical spine injury (20.4%) more often occulted in motorcycle accident, and thoracic spine injury (20.1%) occulted in falls. The highest and lowest rates of spine injurys were related to lumbar spine injury (30.2%) and cervical spine injury (21.5%), respectively. There was a statistically significant relationship between the mechanism of injury and the location of spine injury (p < 0.001). And patients with lumbar spine injury had the highest mortality rate (16.7%). Injury severity score (OR = 1.041, p < 0.001) and length of stay (OR = 1.018, p < 0.001) were strong predictors of mortality in trauma patients with spine injury.ConclusionThe results of the study showed that the incidence of traumatic spine injury rate was approximately 17.0% in southern of Iran. Road traffic injury and falls are the common mechanism of injury to spine. It is important to improve the safety of roads, and passengers, as well as work environment, and improve the quality of cars. Also, paying attention to the pattern of spine injury may assist to prevent the missing diagnosis of spine injury in multiple trauma patients.     

Comparative study on characters and outcomes of patients injured from traffic accidents in different rank hospitals

Objective:To compare the characters and outcomes of patients injured from traffic accidents in different rank hospitals.Methods:From 8 hospitals of ranks I-Ⅲ,1915 cases were sampled and divided into 4 groups.Injuries of all patients were accessed by the method of RTS,AIS-ISS-AP and ASCOT.Results:(1)The higher rank of hospitals,the severer the patients‘ condition were.Mean ISSs in hospital ranks Ⅱ and Ⅲ were greater than 16,which were recommended as a standard of severe trauma.(2)Transportation of severe patients to high level hospitals prolonged the pre-hodpital duration by 5-9h.(3)Factors contributing to death were the trauma severity,complications,hospital ranks that reflect the quality of the medical care.Conclusions:(1)This sample of 1915 cases matches the condition of most Chinese hospitals in characteristics of traffic trauma patients.(2)Most Chinese hospitals can be divided into 3 degree of trauma center by a criteria of ISS and the unexpected death.(3) Incidence of multiple injuries shows no significant difference in each rank of hospitals.(4)The relationship between the hospital rank and the quality of trauma care is significant.We suggest that a RTS=11 or ISS=9 be triaged to trauma center,and a 10% Ps(survival probability) less than the average Ps of a hospital be triage to higher level hospitals.     

Finnish Trauma Audit 2004: current state of trauma management in Finnish hospitals

There is great variation in the organisation of trauma care in European countries. The state of trauma care in Finnish hospitals has not been appropriately reviewed in the past. The aim of the present study conducted by the Finnish Trauma Association (FTA) was to assess the number of Finnish hospitals admitting severe trauma patients, and to evaluate the organisation and training of trauma care in those hospitals. In 2004, a telephone survey to all the Finnish hospitals was conducted, and information on the number of severe trauma patients treated per month, the organisation of acute trauma care, and the existence of multidisciplinary trauma care training was collected. Thirty-six Finnish hospitals admitted trauma patients. The range of estimated number of severely injured trauma patients treated in individual hospitals per month varied from 0.5 to 12, resulting in an estimated number of 1000-1300 patients with severe trauma treated in Finland every year (19-25/100.000 inhabitants). About 20% of the hospitals had a trauma team, and 25% had a systematic trauma education program. Only one hospital had established multidisciplinary and systematic trauma team training. The case load of severe trauma patients is low in most Finnish hospitals making it difficult to obtain and maintain sufficient experience. Too many hospitals admit too few patients, and only a few hospitals have been working on updating their trauma management protocols and education. There is an obvious need for leadership, discussion, legislation and initiatives by the professional organisations and the government to establish a modern trauma system in Finland.     

Use of laparoscopy in trauma at a level II trauma center

Background and Objectives:

Enthusiasm for the use of laparoscopy in trauma has not rivaled that for general surgery. The purpose of this study was to evaluate our experience with laparoscopy at a level II trauma center.

Methods:

A retrospective review of all trauma patients undergoing diagnostic or therapeutic laparoscopy was performed from January 2004 to July 2010.

Results:

Laparoscopy was performed in 16 patients during the study period. The average age was 35 years. Injuries included left diaphragm in 4 patients, mesenteric injury in 2, and vaginal laceration, liver laceration, small bowel injury, renal laceration, urethral/pelvic, and colon injury in 1 patient each. Diagnostic laparoscopy was performed in 11 patients (69%) with 3 patients requiring conversion to an open procedure. Successful therapeutic laparoscopy was performed in 5 patients for repair of isolated diaphragm injuries (2), a small bowel injury, a colon injury, and placement of a suprapubic bladder catheter. Average length of stay was 5.6 days (range, 0 to 23), and 75% of patients were discharged home. Morbidity rate was 13% with no mortalities or missed injuries.

Conclusions:

Laparoscopy is a seldom-used modality at our trauma center; however, it may play a role in a select subset of patients.     

Improving outcomes in a regional trauma system: impact of a level III trauma center

BACKGROUND: Trauma systems decrease morbidity and mortality of injured populations, and each component contributes to the final outcome. This study evaluated the association between a referring hospital's trauma designation and the survival and resource utilization of patients transferred to a level I trauma center. METHODS: Data from the Registry of the American College of Surgeons on patients transferred to a level I trauma center during a 7-year period were subdivided into 3 categories: group 1 = level III-designated trauma center; group 2 = potential level III trauma centers; and group 3 = other transferring hospitals. Trauma and Injury Severity Score methodology was used to provide a probability estimate of survival adjusted for the effect related to injury severity, physiologic host factors, and age. A W statistic was calculated for each type of referring hospital so that comparisons between observed survival and predicted survival could be measured. Differences in W, length of stay, intensive care unit days, and ventilator days were examined using general linear models. RESULTS: Patients transferred to a level I from a level III trauma center (group 1) were more seriously injured (P < .0001) and had improved survival (P < .0018) compared with those transferred from nondesignated hospitals (groups 2 and 3). Patients transferred from large nondesignated hospitals (group 2) had outcomes similar to patients transferred from all other hospitals (group 3). Level I hospital resource utilization did not show significant differences based on referring hospital type. COMMENTS: Outcomes of patients in a trauma system are associated with trauma-center designation of the referring hospitals.     

Disparities in access to trauma care in the United States: A population-based analysis

BackgroundInjury is a major contributor to morbidity and mortality in the United States. Accordingly, expanding access to trauma care is a Healthy People priority. The extent to which disparities in access to trauma care exist in the US is unknown. Our objective was to describe geographic, demographic, and socioeconomic disparities in access to trauma care in the United States.MethodsCross-sectional study of the US population in 2010 using small units of geographic analysis and validated estimates of population access to a Level I or II trauma center within 60 minutes via ambulance or helicopter. We examined the association between geographic, demographic, and socioeconomic factors and trauma center access, with subgroup analyses of urban-rural disparities.ResultsOf the 309 million people in the US in 2010, 29.7 million lacked access to trauma care. Across the country, areas with higher income were significantly more likely to have access (OR 1.30, 95% CI 1.12–1.50), as were major cities (OR 2.13, 95% CI 1.25–3.62) and suburbs (OR 1.27, 95% CI 1.02–1.57). Areas with higher rates of uninsured (OR 0.09, 95% CI 0.07–0.11) and Medicaid or Medicare eligible patients (OR 0.69, 95% CI 0.59–0.82) were less likely to have access. Areas with higher proportions of blacks and non-whites were more likely to have access (OR 1.37, 95% CI 1.19–1.58), as were areas with higher proportions of Hispanics and foreign-born persons (OR 1.51, 95% CI 1.13–2.01). Overall, rurality was associated with significantly lower access to trauma care (OR 0.20, 95% CI 0.18–0.23).ConclusionWhile the majority of the United States has access to trauma care within an hour, almost 30 million US residents do not. Significant disparities in access were evident for vulnerable populations defined by insurance status, income, and rurality.     

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.     

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 outpatient burns in Tehran: An analysis of 4813 cases

This study aims to demonstrate the epidemiologic characteristics of outpatient burn injuries in Tehran. This cross-sectional study was performed over a 1-year period in a referral burn centre in Tehran and included all outpatient burns. The required data were recorded by two trained physicians. Of the 4813 studied patients, including 293 infants, 2901 patients (60%) were male (P < 0.001). The mean age of the adult patients was 31.3 ± 18.3 years, while for infants it was 10.68 ± 2.27 months. In all age groups and both genders, scalding was the most common aetiology. Majority of the burns were non-intentianal (n = 4808) and 70.5% of the injuries occurred at home. Housewives consisted of 24% of the burn patients. With respect to the site of burn, multiple injuries were the most frequent (53%) followed by upper extremities (37%). Most of the burns (96%) were partial thickness. Significant association was present between the aetiology and depth of burn (P < 0.001). The mean affected total body surface area (TBSA) was 3.16 ± 2.92% and there was significant association between burnt TBSA and the mechanism of injury (P < 0.001). In conclusion, it seems that women aged 21–30 years and children younger than 10 years are at greater risk of these injuries and therefore should be the target for preventive strategies.