Exclusive versus Inclusive Trauma System Model in High Volume Trauma Regions
Shahram
Paydar
author
Zahra
Ghahramani
Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
author
Shahram
Bolandparvaz
author
Hossein
Abdolrahimzadeh
author
Abdolkhalegh
Keshavarzi
author
Mohammad Javad
Moradian
author
Hamid Reza
Abbasi
author
text
article
2018
eng
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
269
270
https://beat.sums.ac.ir/article_44448_90e0f33f2e265baed071c1f27ea232e5.pdf
dx.doi.org/10.29252/beat-060401
Diagnostic Accuracy of Rapid Ultrasound in Shock (RUSH) Exam; A Systematic Review and Meta-analysis
Mojtaba
Keikha
Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences , Shahroud, Iran .
author
Mohammad
Salehi-Marzijarani
Department of Biostatistics, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
author
Reihane
Soldoozi Nejat
Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
author
Hojat
sheikh Motahar Vahedi
Assistant professor of emergency medicine, Tehran University of medical sciences, Tehran, Iran.
author
Seyed Mohammad
Mirrezaie
Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
author
text
article
2018
eng
Objective: To perform a diagnostic accuracy of the rapid ultrasound in shock (RUSH) to diagnose the etiology of undifferentiated shock in patients presenting to the emergency department (ED).Methods: We searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till July 2017. Two independent reviewers screened studies for eligibility. Our study analysis is planned in accordance with the guidelines for meta–analysis of diagnostic studies. In the systematic search, of 397 references, 295 were excluded on the basis of the title and abstract. For the remaining 102 articles, the full text was retrieved and critically reviewed. After the selection process, five papers were included.Results: The pooled estimate of all data showed that the RUSH protocol exhibited high sensitivity (0.87, 95% Confidence Interval (CI): 0.80-0.92, I2 = 46.7%) and specificity (0.98, 95% C. I.: 0.96-0.99, I2 = 30.8%). The AUC for SROC, a global measure of the RUSH protocol performance, was 0.98 ± 0.01, indicates the high accuracy of the test. Positive and negative likelihood ratios reported from the studies ranged from 9.83 to 51.32 and 0.04 to 0.33, respectively. The pooled estimate of all data showed that the RUSH protocol exhibited high positive likelihood ratio (19.19, 95% C. I.: 11.49-32.06, I2 = 14.1%) and low negative likelihood ratio (0.23, 95% C. I.: 0.15-0.34, I2 = 18.4%).Conclusion: This meta-analysis suggests that RUSH protocol has generally good role to distinguish the states of shock in patients with undifferentiated shock referred to the emergency department.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
271
278
https://beat.sums.ac.ir/article_44449_a06769d689ea2b4865373945862ff278.pdf
dx.doi.org/10.29252/beat-060402
Epidemiology of Road Traffic Injuries among Elderly People; A Systematic Review and Meta-Analysis
Saber
Azami-Aghdash
author
Mir Hossein
Aghaei
author
Homayoun
Sadeghi-Bazarghani
author
text
article
2018
eng
Objective: To systematically review the epidemiological patterns and interventions for prevention of road traffic injuries (RTIs) among elderly.Methods: Searching keywords including: accident, trauma, road injury, road traffic injuries, aging, old, elder, strategy, intervention, road traffic crash prevention and traffic accident in databases including, Google scholar, SID, IranMedex, PubMed and Scopus. English and non-Persian articles, articles presented in congresses, articles that considered elderly people to have age under than 60 years were excluded. The reporting quality of articles was assessed by two experts using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) check list.Results: RTIs compromised 23.6% of total injuries among elderly. The most frequent injuries were about car accidents (51.4%). Pedestrian injuries composed 48.1% of the RTIs. Head and neck (32.1%) were most injured body parts. There was a significant difference between elderly and non-elderly people in terms of RTIs associated mortality (Odd=2.57 [1.2-5.4 CI 95%]). Overall 25 main domains of intervention and 73 subordinate domains were extracted in five categories (human, road and environment, tools and cars, medical, legal and political issues).Conclusion: According to the notable prevalence and fatality of RTIs, lack of sufficient studies and valid evidence of the present study can provide an appropriate evidence for better interventions for RTIs prevention among elderly.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
279
291
https://beat.sums.ac.ir/article_44450_6983ae321ce348efdbfbb29813f678ac.pdf
dx.doi.org/10.29252/beat-060403
Effect of Intramuscular Ketamine versus Haloperidol on Short-Term Control of Severe Agitated Patients in Emergency Department; A Randomized Clinical Trial
Farhad
Heydari
Emergency Medicine Research Center, Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
author
Alireza
Gholamian
Emergency Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
author
Majid
Zamani
Emergency Medicine Research Center, Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
author
Saeed
Majidinejad
Emergency Medicine Research Center, Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
author
text
article
2018
eng
Objective: To evaluate the efficacy and safety of intramuscular ketamine and haloperidol in sedation of severely agitated patients in emergency department (ED).Methods: This randomized, double-blind clinical trial study was performed on agitated patients referring to two university educational hospitals. Patients were randomly assigned to receive intramuscular (IM) haloperidol (5 mg) or IM ketamine (4 mg/kg). The primary outcome was time to adequate sedation (AMSS ≤ +1). Secondary outcomes included the need for additional sedatives, required intubation, duration of hospitalization, and side effects. Results: The 90 agitated patients were enrolled. The mean age was 30.37±7.36 years (range 18–56); 74% (67/90) were men. The mean time to adequate sedation in ketamine group (7.73 ± 4.71 minutes) was significantly lower than haloperidol group (11.42 ± 7.20 minutes) (p= 0.005). 15 minutes after intervention, the sedation score did not differ significantly in both groups (Ketamine:0.14 ± 0.59 vs. Haloperidol: 0.30 ± 0.60; p=0.167). The incidence of complications was not significantly different between groups. The physician's satisfaction from the patients’ aggression control was significantly higher in ketamine group.Conclusion: These data suggest ketamine may be used for short-term control of agitated patients, additional studies are needed to confirm if ketamine is safe in this patient population. Given rapid effective sedation and the higher physician satisfaction of ketamine in comparison to haloperidol, it may be considered as a safe and appropriate alternative to haloperidol.IRCT Code: IRCT20180129038549N5
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
292
299
https://beat.sums.ac.ir/article_44451_2c789b78deed46e7b0fe53988dda9caa.pdf
dx.doi.org/10.29252/beat-060404
The Effect of Hyoscine on Pain, Tenderness, and Rebound Tenderness in Patients with Appendicitis: Quasi-Interventional Study
Alireza
Esmaeili
author
Vahideh
Salimi
author
Naser
Mohammad Karimi
author
Majid
Hajimaghsoudi
author
Mahmoud
Vakili
author
Ehsan
Zarepur
author
text
article
2018
eng
Objective: To evaluate the effect of hyoscine on pain and tenderness, rebound tenderness and appendicitis patients before surgery and this study can be considered as the first study investigated the efficacy of hyoscine on pain, tenderness, and rebound tenderness in patients with appendicitis.Methods: In this single-group, prospective interventional study (before-after) according to inclusion and exclusion criteria, 70 patients with pain in the right lower abdomen and typical symptoms of appendicitis were evaluated and after surgery, diagnostic accuracy was examined by pathologic results. The pain was evaluated before and after administration of hyoscine by numerical and verbal examination. Tenderness and rebound tenderness were also determined.Results: The mean age of patients was 26.81±7.66. Totally, 42 patients (60%) had reduction in pain, 50 patients (71% percent) had reduction in tenderness, and 39 (55%) had reduction in rebound tenderness after treatment with the drug. A statistically significant reduction of pain and tenderness, rebound tenderness was observed in all of men after administration of hyoscine (p<0.001) but in women, the reduction of severity of tender results was only significant (p=0.002). Data analysis in women and men together showed the significant reduction of pain, tenderness, and rebound tenderness (p<0.001).Conclusion: According to the results, hyoscine can reduce pain, tenderness, and rebound tenderness. So, it seems that hyoscine is a good candidate for patients with appendicitis.IRCT registration number: IRCT2015111825123N1
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
300
305
https://beat.sums.ac.ir/article_44452_2ac9bb157f165232d9d5bdab8c9f0223.pdf
dx.doi.org/10.29252/beat-060405
Outcome of Extra-Articular Distal Humerus Fractures Fixed by Single Column Extra-Articular Distal Humerus Locking Compression Plate Using Triceps Sparing Postero-Lateral Approach
Nadeem
Ali
Hospital for Bone and Joint Surgery, Barzulla,
GMC Srinagar.
author
Naseer
Mir
SKIMS Medical College and Hospital, Bemina
author
Tahir
Dar
SKIMS Medical College and Hospital, Bemina
author
Mohmad
Rather
SKIMS Medical College and Hospital, Bemina
author
Wajahat
Mir
SKIMS Medical College and Hospital, Bemina
author
Senin
Shah
Kasturba Medical College
author
Saheel
Maajid
SKIMS Medical College and Hospital, Bemina
author
text
article
2018
eng
Objective: To determine the time to radiological union and final functional outcome of fixation of extra-articular distal humeral fractures with extra-artricular distal humerus locking plate.Methods: This prospective study was conducted from March 2014 to February 2018 and included extra-articular distal humeral fractures managed by operative fixation using extra-articular distal humerus locking plate. All the fractures were approached using lateral para-tricepetal approach of Gervin, and stabilized with extra-articular distal humerus locking plate with or without lag screws. Time to radiological union was assessed in the follow up and at the final follow up functional outcome was evaluated using Mayo Performance Elbow Score (MEPS). Complications and need for any additional procedures was also recorded.Results: A total of 20 patients with mean age of 36.5 years and an average follow up of 17 months were included. The mean time to radiological union was 17.4 weeks (12 to 36 weeks) which included one delayed union that required bone grafting. The mean flexion at elbow was 127o with only one patient having flexion extension arc movement of less than 100o at the final follow up. The average MEPS at final follow up was 94.7±8 with 19 patients having excellent and good results.Conclusion: Use of extra-articular distal humeral locking plate using lateral para-tricepetal approach in extra-articular distal humeral fractures allows stable fixation of the fracture to allow early return to function with minimal soft tissue dissection and excellent final functional results and minimum complications.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
306
312
https://beat.sums.ac.ir/article_44453_2c00ca1d1d1d0aab5e24c583b2347245.pdf
dx.doi.org/10.29252/beat-060406
Pattern and Distribution of Shock Index and Age Shock Index Score Among Trauma Patients in Towards Improved Trauma Care Outcomes (TITCO) Dataset
Prashant
Bhandarkar
author
Ashok
Munivenkatappa
author
Nobhojit
Roy
author
Vineet
Kumar
author
Luis
Moscote-Salazar
author
Amit
Agrawal
Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, India
author
text
article
2018
eng
Objective: To compare the shock index (SI – which is the ratio of heart rate to systolic blood pressure) and Age SI (Age in years multiplied by SI) with survival outcome of the patients across multicenter trauma registry in India.Methods: Study is based on Towards Improved Trauma Care Outcomes (TITCO) project. Records with valid details of age, heart rate, systolic blood pressure, Injury Severity Scale (ISS) and Glasgow Coma Scale (GCS) score was considered. SI was categorized into four groups; Group I (SI<0.6) as no shock, group II (SI ≥0.6 to <1.0) as mild shock, group III (SI ≥1.0 to <1.4) as moderate shock and group IV (SI ≥1.4) as severe shock. Age SI was categorized decade wise into six groups. Mortality was dependent variable. GCS and ISS were considered as secondary variables.Results: 10843 participants from TITCO registry satisfying inclusion-exclusion criteria were considered for study. Mean SI score in group I to IV was increasing with 0.53 to 1.72 respectively. Age SI was seen to be increasing across its six groups. Gender wise no difference was found among SI group. For severe ISS and critical ISS, mortality in SI group IV was 50% and 56 % respectively. Mortality was increasing across mild to severe GCS among all SI groups.Conclusion: The categorized SI and Age SI had shown increase in death percentages from mild to severe severity of injuries. Similar to GCS and ISS, SI and Age SI should also be calculated and categorized in all health care and further plan for management aspects.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
313
317
https://beat.sums.ac.ir/article_44454_c4530bb7856e8ee97068cb1fc8d1970e.pdf
dx.doi.org/10.29252/beat-060407
Prognostic Value of Arterial Blood Gas Indices Regarding the Severity of Traumatic Injury and Fractures of the Femur and Pelvis
Leila
Mohsenian
Department of Emergency Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
author
Mohamad
Khoramian
Department of Emergency Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
author
Sara
Mazloom
Department of Emergency Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
author
text
article
2018
eng
Objective: To evaluate the prognostic value of arterial blood gas (ABG) indices, especially base excess (BE), regarding the severity of traumatic injury.Methods: A total number of 96 trauma patients with fractures of femur and pelvis were included in this study. Demographic characteristics and clinical information of samples were recorded. The results of ABG test and hemoglobin (Hb) were evaluated at two time intervals (on admission and 6 hours later). The outcome of the patients was evaluated at the end of the study (dead or alive). The ABG indices included O2 saturation (O2Sat), PH, PO2, PCO2, bicarbonate (HCO3) and base excess (BE). The mean of the hemodynamic and ABG indices were compared between those who were discharged and mortality cases. The confounders were compensated using a multivariate logistic regression model.Results: Overall 94 trauma patients with long and pelvic fractures were included. There were 69 (73.4%) men and 25 (26.6%) women among the patients with mean age of 37.43 ± 20.07 years. The mortality rate was 10 (10.6%). The most common mechanism of injury was motorcycle accident in 41 (43.6%) and car collision in 43 (45.7%) patients. We found that mortality was significantly associated with amount of FFP transfusion (p=0.005), but was not associated with amount of transfused packed cells (p=0.113). We also found that mortality was associated with lower BP after 6 hours of admission (p=0.001), higher HR on admission (p=0.036), lower HR after 6 hours (p=0.017), lower O2Sat on admission (p<0.001), higher PCO2 after 6 hours and lower BE on admission (p=0.025). Conclusion: The ABG indices including O2Sat, BE and PCO2 are considered prognostic determinants of outcome in trauma patients with long and pelvic fractures. These findings can be considered as fundamental studies to achieve new diagnostic methods.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
318
324
https://beat.sums.ac.ir/article_44455_8178f90dbb4f135e80d44d914d062fc1.pdf
dx.doi.org/10.29252/beat-060408
Effects of Body Mass Index on Outcome Measures of the Patients with Penetrating Injuries; A Single Center Experience
Farris
Serio
Touro University California
author
Quinn
Fujii
Touro University California
author
Keval
Shah
author
Andrew
McCague
Natividad Medical Center
author
text
article
2018
eng
Objective: To determine if there was any decrease in measures of injury severity or outcome with obese patients (body mass index greater than or equal to 30 kg/m2) as compared to non-obese patients (body mass index less than 30 kg/m2).Methods: We conducted a retrospective review of the trauma database maintained by Natividad Medical Center's Level 2-Trauma program. From July 1st, 2014 to July 1st, 2017 there were 371 cases of penetrating trauma in adults between the ages of 18-80 years old. Overall 311 patients had BMI data recorded. We divided these 311 patients into two groups: penetrating injury due to firearm (n= 198) and penetrating injury due to stabbing or piercing (n=113). We compared non-obese patients against obese patients for age, gender, Injury Severity Score (ISS), length of stay (LOS), Intensive Care Unit LOS, units of blood given, direct transfer from ED to operating room, and mortality.Results: A total of 311 patients were included in the study, 198 (63.6%) patients suffered from gunshot wounds and 113 (36.4) from stab or piercing wounds. The mean age was 33.6 ± 12.8 and there were 283 (91%) men among the victims. Overall 87 (28%) required emergent surgery and a 19 (6.1%) mortality rate was recorded. In the gunshot wound group there was no significant difference between non-obese and obese patients for age (p=0.400), gender (p=0.900), ISS (p=0.544), LOS (p=0.273), Intensive Care Unit LOS (p=0.729), units of blood given (p=0.300), or mortality (p=0.855). We found that in the stab or piercing group there was no significant difference between non-obese and obese patients for age (p=0.900), gender (p=0.900), ISS (p=0.580), LOS (p=0.839), Intensive Care Unit LOS (p=0.305), units of blood given (p=0.431), or mortality (p=0.321).Conclusion: Our findings indicate that in our patient population, there was no significant difference in markers of injury severity, morbidity, or mortality in adult non-obese patients as comparted with obese patients. Furthermore, there was no significant difference between the two groups in operative rates, suggesting that obesity may not confer a protective effect in penetrating trauma.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
325
328
https://beat.sums.ac.ir/article_44456_1fb05718a80349a9fe757630f16d2e9a.pdf
dx.doi.org/10.29252/beat-060409
Validity and Reliability of the Emergency Severity Index and Australasian Triage System in Pediatric Emergency Care of Mofid Children's Hospital in Iran
Mehrnaz
ghafarypour jahrom
Shahidbeheshti university,emergency physition.'medical science'tehran'iran.
author
Mehrdad
Taghizadeh
Shahidbeheshti university,emergency physition.'medical science'tehran'iran.
author
Kamran
Heidari
Shahidbeheshti university,emergency physition.'medical science'tehran'iran.
author
Hojat
Derakhshanfar
Shahidbeheshti university,emergency physition.'medical science'tehran'iran.
author
text
article
2018
eng
Objective: To evaluate the validity, reliability, sensitivity, and specificity of the Emergency Severity Index (ESI) and Australasian Triage System (ATS) for children visiting admitted to the emergency department (ED).Methods: This was a prospective study occurred in the Mofid children's Hospital in Iran from August 2017 to November 2018 and children had aged ≤14 years and presented at the ED with a medical symptom were considered eligible for participation. This study was divided into two phases: in the first phase, we determined the inter-rater reliability of ESI version 4 and ATS by triage nurses and pediatric residents. In the second phase, to analyze the validity, sensitivity, and specificity of each triage system. Reliability and agreement rates were measured using kappa statistics.Results: ESI showed inter-rater reliability with kappa of 0.65–0.92 (P<0.001) and ATS showed inter-rater reliability with kappa of 0.51–0.87 ESI had sensitivity ranged from 81% to 95% and specificity ranged from 73% to 86%. In addition, sensitivity ranged of the ATS were 80% to 95% and specificity ranged from 74% to 87%. Under triage and over triage occurred in 12% and 15% of patients respectively in ESI and 13% and 15% of patients respectively in ATS.Conclusion: The ESI and ATS both valid to triage children in the ED section of Mofid children's Hospital paediatric. Reliability of the ESI is good, moderate to good for the ATS.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
329
333
https://beat.sums.ac.ir/article_44457_0094a62a389606c00bd6abe4d137adeb.pdf
dx.doi.org/10.29252/beat-060410
Assessment of Pre-Hospital Emergency Care and its Associated Factors in Traumatic Patients in North of Iran
Mina
Mohseni
author
Tahereh
Khaleghdoust Mohammadi
author
Zahra
Mohtasham-Amiri
author
Ehsan
Kazemnejad
author
Morteza
Rahbar Taramsari
author
Leila
Kouchakinejad-Eramsadati
author
text
article
2018
eng
Objective: To determine the status of pre-hospital emergency care and its associated factors in traumatic patients.Methods: In across-sectional study, 577 traumatic patients who were transferred to Poursina hospital by EMS (Emergency Medical Services) personnel were selected by simple random sampling method. Pre-hospital emergency services were observed. Then the mean of taken measures scores for each domain was determined in percent and evaluated in terms of associated factors (age, working experience of staff and number of missions per day) and compared using Spearman's test.Results: Out of 577 patients, 454 were men (78.7%) and 123 women (21.3%). Their mean age was 35.1 years old. Accident (82.7%) was the most common mechanism of injury. Most vehicles involved in the accident were light-weight cars (48.5%) and motorcycles (32.2%). A significant relationship was found between age, general domain (p=0.039) and hemodynamic (p=0.019) as well as between work experience and general domain (p=0.018).Conclusion: Given that pre-hospital emergency services provided in most of the domains are relatively far from world standard, results of this research can provide information for managers to improve strategic planning on care and medical services, appropriation of budget, knowledge of personnel and necessary equipment.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
334
340
https://beat.sums.ac.ir/article_44458_b71698c05ccbb438e4f976568df66937.pdf
dx.doi.org/10.29252/beat-060411
Analysis and Forecasting the Accident Mortality Trends in the Islamic Republic of Iran Applying Lee-Carter Model During the Years 2006 to 2035
Saeide
Aghamohamadi
author
Katayoun
Jahangiri
author
Amir
Kavousi
author
Ardeshir
Sayah Mofazali
author
text
article
2018
eng
Objective: To predict the accident mortality trend in next two decades in Iran.Methods: The study population comprised all deaths recorded in the system of registration and classification of causes of death of Ministry of Health and Medical Education of Iran during the years 2006 to 2015. The information was collected via death certificate, burial permit, and reporting forms. To forecast the trends of causes-of-death, Lee Carter model was employed in a demographic package 18.1 of R software version 3.3.1.Results: Based on the results, the highest percentage of all causes of death from accidents (in unintentional accidents) goes to transport accidents, and most top intentional accidents belonged to intentional self-harm. The trends of unintentional accidents in the whole population and both sexes have reduced from 2006 to 2035, such that the rate has reduced from 62.2 in 2006 to 12.1 per 100 thousand populations in 2035. It is anticipated that the causes of death due to intentional accidents with the rate of 8.86 in 2006, will be 1.89 (per 100,000 population) in the year 2035.Conclusion: Accident mortalities have a significant role in the deaths of Iranian population; therefore, to reduce the impact of accident mortality on society, a precise approach is needed to monitor the trends as well as preventing measures and increasing the safety standards.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
341
348
https://beat.sums.ac.ir/article_44459_bfb271c73c0983dd98f722cac189d730.pdf
dx.doi.org/10.29252/beat-060412
Analysis of Risk Factors with Hospital Mortality in Pedestrian Injured Patients; A Dataset Analysis of a Level-I Trauma Center in Southern Iran
Mahnaz
Yadollahi
MD, Assistant Professor of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
author
Narges
Rahmanian
Trauma research center ,Shiraz university of medical sciences, Shiraz, Iran
author
Kazem
Jamali
author
text
article
2018
eng
Objective: To determine the indicators predicting the hospital mortality in pedestrian injured patients admitted to a level I trauma center in Southern Iran.Methods: This case control study was conducted in a Level-I trauma hospital in Shiraz. We selected all survived pedestrians who were admitted in the hospital with duration of admission more than 24 hours in one year from March 2016 to February 2017 as control group and compared with all non-survived pedestrian patients who expired in the hospital according to clinical from March 2012 to February 2017. Multiple logistic regression was performed to identify factors of hospital effect on pedestrian mortality and results expressed by Odds Ratios and their confidence intervals (CI) of 95%.Results: A total of 424 survived pedestrian injured patients were compare to 117 non-survived one. Their mean of survived and non-survived patients were 43.79 ± 19.37 and 56.76 ± 18.55 years respectively of which 361 (66.7%) and 180 (33.3%) were men and women, respectively. We found that the gender does not have any relation with hospital mortality (p=0.275). Followed by, age is in relevance with mortality. Glasgow Coma Scale(GCS), Injury Severity Score (ISS), blood urea nitrogen (BUN), platelet (PLT), potassium (K) and hemoglobin (Hb) are significant factor which are associated with mortality. According to logistic analysis GCS ≤8 (p
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
349
354
https://beat.sums.ac.ir/article_44460_0a07f1fff89d8289fab95ebbfb140eb9.pdf
dx.doi.org/10.29252/beat-060413
Antimicrobial Survey of Local Herbal Drugs against Acinetobacter baumannii Isolated from Patients Admitted to a Level-I Trauma Center
Hossein
Abdolrahimzadeh
Shiraz University of Medical Sciences
author
Shahram
Bolandparvaz
Shiraz University of Medical Sciences
author
Hamid Reza
Abbasi
Shiraz University of Medical Sciences
author
Maryam
Dehghankhalili
Shiraz University of Medical Sciences
author
Shahram
Paydar
Shiraz University of Medical Sciences
author
Amirreza
Dehghanian
Shiraz University of Medical Sciences
author
Salar
Ghoran
Shiraz University of Medical Sciences
author
Mojtaba
Asadollahi
Shiraz University of Medical Sciences
author
Mehdi
Zare
Shiraz University of Medical Sciences
author
text
article
2018
eng
Objective: To determine the antimicrobial activity and entity of several local herbal plants against Acintobacters isolated from trauma patients admitted to a Level-I trauma center.Methods: The antibacterial activities of the Satureja bachtiarica oil and some selected Iranian medicinal plants (Artemisia sieberi and Tanacetum dumosum belonging to the Asteraceae/Compositae; Salvia mirzayanii and Mentha mozaffarianii belonging to the Lamiaceae/Labiatae) were assayed on A. baumannii by microdilution and agar disc diffusion methods. Having obtained the acceptable antibacterial data, the shade-dried aerial parts of the plants were extracted by hydrodistillation method using Clevenger apparatus according to European pharmacopeia for 3 h. The analysis of S. bachtiarica essential oil accompanied by other herbal drug oils were performed by using GC/FID and GC/MS methods.Results: Outcomes revealed that the S. bachtiarica essential oil exhibited the potent antibacterial capability against Acinetobacter strains in comparison with Colistin, as a positive control. For S. bachtiarica, the growth inhibition zone and minimum inhibitory concentration (MIC) values were 21 mm and 0.5 mg/ml, while, for Colistin, the data were in order: 8 mm and 0.016 mg/ml. Consequently, GC/MS outcomes demonstrated that the major components of the essence were carvacrol (48.6%), followed by p-Cymene (16.6%), γ-terpinene (6.9%) and linalool (5.3%).Conclusion: Based on the considerable inhibitory activity against nosocomial infections by essential oil of S. bachtiarica, it could be considered as the suitable candidate in the food industry and pharmaceutical uses.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
355
362
https://beat.sums.ac.ir/article_44461_a224d1fcbf380f6a99c79866e6556234.pdf
dx.doi.org/10.29252/beat-060414
Spontaneous Bacterial Peritonitis in Afebrile Cirrhotic Patients; Report from a Referral Transplantation Center
Sara
Mazloom
Department of Emergency Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
author
Mohamad
Khoramian
Department of Emergency Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
author
Leila
Mohsenian
Department of Emergency Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
author
text
article
2018
eng
Spontaneous bacterial peritonitis (SBP) is a complication of liver cirrhosis with adverse effect on patient prognosis. Early diagnosis and treatment is highly important, especially in patients without remarkable manifestations. We designed this study to determine the prevalence of SBP among afebrile cirrhotic patients and identify high-risk subgroups in a referral center in southern Iran. This cross-sectional study evaluated all afebrile cirrhotic patients, admitted to the gastroenterology ward of Namazi hospital (affiliated with Shiraz University of Medical Sciences, Shiraz, Iran) over a 6-month period in 2017, for the presence and correlates of SBP. Demographic data, clinical findings, and comorbidities were recorded. Ascitic fluid white blood cells (WBC) count >500 and neutrophil count >250 indicated bacterial peritonitis. In total, 97 afebrile cirrhotic patients comprising of 63 (64.9%) men and 34 (35.1%) women were included. All patients had ascites and 89 (91.8%) had abdominal tenderness. Accordingly, abdominal distension was the top presentation. Confirmed etiologies or comorbidities such as HBS, HCV, and liver cancer or metastasis existed in 46 patients. Thirteen (13.4%) had SBP. The correlations of gender (p=0.331), decreased level of consciousness (p=0.145), tenderness (p=0.315). With regards to the type of presentations, only DLOC showed to be significantly higher in SBP negative patients (p=0.022, OR=0.09. 95%CI=0.01–0.62). Also, using binary logistic regression, the correlation of age with SBP was statistically non-significant (coefficient= ⎼0.013, p=0.595). Our findings indicated that routine paracentesis in all cirrhotic patients regardless of fever can help diagnose a number of potentially neglected patients and improve their outcome.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
363
366
https://beat.sums.ac.ir/article_44462_bccbd98026171c5152e6e420176bc1c4.pdf
dx.doi.org/10.29252/beat-060415
Surgical Management of Adult Traumatic Atlantoaxial Rotatory Subluxation with Unilateral Locked Facet; Case Report and Literature Review
Keyvan
Eghbal
Shiraz University of Medical Sciences
author
Abbas
Rakhsha
Shiraz University of Medical Sciences
author
Arash
Saffarrian
Shiraz University of Medical Sciences
author
Abdolkarim
Rahmanian
Shiraz University of Medical Sciences
author
Hamid Reza
Abdollahpour
Shiraz University of Medical Sciences
author
Fariborz
Ghaffarpasand
Trauma Research Center, Shiraz University of Medical Sciences
author
text
article
2018
eng
Atlantoaxial rotatory subluxation (AARS) is rarely occurred in adults with trauma as the most common cause. In type A and B it is usually managed with close reduction and external brace; however, in nonresponsive cases, surgical interventions might be needed. Our patient is a 21-year-old man with neck pain and torticollis after a car turn- over. There was C1-C2 rotatory subluxation with left side locked facet and C1 rotation about 40 degrees relative to C2 on computed tomography without evident of ligamentous injury in magnetic resonance imaging (MRI). However, during the first 48 hours, two tries of close reduction using Gardner cervical traction under fluoroscopy were failed. Thus, the patient underwent open reduction of the subluxation and atlantoaxial fixation (Harm’s technique) with subsequent relief of pain and torticollis. This a rare case of traumatic AARS type A with unilateral locked facet joint in an adult patient which needed surgical manipulation for reduction. The management of the AARS in adults should be individualized in each patient.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
367
371
https://beat.sums.ac.ir/article_44463_681968e285bb71013abd6b565afff640.pdf
dx.doi.org/10.29252/beat-060416
Intrauterine Fetal Traumatic Brain Injury Following Motor Vehicle Accident; A Case Report and Review of the Literature
Mohammad
Safdari
Department of Neurosurgery, Zahedan University of Medical Sciences, Zahedan, Iran.
author
Zohre
Safdari
Department of Radiology, Zahedan University of Medical Sciences, Zahedan, Iran.
author
Masoud
Pishjoo
Department of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran.
author
text
article
2018
eng
Trauma, especially traumatic injuries due to car accidents are one of the causes of maternal and fetal mortality and morbidity during pregnancy. Fetus brain injuries are usually caused fetus death. We herein report a pregnant woman in 28 weeks of gestation. The fetus was found to be normal during in-hospital. At birth, the female neonate demonstrated developmental delay and neurological deficits (hypotonicity). Neuroimaging after birth revealed extreme dilatation of lateral ventricles, hypoplasia and aplasia of the brain. In 4 months, she had multiple morbidities including developmental delay, hypotonia, blindness, oropharyngeal dysphagia and simple partial seizure. Motor and response to stimulation was normal. Appropriate seatbelt usage can protect the fetus from sustaining severe intracranial injuries.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
372
375
https://beat.sums.ac.ir/article_44464_51dd1192484fa23c8030889c413df0a6.pdf
dx.doi.org/10.29252/beat-060417
Isolated Mesenteric Injury causing Ileal Devascularisation with Uterine Perforation following Termination of Pregnancy; A Case Report and Literature Review
Dileep
Hoysal
BGS GLOBAL INSTITUTE OF MEDICAL SCIENCES, BANGALORE
author
Hemashree
Kumaraswamy
author
text
article
2018
eng
Surgical abortion is one of the leading causes of maternal mortality, constituting up to 20% of maternal deaths. Uterine perforation is a rare complication, accounting for4% of all the abortion related complications. Intestinal injury with uterine perforation following termination of pregnancy is even rare and is a potentially fatal complication with mortality of up to 10%. A 27-year-old G3P2L2 woman with 12 weeks of gestation referred to our hospital in hemorrhagic shock with a suspicion of uterine perforation following dilatation and curettage for termination of pregnancy. Patient underwent emergency laparotomy. She was found to have uterine perforation with mesenteric and ileal injuries intraoperatively. Perforation closure with ileoileal resection and anastomosis was done. Postoperatively the patient recovered completely. Prompt reporting/recognition of uterine perforation, preoperative resuscitation and early intervention are the most important steps in the management of patients with intestinal injury. Trauma surgeon should never hesitate or delay in considering an Emergency Laparotomy/laparoscopy in cases of suspected intestinal injury with uterine perforation. Emergency exploration decreases the morbidity and mortality to a great extent in patients with intestinal injury.
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
376
378
https://beat.sums.ac.ir/article_44465_bb970617a5e7800b12adfe193b281702.pdf
dx.doi.org/10.29252/beat-060418
Post-Surgical Transitory Inferior Subluxation of Shoulder
Vikram
Khanna
Department of Orthopaedics,
Ranjana Hospital, Allahabad
author
text
article
2018
eng
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
379
380
https://beat.sums.ac.ir/article_44466_8cc0dd94f90a859b43dc8e864943775d.pdf
dx.doi.org/10.29252/beat-060419
Acknowledgment of the Reviewers for 2018
Best
Reviewers
author
text
article
2018
eng
Bulletin of Emergency And Trauma
Shiraz University of Medical Sciences
2322-2522
6
v.
Issue 4
no.
2018
381
382
https://beat.sums.ac.ir/article_44467_62a217291b851e4ad0be267e72a53a60.pdf