Sayyed Majid Sadrzadeh; Bahram Shahri; Mostafa Kamandi; Maryam Adimolmasali; Behrang Rezvani Kakhki; Hamideh Feiz Disfani
Volume 12, Issue 3 , July 2024, , Pages 130-135
Abstract
Introduction: Recently, various serum markers have been used for the diagnosis and prognosis of acute heart diseases in emergency departments. Thus, the present study was designed and conducted to determine such a role.Methods: This is an Analytical Cross-Sectional study conducted on the patients with ...
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Introduction: Recently, various serum markers have been used for the diagnosis and prognosis of acute heart diseases in emergency departments. Thus, the present study was designed and conducted to determine such a role.Methods: This is an Analytical Cross-Sectional study conducted on the patients with syncope complaints. The patients were entered the study based on the inclusion and exclusion criteria and were subjected to initial evaluations including history, physical examination, ECG, blood sugar measurement, and, if necessary, brain CT scan, Doppler echocardiography, and CTA.Results: A hundred people complaining of syncope were included in this study. The results showed that 19% and 81% of the subjects were suffering from cardiac and non-cardiac syncope, respectively. The average Pro BNP of the studied individuals was 196.06 ± 128.45 pg/ml. according to the results, age and length of hospitalization had a positive and significant relationship with the average Pro BNP (P value<0.01). Furthermore, the average Pro BNP was significantly higher in the people with positive TPI, cardiac syncope, and abnormalities in ECG and Doppler findings (P value<0.01). The results of the diagnostic value of Pro BNP in identifying cardiac syncope also showed that its sensitivity and specificity were 94.73% and 56.79%, respectively.Conclusion: The results of this study showed that the increase in the Pro BNP values was associated with age, increased length of hospitalization, and ECG abnormalities. In addition, as an independent marker, Pro BNP had good acceptability in identifying cardiac syncope cases.
Sajed Arabian; Ali Davoodi; Mehrdad Karajizadeh; Najmeh Naderi; Najmeh Bordbar; Golnar Sabetian
Volume 12, Issue 2 , April 2024, , Pages 81-87
Abstract
Objective: This study aimed to determine the rate of readmission for trauma patients in ICUs, as well as thefactors that predict this outcome.Methods: This retrospective cohort study was conducted at Emtiaz Hospital, a level I referral trauma center(Shiraz, Iran). It analyzed the ICU readmission rates ...
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Objective: This study aimed to determine the rate of readmission for trauma patients in ICUs, as well as thefactors that predict this outcome.Methods: This retrospective cohort study was conducted at Emtiaz Hospital, a level I referral trauma center(Shiraz, Iran). It analyzed the ICU readmission rates among trauma patients over three years. The requireddata were extracted from the Iranian Intensive Care Registry (IICUR), which included patient demographics,injury severity, physiological parameters, and clinical outcomes. Statistical analysis was performed using SPSSversion 25.0. Descriptive statistics and different statistical tests, such as T-tests, Mann-Whitney tests, Chisquare tests, and logistic binary regression test were utilized.Results: Among the 5273 patients discharged from the ICU during the study period, 195 (3.7%) were readmittedduring the same hospitalization. Patients readmitted to the ICU had a significantly higher mean age (54.83±22.73years) than those who were not readmitted (47.08 years, p<0.001). Lower Glasgow Coma Scale (GCS) scoresat admission and discharge were associated with ICU readmission, implying that neurological status andreadmission risk were correlated with each other. Furthermore, respiratory challenges were identified as theleading cause of unexpected readmission, including respiratory failure, hypoxic respiratory failure, respiratorydistress, and respiratory infections such as pneumonia. Injury patterns analysis revealed a higher frequency ofpoly-trauma and head and neck injuries among patients readmitted to the ICU.Conclusion: This study underscored the importance of ICU readmission among trauma patients, with a highreadmission rate during the same hospitalization. By developing comprehensive guidelines and optimizingdischarge processes, healthcare providers could potentially mitigate ICU readmissions and associatedcomplications, ultimately enhancing patient outcomes and resource utilization in trauma ICU settings. Thisresearch provided valuable insights to inform evidence-based practices and improve the quality of care deliveryfor trauma patients in intensive care settings.
Soheil Rafiee; Alireza Baratloo; Arash Safaie; Alireza Jalali; Khalil Komlakh
Volume 10, Issue 4 , October 2022, , Pages 165-171
Abstract
Objective: To probe the factors associated with the outcomes of traumatic brain injury (TBI) patients admittedto emergency department (ED).Methods: This is a cross-sectional study that data gathering was performed via census methods, retrospectively.During one year, all head injury’s patients who ...
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Objective: To probe the factors associated with the outcomes of traumatic brain injury (TBI) patients admittedto emergency department (ED).Methods: This is a cross-sectional study that data gathering was performed via census methods, retrospectively.During one year, all head injury’s patients who admitted to the ED of a tertiary center in Tehran, Iran wereincluded. Age, gender, mechanism of injury, Glasgow coma scale (GCS) and injury severity score (ISS)on admission, presence of extra-cranial injuries, findings of brain computed tomography (CT), duration ofhospitalization, and in hospital outcomes were recorded. Outcome’s assessment for survivors was performedwithin a 6 months-period after discharge based on Glasgow outcome scale (GOS). The variables and outcomes’association were assessed.Results: Totally, 506 patients were evaluated with the mean age of 36.77±21.1 years that 411 (81.2%) were men.Follow up at 6-months post injury was feasible in 487 (96.2%) patients; 59 (11.7%) out of 506 eligible patientsdied. Logistic regression analysis showed the association between assessed variables and patients’ outcome asfollows: age>65 years (OR: 12.21; p<0.001), GCS on admission <8 (OR: 62.99; p<0.001), presence of traumaticIntracerebral hemorrhage (ICH) in brain CT scan (OR: 20.11; p=0.010), duration of hospitalization ≥ 5 days(OR: 0.28; p=0.001).Conclusion: The findings of the current study distinguished some variables that were associated with thepoor outcome of the patients with TBI. Therefore, TBI patients with any of these risk factors may need closecontinues monitoring, early ICU admission, and some other special extra care in ED.
Reza Hosseinpour; Amir Barghi; Saadat Mehrabi; Shirvan Salaminia; Paria Tobeh
Volume 8, Issue 3 , July 2020, , Pages 148-155
Abstract
Objective: To investigate the prognosis and survival rates of a group of Iranian patients with traumatic injuries using the trauma and injury severity score (TRISS) model. Methods: In this prospective cohort study, all the patients with multi-trauma referring to the Yasuj Shahid Beheshti hospital during ...
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Objective: To investigate the prognosis and survival rates of a group of Iranian patients with traumatic injuries using the trauma and injury severity score (TRISS) model. Methods: In this prospective cohort study, all the patients with multi-trauma referring to the Yasuj Shahid Beheshti hospital during 2018 were included. The patients’ demographic information, trauma and history of previous illness were recorded. Vital symptoms including respiratory rate, heart rate, hypertension, pulse rate and Glasgow coma scale (GCS) score were assessed. The injury severity score (ISS) was calculated based on the type and location of the injuries and according to the abbreviated injury scale (AIS) classification. The survival probability of the patients was assessed according to the TRISS model. Results: Overall, 252 trauma patients were evaluated out of whom, 195 (77.4%) were men and 57 (22.6%) women. The mean TRISS score was 24.2 ± 9.32 and the maximum score was 99.7. If we consider the TRISS score probability above 0.5 as the chance of being alive, the mortality rate was 6.75%, that was lower than our series (7.1%). The ISS score and GCS had a positive significant relationship with other variables except respiratory rate, body temperature and hospitalization. Revised trauma score (RTS) was significantly associated with other variables including age, GCS, hemoglobin, systolic blood pressure and respiratory rate. TRISS had an area under curve (AUC) of 0.988 indicating a high prognostic accuracy. Conclusion: The mortality rate was lower than that of being predicted by TRISS. This might be due to treatment effectiveness and care for traumatic patients leading to decreased mortality. TRISS had high prognostic accuracy in trauma patients. We also reported an association between hemoglobin and survival rate. Therefore, it seems that considering the laboratory parameters can be useful in patients with trauma.
Zeinab Naderpour; Mehdi Momeni; Elnaz Vahidi; Javad Safavi; Morteza Saeedi
Volume 7, Issue 4 , October 2019, , Pages 361-365
Abstract
Objective: To determine the possible relationship of procalcitonin (PCT) and D-dimer with the 28-day-mortality rate and severity of sepsis based on sequential organ failure assessment (SOFA) score. Methods: In this cross-sectional study, patients were enrolled based on their signs and symptoms of ...
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Objective: To determine the possible relationship of procalcitonin (PCT) and D-dimer with the 28-day-mortality rate and severity of sepsis based on sequential organ failure assessment (SOFA) score. Methods: In this cross-sectional study, patients were enrolled based on their signs and symptoms of sepsis confirmed by essential laboratory studies. Demographic data, Glasgow coma scale and vital signs, serum PCT and D-dimer levels, creatinine, bilirubin level, arterial blood gas analysis and platelet count were recorded. Disease severity index was assessed based on SOFA score. Patients’ 28-day-mortality rate and hospital length of stay were compared with the study variables. Results: Sixty-four patients with the mean age of 78.3±11.6 were included of whom 34 cases (53.1%) were male. The 28-day-mortality rate was 17%. The analysis showed that only patients’ age (p=0.01) and platelet count (p=0.02) had a statistically significant association with the mortality rate. SOFA score had no statistically significant correlation with PCT or D-dimer; and these two markers didn’t have any significant correlation in terms of predicting mortality due to the sepsis. Conclusion: In our study, PCT and D-dimer failed to show any significant correlation with 28-day-mortality rate of sepsis.
Leila Mohsenian; Mohamad Karim Khoramian; Sara Sadat Mazloom
Volume 6, Issue 4 , October 2018, , Pages 318-324
Abstract
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 ...
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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.
Shahab Shahabi Shahmiri; Mohsen Kolahdouzan; Ara Omrani; Mehdi Khazaei; Hamid Salehi; Abbas Motevalian; Rastin Mohammadi Mofrad; Mohammad Taghi Rezaei; Helia Hemmasian
Volume 5, Issue 3 , July 2017, , Pages 184-189
Abstract
Objectives: To investigate the determinants of mortality and the lethal area 50 (LA50) in large series of Iranian burn patients admitted to a single burn center.Methods: This cross-sectional study was conducted in Shahid Motahari burn center of Tehran, Iran during a 1-year period from 2011 to 2012. We ...
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Objectives: To investigate the determinants of mortality and the lethal area 50 (LA50) in large series of Iranian burn patients admitted to a single burn center.Methods: This cross-sectional study was conducted in Shahid Motahari burn center of Tehran, Iran during a 1-year period from 2011 to 2012. We included all the burn patients who were admitted to our center during the study period. Those with incomplete medical records and those referred to other centers were excluded from the study. The medical records of the included patients were reviewed and the demographic, clinical, laboratory and outcome measures were recorded. The mortality rate was recorded and the determinants of LA50 were analyzed in a univariate and stepwise multivariate model.Result: Overall we included a total number of 1200 subjects with mean age of 30.8 ±18 years. There were 907 (75.6%) men and 293 (24.4%) women among the patients. The total LA50 was 55.5% (95% CI: 52.98%-58.3 %). There was a significant difference between age group >61 years and two 11-20 and 21-30 groups regarding LA50. The advanced age (p<0.001), female gender (p=0.002), inhalational injury (p<0.001) and burn extension determined by TBSA% (p<0.001) were significantly associated with mortality. In addition, male gender (p=0.087), flame (p=0.156), scald (p=0.088) and chemical injuries (p=0.071) were not associated with mortality.Conclusion: The LA50 determine din our study is still much lower than that reported in developed countries, as a result, the quality of medical care is lower. Female gender, age, inhalational injury and extension of burn determined by TBSA% were found to be the independent risk factors of mortality in burn patients in our series.
Hernando Raphael Alvis-Miranda; Andres M. Rubiano; Amit Agrawal; Alejandro Rojas; Luis Rafael Moscote-Salazar; Guru Dutta Satyarthee; Willem Guillermo Calderon-Miranda; Nidia Escobar Hernandez; Nasly Zabaleta-Churio
Volume 4, Issue 2 , April 2016, , Pages 65-74
Abstract
Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately, more prevalent condition in developing countries, with major armed conflicts which is still persisting, since the main trigger is violence at the national or state ...
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Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately, more prevalent condition in developing countries, with major armed conflicts which is still persisting, since the main trigger is violence at the national or state level. Management goals of CGI should focus on aggressive resuscitation and correction of coagulopathy; those with stable vital signs should undergo CT scan head at the earliest possible opportunity. Neuroimaging is vital for planning of surgical management, especially to determine the type of surgery, routes of the approach to the surgical target area and extraction of the impacted foreign bodies, however, surgical management is not always indicated. Although subset of such cases may be managed even with non-surgical management. The treatment comprises of immediate life salvaging resuscitative measures including control of the persistent bleeding, care of associated injury, management of raised intracranial pressure, prevention of cerebrospinal fistula formation by primary watertight dural repair and prevention of infection, through extensive debridement of contaminated, macerated or ischemic tissues; preservation of nervous tissue and restoration of anatomic structures through the hermetic sealing of dural and scalp defect. Recently, only few studies of craniocerebral penetrating injuries are published that too involving smaller patients sample sizes; although classic studies in the military and civil situation noticed associated relatively very high mortality and morbidity and psychological as well as economic impact on the affected individual, the family and the health system in providing ongoing care to the sufferers and society at large. Currently various measures are advocated with aim to reduce the incidence of CGI especially in civilian populations. It is highly necessary and immensely urgent to promote research in a neurocritical care of CGI to provide positive impact on improvement of the quality of life and further providing better care and reduction of overall health care cost.
Amene Sabzi Sarvestani; Mehdi Zamiri; Mehdi Sabouri
Volume 1, Issue 3 , July 2013, , Pages 116-122
Abstract
Objectives: To describe the characteristics and prognostic factors of 28 patients with Fournier’s Gangrene (FG) referred to our medical center at Southeastern Iran.Methods: This was a cross-sectional study including 28 cases of FG that were operated in Surgery department of Zahedan University of Medical ...
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Objectives: To describe the characteristics and prognostic factors of 28 patients with Fournier’s Gangrene (FG) referred to our medical center at Southeastern Iran.Methods: This was a cross-sectional study including 28 cases of FG that were operated in Surgery department of Zahedan University of Medical Sciences during a 10-year period from April 2002 to March 2012. The study analyzed 9 parameters including the body temperature, heart rate, respiratory rate, hematocrit, white blood count (WBC), and serum levels of sodium, potassium, creatininee (twice for 2 for acute renal failure), and bicarbonate for Fournier Gangrene Severity Index (FGSI) score. The aspects taken into account were age, gender, predisposing factors, duration of symptoms, hospitalization period, and number of debridements, disease outcome and the FGSI.Results: All patients were males, aged from 26 to 68 years, with mean age 44.6 ±8.49 years. Statistically significant differences in age (p<0.001), duration of symptoms (p=0.001), number of debridements (p=0.006), hospitalization duration (p<0.001) and FGSI (p<0.001) were found between surviving and dead patients. The mortality rate was 35.7%, and the most common presentation was perianal/scrotal pain (78.6%). Perianal and primary scrotal abscesses were most common causes of FG and were found in 57.14% and 21.42% of patients respectively. The most prevalent predisposing factor was diabetes mellitus in 12 (42.85%) patients. With respect to laboratory findings, statistically significant differences in WBC (p=0.002), creatinine (p<0.001), albumin (p<0.001), calcium (p<0.001) and serum sodium (p=0.035) were found between the surviving and dead patients.Conclusion: Serious outcome of FG was associated with old age, delayed diagnosis and treatment, inadequate surgical debridement, shorter hospitalization and higher FGSI scores. In addition higher WBC, higher creatininee and serum sodium and lower albumin and calcium levels implicated worse prognosis.
