Seyed Reza Modarres; Mohammad Hossein Shokrollahi; Mohsen Yaserian; Maryam Rahimi; Neda Amani; Ali Asghar Manouchehri
Volume 2, Issue 4 , October 2014, , Pages 146-150
Abstract
Objective: To determine the epidemiological characteristics of fatal traumatic accidents in patients referred to a hospital in Babol, Northern Iran.Methods: Thiswas a cross-sectionalstudy being performed during a 1-year period including all the dead trauma patients referred to ShahidBeheshtiHospital ...
Read More
Objective: To determine the epidemiological characteristics of fatal traumatic accidents in patients referred to a hospital in Babol, Northern Iran.Methods: Thiswas a cross-sectionalstudy being performed during a 1-year period including all the dead trauma patients referred to ShahidBeheshtiHospital of Babol. We included all those patients who were transferred to our center to trauma and injuries and passed away during the hospital stay. Those who dieddue toelectrical shock, drowningandsuffocationcaused byhangingsandpoisoningwereexcluded from the study.Demographic information such as age, sex, marital status, education, employment, the type, location, and time of injury, injured parts of body and treatment methods, the cause, location and time of death were recorded.Results: From the 92 dead patients, 76were men(82.6%) and16were women (17.4%). The cause of deathin 53 cases (57.6%) washead injury. Regarding the location,30patients (32.6%) diedat thesceneof the accident,62(67.4%) diedin the hospital. The maximum rateof trauma occurredin the afternoon shiftbetween the hours of13:30 to 19:30.The headand facewere themost damaged organs.Road traffic accidents were the most common cause of injury related mortality recordedin 81 patients (88.0%). Most of the accidentsoccurredinintercity roads in 27 people (33.3%) and the others inrural-urbanroads. Pedestrianswere the most common victims of road traffic accidents mortality being reported in 29 people (35.8%).Conclusion: Road traffic accidents are among the most common cause of injury related mortality in our region. Increasing the public knowledge and improve the traffic law enforcement measures should be considered for decreasing the morbidity and mortality.
Shahram Paydar; Mojtaba Mahmoodi; Mohammad Jamshidi; Hadi Niakan; Mohammad Keshavarz; Nader Moeenvaziri; Mohammad Esmaeil Ghorbaninejad; Farnaz Farrokhnia; Forough Izadi Fard; Zahra Jaafari; Yalda Golshan; Hamidreza Abbasi; Shahram Bolandparvaz; Behnam Honarvar
Volume 2, Issue 3 , July 2014, , Pages 103-109
Abstract
Objective: To explore the pros and cons of early versus delayed intervention when dealing with severe blunt liver injury with significant hemoperitoneum and hemodynamic instability.Methods: This retrospective cross-sectional study was performed at the Nemazi hospital, Shiraz, Southern Iran, level I trauma ...
Read More
Objective: To explore the pros and cons of early versus delayed intervention when dealing with severe blunt liver injury with significant hemoperitoneum and hemodynamic instability.Methods: This retrospective cross-sectional study was performed at the Nemazi hospital, Shiraz, Southern Iran, level I trauma Center affiliated with Shiraz University of Medical Sciences. The study population comprised of all patients who were operated with the impression of blunt abdominal trauma and confirmed diagnosis of liver trauma during an 8-year period. All data were extracted from patients’ hospital medical records during the study period. The patients’ outcome was compared between those who underwent perihepatic packing or primary surgical repair.Results: Medical records of 76 patients with blunt abdominal liver trauma who underwent surgical intervention were evaluated. Perihepatic packing was performed more in patients who have been transferred to operation room due to unstable hemodynamics (p<0.001) as well as in patients with more than 1000 milliliters of hemoperitoneum based on pre-operative imaging studies (e.g. CT/US) (p=0.002).Conclusion: We recommend that trauma surgeons should approach perihepatic packing earlier in patients who have been developed at least two of these three criteria; unstable hemodynamics, more than 1000 milliliters hemoperitoneum and more than 1600 milliliters of intra-operative estimated blood loss. We believe that considering these criteria will help trauma surgeons to diagnose and treat high risk patients in time so significant hemorrhage (e.g. caused by dilatational coagulopathy, hypothermia and acidosis, etc.) can ultimately be prevented and more lives can be saved.
Hassan Ravari; Masoud Pezeshki Rad; Aria Bahadori; Orkideh Ajami
Volume 2, Issue 2 , April 2014, , Pages 72-76
Abstract
ABSTRACTObjective: To compare the conventional angiographic findings in extremity trauma patients with or without runoff. Methods: This was cross-sectional study including all the patients with extremity trauma who underwent conventional angiography during the ...
Read More
ABSTRACTObjective: To compare the conventional angiographic findings in extremity trauma patients with or without runoff. Methods: This was cross-sectional study including all the patients with extremity trauma who underwent conventional angiography during the 2 year period from 2011 to 2013 in Angiography departments of Mashhad University of Medical Sciences. Mechanism of trauma, type of injury and angiographic findings were recorded in a questionnaire for each patient. After completion of treatment and discharge, the treatment type was added. The characteristics as well as clinical findings were compared between those who were diagnosed to have arterial runoff ad those who did not.Results: One hundred and forty eight traumatic patients including 15 female with age range of 11-82 years and 133 men ranging from 25 to 40 years were enrolled. Abnormal angiographic findings were provided in 99 (66.9%) patients including cutoff with distal runoff (n=60, 60.6% of abnormalities), cut off without distal runoff (n=21,21.2%) and spasm (n=14, 14.1%) and other findings (n=4, 4%). Fifty one cases were treated under open surgery and amputation of traumatic limb was done for 13 patients. Amputation rate was higher in patients with cutoff and without runoff than those with cutoff and runoff (33.3% vs. 6.78%; p=0.002).Conclusion: Causes and types of traumatic arterial injury in our study were different with other reports. It was shown that angiographic findings were less important in prognosis and management of patients. Patients with spasm in angiographic findings had a better prognosis than other patients and mostly did not need any vascular surgery. The presence or absence of a distal run off in primary angiographic findings can have a predictive value in the final amputation rate.
Masoud Pezeshki Rad; Hassan Ravari; Aria Bahadori; Orkideh Ajami
Volume 2, Issue 1 , January 2014, , Pages 27-31
Abstract
Objective: To determine the etiology, signs and symptoms, angiography indications and angiography findings in patients with limb penetrating injuries suspected to have arterial injury.Methods: This was a cross-sectional study being performed in Imam Reza Hospital affiliated with Mashhad University of ...
Read More
Objective: To determine the etiology, signs and symptoms, angiography indications and angiography findings in patients with limb penetrating injuries suspected to have arterial injury.Methods: This was a cross-sectional study being performed in Imam Reza Hospital affiliated with Mashhad University of Medical Sciences, Iran between September 2011 and March 2013. We included those patients with extremity blunt and penetrating injuries who were referred for angiography according to standard indications including abnormal distal pulses, complex fracture or dislocation, vascular proximity, fixed hematoma, distal nerve deficit, arterial bruit, thrill and massive soft tissue injuries.Results: During the study period, 148 patients (15 women and 133 men) with a mean age of 31±14.9 (11-82) years were evaluated. The most common cause of injury was motor vehicle accident (127 patients 85%). Angiography indications included abnormal distal pulse examination (124, 83.8%), complex fracture or dislocation (7, 4.7%), near arterial trauma (4, 2.7%), fixed hematoma (3, 2%), nerve damage (1, 0.7%). The angiography was found to be normal in 49 (33.1%) patients. In patients with abnormal angiography findings, 60 (60.6%) had cutoff with distal runoff, 21 (21.2%) had cutoff without runoff, 14 (14.1%) had arterial spasm. Other uncommon findings included active bleeding in 2 patients (2%), pseudoaneurysm in 1 (0.7%) and arteriovenous fistula in 1 (0.7%). Out of 4 patients (2.7%) with vascular proximity, only 1 (0.7%) had abnormal angiography.Conclusion: The most important factor in prediction of result of angiography was distal arterial pulses examination. But these data confirm the low incidence of vascular injury in asymptomatic patients with proximity. So the use of angiography when proximity is the sole indication in an asymptomatic patient with a normal vascular examination should be questioned.
Hamid Reza Kamravan; Ali Haghnegahdar; Shahram Paydar; Mohamad Khalife; Mahsa Sedighi; Fariborz Ghaffarpasand
Volume 2, Issue 1 , January 2014, , Pages 32-37
Abstract
Objective: To describe the epidemiological characteristics of patients with cervical spine injury admitted to Rajaee hospital, Shiraz, Iran.Methods: This cross-sectional study includes all patients admitted with impression of cervical column injury with or without cervical cord injury from October 2009 ...
Read More
Objective: To describe the epidemiological characteristics of patients with cervical spine injury admitted to Rajaee hospital, Shiraz, Iran.Methods: This cross-sectional study includes all patients admitted with impression of cervical column injury with or without cervical cord injury from October 2009 to March 2012 to our level I trauma center in Shiraz. We recorded the patients’ characteristics including age, sex, marital status, mechanism of injury, level of injury, concomitant injury, treatment(non-operative or operative) and clinical outcome. The data were described and compared with the international literature.Results: Among 261 patients referred with impression of spinal cord injury, the diagnosis of spinal column injury (with or without spine cord injury) was confirmed in 206 patients. The mean age of patients was 37.2±15.9 years with Male/Female ratio of 3:1. Car turn-over and car-collisions were the leading causes of injury. The most common spine fracture was C6 vertebra involving 60 (29.1%) patients. Fracture of upper and lower extremities were the most concomitant fractures observed in 31(15.1%) patients. Open surgery was performed in 65(31.6%).Mortality rate was 7.3% (15 patients).Patients with brain, lung and cord injuries had increased risk of death, among 15 deaths,9 patients had brain injury, 5 individuals had lung injury and 10 patients suffered from cord injury.Conclusion: Cervical spine injuries mostly affect young males, and comprise 206 (10%) cases out of 2100 spine injuries in our country. Preventive measures should be taken to reduce cervical spine injuries especially in young age group.
Syed Tajuddin Syed Hassan; Jamaludin Husna; Mohd Riji Haliza; Abdul Raman Rosna; Wan Fei Khaw
Volume 1, Issue 4 , October 2013, , Pages 137-138
Mohammad Reza Rouhezamin; Shahram Paydar; Maryam Hasirbaf; Shahram Bolandparvaz; Hamid Reza Abbasi
Volume 1, Issue 4 , October 2013, , Pages 141-146
Abstract
Objective: To explain an important aspect of violence, the spatiotemporal pattern of trauma in victims of violence visited in emergency room of Rajaei hospital, Shiraz, IranMethods: This cross-sectional prospective study comprised 109 randomly selected victims of violence visited in emergency room ...
Read More
Objective: To explain an important aspect of violence, the spatiotemporal pattern of trauma in victims of violence visited in emergency room of Rajaei hospital, Shiraz, IranMethods: This cross-sectional prospective study comprised 109 randomly selected victims of violence visited in emergency room of Rajaei hospital, a tertiary referral hospital affiliated to Shiraz University of Medical Sciences in winter 2013. We recorded the demographic information as well as data regarding the type and time of the injuries. The data collected for each victim was then entered in a data gathering form.Results: The study included 88% males with mean age 27.8 ± 8.8 years, which encompassed more than 60% young adults. Our study showed a temporal pattern with triple peaks. Moreover, 64% of assault trauma occurred at night. Furthermore, our study showed the majority of our patients suffered from stab wounds and about 57% of patients studied lacked high school diploma. Moreover it was revealed that violence was more common in downtown Shiraz, especially in the Fifth city district with simultaneous presence of many risk factors for violence.Conclusion: The result of this study showed that age, gender, educational status and temporal peak of violence were shown to be similar to other investigations conducted in other countries. Despite these similarities, stabbing were more prevalent in our study. Additionally, the Fifth city district of Shiraz seems to be the main city district where preventive intervention is needed to reduce violence- related injuries.
Hamid Reza Abbasi; Seyed Mohsen Mousavi; Ali Taheri Akerdi; Mohammad Hadi Niakan; Shahram Bolandparvaz; Shahram Paydar
Volume 1, Issue 2 , April 2013, , Pages 81-85
Abstract
Objective: To record and classify mechanisms of injury and injury severity score (ISS) in trauma patients admitted to the largest trauma center in Southern Iran.Methods: This was a prospective cross-sectional study including all the patients who were admitted to Nemazee hospital from 2009 to 2010. We ...
Read More
Objective: To record and classify mechanisms of injury and injury severity score (ISS) in trauma patients admitted to the largest trauma center in Southern Iran.Methods: This was a prospective cross-sectional study including all the patients who were admitted to Nemazee hospital from 2009 to 2010. We recorded the trauma injury information of 1217 patients who were admitted to of emergency room of the Nemazee hospital during a 13-months period by means of a standard questionnaire. ISS was then obtained for every single patient.Results: The mean age of patients was 26.6 ± 15.1 (range 1–95) years. The commonest type of trauma including 279 cases (22.9%) was car accident and the least resulted from shotgun injuries in 13 (1.1%) patients. The lowest ISS was due to assault multiple blunt traumas and the highest ISS resulted from shotgun injury. The mean ISS was about 6.3 ± 1.8 (range 1-66). Overall, 86 patients had scores above 17 (7.1%). A total of 69 male patients (7.5%) compared to 17 females (5.7%) had severe injury (ISS>17). Trauma injuries were significantly more severe in males compared to females (p=0.014). In the sunny and hot seasons total number of patient was higher. The mean ISS was highest in during spring (p<0.001).Conclusion: In Shiraz, most of the trauma injuries are occurred during summer and hot weather. Men have greater number of injuries and higher ISS compared to women. The lowest ISS was due to assault multiple blunt trauma and the highest ISS was caused by shotgun injury, and car accident was the commonest cause of trauma with head and neck being the most frequent sites in our patients.
Fariborz Ghaffarpasand; Maryam Dehghankhalili
Volume 1, Issue 1 , January 2013, , Pages 1-2
Hamid Reza Abbasi; Farnaz Farrokhnia; Sepideh Sefidbakht; Shahram Paydar; Shahram Bolandparvaz
Volume 1, Issue 1 , January 2013, , Pages 17-21
Abstract
Objective: To determine the removal time of the chest tube in ICU trauma patients under positive ventilation pressure (PVP).Methods: This was randomized clinical trial being performed in ICU department of Rajaei trauma hospital from March to December 2011. A total number of 92 trauma patients who were ...
Read More
Objective: To determine the removal time of the chest tube in ICU trauma patients under positive ventilation pressure (PVP).Methods: This was randomized clinical trial being performed in ICU department of Rajaei trauma hospital from March to December 2011. A total number of 92 trauma patients who were admitted in ICU and were under ventilation and had chest tube were randomly assigned into two groups. In case group, chest tube was clamped after 5–7 days. In the control group, chest tube was retained until the patients were under PVP. The chest tube was removed if there was no air leak or the drainage was less than 300 mL.Results: Complications observed in the case and control groups were 4.4% of 4.3% respectively (p=0.862). Among case group with hemothorax, 6.7% developed complication while this ratio for pneumothorax was 7.1% and zero in those with hemopneumothorax (p=0.561), whereas respective values for the control group were 11.1%, 8.3% and zero (p=0.262). Complications were noticed in 10.5% of those with more than 300 ml of pulmonary drainage. There were no complications in patients without air leak. In mild leak, 4.8% of subjects experienced complication, in moderate leak, no complication occurred and in severe ones, complication was visible in 7.7% of patients (p=0.842).Conclusion: The present study showed that the removal of chest tube in patients under ventilation within 5-7 days after its insertion is safe without any complications.
Shahram Bolandparvaz; Behzad Ghaffari; Seyed Mohsen Mousavi; Shahram Paydar; Hamid Reza Abbasi
Volume 1, Issue 1 , January 2013, , Pages 34-37
Abstract
Objective: To evaluate the predictive value of some biochemical markers in the outcome of extremity vascular trauma.Methods: This study comprised 30 patients with traumatic arterial injury and acute limb ischemia referred to Namazi hospital affiliated with Shiraz University of Medical Ssciences, over ...
Read More
Objective: To evaluate the predictive value of some biochemical markers in the outcome of extremity vascular trauma.Methods: This study comprised 30 patients with traumatic arterial injury and acute limb ischemia referred to Namazi hospital affiliated with Shiraz University of Medical Ssciences, over a period of 8 months, from Sep 2009 to Jul 2010. Venous blood samples were drawn from distal ischemic limb to determine pH, HCO3 - , PCO2 , PO2 , Na+, and K+ before definitive surgical intervention. Comparable samples were also obtained from veins of non- ischemic upper extremities. The biochemical assays were compared after monitoring the revasculurized limbs and evaluation of viability during a period of 7 days.Results: The mean age of the patients was 28.3 ± 7.8 (range: 18–56) years. Two (6.6%) patients underwent amputation because of developing irreversible limb ischemia after vascular reconstruction. Both patients had blunt traumatic knee injury accompanied by nerve, vein and soft tissue damage. The statistical analysis showed correlations between parameters, except for Na+, of local (ischemic limb) and systemic samples. In this context, the highest correlation was observed in regard to HCO3 - .Conclusion: The correlation was most pronounced with respect to HCO3 - . Ischemic limbs exhibited reduction in pH and PO2 but, PCO2 and K increased after ischemia of injured limbs. PO2 reflects tissue perfusion and is of value in predicting the outcome. We believe that blunt trauma and associated nerve, vein and soft tissue injuries pose negative prognostic effects on limb survival postoperatively.
