Hooman Rezaei; Elham Navipour; Samane Zafarabadi; Mehrdad Karajizadeh; Fatemeh Javanmardi; Mahnaz Yadollahi; Maryam Hosseini
Volume 13, Issue 4 , October 2025, , Pages 185-194
Abstract
Objectives: This study aimed to systematically review and quantify the association between D-dimer levels and injury outcomes in trauma patients through a meta-analysis.Methods: A systematic literature search of PubMed, MEDLINE/PubMed, and Web of Science was conducted from 2011 to 2023, supplemented ...
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Objectives: This study aimed to systematically review and quantify the association between D-dimer levels and injury outcomes in trauma patients through a meta-analysis.Methods: A systematic literature search of PubMed, MEDLINE/PubMed, and Web of Science was conducted from 2011 to 2023, supplemented by manual reference list searches. Two independent reviewers assessed the risk of bias using the Newcastle-Ottawa Scale. The primary outcomes were mortality and deep vein thrombosis (DVT).Results: Of 84 identified articles, 17 were eligible for full-text assessment, and 12 were included in the final analysis. A random-effects model was used to pool the study results. The analysis revealed a statistically significant difference in mean D-dimer levels between patients with poor outcomes and those without poor outcomes (p=0.0003). The standardized mean difference (SMD) was 0.51 (95% confidence interval [CI]:0.24 to 0.79). Furthermore, a significant difference in mean D-dimer levels was observed between survivors and non-survivors (p=0.03, SMD:0.42, 95% CI:0.04-0.79) and between patients with DVT and those without DVT (p=0.0008, SMD:0.79, 95% CI:0.32-1.25).Conclusion: This meta-analysis indicated that elevated D-dimer levels upon admission could be a valuable prognostic marker in trauma patients and might help predict poor outcomes.
Aditya Wardhana; Nadya Farhana; Putri Fernizi Harfah; Sheila Oklia
Volume 13, Issue 4 , October 2025, , Pages 203-214
Abstract
Objective: This systematic review and meta-analysis aimed to evaluate the impact of albumin administration on mortality and total resuscitation volume in burn patients.Methods: We systematically searched ScienceDirect, Cochrane, PubMed, MEDLINE, Scopus, and ProQuest in June 2025 using the terms “Burns,” ...
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Objective: This systematic review and meta-analysis aimed to evaluate the impact of albumin administration on mortality and total resuscitation volume in burn patients.Methods: We systematically searched ScienceDirect, Cochrane, PubMed, MEDLINE, Scopus, and ProQuest in June 2025 using the terms “Burns,” “Resuscitation,” and “Albumin.” Studies were included if they investigated albumin as part of burn resuscitation in adult patients and reported on mortality and total resuscitation volume. Pediatric studies, studies using albumin for other purposes, and those using other colloids were excluded. Reviewers independently extracted data on study characteristics, patient demographics, and outcomes. The risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-randomized studies (NRCTs). Pooled analyses were performed using Review Manager 9.3.0, applying random-effects models.Results: Eleven of the 7,365 identified articles were included. Albumin administration did not significantly affect mortality (OR=1.19 [0.62–2.28], p=0.57) or total resuscitation volume (OR=0.69 [-0.93–2.31], p=0.34). However, albumin use was associated with a reduced incidence of sepsis (OR=1.18 [1.02–1.38], p=0.03) and ARDS (OR=2.64 [1.43–4.86], p=0.02).Conclusion: The administration of albumin did not significantly impact mortality or resuscitation volume in burn patients. While there is some evidence of potential benefits in reducing complications, this is limited by heterogeneity, underscoring the need for further high-quality RCTs.
Marjan Hamidnezhad; Mozhgan Ansari; Tahura Afshari Saleh; Samira Foji
Volume 13, Issue 2 , April 2025, , Pages 76-82
Abstract
Objectives: This study aimed to compare the effectiveness of Trauma and Injury Severity Scores (TRISS) and Madras Head Injury Prognostic Scale (MHIPS) in assessing the prognosis of head trauma patients in the emergency department.
Methods: In this descriptive-analytical (predictive) study, 140 head ...
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Objectives: This study aimed to compare the effectiveness of Trauma and Injury Severity Scores (TRISS) and Madras Head Injury Prognostic Scale (MHIPS) in assessing the prognosis of head trauma patients in the emergency department.
Methods: In this descriptive-analytical (predictive) study, 140 head trauma patients admitted to the emergency department of Shahid Beheshti Hospital (Sabzevar, Iran), were included from January to November 2023. Participants were selected via convenience sampling method and based on the inclusion criteria. Data were collected using a demographic questionnaire, the TRISS, and the MHIPS scale, and analyzed using Stata software (version 17).
Results: The mean age of the injured patients was 39.72±19.86 years, and 102 (73%) patients were male. For intensive care unit (ICU) hospitalization prediction, the MHIPS tool showed a sensitivity of 92%, specificity of 86%, positive predictive value (PPV) of 60%, and negative predictive value (NPV) of 98%. For mortality prediction, the MHIPS tool had a sensitivity of 89%, specificity of 86%, PPV of 27%, and NPV of 99% in predicting death. The TRISS tool demonstrated a sensitivity of 81%, a specificity of 96%, a PPV of 81%, and an NPV of 95% for ICU hospitalization, and a sensitivity of 75%, specificity of 87%, PPV of 26%, and NPV of 98% for mortality. No significant difference was observed between TRISS and MHIPS in predicting the probability of ICU admission and mortality (p=0.797).
Conclusion: Both TRISS and MHIPS demonstrated satisfactory predictive value for head trauma outcomes, with neither tool being superior to the other.
Objectives: This study aimed to compare the effectiveness of Trauma and Injury Severity Scores (TRISS) and Madras Head Injury Prognostic Scale (MHIPS) in assessing the prognosis of head trauma patients in the emergency department.
Methods: In this descriptive-analytical (predictive) study, 140 head trauma patients admitted to the emergency department of Shahid Beheshti Hospital (Sabzevar, Iran), were included from January to November 2023. Participants were selected via convenience sampling method and based on the inclusion criteria. Data were collected using a demographic questionnaire, the TRISS, and the MHIPS scale, and analyzed using Stata software (version 17).
Results: The mean age of the injured patients was 39.72±19.86 years, and 102 (73%) patients were male. For intensive care unit (ICU) hospitalization prediction, the MHIPS tool showed a sensitivity of 92%, specificity of 86%, positive predictive value (PPV) of 60%, and negative predictive value (NPV) of 98%. For mortality prediction, the MHIPS tool had a sensitivity of 89%, specificity of 86%, PPV of 27%, and NPV of 99% in predicting death. The TRISS tool demonstrated a sensitivity of 81%, a specificity of 96%, a PPV of 81%, and an NPV of 95% for ICU hospitalization, and a sensitivity of 75%, specificity of 87%, PPV of 26%, and NPV of 98% for mortality. No significant difference was observed between TRISS and MHIPS in predicting the probability of ICU admission and mortality (p=0.797).
Conclusion: Both TRISS and MHIPS demonstrated satisfactory predictive value for head trauma outcomes, with neither tool being superior to the other.
sayyed majid sadrzadeh; Vahid Talebzadeh; Seyed Mohamad Mousavi; Behrang Rezvani Kakhki; elnaz vafadar moradi; Hamideh Feiz Disfani
Volume 13, Issue 1 , January 2025, , Pages 32-36
Abstract
Objectives: This study aimed to investigate the prognostic role of lactate clearance in predicting outcomes among trauma patients admitted to the emergency department.Methods: This retrospective cohort study was conducted on patients referred to the Emergency Department. Serum lactate levels were measured ...
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Objectives: This study aimed to investigate the prognostic role of lactate clearance in predicting outcomes among trauma patients admitted to the emergency department.Methods: This retrospective cohort study was conducted on patients referred to the Emergency Department. Serum lactate levels were measured at admission and 2 hours later. The patients were followed up for 72 hours to assess outcomes, including discharge, hospitalization in other wards, and mortality.Results: The results showed a significant difference between the mean age, Glasgow Coma Scale (GCS), systolic blood pressure (SBP), pulse rate (PR), and oxygen saturation (O2 Sat) of the trauma patients in relation to mortality prognosis (p<0.05). Additionally, significant differences were found in primary lactate, lactate levels two hours post-admission, and lactate clearance levels based on the patient’s prognosis (p<0.01). Multivariate logistic regression analysis revealed that lactate clearance was associated with a reduced mortality rate among trauma patients (OR=0.907, p<0.05).Conclusion: The findings of this study showed that lactate clearance, as an independent predictive factor, was associated with poorer prognosis and increased mortality rates in trauma patients.
Maryam Ramezanian; Parissa Bagheri; Cyrus Emir Alavi; Mohaya Farzin; MohammadReza Mobayen; Moein Moghaddam Ahmadi; Mohammad Tolouei; Siamak Rimaz; Mehdi Karimian; Hojat Eftekhari; Kiana Baghi; Ali Shabbak
Volume 13, Issue 1 , January 2025, , Pages 47-52
Abstract
Objectives: Severe burns often result in significant intravascular albumin loss, leading to hypoalbuminemia. This study aimed to evaluate the association between serum albumin levels and clinical outcomes in burn patients.Methods: A retrospective, single-center study was conducted at Velayat Hospital ...
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Objectives: Severe burns often result in significant intravascular albumin loss, leading to hypoalbuminemia. This study aimed to evaluate the association between serum albumin levels and clinical outcomes in burn patients.Methods: A retrospective, single-center study was conducted at Velayat Hospital (Rasht, Iran), including burn patients aged ≥16 years, who were admitted between April 2019 and March 2020. Serum albumin levels were recorded on day 1, day 7, and at discharge. The main variables analyzed included albumin levels, length of hospital stay, skin graft rate, need for mechanical ventilation, and mortality.Results: Among the 74 patients included in the study, 14 (18.9%) died, while 60 (81.1%) survived. The mean serum albumin levels on days 1, 7, and at discharge were significantly higher in survivors (3.09±0.22, 3.12±0.23, and 3.18±0.28 g/dL, respectively) than non-survivors (2.22±0.29, 2.74±0.29, and 2.07±0.69 g/dL, respectively) at all time points (p<0.001). The serum albumin level measured on day 1 was significantly lower in patients who required mechanical ventilation than in those who did not (2.86±0.47 vs.3.09±0.13, p=0.03). Additionally, a significant inverse relationship was observed between serum albumin levels and both total body surface area burned (TBSA) and graft extent (day 1: rs=-0.76, day 7: rs=-0.74, discharge: rs=−0.62; p<0.001 for TBSA; and day 1: rs=-0.59, day 7: rs=-0.58, discharge: rs=−0.50; p<0.001 for graft extent). Conclusion: Hypoalbuminemia was associated with poor clinical outcomes in patients with severe burns. Serum albumin levels might serve as a specific marker of burn severity and a predictor of mortality.
Hassanreza Mohammadi; ali Erfani; Sohrab Sadeghi; khalil komlakh; masoumeh otaghi
Volume 12, Issue 3 , July 2024
Abstract
Objectives: This study was conducted to investigate the factors affecting mortality due to spinal cord traumain patients admitted to the intensive care unit (ICU).Methods: This study was conducted in a group of patients who were admitted to the ICU with a TraumaticSpinal Injuries (TSI) diagnosis. The ...
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Objectives: This study was conducted to investigate the factors affecting mortality due to spinal cord traumain patients admitted to the intensive care unit (ICU).Methods: This study was conducted in a group of patients who were admitted to the ICU with a TraumaticSpinal Injuries (TSI) diagnosis. The researcher started sampling by assessing the documents of the patientshospitalized in the ICU, and the diagnosis of TSI was confirmed for them. Besides, utilizing a researcher-madechecklist, factors affecting the mortality of patients were identified. The data were analyzed using the SPSSsoftware version 16. P<0.05 was considered statistically significant.Results: About 412 (64.2%) patients were men, about 213 (33.2%) of the patients had GCS between 3-8 grade.There were injuries in the pelvis area. Moreover, there was a significant relationship between GCS score statusand the number of injury follow-ups in addition to TSI. Therefore, the mortality rate was higher in patients whohad lower GCS (Odds ratio=2.32, p<0.001). There was also a significant relationship between the number ofinjuries and the mortality rate, and patients who had multiple traumas had a higher mortality rate. Besides, asignificant relationship was observed between the complications caused by trauma, including cerebrovascularaccident, cardiac arrest, acute respiratory distress syndrome (ARDS), pneumonia, and the mortality of patientshospitalized in the SICU (p<0.05)Conclusion: The patients’ mortality was influenced by factors such as their level of consciousness, the numberof traumas caused in the spinal cord, and the occurrence of comorbidities such as cerebrovascular accident,cardiac arrest, ARDS, and pneumonia. Therefore, it is necessary to take the essential measures to reduce thesecomplications.
Behrang Khafafi; Omid Garkaz; Saeed Golfiroozi; Sahar Paryab; Laia Ashouri; Sevda daei; Hamid Reza Mehryar; Mousa Ghelichi-Ghojogh
Volume 10, Issue 3 , July 2022, , Pages 122-127
Abstract
Objective: To compare the ability of quantitative trauma severity assessment methods based on Glasgow comascale, age, and arterial pressure (GAP), revised trauma score (RTS), and injury severity score (ISS) criteria indetermining the prognosis of accidental patients.Methods: This cross-sectional study ...
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Objective: To compare the ability of quantitative trauma severity assessment methods based on Glasgow comascale, age, and arterial pressure (GAP), revised trauma score (RTS), and injury severity score (ISS) criteria indetermining the prognosis of accidental patients.Methods: This cross-sectional study was performed on random patients referred to Imam Khomeini Hospitalin Urmia from March 20, 2020 to September 21, 2020. The data were obtained by using a checklist includesitems such as age, sex, respiration rate, oxygen saturation level, pulse rate, primary blood pressure, initialGlascow coma scale (GCS), patient outcome and injury to different parts of body. After collecting the data, itwas entered into SPSS 18 and analyzed with the descriptive and analytical statistics include an independentt-test and receiver operating characteristic curve (ROC) curves.Results: Out of 1930 studied patients, 365 (18.9%) were women and 1565 (81.1%) were men. The mean age ofpatients was 37.05±17.11 years and women were significantly older than men. The mortality rate was 4.8% andwas significantly more in men compared to women. The mean blood pressure, GCS and oxygen saturation levelwere lower in deceased patients. The mean GAP, ISS and RTS values were 23.13±2.69, 4.07±3.82, 7.72±0.52,respectively. The mean values of GAP and RTS were significantly low in deceased patients whereas the meanISS value was significantly high in the deceased patients. The Area under the curve (AUS) for ISS was greaterthan the other two scoring systems.Conclusion: The findings of the current study showed that all three systems were adequately efficient toprognoses the final outcome in multi-trauma patients but the ISS measure was better than the other two criteria.
Kasturi Mukherjee; Debojyoti Bhattacharjee; Jayati Roy Chowdhury; Raghunath Bhattacharyya
Volume 10, Issue 1 , January 2022, , Pages 33-39
Abstract
Objective: To determine correlation of important biochemical laboratory investigations in different trauma patients and their degree of injury severity and overall mortality association. Methods: In this hospital based retrospective observational study, 238 trauma patients were divided into two groups. ...
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Objective: To determine correlation of important biochemical laboratory investigations in different trauma patients and their degree of injury severity and overall mortality association. Methods: In this hospital based retrospective observational study, 238 trauma patients were divided into two groups. Group I with injury severity score (ISS)16. Haemoglobin (Hb), international normalized ratio, serum creatinine, blood urea nitogen (BUN), serum electrolyte, serum uric acid and liver function parameters were recorded and statistically analyzed. Results: Group II had statistically significant (p <0.0001) elevated levels for referral pulse rate, creatinine, BUN, liver enzymes and decreased level in Hb% and potassium level compared to Group I. Strong positive correlation only exists between BUN and severity score, moderate positive correlation exists between creatinine, aspartate transaminase, and alanine transaminase, alkaline phosphatase and severity score and negative correlation between potassium and severity score. In this study, higher odds of high BUN and creatinine and lower potassium to normal values are associated with bad outcome such as higher mortality in the population of high ISS (>16). Conclusion: The study establishes the absolute need of doing three laboratory parameters (serum creatinine, serum blood urea nitrogen and serum potassium) instead of doing laboratory tests battery at the time of trauma victims admission and predicting survival among injured patients in trauma population from Indian settings.
Arvind Kumar; Yawar Haider; Jigyasa Passey; Rizwan Khan; Sahil Gaba; Mukesh Kumar
Volume 9, Issue 2 , April 2021, , Pages 51-59
Abstract
Objective: To analyze the factors associated with mortality in fracture patients with concomitant COVID-19 infection based on the available published data. Methods: Keywords such as “fracture” and “COVID or COVID-19” were searched through three major databases includes ...
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Objective: To analyze the factors associated with mortality in fracture patients with concomitant COVID-19 infection based on the available published data. Methods: Keywords such as “fracture” and “COVID or COVID-19” were searched through three major databases includes PubMed, EMBASE, and Google Scholar. Selection criteria were all published reports providing the mortality related information of COVID-19 positive fracture patients. Published papers containing mortality data of COVID-19 positive fracture patients were considered for qualitative review. For meta-analysis, the presenting individual’s data were considered to study the different parameters association with mortality. Results: The rate of mean mortality in COVID-19 positive fracture patients was 34%, and 91.7% of patients had hip fractures. Older age and hip fractures had a significant association with higher mortality rates in COVID-19 positive fracture patients.Conclusion: The mortality rates are considerably higher in COVID-19 positive patients with fractures compared to COVID-19 positive patients without fractures and to the COVID-19 negative fracture patients. Early surgical intervention should be preferred in hip fractures among COVID-19 positive patients for general stabilization and improved respiratory function. Older age and hip fractures are the main predictors of mortality in these patients.
Sadettin Er; Sabri Özden; Umut Fırat Turan; Egemen Özdemir; Barış Saylam; Mesut Tez
Volume 8, Issue 4 , October 2020, , Pages 224-228
Abstract
Objective: To compare the differences in the clinical course of acute appendicitis between early elderly (60-79 years) and late elderly patients (≥80 years). Method: The sample consisted of 177 patients aged over 60 that underwent surgery at the emergency service with the diagnosis of acute appendicitis ...
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Objective: To compare the differences in the clinical course of acute appendicitis between early elderly (60-79 years) and late elderly patients (≥80 years). Method: The sample consisted of 177 patients aged over 60 that underwent surgery at the emergency service with the diagnosis of acute appendicitis between January 2010 and May 2018. Patients’ data were retrospectively obtained from electronic records. Patients that had undergone appendectomy or negative appendectomy or had an appendix tumor were excluded from the study. The patients were divided into two groups by age; early elderly (60-79 years) and late elderly (≥80 years). Results: Of the 177 patients included in the study, 162(91%) were 60-79 years old and 15 (9%) were over 80. A statistically significant difference was found between the early and late elderly groups in terms of perforation, requirement for intensive care (p =0.001), red cell distribution width (p =0.025), the Clavien-Dindo classification (p =0.020), and the Charlson comorbidity index (p =0.005). The mean hospital stay was four and 11 days for early and late elderly groups, respectively. Multivariate analysis revealed that age alone was an independent factor with a statistically significant effect on mortality (OR=Odds Ratio: 53, 95% CI: 16.91-166.08; (p <0.001)). Conclusion: In particular, in the elderly patients over 80 years old, the clinical manifestation of acute appendicitis at hospital admission is in the form of perforation. Therefore, in this age group, a careful, precise and prompt diagnosis is crucial.
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.
Sait Saif; Yahya Ibrahim; Peyman Bakhshayesh
Volume 8, Issue 2 , April 2020, , Pages 107-110
Abstract
Objectives: To assess whether intentional traumatic injuries are associated with higher mortality rate when compared to unintentional injuries. Methods: Data from SweTrau (Swedish National Trauma Registry). Information regarding age, gender, injury severity score (ISS), new injury severity score (NISS), ...
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Objectives: To assess whether intentional traumatic injuries are associated with higher mortality rate when compared to unintentional injuries. Methods: Data from SweTrau (Swedish National Trauma Registry). Information regarding age, gender, injury severity score (ISS), new injury severity score (NISS), Glasgow coma scale (GCS), systolic blood pressure, and respiratory rate were collected via “SweTrau”. “Mortality within 30 days of injury” was defined as having been registered as dead within 30 days following the injury. Intentional injuries compared to non-intentional injuries. Multivariate regression analysis was conducted. Stepwise forward and backward regression was conducted. Results: A total number of 3875 patients were included. There were 3613 (93%) non-intentional and 262 (7%) intentional patients. The 30-day mortality rate was higher in the intentional group compared to non-intentional group, 10% vs. 4% (p<0.001). Patients in the intentional group were younger than the non-intentional group, at 39±18 vs. 47±21 years old (p<0.001). In both, the forward and backward tests injury intention remained statistically significant with OR 2 (CI 1.1-3.7). Shock (OR 4.7, CI 2.9-7.8), Severe Head Injury (OR 8.9, CI 5.3-14.7), Age ≥ 60 (OR 6.7, CI 4.1-10.8), ISS ≥16 (OR 10.8, CI 6.9-16.9) and ASA (OR 3.5, CI 2.2-5.7) were other factors affecting mortality. Conclusion: Injury intention was an independent factor contributing to mortality in our study. This particular cohort needs further attention during trauma management with a holistic insight to improve their survival.
Mahnaz Yadollahi; Ali Kashkooe; Reza Rezaiee; Kazem Jamali; Mohammad Hadi Niakan
Volume 8, Issue 1 , January 2020, , Pages 27-33
Abstract
Objective: To compare the injury severity scales as predictors of mortality in trauma patients to search for the best scale.Methods: In a prospective cohort study and systematical random sampling conducted from March to September 2017, trauma patients over the age of 13 years were enrolled. ...
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Objective: To compare the injury severity scales as predictors of mortality in trauma patients to search for the best scale.Methods: In a prospective cohort study and systematical random sampling conducted from March to September 2017, trauma patients over the age of 13 years were enrolled. The investigated variables were age, gender, systolic blood pressure, heart rate, respiratory rate, injured body region, Glasgow Coma Scale (GCS), injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS) and the outcome.Results: Totally, 1410 trauma patients were followed up, out of which 68.5% were male. The participants’ mean age was 43.5±20.88 years. After adjusting the confounding effects, age over 60 years (OR=7.38, CI [3.91-13.93]), GCSthan 5.5.Conclusion: Our results showed that TRISS, RTS, GCS, and ISS were all very effective approaches for evaluating prognosis, mortality and probable complications in trauma patients; thus, these systems of injury evaluation and scoring are recommended to facilitate treatment. TRISS, RTS, and ISS had almost the same sensitivity that was higher than GCS, but GCS had the most specificity. Finally, TRISS was selected as the most efficient scale for predicting mortality.
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.
Mehrdad Amir-Behghadami; Ali Janati
Volume 7, Issue 4 , October 2019, , Pages 433-433
Abstract
In the original article entitled “Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients”[1] which was published in July 2019 issue of the journal, there was an error in the specified mortality outcome in the manuscript. The published ...
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In the original article entitled “Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients”[1] which was published in July 2019 issue of the journal, there was an error in the specified mortality outcome in the manuscript. The published version describes 30-day mortality, however, the correct outcome measure should be 90-day mortality throughout the article. The article has been corrected accordingly online.
Rebecka Ah; MB BChir; Yang Cao; Hakan Geijer; Kardo Taha; Sahar Pourhossein-Sarmeh; Peep Talving; Olle Ljungqvist; Shahin Mohseni
Volume 7, Issue 3 , July 2019, , Pages 223-231
Abstract
Objective: To evaluate the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in comparison with other risk factors for mortality including osteopenia as an indicator for frailty in geriatric patients subjected to emergency laparotomy. Methods: ...
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Objective: To evaluate the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in comparison with other risk factors for mortality including osteopenia as an indicator for frailty in geriatric patients subjected to emergency laparotomy. Methods: All geriatric patients (≥65 years) undergoing emergency laparotomy at a single university hospital between 1/2015 and 12/2016 were included in this cohort study. Demographics and outcomes were retrospectively collected from medical records. Association between prognostic markers and 30-day mortality was assessed using Poisson and backward stepwise regression models. Prognostic value was assessed using receiver operating characteristic (ROC) curves.Results: 209 patients were included with a mean age of 76 ± 7.3 years. American Society of Anesthesiologists (ASA) classification, age, indication and type of surgery, hypotension, transfusion requirement and current malignancy proved to be statistically significant predictors of 30-day mortality. P-POSSUM mortality was statistically significant in the backward stepwise regression (incidence rate ratio=1.58, 95% CI: 1.16–2.15, p=0.004) while osteopenia was not. P-POSSUM had poor prognostic value for 30-day mortality with an area under the ROC curve (AUC) of 0.59. The prognostic value of P-POSSUM improved significantly when adjusting for patient covariates (AUC=0.83).Conclusion: P-POSSUM and osteopenia alone hardly predict 30-day mortality in geriatric patients following emergency laparotomy. P-POSSUM adjusted for other patient covariates improves the prediction.
Kam Lun Ellis Hon; Szewei Huang; Wai Sang Poon; Hon Ming Cheung; Patrick Ip; Benny Zee
Volume 7, Issue 3 , July 2019, , Pages 256-262
Abstract
Objective: To determine the mortality, morbidity, types of intracranial hemorrhages, and factors associated with length of stay (LOS) associated with accidental traumatic brain injury (TBI) at a pediatric intensive care unit (PICU) of a regional trauma center in an Asian city.Methods: This study is a ...
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Objective: To determine the mortality, morbidity, types of intracranial hemorrhages, and factors associated with length of stay (LOS) associated with accidental traumatic brain injury (TBI) at a pediatric intensive care unit (PICU) of a regional trauma center in an Asian city.Methods: This study is a retrospective review of types of head injury, mortality and morbidity demographics of patients admitted to a PICU with TBI. All patients with accidental TBI were included, namely road traffic injury (RTI) and fall, and their demographics compared. Non-accidental injuries (NAI) were excluded.Results: 95 children (78% males) were admitted to a PICU with RTI or falls from 2002 to 2017. They accounted for 3.7% of PICU admissions. Comparing with falls, victims of RTI were older (p<0.001) and more likely to suffer from skull fracture (p=0.017). There were 4 deaths with falls (6.8%) but none with RTI. Subarachnoid hemorrhages, extradural hemorrhages, the use of mechanical ventilation, inotropes and neurological supports were associated with longer LOS in PICU in these injuries (p<0.001).Conclusion: A longer PICU LOS is associated with extradural and subarachnoid hemorrhages, usage of inotropes, mechanical ventilation and neurological supports in falls and RTI. Three-quarters of victims are males. Preventive health education should be especially directed to boys to reduce severe TBI in this Asian city.
Mahnaz Yadollahi; Mojgan Behzadi Seyf-abadi; Forough Pazhuheian
Volume 7, Issue 2 , April 2019, , Pages 176-182
Abstract
Objective: To investigate the severity of injuries and the pattern of jaw and facial injuries in trauma patients and also to determine the predictors of the outcome in these patients.Methods: This cross-sectional study was conducted on 2697 patients with facial trauma who referred to trauma center in ...
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Objective: To investigate the severity of injuries and the pattern of jaw and facial injuries in trauma patients and also to determine the predictors of the outcome in these patients.Methods: This cross-sectional study was conducted on 2697 patients with facial trauma who referred to trauma center in Shahid Rajaee (Emtiaz) Hospital, Shiraz, Iran during 2010-2015. Injury severity score was determined through the conversion of injury codes of the International Classification of Diseases, tenth revision (ICD-10). Binary logistic regression by backward method was used to determine the partial effects of independent risk factors on death odds ratio.Results: The mean age of patients with maxillofacial injuries was 31.96 ± 15.80 years. The mean injury severity score (ISS) was 4.3 ± 4.4 and about 80% of the patients had an ISS between 1 and 8. Mandible fracture and ear injuries, respectively, were the most and the least prevalent types of maxillofacial injury. The odds ratio of death by motorcycle accident was 1.7 times higher than falling down in maxillofacial patients.Conclusion: Age, gender (male), ISS, and mechanism of injury were the significant predictors of mortality in the facial trauma patients. Mandible fracture and ear injury, respectively, were the most and the least prevalent types of maxillofacial injury. Our findings demonstrate the need for referral to the maxillofacial surgeon and maxillofacial surgery should be in connected with neurosurgical centers.
Prashant Bhandarkar; Ashok Munivenkatappa; Nobhojit Roy; Vineet Kumar; Luis Rafael Moscote-Salazar; Amit Agrawal
Volume 6, Issue 4 , October 2018, , Pages 313-317
Abstract
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 ...
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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.
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.
Amir Azarhomayoun; Maryam Aghasi; Najmeh Mousavi; Farhad Shokraneh; Alexander R. Vaccaro; Arvin Haj Mirzaian; Pegah Derakhshan; Vafa Rahimi-Movaghar
Volume 6, Issue 3 , July 2018, , Pages 181-194
Abstract
Objective: To estimate the summation of mortality rate and the contributing factors in patients with traumatic thoracolumbar spinal cord injuries (TLSCI).Methods: A systematic search of observational studies that evaluated the mortality associated with TLSCI in MEDLINE and EMBASE was conducted. The study ...
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Objective: To estimate the summation of mortality rate and the contributing factors in patients with traumatic thoracolumbar spinal cord injuries (TLSCI).Methods: A systematic search of observational studies that evaluated the mortality associated with TLSCI in MEDLINE and EMBASE was conducted. The study quality was evaluated using a modified quality assessment tool previously designed for observational studies.Results: Twenty-four observational studies involving 11,205 patients were included, published between January 1, 1997, and February 6, 2016. Ten studies were of high quality, thirteen were of moderate quality, and one study was of low quality. Seventeen reports described risk factors for mortality and eleven of these studies used a multiple regression models to adjust for confounders.The reported mortality rate ranged from 0 to 37.7% overall and between 0 and 10.4% in-hospital. The sum of mortality for in-hospital, 6-month, and 12-month were 5.2%, 26.12%, 4.3%, respectively. The mortality at 7.7 years follow-up was 10.07% and for 14 years follow-up reports ranged from 13.47% to 21.46%. Associated data such as age at injury, male to female ratio, pre-existing comorbidities, concomitant injuries, duration of follow-up, and cause of death have been underreported in studies investigating the mortality rate after TLSCI.Conclusion: Currently no study has accurately assessed mortality in the thoracolumbar spine, while there is general agreement that traumatic thoracolumbar spinal cord injuries are important.
Amir Nik; Mohammad Sobhan Sheikh Andalibi; Mohammad Reza Ehsaei; Ahmadreza Zarifian; Ehsan Ghayour Karimiani; Gholamreza Bahadoorkhan
Volume 6, Issue 2 , April 2018, , Pages 141-145
Abstract
Objective: To compare the efficacy and functional outcome of Glasgow Coma Scale (GCS) score with that of Acute Physiology and Chronic Health Evaluation Score II (APACHE II) in patients with multiple trauma admitted to the ICU.Methods: This cross-sectional study included 125 patients with traumatic brain ...
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Objective: To compare the efficacy and functional outcome of Glasgow Coma Scale (GCS) score with that of Acute Physiology and Chronic Health Evaluation Score II (APACHE II) in patients with multiple trauma admitted to the ICU.Methods: This cross-sectional study included 125 patients with traumatic brain injury associated with systemic trauma admitted to the ICU of Shahid Kamyab Hospital, Mashhad, between September 2015 and December 2016. On the day of admission, data were collected from each patient to calculate GCS and APACHE II scores. Sensitivity, specificity, and correct outcome prediction was compared between GCS and APACHE II.Results: Positive predictive value (PPV) at the cut-off points was higher in APACHE II (80.6%) compared with GCS (69.2%). However, negative predictive value (NPV) of GCS was slightly higher in comparison with APACHE II. Moreover, the area under the receiver operating characteristic (ROC) curve for sensitivity and specificity of GCS and APACHE II showed no significant difference (0.81±0.04 vs. 0.83±0.04; p=0.278 respectively).Conclusion: Our study suggested that there was no considerable difference between GCS and APACHE II scores for predicting mortality in head injury patients. Both scales showed acceptable PPV, while APACHE II showed better results. However, the utilization of GCS in the initial assessment is recommended over APACHE II as the former provides higher time- and cost-efficiency.
Homayoun Sadeghi-Bazargani; Bahram Samadirad; Nasrin Shahedifar; Mina Golestani
Volume 6, Issue 2 , April 2018, , Pages 146-154
Abstract
Objective: To study the epidemiology of car user road traffic fatalities (CURTFs) during eight years, in East Azerbaijan, Iran.Methods: A total of 3051 CURTFs registered in East Azerbaijan forensic medicine organization database, Iran, during 2006-2014, were analyzed using Stata 13 statistical software ...
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Objective: To study the epidemiology of car user road traffic fatalities (CURTFs) during eight years, in East Azerbaijan, Iran.Methods: A total of 3051 CURTFs registered in East Azerbaijan forensic medicine organization database, Iran, during 2006-2014, were analyzed using Stata 13 statistical software package. Descriptive statistics (p<0.05) and inferential statistical methods such as Chi-squared test and multivariate logistic regression with p<0.1 were applied. Results: Of the 7818 road traffic injury (RTI) deaths, 3051 (39%) were car users of whom 71% were male (mean age of 36.7±18.5 years). The majority of accident mechanisms were vehicle-vehicle crashes (63.95%), followed by rollover (26.24%). Crash causing vehicle fall increased the pre-hospital death likelihood by 2.34 times. The prominent trauma causing death was head trauma (in 62.5%). In assessing the role of type of counterpart vehicle on pre-hospital mortality, considering the other cars to be the reference group for comparison, deceased victims were 1.83 times more likely to die before hospital when the counterpart vehicle was a truck and 1.66 times more for buses.Conclusion: Decreasing the car users’ fatalities using appropriate strategies such as separating the roads for heavy and light vehicles and improving the injury related facilitation may be effective. Male drivers with low education could be prioritized for being trained.
Abdolkhalegh Keshavarzi; Sina Kardeh; Amirhosein Pourdavood; Mana Mohamadpour; Maryam Dehghankhalili
Volume 6, Issue 1 , January 2018, , Pages 59-63
Abstract
Objective: To evaluate the lethal area 50 (LA50) and determinants of mortality in burn patients admitted to a single burn center.Methods: This retrospective cross-sectional study was conducted in a tertiary burn center affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, during a 1-year ...
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Objective: To evaluate the lethal area 50 (LA50) and determinants of mortality in burn patients admitted to a single burn center.Methods: This retrospective cross-sectional study was conducted in a tertiary burn center affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, during a 1-year period from 2015 to 2016. To determine prognostic factors in fatal burns, medical records of eligible burn patients were reviewed for demographic and clinical variables, as well as patient outcome. Also, LA50 was calculated using Probit analysis.Results: Overall 559 patients with the mean age of 27.2±23.65 years and including 343 (61.4%) males and 216 (38.6%) females were enrolled in this study. The average burn TBSA% was 31.38±24.41% (1-100%). Duration of hospital stay ranged from 1 to 67 days (15.11±10.64). With 93 expired patients, the mortality rate was calculated to be 16.6%. The total LA50 was 66.55% (58.4-79.3). Fire was the most common cause of burn injury.Conclusion: Compared to developed countries, in our burn center the LA50 and survival rate of burn patients are lower. This indicates an urgent need for prompt attention in order to improve current policies regarding this public health issue to reduce mortality.
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.
