eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
93
98
10.29252/beat-070201
45356
Review Article
A Productive Proposed Search Syntax for Health Disaster Preparedness Research
Behnaz Rastegarfar
dr.rastegarfar@gmail.com
1
Ali Ardalan
2
Saharnaz Nejat
3
Abbasali Keshtkar
4
Mohammad Javad Moradian
moradianshiraz@gmail.com
5
Dept. of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Dept. of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Dept. of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Objective: To find a proper search strategy to do a systematic review related to preparedness for disasters.Methods: MeSH and Emtree terms were searched to detect synonyms for two main search terms “disaster” and “preparedness”. Expert opinion on the synonyms was examined applying a Google form. The adopted syntax was searched in PubMed and results were sifted. Hand searching in two top key journals was done and sensitivity was calculated.Results: Out of 1120 articles, 122 were included. In PDM journal, 10 articles were included by hand searching, out of which 5 were not spotted in PubMed search with the proposed syntax. In DMPHP journal, 13 publications were included, with 5 not found in PubMed search. Because of human error in hand searching 2 articles were added.Conclusion: The proposed syntax in this study achieves a sensitivity of search of 0.6 in PubMed which could be quite applicable for researchers. Moreover, in case only MeSH or Emtree terms were applied in search strategy or where hand searching was not performed, there were a number of articles missed.
https://beat.sums.ac.ir/article_45356_b618765a4c62787b8ddfa26629bdf6a4.pdf
Disaster
Health
Preparedness
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
99
104
10.29252/beat-070202
45357
Original Article
Size Estimation of Under-Reported Suicides and Suicide Attempts Using Network Scale up Method
Mehdi Moradinazar
moradi.mehdi1363@yahoo.com
1
Farid Najafi
2
Mohammad Reza Baneshi
3
Ali Akbar Haghdoost
4
Assistant Professor of epidemiology, Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Research Center for Environmental Determinants of Health (ECEDH), Public Health School, Kermanshah Medical Science University, Kermanshah, Iran.
Modeling in Health Research Center, Institute for Future Studies in Health, Kerman Medical Science University, Kerman, Iran
Modeling in Health Research Center, Institute for Future Studies in Health, Kerman Medical Science University, Kerman, Iran
Objective: To estimate (under reporting) UR of SDS (Suicide deaths) and SAS (suicide attempts) in Kermanshah Province which is among provinces with high suicide rate in Iran.Methods: For estimating the size of UR suicide death registers, all cases of SAS and suicide deaths were retrieved from forensic medicine and health centers. Then, using network scale up method, a sample of 500 cases, aged 18 to 65 years, were randomly selected from the general population on the basis of age - sex proportion. To find the 95% confidence interval, bootstrap technique was used.Results: The average coverage of SDS was 58.4%, the lowest and highest coverage rate of SDS were attributed to self-immolation (34.2%) and hanging (80.7%), respectively. The coverage rate of SAS for self-immolation and deliberate self-poisoning were 82.4% and 77.2%, respectively. Size estimation of SAS by NSU method revealed that deliberate self-poisoning with medication (61.7%), poisoning with toxins and chemicals (20.6%), and self-immolation (7.7%) were the most frequent methods of SAS.Conclusion: Given the low coverage of suicide registers, all causes of death, especially deaths classified as accident or deaths with undetermined category, are required to be accurately registered. Investigations of causes of death, correction of wrong codes, as well as interviews with survivors to give them assurance can reduce the rate of suicide denial and result in increased accuracy of death register coverage.
https://beat.sums.ac.ir/article_45357_7909f7810fa2fe06e39cbcd927247a4f.pdf
Network scale up
Suicide
Size estimation
Under reporting
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
105
111
45339
Original Article
The Feasibility of Increasing Hospital Surge Capacity in Disasters through Early Patient Discharge
Sima Feizolahzadeh
1
Aliakbar Vaezi
vaeziali@ssu.ac.ir
2
Ali Taheriniya
3
Masoud Mirzaei
4
Mohammadreza Vafaeenasab
5
Davoud Khorasani-zavareh
davoud.khorasani@gmail.com
6
PhD candidate of Emergency& Disaster Health, Faculty of health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Associate Professor, Department of nursing, School of of nursing & midwifery, Research Center for nursing &midwifery Care in family health, Shahid Sadughi University of Medical Science,yazd Iran.
Assistant professor, Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran.
Associate Professor, Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
a- Department of Health in Disaster and Emergency, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
b- Associate Professor, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Objective: Hospitals are expected to be able to provide quality services during disasters. However, hospital capacity is limited and most hospital beds are almost always occupied. The aim of this study was to determine the feasibility of increasing hospital surge capacity during disasters through identification of patients suitable for safe early discharge.Methods: This cross-sectional study was conducted from May 2017 to February 2018 in two phases. In phase I, the Early Discharge Checklist was developed by a multidisciplinary panel of experts. Then in phase II, the checklist was used to assess the dischargeability of 396 in-patients in general wards of hospitals in Alborz province, Iran. Data were analyzed through the SPSS software (v. 22.0) and the results were presented by descriptive and analytical statics at a significance level of less than 0.05.Results: Of 396 patients, (64.65%) were male, (68.9%) were married, and (38.6%) aged more than 54. Moreover, (34.6%) patients were dischargeable. Patients in cardiology wards were more dischargeable. At follow-up assessment, 33.3% of patients had been discharged after 48 hours. There was a significant relationship between patient dischargeability and 48-hour hospitalization status (p=0.001). Dischargeability had no significant relationships with patients’ demographic characteristics (p>0.05).Conclusion: A considerable percentage of in-patients are dischargeable during disasters. The Early Discharge Assessment Checklist, developed in this study, is an appropriate tool to provide reliable data about early dischargeability in disasters.
https://beat.sums.ac.ir/article_45339_ff670202843b6ab4eb9fd0db3fcccde7.pdf
Early discharge
Hospital surge capacity
Disaster
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
112
117
10.29252/beat-070204
45340
Original Article
Game versus Lecture-Based Learning in Disaster Risk Education; An Experience on Shiraz High School Students
Mohamad Javad Moradian
1
Zahra Mehraein Nazdik
z.mehraein@gmail.com
2
Objective: To compare the effect of lecture and game methods in disaster risk education on high school students' knowledge.Methods: This research was a randomized field trial of educational intervention for high school’s students in Shiraz, Iran. Through cluster sampling, the 332 students were randomly selected and their knowledge was compared in two randomized allocated intervention groups by pretest and posttest. For one group a classic lecture about the basic concepts of disaster risk management were presented. In the other group through a game base method and demonstrations the mentors tried to educate the considered concepts.Results: In this study 332 students were participated in lecture (n=166) and game (n=166) groups. There was a significant increase between the mean of students' knowledge in the two groups of lectures and games method after educational intervention. The mean of students' disaster risk knowledge in the lecture and game methods were 17.47 and 29.77 percent respectively (p<0.001).Conclusion: The game's educational method was more effective than the traditional lecture method on students' knowledge and it can be considered as a new approach for promoting the behaviors on disaster risk management.Clinical Trial Registry: IRCT20171014036766N
https://beat.sums.ac.ir/article_45340_68206ba27d3b822fa4fcc0d8cc220c17.pdf
Education through game method
Knowledge
Disaster risk
Students
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
118
123
10.29252/beat-070205
45341
Original Article
Comparison of Ketamine-Propofol and Ketamine-Thiopental on Bispectral Index Values during Monitored Anesthesia Care (MAC) in Minor Traumatic Orthopedic Surgery; A Randomized, Double-Blind, Clinical Trial
Afsaneh Nowroozi
1
Hanieh Kianipour
2
Houshang Taleby
3
Bijan Yazdi
4
Objective: To compare the effects of ketamine-propofol and ketamine-thiopental on bispectral index values during monitored anesthesia care in minor orthopedic surgeries.Methods: This randomized double-blind clinical trial was performed on 90 patients undergoing minor orthopedic surgeries. Participants were randomly allocated to either groups of propofol or thiopental. Bispectral index (BIS), non-invasive arterial blood pressure, SpO2, and electrocardiogram were monitored every 5 minutes. Patients in propofol group received a bolus dose of 0.5 mg/kg ketamine, plus 0.5 mg/kg propofol. In thiopental group, patients received a bolus dose of 0.5 mg/kg ketamine, plus 50-75 mg thiopental. After the surgery, recovery duration, patients’ pain score (VAS) and any intra-operative recall or awareness were recorded. Statistical analysis was performed using SPSS version 19.0Results: BIS was lower in ketamin-propofol group (p< 0.001). Mean arterial blood pressure, heart rate and O2 saturation showed a significant difference between two groups (p< 0.001), which were lower in ketamin–propofol group. VAS score was higher in ketamin-thiopental group (p< 0.001). Both groups were similar in intra-operative recall/awareness.Conclusion: Ketamine-propofol combination deliver a better control over monitored anesthesia during surgery, providing lower BIS, higher O2 saturation and lower heart rate and arterial blood pressure in patients undergoing minor traumatic orthopedic surgeries.Clinical trial registration: IRCT6N 2016032320258
https://beat.sums.ac.ir/article_45341_9719372688ae705794491e721acc61a5.pdf
Monitored anesthesia care
Ketamin
Propofol
Thiopantal sodium
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
124
129
10.29252/beat-070206
45342
Original Article
Efficacy of Simultaneous Administration of Nimodipine, Progesterone, and Magnesium Sulfate in Patients with Severe Traumatic Brain Injury: A Randomized Controlled Trial
Ali Abdoli
1
Farshid Rahimi-Bashar
2
Saadat Torabian
3
Sepideh Sohrabi
4
Hamid Reza Makarchian
5
Objective: To investigate the safety and efficacy of simultaneous administration of nimodipine, progesterone, magnesium sulfate in patients suffering from severe traumatic brain injury (TBI).Methods: Overall, 90 patients with blunt head trauma who were admitted to the Besat hospital, Hamadan University of Medical Sciences, Iran through the Emergency Department in 2017 to 2018 were randomly assigned to the study or control groups each containing 45 patients. In the study group, intravenous nimodipine 60 mg every 12 hours for 5 days, intramuscular progesterone 1 mg/kg daily for 5 days, and magnesium sulfate 5 grams stat followed by 2.5 grams every 4 hours for 21 days were administered. Daily GCS and jugular venous oxygen saturation (SjvO2) of the patients were measured on admission day (day 0) through hospitalization day 4 at the intensive care unit. Then, all patients were visited at three months after discharge.Results: The mean age of the patients was 31.4 ± 12.8 years including 59 (65.6%) men with no significant difference between the groups. The baseline GCS and SjvO2 of the patients were comparable in both groups, however, GCS of the patients in the study group were significantly higher in the next 4 hospitalization days compared to the controls. Whereas, the SjvO2 of the patients were not significantly different between the groups during these days. Three-month mortality rate of the patients in the study group was significantly lower than the three-month mortality rate of the patients in the control groups (22.2% vs. 42.2%, p=0.042).Conclusion: Administration of combined protocol of magnesium sulfide, progesterone and nimodipine may be safe and effective in patients suffering from severe TBI.Clinical Trial Registry: IRCT201210229534N2
https://beat.sums.ac.ir/article_45342_030f69f9c61440dc92408da10724227a.pdf
Traumatic brain injury
Nimodipine
Progesterone
Magnesium sulfate
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
130
136
10.29252/beat-070207
45343
Original Article
Effects of Epidural Needle Rotation on Evolution of Unilateral Epidural Block and Patients’ Hemodynamics beside Recovery Profile in Patients Undergoing Arthroscopic Knee Surgeries; A Randomized Clinical Trial
Behnam Hosseini
1
Faramarz Mosaffa
2
Shideh Dabir
3
Hamed Tanghatari
4
Mehrdad Taheri
5
Objective: To evaluate the evolution pattern of epidural block after rotating the needle tip 45° to the operative side and evaluate its effects on patients’ hemodynamics and recovery profile in those undergoing arthroscopic knee surgery.Methods: Forty participants were randomly subdivided into control and rotation group (n=20). An 18-gauge, 3.5 inch, Tuohy needle was placed at the level of L4-5 and pushed forward into the epidural space through parasagittal approach, in control group, the needle was pushed forward to the epidural space in cephaldad 90 degrees. For the rotation group, the needle was pushed forward to the epidural space and the tip was rotated 45 degrees to the surgical side.15 mL of bupivacaine 0.5% was injected and evolution of sensory and motor blocks until 2-segment regression of the sensory level below to T10 as well as total duration of motor block and surgery were recorded. Hemodynamic parameters (HR, MAP, and SPO2), hypotension, fluid intake, vasopressors, first ambulation and spontaneous urination were recorded. Statistical analysis was performed using SPSS and P≤0.5 considered significant.Results: Sensory block up to T10 level, Complete motor block and time for 2-segment regression of sensory level were earlier in the 45°-rotation than in the control group (p<0.001).Total duration of motor block in control group was lower than rotation group (p<0.001).Hypotension, N&V, vasopressors and fluid intake showed no statistically difference between the two groups (p=0.219). First spontaneous urination and ambulation were significantly lower in rotation group (p<0.001).Conclusion: 45 degrees’ needle rotation to the surgical side provides a faster block evolution and hastened recovery profile with no significant difference in hemodynamic fluctuations.Clinical trial registry: IRCT20130518013364N7
https://beat.sums.ac.ir/article_45343_4c9e1904c3129232fa7ac6a853c7f47c.pdf
Epidural anesthesia
Hemodynamic
Block evolution
Recovery profile
Needle rotation
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
137
143
10.29252/ beat-070208
45344
Original Article
Cervical Epidural Steroid Injection: Parasagittal versus Midline Approach in Patients with Unilateral Cervical Radicular Pain; A Randomized Clinical Trial
Masoud Hashemi
1
Payman Dadkhah
2
Mehrdad Taheri
3
Kasra Dehghan
4
Rohollah Valizadeh
5
Objective: To compare parasagittal interlaminar cervical epidural steroid injection (PSIL-CESI) and the classic midline interlaminar cervical epidural steroid injection (MIL-CESI) in terms of pain relief and functional improvement in patients with unilateral upper extremity radicular pain.Methods: This was a randomized clinical trial being conducted in a single pain center in Tehran. Twenty-six patients were allocated into two groups of 13, undergoing either PSIL-CESI or MIL-CESI. After confirmation of radiocontrast spread in the epidural space by fluoroscopic guidance, dexamethasone 8 mg and bupivacaine 0.125% in a volume of 5 ml were delivered to the epidural space. Evaluation of functional state and pain intensity before and 1 month after the procedure was accomplished using the neck disability index (NDI) and the numeric rating scale (NRS) respectively.Results: Demographic and baseline characteristics of the cases showed no significant statistical difference. Improvements in the NDI and the NRS were observed in both groups; meanwhile, improvements were more pronounced in the PSIL-CESI group as compared to the MIL-CESI group (P<0.001). With the PSIL approach the ventral spread of radiocontrast was significantly higher (38%) than with the MIL approach (0.7%) (P<0.001). All patients in PSIL group showed radiocontrast spread ipsilateral to the painful side and all patients in the MIL group showed a midline distribution of radiocontrast.Conclusion: PSIL-CESI provides superior pain relief and improvement of functional disability in patients with unilateral upper extremity radicular pain in comparison to the classic MIL-CESI.Clinical trial registry: IRCT20180524039816N1
https://beat.sums.ac.ir/article_45344_400d6cea0ae4712cb8eaedc68f8c8a80.pdf
Injections, Epidural
Pain management
Upper extremity
Treatment outcome
Radiculopathy
Intervertebral disc disease
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
144
149
10.29252/beat-070209
45345
Original Article
Lumbar Transforaminal Epidural Steroid Injection in Patients with Lumbar Radicular Pain; Outcome Results of 2-Year Follow-Up
Masoud Hashemi
1
Payman Dadkhah
2
Mehrdad Taheri
3
Mahshid Ghasemi
4
Ali Hosseinpour
5
Objective: To evaluate the effectiveness of transforaminal lumbar epidural steroid injections (TFESI) in patients with unilateral radiculopathy due to lumbar intervertebral disc protrusion regarding pain intensity, functional disability, current opioid intake and patients’ satisfaction.Methods: The study is conducted in a pain management center (Tehran, Iran), during 2018. Inclusion criteria were age ≥18 years, radiculopathy for more than 6 months due to imagine-proved lumbar intervertebral disc protrusion and no response to conservative treatments. Exclusion criteria were spinal canal stenosis, lumbar surgery, and inability to communicate in Persian language. During a phone call interview, cases were instructed to rate their pain intensity according to the visual analogue scale (VAS), functional ability, satisfaction according to the patient satisfaction score (PSQ) and report current opioid use and additional injection and/or surgery.Results: Forty-three (89.5%) of the 48 subjects were reachable for study with mean age of 59.14 years and 16 subjects were men (37.2 %). Mean VAS after intervention was 4.67 and before the intervention was 6.91 (p=0.002). Mean functional disability before intervention was 47.23 and after intervention was 37 (p<0.001). Mean patient satisfaction score was 3.07 while 18 cases reported a PSQ level ≥4. 10 cases reported using opioid for analgesia, 23 cases reported receiving additional TFESIs and 11 reported having undergone lumbar surgery.Conclusion: Lumbar Epidural steroid injection is an effective non-surgical treatment option with regard to pain relief and improvement in functional ability with an average patients’ satisfaction during 2 years follow up although nearly 25% of patients may need additional injections and half of the patients may finally proceed to surgery.
https://beat.sums.ac.ir/article_45345_ee40d7c85d3d0af5506cca88afa26540.pdf
Radiculopathy
Steroid injection
Epidural steroid injection
Outcome
Pain management
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
150
155
10.29252/beat-070210
45346
Original Article
Unilateral Epidural Blockade for Lower Limb Fracture Surgery: Parasagittal Epidural Versus Midline Epidural Anesthesia
Masoud Hashemi
1
Payman Dadkhah
2
Mehrdad Taheri
3
Sirous Momenzadeh
4
Tahereh Parsa
5
Behnam Hosseini
6
Mohammadreza Abbasian
7
Objective: To compare the efficacy of parasagittal interlaminar (PIL) and midline interlaminar (MIL) approaches for epidural block in patients with lower limb orthopedic surgery. Methods: This double-blind randomized clinical trial was performed on 40 patients undergoing tibial shaft fracture surgery. In PIL group, an 18-gauge, 3.5 inch, Tuohy needle was placed at the level of L2-3 or L3-4 intervertebral spaces and pushed forward in a posteroanterior (PA) direction vertical to the body surface. After determining the most lateral place for needle arrival in an anteroposterior (AP) view, needle was pushed forward into the epidural space. For the MIL group, needle was pushed forward from the midline interspinous space with the same method. After confirmation of needle position, 1 mL of contrast was injected to confirm the epidural space distribution and then 15 ml lidocaine 2% was injected. The sensory and motor block level, onset, duration, heart rate (HR), mean arterial pressure (MAP), and arterial oxygen saturation (SPO2), and success rate were recorded.Results: Mean patients’ baseline characteristics showed no statistically significant difference between the two groups. (p>0.05). Outcome measures were statistically different and significantly higher in PIL group (p-values for sensory block level
https://beat.sums.ac.ir/article_45346_78aab9d8f4532ddbaf3b6f47a6af469d.pdf
Anesthesia
Epidural
Interlaminar approach
Parasagittal approach motor block
Sensory block
Hemodynamics stability
Success rate
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
156
161
10.29252/beat-070211
45347
Original Article
Three Dimensional Quality Assessments of Applied Pelvic Binders
Peyman Bakhshayesh
peyman.bakhshayesh@ki.se
1
David Hullberg Risling
2
Anders Enocson
3
Karolinska Institute
Objective: To assess the quality of applied pelvic binders using three dimensional computer tomography (3D CT).Methods: A local trauma registry was used to identify patients with pelvic fractures after high-energy trauma during 2011-2015. A 3D CT reconstruction was made from the initial trauma computer tomography images to assess the level of application, symmetricity of the binder and achieved fracture reduction. An acceptable application of the pelvic binder was deemed if it was at the trochanteric level, symmetric and minimized residual displacement.Results: We found 73 patients with a pelvic fracture and a pelvic binder on the initial trauma CT-scan. The mean (±SD) age of the patients was 46±17 years and 40% (n=29) were females. The median ISS score was 38 (IQR;29-50), the mean systolic blood pressure on arrival was 106±46 mmHg and the median GCS on arrival was 14 (IQR;7-15). We found that 59% (n=43) of the binders were correctly applied (symmetric at the trochanteric level, symmetrical and with acceptable residual displacement of the fracture). The 30-day mortality was higher in patients with non-correct application 17% (n=5/30) compared to patients with correct application of the pelvic binder 9.3% (n=4/43) however this was not statistically significant (p=0.562).Conclusion: A substantial number of patients had non-correct application of pelvic binders. Future studies using 3D technique are encouraged to further investigate clinical impacts of non-appropriate application of pelvic binders.
https://beat.sums.ac.ir/article_45347_2db928e28521b7b7660f59e106ba76d7.pdf
Pelvic binder
Pelvic trauma
Resuscitation
Hospital length of stay
3D CT scan
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
162
168
10.29252/beat-070212
45348
Original Article
Trampoline Park Injuries and Their Burden on Local Orthopaedic and Emergency Services
Stevan Jordan
1
Roozbeh Shafafy
2
Amelia Davidson
3
Christopher To
christopher.to@nhs.net
4
Kathryn Gill
5
Matthew Solan
6
Royal Surrey County Hospital NHS Trust
Brighton and Sussex University Hospitals NHS Trust
Royal Surrey County Hospital NHS Trust
Brighton and Sussex University Hospitals NHS Trust
Royal Surrey County Hospital NHS Trust
Royal Surrey County Hospital NHS Trust
Objective: To investigate the incidence of trampoline park injuries (TPIs) at a local recreational facility and to quantify the burden on emergency and orthopaedic services at our institute.Methods: All patients that presented to the Emergency Department (ED) from the trampoline park via ambulance from July 2014 to November 2015 were included in the study. Patients’ medical records were reviewed for clinical details including date, location and type of injury, treatment received, length of stay and outpatient follow-up. A cost analysis was performed to estimate the financial impact of each injury.Results: A total of 71 patients were included in the study, with a mean age of 20 (7-48). Soft tissue sprains (n=29, 41%) and fractures (n=25, 35%) were the most common injuries, with the majority occurring in the lower limb. Two patients sustained open tibial fractures necessitating transfer to level 1 trauma centres. Fourteen patients (20%) underwent surgery, predominantly requiring open reduction and internal fixation. Overall, 18 patients (25%) required admission to hospital with mean length of stay of 2 days. The cost for pre-hospital, emergency and in-patient care amounted to over £80,000.Conclusion: TPIs pose a significant financial cost for local orthopaedic and emergency services. Contrary to studies evaluating home trampoline injuries, the majority of fractures at trampoline parks occurred in the lower limbs. Improved injury prevention strategies are required to help reduce morbidity and lower the financial implications for local NHS trusts.
https://beat.sums.ac.ir/article_45348_9d85c2e1560f01ef084796ef163e4fbb.pdf
Trampoline park injuries
Local
Orthopaedic
emergency
Services
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
169
175
10.29252/beat-070213
45349
Original Article
Elastic Stable Intramedullary Nailing for Treatment of Pediatric Femoral Fractures; A 15-Year Single Centre Experience
Zenon Pogorelic
zpogorelic@gmail.com
1
Tonći Vodopić
2
Miro Jukić
3
Dubravko Furlan
dfurlan@kbsplit.hr
4
Department of Pediatric Surgery
University Hospital of Split
University of Split
Department of Pediatric Surgery
University Hospital of Split
Department of Pediatric Surgery
University Hospital of Split
Objective: To analyze outcomes of treatment and complications in children treated with elastic stable intramedullary nailing (ESIN) due to femoral fracture.Methods: From May 2002 until May 2018 case records of 103 patients (76 male and 27 female), with median age of 9 (range, 3-17) and follow-up of 92 months, who underwent ESIN because of displaced femoral fracture were retrospectively reviewed. The patient’s information including age, sex, side involved, trauma mechanism, type of fracture, associated injuries, neurovascular status, complications, operation time, duration of hospital stay, time to implant removal were analyzed. The surgical procedure implied a reposition of bone fragments and osteosynthesis with titanium elastic nails introduced through an incision over the lateral and medial border of the distal femoral metaphysis.Results: All patients achieved complete radiographic healing at a mean of 8.5 (range, 5-15) weeks. Nine (8.49%) postoperative complications were recorded: three entry site skin irritation, two cases of valgus angulation and one case of nail protrusion, re-fracture, Varus angulation and delayed union. All complications, except case of re-fracture and one valgus angulation, were treated conservatively, with no long term consequences for the patients. Two patients were re-operated. After removal of nails all patients recovered complete function of the extremity, without long term consequences.Conclusion: The ESIN for treatment of femoral fractures shows very good functional and cosmetic results. It allows an early functional and cast-free follow-up with a quick pain reduction. Because of the excellent objective and subjective results, the operative stabilization of femoral fractures with ESIN should be recommended to all pediatrics patients.
https://beat.sums.ac.ir/article_45349_269dd1addadfe788c4cafb51dab4c2b6.pdf
Femur
Fracture
children
Titanium elastic nails
Flexible intramedullary nailing, Elastic stable intramedullary nailing
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
176
182
10.29252/beat-070214
45350
Original Article
Pattern of Maxillofacial Injuries and Determinants of Outcome in a Large Series of Patients admitted to a Level-I Trauma Center
Mahnaz Yadollahi
yadollahim@sums.ac.ir
1
Mojgan Behzadi Seyf-abadi
2
Forough Pazhuheian
fpazhuheian@yahoo.com
3
Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
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.
https://beat.sums.ac.ir/article_45350_680c9993ef101948e7a845a5ac08d144.pdf
Maxillofacial trauma
Mortality
Injury severity score
Mechanism of injuries
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
183
186
10.29252/beat-070215
45351
Case Report
Arc of Buhler Pseudoaneurysm Causing Fatal Retroperitoneal Hemorrhage; A Rare Case Report and Discussion of Relevant Literature
Saptarshi Biswas
spartabiswas@gmail.com
1
Shekhar Gogna
2
DEPARTMENT OF TRAUMA AND ACUTE CARE SURGERY,
FORBES HOSPITAL.
ALLEGHENY HEALTH NETWORK.
PENNSYLVANIA.USA
Department of General Surgery,
Westchester University Medical Center, Valhalla, New York.
Identification of any variant anatomy prior to surgery is as essential as having knowledge of normal anatomy. These surprises bring on many challenges along with as they can be fatal. We encountered a case of patient who succumbed down to an unrecognized rare mesenteric vasculature variant known as “Arc of Buhler” (AOB) which is a persistent embryonic ventral anastomosis between the Celiac trunk and the Superior mesenteric artery. It is usually asymptomatic and found incidentally after evaluation for other pathologies. We herein report a pseudoaneurysm of Arc of Buhler being surgically managed after massive retroperitoneal hemorrhage. Unfortunately, the patient did not survive the procedure and passed away. AOB aneurysms present formidable risks to patients and diagnostic and therapeutic challenges to physicians. They are rare and require high index of suspicion on radiographic imaging. Present case reports underscore the importance of identifying it and treating it regardless of the size.
https://beat.sums.ac.ir/article_45351_37b5b50b30677761e4a0dd224f5c4254.pdf
Pseudoaneurysm
Fatal hemorrhage
Retroperitoneum
Arc of Buhler (AOB)
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
187
191
10.29252/beat-070216
45352
Case Report
Traumatic Bilateral Luxatio Erecta from a Sliding Injury Down a Ladder; A Rare Case Report and Literature Review
Saptarshi Biswas
spartabiswas@gmail.com
1
Ronald Peirish
ronald.peirish@med.lecom.edu
2
DEPARTMENT OF TRAUMA AND ACUTE CARE SURGERY,
FORBES HOSPITAL.
ALLEGHENY HEALTH NETWORK.
PENNSYLVANIA.USA
Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA.
Bilateral inferior shoulder dislocations also known as luxatio erecta is an extremely rare injury that is commonly complicated with injuries to the humeral head, glenoid, clavicle, scapula, rotator cuff, capsule, ligaments, brachial plexus, axillary artery and vein. Our patient is a 66-year-old man who presented with both upper extremities above his head in a fixed abducted position after sliding down a ladder approximately 6-meters. Initial radiographs revealed both humeral heads to be located below the glenoid fossa with each humeral shaft parallel to the scapular spines. Computed tomography (CT) revealed a right Hill-Sachs compression fracture (posterolateral humeral head) with a bony Bankart fracture (anteroinferior glenoid) and an avulsion fracture of the left acromion. Successful closed reduction was obtained. Upon follow up, bilateral rotator cuff tears were suspected and confirmed with magnetic resonance imaging (MRI). Early recognition, treatment and follow-up is essential to minimize complications.
https://beat.sums.ac.ir/article_45352_4fbfb60bb6ccc838b14a4656e2e90e68.pdf
Bilateral luxatio erecta
Bilateral inferior shoulder dislocations
Trauma
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
192
195
10.29252/beat-070217
45353
Case Report
Prone Positioning for Management of Fat Embolism Syndrome in a Patient with Spine Fracture; An Unusual Scenario and Review of Literature
Abhay Tyagi
1
Richa Aggarwal
pathakricha@yahoo.co.in
2
Kapil Soni
3
Anjan Trikha
4
Fat embolism syndrome is a rare but fatal complication seen commonly in patients with polytrauma. Its earliest manifestation is hypoxemia due to deposition of fat globules in pulmonary circulation which can progress to severe acute respiratory distress syndrome, the treatment of which is mainly supportive. We describe the case of a 17-year-old male who was admitted in our intensive care unit (ICU) for severe hypoxemia due to fat embolism. He had burst fracture of 5th lumbar vertebra with canal compromise along with other fractures. Failing conventional ventilation, the patient was placed in prone position taking proper precautions in positioning giving due consideration to his unstable lumbar spine. There was no neurological insult and in the next two days, he was weaned off from the ventilator. Though prone position is relatively contraindicated in patients with unstable spine, we employed early prone positioning taking adequate precautions, the benefit of which we believe outweighed the risk.
https://beat.sums.ac.ir/article_45353_50a7433e8bdc916093f5e6d2118c20a4.pdf
Fat embolism
prone position
Trauma
ARDS
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
196
198
10.29252/beat-070218
45354
Case Report
Conservative Management of Postpartum HELLP Syndrome and Intraparenchymal Liver Hematoma; A Case Report
Manouchehr Ghorbanpour
1
Hamid Reza Makarchian
2
Babak Yousefi
3
Mehrdad Taghipour
4
The HELLP syndrome is an important variant of pre-eclampsia which is known by triad of hemolysis (H), elevated liver enzymes (EL) and low platelet count (LP). Intraparenchymal liver hematoma is a rare and important complication of HELLP syndrome which is a life threatening condition. The incidence of intraparenchymal hematoma of the liver has been reported to vary from 1 in each 40,000 to 250,000 deliveries worldwide. Herein we report a case of intraparenchymal liver hematoma following HELLP syndrome. An 18 year- old woman with moderate to severe preeclampsia after delivery, presented with Right upper quadrant (RUQ) pain and tachycardia and significant drop in hemoglobin level. Ultrasonography revealed intraparenchymal liver hematoma. This finding was also confirmed by computerized tomography (CT)-scan. Conservative treatment was applied and the patient improved without need of any surgical intervention. Spontaneous hepatic hematoma should always be considered as a life threatening and important complication of HELLP syndrome during pregnancy and it can be managed conservatively in a hemodynamically stable patient.
https://beat.sums.ac.ir/article_45354_b55fb47db786acfcc5a58f4f0c19eb00.pdf
Hematoma
HELLP syndrome
Liver
Postpartum
eng
Shiraz University of Medical Sciences
Bulletin of Emergency And Trauma
2322-2522
2322-3960
2019-04-01
7
Issue 2
199
200
10.29252/beat-070219
45355
Letter to the Editor
Flood in the South-West of Iran in 2019; Causes, Problems, Actions and Lesson Learned
Mahmoudreza Peyravi
peyravi110@gmail.com
1
Ali Asghar Peyvandi
2
Ali Khodadadi
3
Milad Ahmadi Marzaleh
miladahmadimarzaleh@yahoo.com
4
Assistant Professor, Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
MD. Hearing Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Associate Professor, Department of Immunology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. & Khuzestan Red Crescent, Ahvaz, Iran
Ph.D. Candidate of Health in Disasters and Emergencies, Student Research Committee, Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
Dear Editor,Extreme climatic changes have increased the frequency and intensity of natural disasters all over the world imposing disastrous effects on human life and environment[1]. One of the dangerous disasters is flood. Flood may happen due to extreme rain or human-made actions in shores[2]. This report has investigated the feature and causes, actions taken, problems faced and lessons learned regarding flood management in Khuzestan province in Iran in January, 2019.
https://beat.sums.ac.ir/article_45355_f9c5423eb39db9ecedc56175bbb3e6ea.pdf
Flood
Climate Change
Health
Lesson learned
Iran