Bulletin of Emergency And Trauma

Abstract Objective: To investigate the relationship between outcomes and demographic-clinical variables in in-hospital cardiac arrest (IHCA).
Methods: The Medline database was searched along with Google Scholar, Scopus, Web of Science, and Persian language database without time limitation until January 6th, 2020. The inclusion criteria included papers published in journals or presented in English and Persian congress that reported the IHCA outcomes based on the Utstein criterion. All the descriptive, cross-sectional, and cohort studies on CPR were covered based on inclusion and exclusion criteria. Primary checks covered titles and abstracts followed by a full-text check of the remaining papers from the first screening stage. Data analysis was done using comprehensive metaanalysis (CMA) software version 2.0. The finding’s heterogeneity was checked using Q and Cochran tests with heterogeneity >50% and the random-effects model was used to estimate survival and favorable neurological outcome (FNO) in the analysis. To detect the publication bias of studies, the subgroup test, meta-regression test,
sensitivity analysis test, funnel plot, and Eagger’s regression test were used.
Results: Survival to discharge was 19.1% (95% CI=16.8-21.7) and FNO in the survived to discharge cases was 68.1% (95% CI=55.8-78.3). Survival to discharge and FNO were notably higher in men, CPR duration <15min, and shockable dysrhythmias.
Conclusion: IHCA outcomes are poor in developing countries. The outcomes of IHCA in terms of gender were inconsistent with the result reported by other meta-analyses.

Abstract Objective: To study a Boswellia and ginger mixture on the memory dysfunction of the mild traumatic brain
injury (mTBI) patients.
Methods: Patients with mTBI were asked about memory impairment following the injury. One hundred mTBI
patients were visited and assessed using an auditory-visual learning test (AVLT) questionnaire. By using
random permuted blocks, patients were given the Memoral (a mixture of 360 mg of Boswellia and 36 mg of
ginger) or placebo and were asked to consume it for a month. Patients were assessed one and three months
afterward using the second and third steps of AVLT, respectively.
Results: One hundred patients were included in the study and divided into control and intervention groups.
The mean age of the patients was 36.83±14.71, and there were no significant differences between the two
groups (p=0.41). There were no statistically significant differences in the baseline scores of different AVLT
parameters between the two groups. All patients had improvements in different parameters after three months.
But some factors include the scores’ change in total learning, retroactive interference score, forgetting rate,
and net positive score were significantly higher in treatment groups at one-month and three-month follow-ups
compared to the placebo group. In contrast, word span and hit parameters had the same pattern of improvement
in both groups.
Conclusion: The herbal medication can have a satisfactory effect on eliminating post-mTBI memory dysfunction
while having no considerable adverse effects. The effect of these components can also be sustained after a twomonth
timeframe. These results may assist patients to have less mental involvement.

Abstract Objective: To probe the factors associated with the outcomes of traumatic brain injury (TBI) patients admitted
to emergency department (ED).
Methods: This is a cross-sectional study that data gathering was performed via census methods, retrospectively.
During one year, all head injury’s patients who admitted to the ED of a tertiary center in Tehran, Iran were
included. Age, gender, mechanism of injury, Glasgow coma scale (GCS) and injury severity score (ISS)
on admission, presence of extra-cranial injuries, findings of brain computed tomography (CT), duration of
hospitalization, and in hospital outcomes were recorded. Outcome’s assessment for survivors was performed
within a 6 months-period after discharge based on Glasgow outcome scale (GOS). The variables and outcomes’
association were assessed.
Results: Totally, 506 patients were evaluated with the mean age of 36.77±21.1 years that 411 (81.2%) were men.
Follow up at 6-months post injury was feasible in 487 (96.2%) patients; 59 (11.7%) out of 506 eligible patients
died. Logistic regression analysis showed the association between assessed variables and patients’ outcome as
follows: age>65 years (OR: 12.21; p<0.001), GCS on admission <8 (OR: 62.99; p<0.001), presence of traumatic
Intracerebral hemorrhage (ICH) in brain CT scan (OR: 20.11; p=0.010), duration of hospitalization ≥ 5 days
(OR: 0.28; p=0.001).
Conclusion: The findings of the current study distinguished some variables that were associated with the
poor outcome of the patients with TBI. Therefore, TBI patients with any of these risk factors may need close
continues monitoring, early ICU admission, and some other special extra care in ED.

Abstract Objective: To compare clinical and paraclinical similarities between trauma patients with positive RT-PCR
tests (PCR+ve) and the RT-PCR negative ones (PCR -ve).
Methods: This a case-control study, where cases had a PCR+ve and controls had a negative result. Two groups
were compared regarding (para) clinical values. Multivariable binary logistic regression analysis investigated
the variables predicting COVID-19 and the mortality rate.
Results: Both groups were similar regarding the clinical findings and comorbidities (p>0.05). PCR+ve group
had lower lymphocyte count (1.41 [1.45] vs. 1.66 [1.61], p=0.030), CPK level (411 [928.75] vs. 778 [1946.5].
p=0.006) and CRP level (17 [42.5] vs. 24 [50.75], p=0.004). However, none of these findings were significant in
the multivariable analysis. Finally, PCR+ve group had increased odds of death (OR=2.88; 95% CI=1.22-7.41).
Conclusion: Unlike our primary hypothesis, the study failed to mark any significant (para) clinical features
guiding us to detect COVID-19 earlier in trauma patients. Moreover, the PCR+ve group is at increased mortality
risk. A larger, multicentric prospective study should be designed to address this issue.

Abstract Objective: To assess psychometric properties of the European Quality of Life 5-Dimension 3-Level Version
(EQ-5D-3L) commonly used tool for measuring road traffic injury (RTI) patients’ quality of life.
Methods: The psychometric study assessed the reliability and applicability of EQ-5D-3L through phone
surveys, based on a national cohort platform. Data of 150 RTI patients recruited from the cohort study were
included as 50 patients per each follow-up phase (one, six, and twelve months after discharge). A 12- day-time
span was between test and retest. We measured psychometric properties (internal consistency reliability and
stability reliability) and agreement using Kappa coefficients and percentages of agreement and Bland-Altman
method. Data were analysed using software STATA statistical package.
Results: The majority of patients were men (80%) with mean age (SD) of 41(14.7%), employed (78%) and
educated (86%). The Persian version represented high internal consistency reliability at total level (Cronbach’s
α=0.81) and moderate to good reliability at phase levels (0.62-0.87). The stability reliability was excellent at
total (ICC=0.98, 95% CI: 0.97, 0.98) and phase levels (0.97-0.98. The kappa agreement coefficients were valued
moderate to perfect (0.6-0.8, p>0.0001). The Bland-altman plot illustrated high agreement between test and
retest scores. No floor and ceiling effects were found.
Conclusion: The study revealed that EQ-5D-3L was highly reliable and responsive to be applied through phone
interviews at three different times post injury and discharge, as no previous study considered its psychometric
properties at various phone follow-ups after RTIs.

Abstract Objective: To determine the prevalence of crash and associated factors among commercial motorcyclists in
Owo, Ondo State, Nigeria.
Methods: This study is a descriptive cross-sectional study. Data was collected by using pre-tested structured
questionnaires administered to commercial motorcyclists. Collected information was socio-demographic
characteristics of the respondents, riding experience, formal training, possession of valid drivers’ licence,
motorcycle ownership status, mobile phone usage, history of crash in the previous one year, riding hours per
day, helmet use, carrying more than one passenger, riding against traffic and daily income.
Results: The study were enrolled 502 individuals with a mean age of 31.5±8.7. The ratio of men to women
was 250:1. All respondents who admitted to engage in the study had at least one risky behaviour in the past
(95.4% admitted to transporting one passenger more than the legal) and 56.6% admit to a prior history of
traffic offences. The crashes’ predictive factors include respondent age, cell phone use while riding, prior traffic
offences, carrying more than one pillion rider, use of stimulants such as kolanut and bitter kola, alcohol drink
riding, and admission of fault in the prior of crashes.
Conclusion: Commercial motorcyclists in Owo, Ondo State Nigeria engaged in risky behaviours that raised
their likelihood of being involved in crashes. The objectives of public enlightenment and driver education at
these behaviours could help to reduce the occurrence of crashes among them. 

Abstract Peritoneal tuberculosis (PTB) is a rare subset of extrapulmonary tuberculosis which account for only 0.5-1% of all cases. PTB diagnosis can be challenging due to nonspecific clinical manifestations. We present a known case of pulmonary tuberculosis that admitted to the surgery ward due to the major complaint of abdominal pain since ten days before admission. In imaging studies, positive findings favoring mechanical obstruction were detected. There were also several hypodense lesions in the liver suggestive of visceral tuberculosis. An adhesion was noted during exploratory laparotomy prior to the ileocecal valve responsible for intestinal obstruction, which was released. Pathology reports of excised tissues were consonant with the PTB diagnosis. PTB diagnosis can be challenging because of its presentation. This can delay the treatment of patients and thus increase morbidity and mortality. As a result, physicians should always be aware of the PTB diagnosis in patients with nonspecific abdominal involvement.

Abstract Blunt traumatic aortic injury is a deadly phenomenon in traumatic injuries. Damage control is essential in the management of traumatic patients. We reported a 20-years-old man brought to the trauma center from a car turnover crash scene. Blunt traumatic aortic injury grade III was revealed by contrast-enhanced computed tomography requiring urgent intervention. After an uneventful open repair of the aorta with Dacron graft, diffuse blood oozing occurred from the mediastinum and left pleural cavity. We packed the thoracic bleeding sites and removed the packings after four days. The patient developed no signs of cardiopulmonary compromise until the removal of the packings. Later, the patient was discharged with no complications. Through the followups, he had no complaint regarding the surgery. The patient has a normal chest x-ray one year later. Thoracic gauze packing is limitedly practiced due to concerns for cardiopulmonary compromises. To the best of our knowledge, this is the first time that this technique has been performed in the open repair of blunt traumatic
thoracic aortic injury as damage control.