Bulletin of Emergency And Trauma

Abstract Objective: To estimate the rate of driving hazard perception (HP), explicate the content of HP and determine
its components.
Methods: The present study is a systematic review and a meta-analysis which is carried out to gather data,
to search Science Direct, PubMed, Scopus, PROQUEST, web of knowledge databases, Google scholar search
engine and also to search manually from January 2000 to September 2021 with using related keywords. EndNote
X20 software was used to manage and screening studies. Stata16 was used for meta-analysis. Thematic content
analysis was used to analyze the findings. The entire review process was conducted by two authors, and disputes
were referred to a third person.
Results: Out of the 1167 founded articles, 50 were finally included in the study. According to 10 imported
papers for meta-analysis includes 2770 sample size, general HP of drivers is estimated 3.33 [4.04-2.62 with CI
95, I2=89.72]. Also, HP for experienced and beginner drivers is estimated 3.26 [2.23-4.26 with CI 95, I2=89.47]
and 3.42 [2.41-4.43 with CI 95, I2=89.68], respectively. Also, in the data meta-synthesis, 28 definitions of HP
and 6 main components are identified to evaluate HP using thematic content analysis.
Conclusion: In this study, obtained results show that all people need constant and gradual training at all levels.
A factor that can be effective to improve drivers’ HP is to make drivers to take training courses and to pass
standard tests at the time of obtaining driving license.

Abstract Objective: To design and conduct the effectiveness of Ketamine vs Dexmedetomidine in children’s sedation at
emergency department (ED).
Methods: This randomized clinical trial study was carried out at the two trauma centers in Mashhad, Iran. The
patients were divided into two groups by means of a random numbers table to be treated with Ketamine (N=20)
or Dexmedetomidine (N=20). Their demographic information and sedation times of drugs were collected and
analyzed.
Results: In general, sedation time was significantly higher in the ketamine group, 14.35 minutes (IQR:9.82-
19) than in the dexmedetomidine group, 9.7 minutes (8.35-14.23) (p=0.023). Time of injection to complete
anesthesia was 45.25 (IQR:30-58) and 72 (IQR:60.25-82) minutes in ketamine and dexmedetomidine groups,
respectively (p<0.01). In the case of recovery, grade 4 of the Ramsey scale was statistically more prevalent in
dexmedetomidine (45%) than in the ketamine group (p=0.0001).
Conclusion: This study demonstrated that dexmedetomidine could be used in cases where a shorter sedation
time is vital. Ketamine could be a better choice where full recovery time (from injection) matters most.

Abstract Objective: To evaluate the spiral chest computed tomography (CT) scan findings in patients with multiple
trauma during the COVID-19 pandemic.
Methods: This retrospective study was performed on multiple trauma patients admitted to a tertiary hospital in
the north of Iran in 2020. All patients with multiple trauma who had undergone a chest spiral CT were included
in this study. Furthermore, the data analysis was performed through descriptive and analytical statistics using
SPSS software.
Results: A total of 600 patients were included over the study period. The mean age of patients was 48.2±20.3
years. Of the total, 496 (65.3%) patients had blunt chest injuries, and 104 (34.7%) had penetrating chest injuries.
Falling was the most common mechanical cause of chest trauma in 270 patients (45%). Surgical interventions
were performed in 110 (18.3%) patients. A total of 276 (46%) patients had chest injuries identified by CT
scans. Many patients (15.6%) had ground-glass lung opacity in the CT scan reports. Lung consolidation,
pneumothorax, lung contusion, hemothorax, and rib fractures were the most common.
Conclusion: Due to the high frequency of typical findings in spiral CT scan examinations, obtaining a reliable
history of trauma severity, injury mechanism, and a detailed physical examination is recommended before
prescribing a CT scan for patients.

Abstract Objective: Ventilator-associated pneumonia is the common cause of morbidity and mortality in the intensive
care unit. Due to the antimicrobial effect of chlorhexidine, and the long-lasting result of mucoadhesive drugs,
this study aimed to determine the effect of chlorhexidine mucoadhesive gel on the prevention of ventilatorassociated
pneumonia in critical patients.
Method: In this clinical trial, 64 ventilated patients were selected and randomly allocated into two groups. The
first group received 0.2% chlorhexidine mucoadhesive gel and the second group received 0.2% chlorhexidine
solution as a mouthwash. Every three days, the incidence of ventilator-associated pneumonia was evaluated
by the clinical score of pulmonary infection. The data were analyzed by SPSS statistical software version 20.
Results: There was no statistically significant difference in demographic characteristics between the two
groups. In the control group, 25% of the patients had ventilator-associated pneumonia, while it was only 15.6%
in the intervention group; however, the incidence of ventilator-associated pneumonia revealed no significant
difference between the two groups (HR ratio, 0.86; 95% confidence interval, 0.49 to 1.83 p=0.356).In addition,
there was no statistically significant difference between the number of days connected to the ventilator
(p=0.854), the number of days hospitalized in the intensive care unit (p=0.423), and the death rate (p=0.634)
between the two groups.
Conclusion: Although no significant statistical difference was detected between chlorhexidine mucoadhesive
gel and chlorhexidine solution in the prevention of ventilator-associated pneumonia, the incidence of pneumonia
in the mucoadhesive gel group was clinically less than in the control group. It is better to repeat the study with
a larger statistical population.

Abstract Objectives: To study the anti-inflammatory and antioxidant effects of flaxseed oil and olive oil on inflammatory
markers for facilitating wound healing.
Methods: One hundred and twelve patients were randomly selected to four groups with a total burn surface
area (TBSA) of 20-50%. The four groups includes olive oil (OO), flaxseed oil (FO), mixture of olive oil and
flaxseed oil (OF), and control group and received 30g of oils for three weeks. Serum high-sensitivity C-reactive
protein (hs-CRP), ferritin and albumin level as inflammatory markers, as well as cholesterol, triglyceride,
high-density lipoprotein (HDL) and low-density lipoprotein (LDL) as the lipid profile were explored. Wound
healing was assessed by photographing on days 2, 8, 15, and 22 (during three weeks of intervention) and were
analyzed in imageJ software.
Results: The greatest reduction in the level of hs-CRP and ferritin was observed in the OF (-21.38±44.41)
(-132.79±165.36), while the lowest reduction was reported in the control group (-36.36±79.03) (141.08±262.36).
Compared to control group, OO significantly increased albumin (0.88±0.65). Reduction of wound healing at the
end of the first week of intervention was not significant in the study groups. However, the stereology examination
showed significant improvement in wound healing at the end of the second and third weeks in the OF.
Conclusion: Based on the findings, combination of herbal oils reduce inflammation and improve wound healing
and showed positive effects on the size of wounds in burn patients.

Abstract Objective: According to the reports of the World Health Organization approximately 300,000 deaths occur
yearly worldwide due to burns or burn-associated injuries. This study aims to review the epidemiology of burns
in pediatrics and adolescents in Fars province between 2017 and 2018.
Methods: This is a cross-sectional study that investigated all people ≤18 years old who suffered from burn
injuries in Fars province between 2017 and 2018. We use data from the file of burn patients which was provided
by pre-hospital emergency services of Fars province. This data comprises demographic information (age and
gender), burn-related information (type, degree, and severity of burns), mode of transfer (outpatient surgery or
transfer to hospital) and the outcome of the disease (death before arrival to the hospital or alive).
Results: The average age of the subjects of this study was 5.8±8.9. We also categorized the subjects into four
age groups, 1-4, 5-8, 9-13 and 15-18 years. The number of boys who suffered from burn injuries is significantly
more than the girls (p=0.011). Also, there is a remarkable correlation between burn with age (p<0.001) and
burn with disease outcome (p=0.01). The Most common cause of burns in boys was nonchemical hot objects
and liquids (28.5%). Likewise, the possibility of mortality in burn patients who faced an electric shock was
22.66%. ([95%CI=2.32-220.63], p<0.001 OR=22.66).
Conclusion: This study shows that pediatrics and adolescents ≤ 4 have the most burn injuries, and boys have
twice as many burn events as girls. More importantly, the most common cause of burns in both genders was
burning with non-chemical hot objects and liquids, in particular, in the age group of 1-4 years, in which event
happens at home.

Abstract Leech therapy (Hirudotherapy) is a method used in the treatment of many diseases since ancient times.
Although many complications have been reported following the use of this method, no systemic life-threatening
bleeding has yet been described. A-43-year-old male patient was diagnosed with upper gastrointestinal
bleeding following leech application that he had received for infertility one week earlier. The complications of
hirudotherapy typically spontaneously improve due to the local effects of this treatment. The most frequently
reported complications are local infections, and less commonly allergies and prolonged local bleeding can
occur. However, in this case report, we describe a life-threatening upper gastrointestinal bleeding as a new
complication. Gastrointestinal bleeding appearing a week after leech therapy does not necessarily mean
that leeches caused gastrointestinal bleeding in this case. Nevertheless, considering the development time
of gastrointestinal bleeding, it can be deduced that it was possibly due to hirudotherapy. Patients should be
informed about alarming symptoms that can indicate complications following leech application.