Bulletin of Emergency And Trauma

Abstract Objective: The present study was conducted to evaluate previous studies on hazard perception among road users.
Methods: A comprehensive search was conducted using electronic databases and search engines including
Science Direct, PubMed, Scopus, Embase, Web of Science, Iranmedex, SID, Irandoc, and Google Scholar from
January 2000 to September 2021. The search was performed using a combination of medical subject heading
terms and keywords. Endnote software version 20.0 (Clarivate, Philadelphia, PA, USA) was used to organize
the included articles. Thematic content analysis was used to analyze the findings. The entire review process
was conducted by two authors, and unresolved challenges were discussed with other researchers.
Results: Findings of the study show that all of the tests could discriminate between inexperienced and
experienced drivers. The use of dynamic hazard perception tests was more common than static tests, and in
some cases, simulators were used. Moreover, the results indicated a weak correlation between the results of
dynamic and static tests. Therefore, it could be claimed that both dynamic and static methods measured certain
dimensions of hazard perception.
Conclusion: Regarding the importance of hazard perception, the findings of this study can provide further
progress in designing hazard perception tests. The hazard perception tests can be sensitive to cultural or legal
differences. It should also be noted that in developing tools for measuring drivers’ hazard perception, different
dimensions of hazard perception must be considered, so that the level of drivers’ hazard perception can be
reported accurately.

Abstract Objective: This study aimed to evaluate the radiologic and clinical outcomes of TKA with non-stemmed tibial components in relation to their body mass index (BMI).
Methods: In this retrospective cohort study, the outcome of TKA with non-stemmed tibial components based on their BMI was evaluated (BMI<30 vs. BMI≥30). The patients’ function was assessed using the International Knee Documentation Committee (IKDC) and Lysholm knee questionnaires. Radiologic evaluation for probable signs of loosening was performed using two quantitative scoring systems by Ewald and Bach et al. Moreover, we reviewed the current literature on the application of non-stemmed tibial components in obese patients.
Results: Twenty-one patients (two men and 19 women) with BMI≥30 and a mean age of 65.1±9.5 years, and 22 patients (three men and 19 women) with BMI<30 and a mean age of 63.6±8.5 years were studied. The mean follow-up periods with BMI≥30 (47.0±19.8 months) and BMI<30 (49.2±18.7 months) were comparable (p=0.618). No patients in either group experienced clinical loosening. Besides, none of the patients had any kind of revision surgery. The patients in both BMI groups had comparable IKDC scores (both the total score and its sub-scores; p>0.05). Furthermore, the total Lysholm knee scores were similar in both groups (p=0.122). Using both scoring systems, the peri-prosthetic bone radiolucency near the tibial components was similar in both groups (p>0.999).
Conclusion: The present study found no significant difference in the radiologic or clinical outcome of unstemmed TKA in patients with BMIs under and over 30. 

Abstract Objective: This study aimed to evaluate epidemiological aspects of fatal injuries in Georgia.
Methods: This was a retrospective, descriptive study that included all traumatic injury deaths in Georgia
from January 1 to December 31, 2018. The National Center for Disease Control and Public Health of Georgia’s
The Electronic Death Register database was utilized in this research.
Results: Of the study fatal injuries, 74% (n=1489) were males. 74% (n=1480) of all fatal injuries were caused
by unintentional injuries. Road traffic accidents (25%, n=511) and falls (16%, n=322) were the primary causes
of mortality. During the research year, the number of Years of life lost (YLL) was associated with injuries and
was increased to 58172 for both sexes (rate per 1000 population: 15.6). Most of the years were lost in the age
group of 25-29 years (7515.37). Road traffic deaths accounted for 30% (17613.50) of YLL.
Conclusion: Injuries are still a major public health problem in Georgia. In 2018, 2012 individuals died from
injuries across the country. However, mortality and YLL rates of injury varied by age and cause of injury. To
prevent injury-related mortality, it is crucial to conduct ongoing research on high-risk populations.

Abstract Objective: This study aimed to investigate blood glucose levels in patients with brain injury caused by mild
traumatic brain injury (TBI) as a foundation for determining whether these patients need a brain CT scan or
not.
Methods: This cross-sectional study was conducted on patients with mild TBI, who were referred to the
emergency department from March 1, 2022, to September 1, 2022. After the confirmation of mild TBI by an
emergency medicine specialist, blood samples were taken from the patients to measure blood glucose levels.
Then a brain CT scan was performed, and blood glucose levels were compared between patients with and
without CT indications of brain injury. A checklist was used to collect data, and the data were analyzed using
SPSS software (version 23).
Results: In the CT scans of the 157 patients included in the study, 30 patients (19.2%) had a brain injury in
the CT scan. The mean blood glucose level was significantly higher in patients with brain injury, especially in
the presence of vertigo and ataxia, than patients without brain injury in the CT scan (p<0.0001). There was a
significant positive correlation between age and blood glucose level (r=0.315, p<0.0001).
Conclusion: Patients with mild TBI who had signs of brain injury in the CT scan had significantly higher blood
glucose levels than patients with normal CT scan findings. Although indications for performing a brain CT
scan are usually based on clinical criteria, blood glucose levels can be helpful in determining the requirement
for a brain CT scan in patients with mild TBI.

Abstract Objective: Burn trauma is a life-threatening incident that may be accompanied by several risk factors that
increase morbidity and mortality. Drug abuse is one of the lifestyle dangers on the rise globally and can have
an impact on the outcomes of burn injuries. This study aimed to evaluate the effect of drug abuse on the clinical
outcomes of adult burn patients who were admitted to a burn center in the North of Iran.
Methods: This retrospective cross-sectional study included adult burn patients who were referred to Velayat
Hospital, between March 1, 2021, and March 20, 2022. The hospital information system (HIS) was used to
select patients with a history of drug use and then were compared with burn victims who had never used drugs
before. In both groups, demographic information, the cause of the burn, the comorbid diseases, total body
surface area, length of stay, and outcomes were collected and recorded for both groups.
Results: This study included 114 inpatients, 90 of whom (78.95%) were men. The mean age of the patients was
43±15 years. The mean length of hospitalization in the drug-user group was significantly higher than in the
non-drug abuse group (p=0.004). The drug abuse group had significantly higher rates of comorbid diseases
(p=0.021), inhalation injury (p<0.001), mortality (p=0.002), and pneumonia (p<0.001). However, there were no
statistically significant differences in the Infection and Sir’s rates (p=0.583) between the groups.
Conclusion: Drug abuse is a risk factor in adult burn patients, which can affect the length of stay and burnrelated morbidities.

Abstract Objective: This study aimed to evaluate the Iranian ophthalmologists’ knowledge of prescribing prophylactic
antibiotics to patients with open globe injury (OGI) in Iran.
Methods: In this cross-sectional study, we utilized a questionnaire to evaluate the ophthalmologists’ knowledge
about prescribing antibiotics as prophylaxis. This survey was conducted in Tehran and its suburbs. The
questionnaire included demographic information as well as ophthalmologists’ knowledge levels. Cronbach’s
alpha was used to determine its validity and reliability. The obtained data were analyzed using SPSS 24.0.
Results: Of 192 subjects, 111 (35 women, 76 men) were included. About 65 (58.6%) specialists and 45 (41.4%)
subspecialists with different orientations completed the questionnaires. The total knowledge score was
13.04±2.96. The following are the results of ophthalmologists’ responses to questions regarding the cornea/
scleral injury (1.09±1.72), prophylactic antibiotics administration (2.79±1.11), the infectious agents in eye
surgeries (3.21±1.49), diagnosis and treatment (2.84±0.944), and the effects of ocular antibiotics as well as their
proper dosage (2.96±2.35). There was no significant relationship between some demographic information such
as sex, working hours, workplace, and the number of studied articles (p>0.05). In addition, ophthalmologists
with less work experience had significantly higher levels of knowledge than those with more work experience.
Conclusion: The findings indicated that the majority of ophthalmologists had a basic knowledge of prescribing
prophylactic antibiotics in OGI.

Abstract Wunderlich syndrome, also known as the spontaneous non-traumatic retroperitoneal hemorrhage, is an
uncommon condition characterized by acute, spontaneous, non-traumatic renal hemorrhage into the subcapsular
or perirenal spaces. The majority of the cases are caused by renal cell carcinoma or renal angiomyolipoma.
Other causes are arteriovenous malformation, cystic renal disease, and anticoagulation medications. The
classic presentation is “Lenk’s triad” of acute flank pain, palpable flank mass, and hypovolemia. The diagnosis
is based on clinical suspicion and confirmed by a CT scan, which is the preferred imaging modality. Due to
the rarity of these cases and the wide range of clinical manifestations, the treatment is divergent ranging from
conservative management to nephrectomy. Herein, we present a case of massive right renal hemorrhage caused
by warfarin toxicity that was initially misdiagnosed as acute renal colic due to the patient’s refusal to refer to
the clinic during Corona Virus Disease- 19 era and was later managed with a right nephrectomy. 

Abstract Some non-pharmacological techniques have been shown to effectively reduce pain, including cognitive-behavioral therapy, hypnosis, relaxation techniques, and interaction through television, music, and storytelling. Recently, new advanced technologies such as virtual reality immersion therapy (VRIT) and simulation for therapy (SFT) have been used in post-burn rehabilitation. Immersive VR is a cognitive–behavioral technique based on distraction used for treating physical and psychological pain. A comprehensive evaluation of nine clinical trials demonstrated that VR technology combined with pharmaceutical analgesics was significantly more effective in reducing pain and anxiety in burn patients. On the other hand, to improve therapeutic effectiveness in rehabilitation settings such as post-burn conditions, the combined use of related methods such as interactive game consoles (IGC) is increasingly used. IGCs are more favored for use in burn rehabilitation because they are less cumbersome than other forms of VR. Virtual reality games can provide practical and attractive therapy that allows the child to amuse by artificial scenes that appear and feel similar to real-world scenes.

In general, it can be said that new technological developments, such as interactive virtual reality, gamification, powerful computers, and portable tablets, and their universal popularity, now offer the chance to integrate knowledge from clinical practice, neuroscience knowledge, and design ideas. In addition, the wide range of virtual communication options and computer games provide physicians to choose appropriate tools that help in treatment. This perspective aims to explain the potential of game design principles to generate more motivation and content for therapy integrated with the proper technological context, like virtual reality.