Bulletin of Emergency And Trauma

Abstract Objective: This study aimed to comprehensively determine the factors that affect the hospitals’ functional
preparedness in response to disasters.
Methods: A systematic review of studies published in English and Persian up to the end of 2022 was performed
by searching PubMed Central, Web of Science, Scopus, ProQuest, SID, and Elmnet databases. Articles that
assessed hospitals’ functional preparedness were searched by using a combination of medical subject heading
terms and keywords including disaster, emergency, preparedness, hospital preparedness, health care facilities
preparedness, hospital functional preparedness, health care facilities functional preparedness, readiness, and
effective factors. Additionally, journals and gray literature were manually searched. Two independent reviewers
screened the eligible papers. The inclusion criteria were the full text should be published up to the end of 2022,
in both Persian and English, and focus on hospital preparedness. The extracted data were manually analyzed,
summarized, and reported using the content analysis method.
Results: Of the 3465 articles, 105 studies were eventually included in the final analysis. Eighty-two influential
factors were identified and classified into seven categories: government, coordination, control, and commanding
(7 factors), existing guidelines and preparedness plans (12 factors), regulations (6 factors), supplying of resources
(37 factors), education and training (8 factors), multi-layered information management and communication
systems (8 factors), and contextual factors (4 factors).
Conclusion: There are different dimensions of hospital preparedness for disasters, each of which is influenced
by several independent factors. Addressing these factors will enhance the actual functional preparedness of
hospitals encountering disasters.

Abstract Objective: To investigate the use of prognostic markers such as C-reactive protein (CRP) and D-dimer for
clinical outcomes in patients with mild traumatic brain injury (TBI).
Methods: This cross-sectional study was conducted on patients with mild head trauma who were admitted
to the Emergency Department of Imam Khomeini Hospital (Sari, Iran). Data were collected from 2018 to
2019. Age, sex, the time of injury hospitalization, length of hospitalization, length of unconsciousness, blood
pressure, heart rate, respiratory rate, and concomitant symptoms were all recorded using a pre-designed
checklist. The patient’s Glasgow Coma Scale (GCS), CRP, and D-dimer were also measured. Moreover, all
patients underwent CT scan.
Results: This study included 74 patients with TBI. The mean age of the participants was 36.92±3.54. The
mean CRP and D-dimer values were 5.69±0.77 and 0.58±0.11 in these patients, respectively. At the cut-off
point of 11.50 for CRP, the sensitivity and specificity to detect the pathological lesions in CT scan was 75%
and 95.50%, respectively (p<0.001). Additionally, with a D-dimer cut-off point of 0.90, the sensitivity and
specificity for diagnosing pathological lesions in CT scan were 100% and 98.50%, respectively (p<0.001).
Conclusion: In general, the CRP and D-dimer levels of patients with mild TBI (GCS≥13) can be assessed to
protect against CT-induced radiation exposure and subsequent disorders; if they do not exhibit clinical signs to
increase the risk of adverse brain damage, such as reduced level of consciousness, drowsiness, and prolonged
periods of unconsciousness.

Abstract Objective: To determine the causal relationship between aging and nighttime driving and the odds of injury
among elderly drivers.
Methods: In this cross-sectional study, 5460 car accidents were investigated from 2015 to 2016. The data were
extracted from the Iranian Integrated Road Traffic Injury Registry System. Pedestrian accidents, motorcycle
crashes, and fatalities were excluded from the study. To account for major confounders, Bayesian-LASSO, and
treatment-effect cutting-edge approaches were used.
Results: Overall, 801 injuries (14.67%) were evaluated. The results of the univariable analysis indicated that
aging and nighttime had adverse effects on the odds of road traffic injuries (RTIs), even after adjusting for
the effect of other variables, these effects remained statistically significant. According to a newly developed
approach, the overall effects of aging and nighttime were significantly and directly correlated with the odds of
being injured for older adults (both p<0.001). Our findings indicated that drivers over 75 years old experienced
23% higher injury odds (OR=1.23, 95% CI:1.11 to 1.39; p<0.001), while driving at night increased the odds by
1.78 times (OR=1.78, 95% CI:1.51 to 1.83; p<0.001).
Conclusion: Aging and nighttime driving are significant risk factors for RTIs among elderly drivers. This
highlights the importance of implementing targeted interventions to enhance road safety for this vulnerable
population. Furthermore, the use of advanced Bayesian-LASSO and treatment-effect statistical methods
highlights the importance of utilizing sophisticated methodologies in epidemiological research to effectively
capture and adjust for potential confounding factors.

Abstract Objective: To identify the distinctive features of acutely injured patients who were presented to the emergency department (ED) and their association with mortality and surgical intervention outcomes.
Methods: This cross-sectional study was conducted on all trauma patients resuscitated in the ED of Shahid
Rajaee (Emtiaz) Trauma Hospital (Shiraz, Iran) from May 2018 to June 2019. Demographic information, the
mechanism of trauma, trauma type, injured body regions, criteria of abbreviated injury scale (AIS) score,
injury severity score (ISS), and surgical intervention was all taken into consideration. The items related to the
mortality and surgical performance outcomes among the patients were analyzed.
Results: Of all 1281 cases, 82.9% were men, and the mean age of the patients was 37.9±19.1 years. The most
common mechanism of injury was a car accident, and the thorax was the most prevalent injured area of the
body. The majority of the patients had moderate blunt trauma. The mechanism of trauma, ISS, and the severity
of head trauma were all significantly correlated with operation interventions. Moreover, age, the mechanism
and type of trauma, ISS, and the necessity for the surgery were significantly associated with death occurrence.
Additionally, head, thorax, and abdomen trauma were significantly related to a high mortality rate.
Conclusion: Age, trauma mechanism and type, ISS, and the necessity for surgery were significantly associated
with the mortality rate of injured patients. The severity of the trauma, particularly head injuries and the
mechanism of damage were important determinants in concern for surgery the necessity.

Abstract Objective: Emergency medical technicians (EMTs) are at risk of developing post-traumatic stress disorder
(PTSD) as a result of seeing painful events involving suspected COVID-19 patients and being concerned about
potentially infecting themselves and their families. Therefore, screening for these disorders is essential in the
post-Corona era. This study aimed to investigate the prevalence of PTSD among EMTs and its relationship with
occupational stress and depression when dealing with patients with suspected COVID-19.
Methods: This cross-sectional study was conducted on EMTs at Zanjan University of Medical Sciences using
a convenience sampling method. Data were collected using a demographic information questionnaire, PTSD
checklist, occupational stress questionnaire, and the Goldberg depression scale. The data were analyzed using SPSS
software. Statistical tests such as Pearson correlation and logistic regression analysis were used to evaluate the data.
Result: 205 EMTs participated in this cross-sectional study. The mean and standard deviation of PTSD was
37.13±12.93 (17-85), and according to the cut-off (45), the prevalence of PTSD was 30.7%. There was a direct and
significant association between the total PTSD and depression scores (r=0.435, p=0.001). Some occupational stress
domains, such as demand (r=0.306, p=0.001), colleague support (r=0.149, p=0.033), and communication (r=0.293,
p=0.001) had a significant association with PTSD. The domains of sadness in depression (OR=1.074, p=0.027)
and demands in occupational stress (OR=1.872, p=0.029) were the most important predictors of PTSD. Among
demographic variables, employment status was the most important protective factor for PTSD (OR=0.378, p=0.038).
Conclusion: PTSD affected one-third of EMTs, and it had a significant relationship with various dimensions
of depression and occupational stress. Due to the chronic nature of these diseases, policymakers are advised to
prioritize psychological screening of EMTs as part of the post-Corona policy.

Abstract Objective: Breaking bad news (BBN) is a critical aspect of healthcare delivery that can have significant
implications for patients’ outcomes. Inadequate and inappropriate delivery of bad news can result in detrimental
psychological and emotional effects. This study aimed to compare the performance of emergency department
(ED) personnel and patients’ preferences in BBN.
Methods: This descriptive-analytical study was conducted in 2022, and 135 patients who were admitted to the
ED were included using quota sampling. Data were collected using a demographic questionnaire, a researchermade
questionnaire, and a standard questionnaire on attitudes toward the methods of BBN in the ED. The data
were analyzed using SPSS software (version 16), and a p-value<0.05 was considered statistically significant.
Results: The results showed that the majority of patients (69.6%) received bad news from nurses. Based on the
conditions mentioned in the standard questionnaire, the overall performance of personnel was 6.08±4.22 out of
19, while the overall attitude score (59.66±7.66 out of 76) revealed patients’ high tendency to receive bad news.
There was a statistically significant difference between the total score of personnel performances and the total
score of patients’ attitudes (p=0.001).
Conclusion: The performance of ED personnel concerning patients’ attitudes toward the method of BBN in
the emergency department was not optimal. Therefore, it is recommended to implement appropriate training
programs for medical professionals, especially physicians, and nurses, to enhance their communication skills
and reduce the detrimental effects of inappropriate delivery of bad news in medical settings.

Abstract Objective: Considering the growing use of emergency medical services (EMS), we evaluated the level of
public awareness of emergency situations in Iran.
Methods: This cross-sectional study was conducted from August 2021 to January 2023 on Iranian residents
in Tehran, who were older than 18 years old. The participants were directed to a URL for an online survey
link and asked to select their preferred options for the predetermined scenarios. We divided the participants
into three groups: abuse, misuse, and non-use. At least 12 correct answers were required to qualify as
acceptable knowledge and practice responses (KP score). Then, the relationship between participants’ baseline
characteristics and their level of awareness was investigated.
Results: Totally, 3864 people participated in the study, of whom 50.5% were men. The participants’ ages
ranged from 18 to 90 years old, with a mean age of 40.01±11.30 years. In general, the rate of abuse, misuse,
and not-use in at least one scenario was 74.5%, 64%, and 70.4%, respectively. The results of the multivariable
regression analysis indicated that female sex (OR=1.29), a higher education level (OR=3.36), a higher income
level (OR=1.64), and Turkish ethnicity (OR=1.20) were significantly associated with the correct KP score.
Conclusion: The degree of inappropriate utilization of EMS services in Iran was significant. We found that
the proper knowledge regarding the appropriate use of EMS was significantly associated with the participant’s
level of education, academic field, job, and income.

Abstract Due to the specific features of the adrenal glands, traumatic adrenal injury is a rare phenomenon. The
majority of these rare types of traumas are caused by blunt force injuries and rarely by penetrating
mechanisms. In such cases, a whole-body computed tomography scan is essential for early diagnosis.
This paper describes an uncommon case of adrenal hematoma and contusion followed by blunt abdominal
trauma. A 35-year-old woman was admitted to the emergency department after a high-speed vehicle-pedestrian
collision. She presented with decreasing level of consciousness. Additionally, a thoracoabdominal CT scan
revealed a left flank hematoma. Blunt adrenal injury, often accompanied by multiorgan damage, is a rare
occurrence resulting from severe accidents. Accurate diagnosis based on clinical symptoms requires high
clinical suspicion, particularly in isolated cases, and treatment depends on the patient’s condition.