Bulletin of Emergency And Trauma

Abstract Objective: This study aimed to investigate the death trend and years of life lost (YLL) caused by social harm
in Ilam province.
Methods: This cross-sectional study was conducted in Ilam province from 2009 to 2019. To estimate YLL, all
deaths caused by suicide, homicide, and addiction were included in the study. The data were collected from the
Forensic Medicine Organization. The analysis was carried out using SPSS software (version 23.0). A p-value
of <0.05 was considered statistically significant.
Results: Between 2009 and 2019, there were 1712 occurrences of suicide, homicide, and addiction, which
resulted in a total of 62,605 years of lost life (53,934 per 100,000 people). The highest frequency was related
to the age group of 15-29 years, while the lowest was related to the age group of 0-14 years (p<0.001). During
the studied period, men were more likely than women to commit suicide, homicide, and addiction in Ilam
(p>0.439). Between 2009 and 2019, the number of suicides and homicides in Ilam province started a decreasing
trend for both sexes, while the number of deaths caused by addiction was increasing.
Conclusion: The results of this study indicated that the age groups of 15-29 years had the highest rate of
YLL is caused by suicide, homicide, and addiction for both sexes. Furthermore, the findings showed that YLL
decreased for suicide and homicide, but increased for addiction.

Abstract Objective: This study aimed to compare the outcomes of fixing scapholunate with pins and screws in parallel,
convergent, and divergent orientations.
Methods: In this computer simulation study, the CT scan images of a healthy subject were
used to construct a 3D model of the wrist joint using MIMICS software. The imposed force to scaphoid and
3D model lunate bones, as well as the scapholunate angle and distance, were compared in different surgical
techniques using parallel, divergent, and convergent pins and screws.
Results: In the absence of external force, the imposed stress applied to the scaphoid and lunate bones in cases
of parallel pins and screws were 7.5MPa, 5.08MPa (pins), 1.134MPa, and 1.151MPa (screws), and 10.90MPa,
10.90MPa (pins), 9.7MPa, and 34.1MPa (screws) for 50N flexion force. The imposed stress in this approach is
significantly lower compared to other interventions. Better outcomes were seen regarding scapholunate angle
and scapholunate distance in using parallel pins or screws as well.
Conclusion: In conclusion, implementing parallel pins and screws for scapholunate fixation had better results
in terms of achieving carpal stability in scapholunate dissociation. However, fixation with pins and screws
showed a statistically significant difference. Furthermore, a wide range of motion exercises with no additional
forces can be used in the rehabilitation of patients undergoing this surgery.

Abstract Objective: This study aimed to investigate the necessity of cervical collars in patients with neck problems.
Methods: This cross-sectional study was conducted on 114 patients who were admitted to the Haft Tir and
Rasoul Akram Hospitals (Tehran, Iran) from August to September 2022. The Nexus protocol was used to select
the patients with cervical collars. According to the protocol, a cervical collar was required for individuals who
had at least one symptom. If none of these symptoms existed, the cervical collar was deemed unnecessary. The
data were analyzed using the Chi-square test and Fisher’s exact test.
Results: Of the 114 trauma patients, the cervical collar was used unnecessarily by 49 (43%) patients. Tenderness
was the most common complication in 62 patients (54.4%). The prevalence of unnecessary cervical collar
use was 37.5% in female trauma patients and 43.88% in male trauma patients, which was not statistically
significant (p=0.63). The prevalence of unnecessary cervical collar use in trauma patients with multiple trauma
was 39.42% and 80% in patients without multiple trauma, which was statistically significant (p=0.018). Patients
with a medical history had a higher rate of unnecessary use of the cervical collar (47.96%) than those without
a history (12.5%), and this difference was statistically significant (p=0.008).
Conclusion: The guidelines for using cervical collars need to be updated by the EMS. Due to the large number
of trauma patients in Iran, cervical collars for necessary conditions can help reduce healthcare expenses
and injuries caused by unnecessary cervical collars.

Abstract Objective: This study evaluated the occupational burnout (OB) and spiritual well-being (SWB) of emergency
nurses as well as the associations between these variables.
Method: This cross-sectional study was conducted in six hospitals and emergency medical centers affiliated with
Ardebil University of Medical Sciences (Ardebil, Iran), in 2020. Data were collected via socio-demographic,
Spiritual Well-Being Scale (SWBS), and Maslach Burnout Inventory (MBI) questionnaires.
Results: This study included 239 emergency department nurses. The mean age of the participants was 34.4±6.4
years. The mean of existential well-being and religious well-being was 40.3±8.7 and 41.0±9.2, respectively. The
results indicated that moderate (P=0.007) and severe (P<0.001) personal accomplishment was a positive and
significant predictor of the SWB in emergency department nurses.
Conclusion: Proper planning and provision of suitable educational programs in the dimension of the SWB
of nurses prevent the creation and continuation of OB and increase the self-efficacy and job satisfaction of
emergency medical staff, resulting in better patient care.

Abstract Objective: This study aims to characterize the demographic, clinical, and radiological features of gunshot
wound (GSW) patients as well as identify predictors of prolonged hospitalization.
Methods: In this retrospective study, a consecutive sampling method was used, including all patients with
GSWs in any anatomical region. Data collection included demographic and clinical information, radiological
findings, treatment specifics, and outcome variables, such as hospitalization length of stay (LOS) as the primary
outcome. To identify predictive factors associated with prolonged LOS, logistic regression analysis was used.
Results: We studied 212 GSW cases, including 95.8% were men and 4.2% were women. The mean age of the
studied group was 30.17±7.80 years. GSWs occurred in extremities (80.2%), abdomen (9.0%), thorax (4.7%),
and head or neck (5.2%). Two patients (0.9%) had both abdominal and thoracic GSWs. The most prevalent
radiological study was an X-ray (83.0%). Patients with head and neck GSWs had the longest emergency
department stay, while patients with abdominal GSW patients had the shortest (p=0.068). The highest rates
of blood product transfusion were observed in abdominal GSWs (63.2%), emergency surgery (63.2%), and
ICU admission (42.1%). Head and neck GSWs had the longest hospitalization LOS (7.5 days). Longer LOS
was significantly associated with abnormalities in radiological findings, receiving blood products, and ICU
admission (p≤0.001). Significant predictors of prolonged LOS were major abnormalities in radiological findings
[odds ratio (OR)=5.3; 95% confidence interval (CI):2.8-10.2], head and neck GSWs (OR=6.1; 95% CI:1.2-31.9),
and blood product transfusion (OR=4.1; 95% CI: 1.0-16.3).
Conclusion: This study provides insights into factors influencing prolonged hospitalization in GSW patients,
highlighting the importance of radiological findings, head and neck injuries, and blood product transfusion.

Abstract Thoracic ossification of the posterior longitudinal ligament (OPLL) is a rare condition that is mainly
accompanied by cervical OPLL or ossification of thoracic ligamentum flavum. In case of causing neurological
manifestations, it is preferred to treat the condition surgically. Several surgical procedures were introduced,
including anterior, posterior, or combined approaches. Laminectomy with instrumented fusion is the most
popular procedure utilized via the posterior approach. A 32-year-old obese woman, who suffered from back
pain and weakness in both lower extremities for one month, was referred to our spine outpatient clinic. Imaging
revealed lower thoracic OPLL (T7/T8 & T8/T9 & T9/T10). The posterior longitudinal ligament had a mixed
ossification pattern (beaked and continuing cylindrical). To maintain thoracic spine stability and prevent future
kyphosis, we performed laminectomy and long segment fixation (T7 to T12). The post-operative neurological
examination revealed a considerable increase in muscle strength and significant pain relief.

Abstract This paper offers a historical exploration of how death was diagnosed in Persian medicine, highlighting the evolution of diagnostic criteria and the contributions of key scholars. In the post-medieval era, defining death and establishing diagnostic criteria underwent significant development, albeit with ongoing debates. Notably, medieval Persian scholars, such as Qutb al-Din al-Shirazi, played a crucial role in this discourse. Qutb al-Din al-Shirazi, a prominent Persian polymath, synthesized earlier knowledge to provide a comprehensive set of diagnostic criteria for death in traditional Persian medicine. These criteria encompassed physical examinations like assessing nail shininess, feeling pulsatile vessels in specific areas, observing pupillary reactions to light, and even monitoring the movement of a thread near the mouth and nose. His mention of the pupillary light reflex is one of the earliest known references to this phenomenon in medical history. Medieval Persian practices also involved placing a water container on the chest of the individual to detect the absence of chest wall motion associated with respiration as a sign of death. Furthermore, scholars like Ibn-e Sina (Avicenna) stressed the importance of monitoring pulse and respiration as vital signs, especially when administering potentially lethal drugs. In cases of uncertain diagnosis, such as stroke, medieval Persians postponed burials for up to three days. These historical insights provide a fascinating glimpse into the evolving understanding of death in Persian medicine and the intricate methods used for its diagnosis.

Abstract In a rapidly changing environment, healthcare systems in polar regions face increasing pressures imposed by climate change, burgeoning tourism, and potential ramifications for future space exploration. The urgency to reevaluate health stewardship and governance in these areas is driven by unique challenges, including geographical barriers and scarce resources. Further accentuated by the ongoing COVID-19 pandemic and the anticipated boom in the polar tourism industry, the need for robust emergency, trauma, and surgical care is highlighted. The objective of this paper is to address these challenges and advocate for a unified health governance approach. Adopting measures like artificial intelligence, telemedicine, and advanced technologies is suggested to promote the effectiveness of remote care, considering the distinct limitations of these regions. Moreover, research focused on the human health impact of these extreme conditions is paramount for formulating adequate responses, thereby improving the overall readiness and resilience of the healthcare systems in these regions.