Bulletin of Emergency And Trauma

Abstract Objective: This study aimed to compare the clinical risks and outcomes of COVID-19 and influenza.
Methods: The search for relevant articles was conducted using both a database search method and a manual
search, which involved searching through the reference lists of articles related to the topic for additional studies.
The Quality assessment was carried out using the Newcastle Ottawa tool, and the data analysis was conducted
using the Review Manager Software (RevMan 5.4.1).
Results: The meta-analysis results indicated that COVID-19 patients had similar lengths of hospital stays
(SMD: -0.25; 95% CI: -0.60-0.11; p=0.17). However, COVID-19 patients had significantly higher mortality rates
(RR: 0.28; 95% CI: 0.21-0.37; p<0.0001), in-hospital complications (RR: 0.57; 95% CI: 0.50-0.65; p<0.00001),
intensive care unit (ICU) admissions (OR: 0.48; 95% CI: 0.37-0.61; p<0.00001), length of ICU stay (SMD:
-0.45; 95% CI: -0.83-0.06; p=0.02), and mechanical ventilation use (OR: 0.36; 95% CI: 0.28-0.46; p<0.00001).
Conclusion: The findings suggested that COVID-19 was more severe than influenza. Therefore, “flu-like”
symptoms should not be dismissed without a clear diagnosis, especially during the winter when influenza is
more prevalent.

Abstract Objective: Laryngeal mask airway (LMA) insertion has been found to reduce cardiovascular responses when
compared to laryngoscopy and intubation. This research aimed to examine the impact of various techniques
employed for LMA insertion on cardiovascular response.
Methods: This randomized, double-blind clinical trial included 90 elective surgery candidates divided into
three groups of 30. All patients underwent similar anesthesia. The LMA was inserted using the classical
technique, 180° rotation technique, and face-to-face triple maneuver technique (FFTMT). The cardiovascular
responses, the success rate of LMA placement, and other outcomes were documented and compared among
the three methods.
Results: The study revealed that the blood pressure of patients 10 minutes after LMA insertion using the
rotational technique was higher than the standard technique (p=0.019). The pulse rate in the third (p=0.044,
p=0.024) and fifth minutes (p=0.028, p=0.048) following the insertion of LMA demonstrated higher values
when utilizing the FFTMT than the standard and rotational technique groups, respectively. Moreover, the
incidence of sore throat following surgery in the FTFTM group was slightly greater than that observed with the
standard and rotation techniques (p=0.389 and p=0.688, respectively).
Conclusion: The findings of the present investigation indicated that implementing the classic technique for
LMA placement resulted in a more consistent blood pressure (BP) and pulse rate (PR) response than the 180°
rotation and FFTMT. Furthermore, the classical method exhibited a marginally lower success rate in terms of
LMA insertion than the alternative methods. 

Abstract Objective: Trauma-related injuries are the leading cause of death and disability in the active population, with
devastating economic, health, and social consequences for nations. TThis study aimed to assess the economic
burden of injuries in Iran.
Methods: In this study, the economic impact of trauma in Iran in 2019 was estimated using a prevalence-based
approach. The prevalence was estimated based on available statistics in Iran and the GBD website. Direct
medical expenditures were calculated using a top-down approach. The cost of lost production due to injuries
and premature death was also estimated using the DALY value. Microsoft Excel 2019 and Stata software
version 13.0 were used for the analysis.
Results: In Iran, approximately 16,500,000 individuals were estimated to have sustained injuries in a single
year. The average direct medical expenses for each trauma patient were around $226. Fractures contributed
to 39% of the financial impact of trauma. The overall economic burden of trauma in Iran was calculated
to be $10,214,403,423. Approximately 66% of this economic burden was attributed to lost productivity and
premature death resulting from trauma, while direct medical costs made up 34%.
Conclusion: The economic burden of trauma in Iran is expected to significantly rise in the future. It may
be necessary to enhance awareness of injury-related mortality and disability, improve therapies, and expand
evidence-based interventions to reduce the economic impact of injuries.

Abstract Objective: With the COVID-19 outbreak in countries around the world, the countries’ healthcare systems
underwent an unprecedented shock. This study aimed to examine the resilience of the medical service delivery
system in providing emergency services during the Covid-19 pandemic.
Methods: This study was conducted in a reference hospital in Kerman that provided emergency services to
trauma patients. It compared service delivery before and after COVID-19, as well as during the COVID-19 peak
and non-peak periods. The compared variables were the number of trauma patients admitted to the hospital and
the ICU, the number of patients who died in the hospital due to trauma, and the length of stay in the hospital
and the ICU.
Results: The pre- and post-COVID-19 comparisons showed no significant difference in the number of daily
hospital admissions, ICU admissions, and patient deaths. The median length of stay in the ICU was significantly
reduced by almost 2 days during the COVID-19 outbreak. However, the length of stay at the hospital was almost
the same. Furthermore, a comparison of the COVID-19 peaks and non-peak periods indicated no statistically
significant difference in the number of admissions in the ICU, hospital and ICU length of stay, and traumainduced mortality.
Conclusion: Despite the substantial workload imposed by COVID-19 on hospitals, especially during the peak
periods of the disease, the provision of medical services to emergency trauma patients did not drop significantly,
and the quality of services provided to patients was within the acceptable range. 

Abstract Objective: This study aimed to determine the rate of readmission for trauma patients in ICUs, as well as the
factors that predict this outcome.
Methods: This retrospective cohort study was conducted at Emtiaz Hospital, a level I referral trauma center
(Shiraz, Iran). It analyzed the ICU readmission rates among trauma patients over three years. The required
data were extracted from the Iranian Intensive Care Registry (IICUR), which included patient demographics,
injury severity, physiological parameters, and clinical outcomes. Statistical analysis was performed using SPSS
version 25.0. Descriptive statistics and different statistical tests, such as T-tests, Mann-Whitney tests, Chisquare tests, and logistic binary regression test were utilized.
Results: Among the 5273 patients discharged from the ICU during the study period, 195 (3.7%) were readmitted
during the same hospitalization. Patients readmitted to the ICU had a significantly higher mean age (54.83±22.73
years) than those who were not readmitted (47.08 years, p<0.001). Lower Glasgow Coma Scale (GCS) scores
at admission and discharge were associated with ICU readmission, implying that neurological status and
readmission risk were correlated with each other. Furthermore, respiratory challenges were identified as the
leading cause of unexpected readmission, including respiratory failure, hypoxic respiratory failure, respiratory
distress, and respiratory infections such as pneumonia. Injury patterns analysis revealed a higher frequency of
poly-trauma and head and neck injuries among patients readmitted to the ICU.
Conclusion: This study underscored the importance of ICU readmission among trauma patients, with a high
readmission rate during the same hospitalization. By developing comprehensive guidelines and optimizing
discharge processes, healthcare providers could potentially mitigate ICU readmissions and associated
complications, ultimately enhancing patient outcomes and resource utilization in trauma ICU settings. This
research provided valuable insights to inform evidence-based practices and improve the quality of care delivery
for trauma patients in intensive care settings.

Abstract Objective: The present study aimed to determine the prevalence and severity of moral distress (MD) and its
associated factors among emergency department nurses.
Methods: This cross-sectional study was conducted in 2023 on 172 nurses from the emergency departments of
medical training centers affiliated with Mazandaran University of Medical Sciences. The census method was
used to collect the data, which included demographic variables and Corley’s MD questionnaire. The Data were
analyzed using SPSS software (version 22), using an independent T-test, analysis of variance (ANOVA), and
multiple regressions.
Results: Out of 172 nurses, 60.5% were women, with an average age of 32.52±6.88 years. The results
demonstrated an average MD score of 69.73±25.68. In terms of frequency and intensity, around 53.5% of
the participants experienced MD at a low level (0-72), while the remaining 46.5% reported experiencing it
at a medium level (14-73). A significant association was found between MD and age (p=0.037), workplace
hospital (p=0.005), and history of mental disorders (p=0.005). Furthermore, linear regression analysis revealed
a statistically significant association between MD, marital status, and occupational type (p<0.05).
Conclusion: The results showed that nurses had low to moderate levels of MD. Several factors, including
age, history of mental disorders, marital status, employment type, workplace hospital, and education, were
associated with the overall MD score. To reduce MD and its negative effects on nurses, it is necessary to
address these factors and develop an effective strategy for identifying and managing MD to improve nursing
care quality

Abstract Airgun injuries are prevalent in the pediatric population. The present study described a case of air gun pellet
injury to the left carotid artery and its successful management. A 25-year-old man presented to the emergency
department complaining that his son had accidentally injured him with an air gun pellet while playing. The
X-ray cervical spine revealed a single foreign body (pellet) located directly anterior to the C5-C6 vertebra. A
CT angiography of the neck showed a spherical hyperdense object just anterior to the C6 vertebral body on
the left side, 3 mm posteromedial to the left common carotid artery, which was most likely a pellet foreign
body. The patient was sent to operation theatre (OT) for exploration. There was a rent in the internal carotid
artery with active bleeding. After exerting both proximal and distal control, the rent was closed. Close air gun
injury could result in gunshot wounds, as in the present case. Plain X-rays in AP and lateral view are required.
Nonoperative management could be employed in a restricted group of patients with satisfactory outcomes.
Those who have vascular involvement will require surgical intervention.

Abstract Virtual reality (VR) technology is a computer-generated experience that allows you to immerse yourself in a 3D world. By wearing a VR headset, you can step into a virtual world and interact with it as if it were real (3). Virtual reality technology has rapidly emerged as a transformative tool in various industries, revolutionizing how we perceive and interact with simulated environments. With its immersive and interactive capabilities, VR has now found its way into the realm of medical training, particularly in the context of cardiopulmonary resuscitation. Effective CPR training is crucial for improving survival rates during cardiac emergencies, and virtual reality offers a promising avenue to enhance the training experience. VR offers a more immersive and interactive learning experience, turning the dull and detached into an engaging and memorable training session. With VR, trainees can put on a headset and find themselves in a simulated environment, where they can practice CPR on virtual patients who react and respond realistically (8).