Treatment Costs of Traffic Accident Casualties in a Third-level Hospital in Iran; a Preliminary Study

Introduction: The costs of traffic accidents in low- and middle-income countries are estimated to add up to $65 billion annually, which is a little higher than the amount they receive as a final aid for development. The present retrospective study aims to evaluate the treatment costs of the hospitalized injured individuals in traffic accidents. Methods: The present study was carried out in Imam Hossein Hospital, Tehran, Iran. The study population consisted of all the individuals injured in traffic accidents, admitted to the hospital wards. Data were collected by a trained emergency physician. Demographic data, injury mechanism, the type of vehicle, the admission ward of the patient, and treatment costs were collected. Results: A total of 200 patient files were evaluated (males: 89$1622.1. Statistical analyses showed that treatment costs in the neurosurgery ward was significantly higher than those in orthopedic and general surgery wards (df: 3; F=9.5, P=0.008). Conclusion: The results of the present study showed that the mean cost of each traffic accident victim in Tehran is approximately $1622.1 and these patients sustain significantly higher costs in neurosurgery ward

Effects of Supplementation and Training on Ameliorating Lipid Profiles and Protection against Coronary Artery Disease; an Experimental Study

Introduction: The use of antioxidants may reduce the harmful effects of radicals during exercise and extreme sports. The Current study aimed to investigate the effect of this supplement on the lipid profiles in exercise-induced muscle injury. Methods: In this experimental study, 64 Wistar rats were randomly divided into four groups of control, exercise, exercise + Resveratrol (REV) and REV.  After a week of adaptation, endurance and acute exercises were conducted in a motor driven treadmill, followed by using a training protocol in which running speed was gradually elevated until 19 weeks of age. Finally, the levels of cholesterol (CHO), triglycerides (TG), low-density lipoproteins (LDL), high-density lipoproteins (HDL), and very low-density lipoproteins (VLDL) were compared between the groups. Results: There was no statistically significant difference in CHO plasma level between the studied groups after acute and endurance exercises. There was a significant increase in the level of TG in the exercise group (p = 0.001) and the exercise + REV (p = 0.004) group after acute and endurance exercises. After the implementation of the endurance and acute exercises none of the studied groups had statistically significant changes in HDL plasma level. There was a significant decrease in LDL plasma levels in the exercise (p = 0.007) and the exercise + REV (p = 0.01) groups. After performing endurance protocol, VLDL plasma levels increased significantly in the exercise (p = 0.001) and the exercise+ REV (p = 0.005) groups in comparison with control group. Conclusions: Based on the findings, there was no difference in the level of CHO and HDL between the training groups, REV and control groups. However, both endurance exercise and acute exercise trainings resulted in an increase in TG and VLDL levels and decrease in LDL level, compared with the control group

The Accuracy of Urinalysis in Predicting Intra-Abdominal Injury Following Blunt Traumas

Introduction: In cases of blunt abdominal traumas, predicting the possible intra-abdominal injuries is still a challenge for the physicians involved with these patients. Therefore, this study was designed, to evaluate the accuracy of urinalysis in predicting intra-abdominal injuries. Methods: Patients aged 15 to 65 years with blunt abdominal trauma who were admitted to emergency departments were enrolled. Abdominopelvic computed tomography (CT) scan with intravenous contrast and urinalysis were requested for all the included patients. Demographic data, trauma mechanism, the results of urinalysis, and the results of abdominopelvic CT scan were gathered. Finally, the correlation between the results of abdominopelvic CT scan, and urinalysis was determined. Urinalysis was considered positive in case of at least one positive value in gross appearance, blood in dipstick, or red blood cell count. Results: 325 patients with blunt abdominal trauma were admitted to the emergency departments (83% male with the mean age of 32.63±17.48 years). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of urinalysis, were 77.9% (95% CI: 69.6-84.4), 58.5% (95% CI: 51.2-65.5), 56% (95% CI: 48.5-63.3), 79.6% (95% CI: 71.8-85.7), 1.27% (95% CI: 1.30-1.57), and 0.25% (95% CI: 0.18-0.36), respectively. Conclusion: The diagnostic value of urinalysis in prediction of blunt traumatic intra-abdominal injuries is low and it seems that it should be considered as an adjuvant diagnostic tool, in conjunction with other sources such as clinical findings and imaging

Unintentional Home Injury Prevention in Preschool Children; a Study of Contributing Factors

Introduction: Different factors such as parents’ knowledge and attitudes regarding preventive measures (PM) have a great role in reducing children unintentional home injuries. The present study aims to evaluate the contributing factors of unintentional home injury prevention in preschool victims presented to the emergency department. Methods: The subjects consisted of all the mothers of preschool children who were presented to the emergency department of Imam Hossein and Shohadaie-Hafte-Tir Hospitals, with unintentional home injuries, from March 2011 to February 2012. The participants were divided into two groups according to implementation of preventive measures status. The significant confounding factors of PM application was determined by chi-squared test and entered into the backward multivariate logistic regression model. Results: 230 mothers with the mean age of 29.4 ± 5.2 years were evaluated. 225 (97.83%) of them were still married, 74 (32.17%) had high school education or higher, 122 (53.04%) were homemakers, and 31 (13.49%) worked outside the home for at least 8 hours daily. High level of knowledge (OR = 0.05; 95% CI: 0.002‒0.32; P = 0.002), appropriate attitude (OR = 0.12; 95% CI: 0.03‒0.51; P = 0.01), having at least three children (OR = 7.2; 95% CI: 1.1‒32.9; P = 0.04), daily absence of mother for at least 8 hours (OR = 9.2; 95% CI: 2.2‒35.46; P = 0.002), and a history of home injury during the previous 3 weeks (OR = 8.3; 95% CI: 2.1‒41.3; P = 0.001) were independent factors which influenced application of preventive measures. Conclusion: Increasing mothers’ knowledge level and improving their attitudes were facilitating factors and mothers’ absence from the house for more than 8 hours a day and having at least 3 children were obstacles to application of preventive measures. In addition, a history of same injury during the previous 3 weeks increased the risk of repeated event

True Vertigo Patients in Emergency Department; an Epidemiologic Study

Introduction: Vertigo prevalence is estimated to be 1.8% among young adults and more than 30% in the elderly. 13-38% of the referrals of patients over 65 years old in America are due to vertigo. Vertigo does not increase the risk of mortality but it can affect the patient’s quality of life. Therefore, this study was designed to evaluate the epidemiologic characteristics of vertigo patients referred to the emergency department (ED). Methods: In this 6-month retrospective cross-sectional study, the profiles of all vertigo patients referred to the ED of Imam Hossein Hospital, Tehran, Iran, from October 2013 to March 2014 were evaluated. Demographic data and baseline characteristics of the patients were recorded and then patients were divided into central and peripheral vertigo. The correlation of history and clinical examination with vertigo type was evaluated and screening performance characteristics of history and clinical examination in differentiating central and peripheral vertigo were determined. Results: 379 patients with the mean age of 50.69 ± 11.94 years (minimum 18 and maximum 86) were enrolled (58.13% female). There was no sex difference in vertigo incidence (p = 0.756). A significant correlation existed between older age and increase in frequency of central cases (p < 0.001). No significant difference was detected between the treatment protocols regarding ED length of stay (p = 0.72). There was a significant overlap between the initial diagnosis and the final decision based on imaging and neurologist’s final opinion (p < 0.001). In the end, 361 (95.3%) patients were discharged from ED, while 18 were disposed to the neurology ward. No case of mortality was reported. Conclusion: Sensitivity and specificity of history and clinical examination in differentiating central and peripheral vertigo were 99 (95% CI: 57-99) and 99 (95% CI: 97-99), respectively

میزان توافق شوک ایندکس و نقص باز در تعیین شدت شوک بیماران مبتلا به ترومای متعدد

Introduction: Although using clinical scales to predict shock severity is interesting for physicians as they provide rapid evaluation without need for special equipment, they are not highly reliable. Therefore, the present study was designed with the aim of assessing the agreement between shock index and base defects as scales of determining shock severity in multiple trauma patients. Methods: In the present prospective cross-sectional study, the agreement of shock index and base defects in determining shock severity in multiple trauma patients presenting to emergency department (ED) was assessed. Patients with blunt multiple trauma aged between 15 to 6 years with 8-15 consciousness level and without any underlying illness were enrolled and finally the data were analyzed using SPSS 20. Results: In total, 387 patients with the mean age of 36.31 ± 15.03 years (15 – 90) were studied (80.6% male). Most patients were in the 21-30 years age group (37.7%) and the most common trauma mechanisms were car accident (50.1%) and falling from height (24.8%). In addition, 15 (3.9%) patients had systolic blood pressure <90 mmHg and 49 (12.7%) had a heart rate >100/min. According to kappa coefficient, a 0.824 agreement was seen between these scales in rapid prediction of shock index. With the shock index increasing, the number of blood units received in the initial 6 hours of admission to ED for patient resuscitation rose from 0.02 to 1.72 units. Conclusion: Considering the results of the present study, it seems that shock index and base defect scales have acceptable agreement in prediction of shock severity in multiple trauma patients. This agreement increases in the 2 extremes namely normal and severe cases (level 1 and 4). مقدمه: هر چند استفاده از معیارهای بالینی برای پیشگویی شدت شوک به علت عدم نیاز به تجهیزات خاص و ارزیابی سریع مورد توجه پزشکان می باشد ولی قابل اعتماد بالایی ندارند. لذا مطالعه حاضر با هدف ارزیابی میزان توافق معیارهای شوک ایندکس و نقص باز در تعیین شدت شوک بیماران مبتلا به ترومای متعدد طراحی شده است. روش کار: در مطالعه مقطعی آینده نگر حاضر، میزان توافق دو معیار شوک ایندکس و نقص باز در تعیین شدت شوک ناشی از تروما در بیماران مراجعه کننده به بخش اورژانس طراحی شده است. بیماران با ترومای متعدد غیر نافذ در محدوده سنی 15 تا 65 سال با سطح هوشیاری 8 تا 15 و بدون بیماری زمینه ای وارد مطالعه شدند و در نهایت اطلاعات با استفاده از نرم افزار SPSS نسخه 20 آنالیز گردید. يافته ها: در مجموع 387 بیمار با میانگین سنی 03/15 ± 31/36 سال (90-15) وارد مطالعه شدند (6/80 درصد مرد). بیشتر بیماران در رده سنی 21 تا 30 سال قرار داشتند ( 7/37 درصد( و شایع ترین مکانیسم های تروما تصادف با اتومبیل (1/50 درصد) و سقوط از ارتفاع (8/24 درصد) بودند. 15 (9/3 درصد) بیمار فشار خون سیستولیک کمتر از 90 میلی متر جیوه و 49 (7/12 درصد) بیمار تعداد ضربان قلب بالاتر از 100 بار در دقیقه داشتند. بر اساس ضریب توافق کاپا، توافقی برابر با 824/0 بین دو معیار مذکور در پیش بینی زودرس شوک بدست آمد. با افزایش شدت شوک تعداد واحد خون دریافتی در 6 ساعت ابتدایی ورود به اورژانس برای احیاء بیمار از 02/0 واحد به 72/1 واحد افزایش یافت. نتيجه گيری: بر اساس یافته های مطالعه حاضر به نظر می رسد معیار های شوک ایندکس و نقص باز توافق قابل قبولی در پیشگویی شدت شوک بیماران مولتیپل تروما دارند. این توافق به خصوص در دو سر طیف یعنی موارد نرمال و شدید (درجه یک و چهار) بیشتر می باشد

Comparing the Quality and Complications of Tube Thoracostomy by Emergency Medicine and Surgery Residents; a Cohort Study

Introduction: Tube thoracostomy complications depend on the operator’s skill, patients’ general condition and the place in which the procedure is done. The present study aimed to compare the quality and complications of tube thoracostomy carried out by emergency medicine residents (EMRs) and surgery residents (SRs).Methods: This cohort study was conducted on 18-60 years old trauma patients in need of tube thoracostomy presenting to two academic emergency departments. Quality of tube placement and its subsequent complications until tube removal were compared between SRs and EMRs using SPSS 20.Results: 72 patients with the mean age of 37.1±14.1 years were studied (86.1% male). 23 (63.8%) cases were complicated in SRs and 22 (61.1%) cases in EMRs group (total= 62.5%). Chest drain dislodgement (22.2% in SRs vs. 22.2% EMRs; p>0.99), drainage failure (19.4% in SRs vs. 16.7% EMRs; p=0.50), and surgical site infection (11.1% in SRs vs. 19.4% EMRs; p=0.25) were among the most common observed complications. The overall odds ratio of complication development was 0.89 (95% CI: 0.35-2.25, p = 0.814) for SRs and 1.12 (95% CI: 0.28-4.53, p = 0.867) for EMRs.Conclusion: The findings of the present study showed no significant difference between SRs and EMRs regarding quality of tube thoracostomy placement and its subsequent complications for trauma patients. The rate of complications were interestingly high (>60%) for both groups

Quality of Life in Emergency Medicine Specialists of Teaching Hospitals

Introduction: Quality of life (QOL) of emergency medicine specialists can be effective in providing services to patients. The aim of the present study was evaluating the lifestyle of emergency medicine practitioners, understanding their problems, and addressing the solutions to enhance and improve their lifestyles, in teaching hospitals in Iran. Method: This descriptive cross-sectional study was conducted on emergency medicine physicians in 10 teaching hospitals of Iran in 2011. Emergency physicians with at least three years of experience who interested in the study, were enrolled in the project. All participants filled out the consent form and QOL questionnaires, then underwent physical examinations and some medical laboratory tests. Categorical variables were reported as percentages, while continuous variables expressed as means and standard deviations. p <0.05 was considered statistically significant. Results: Totally, 100 subjects participated in the study, of whom 48 were male. The mean and standard deviation of the physicians’ age were 38.7±5.1 years. 43% of physicians had an average QOL, while 37% good. 96% of studied physicians had a good condition regarding habitual history, while 93% of them had a poor condition in performing screening tests. Exercise program and personal health in individuals with normal BMI were correlated with higher levels of QOL. BMI was higher in 40-50 years old subjects than youngers. Hypertension was present in five cases (5%), hypercholesterolemia in six (6%), hypertriglyceridemia in six (6%), increased LDL in four (4%), low HDL in four (4%), and impaired FBS in 4 (4%). Conclusion: The findings showed that 63% of studied emergency physicians had an average level of QOL and other ones good. The majority of physicians had undesirable situation regarding the performance of screening tests

Diagnostic Accuracy of Ultrasonography and Radiography in Initial Evaluation of Chest Trauma Patients

Introduction: Application of chest radiography for all multiple trauma patients is associated with a significant increase in total costs, exposure to radiation, and overcrowding of the emergency department. Ultrasound has been introduced as an alternative diagnostic tool in this regard. The aim of the present study is to compare the diagnostic accuracy of chest ultrasonography and radiography in detection of traumatic intrathoracic injuries. Methods: In the present prospective cross-sectional study, patients with traumatic intrathoracic injuries, who were referred to the emergency department from December 2013 to December 2014, were assessed. The patients underwent bedside ultrasound, radiographic and computed tomography (CT) scan examinations based on ATLS recommendations. Screening performance characteristics of ultrasonography and radiography were compared using SPSS 21.0. Chest CT scan was considered as gold standard. Results: 152 chest trauma patients with a mean age of 31.4 ± 13.8 years (range: 4 ‒ 67), were enrolled (77.6% male). Chest CT scan showed pulmonary contusion in 48 (31.6%) patients, hemothorax in 29 (19.1%), and pneumothorax in 55 (36.2%) cases. Area under the ROC curve of ultrasonography in detection of pneumothorax, hemothorax, and pulmonary contusion were 0.91 (95% CI: 0.86‒0.96), 0.86 (95% CI: 0.78‒0.94), and 0.80 (95% CI: 0.736‒0.88), respectively. Area under the ROC curve of radiography was 0.80 (95% CI: 0.736‒0.87) for detection of pneumothorax, 0.77 (95% CI: 0.68‒0.86) for hemothorax, and 0.58 (95% CI: 0.5‒0.67) for pulmonary contusion. Comparison of areas under the ROC curve declared the significant superiority of ultrasonography in detection of pneumothorax (p = 0.02) and pulmonary contusion (p < 0.001). However, the diagnostic value of the two tests was equal in detection of hemothorax (p = 0.08). Conclusion: The results of the present study showed that ultrasonography is preferable to radiography in the initial evaluation of patients with traumatic injuries to the thoracic cavity

Serum Paraoxonase-1 Changes in Thermal Burn Patients

مقدمه: افزایش غلظت اکسیدان ها یا افت آنتی اکسیدانی منجر به از بین رفتن تعادل اکسیدان-آنتی اکسیدانی و به وجود آمدن حالتی به نام استرس اکسیداتیو می شود. به نظر می رسد جبران کمبود آنتی اکسیدانی در شرایط مذکور بتواند در کاهش ضایعات ناشی از بیماری و تسریع روند بهبود کمک کننده باشد. لذا مطالعه حاضر با هدف ارزیابی تغییرات سطح سرمی آنزیم آنتی اکسیدان پاراکسوناز-1 در بیماران دچار سوختگی حرارتی طراحی شده است. روش کار: مطالعه موردی-شاهدی آینده نگر حاضر از تاریخ اول تیر 1393 به مدت 3 ماه  بر روی بیماران دچار آسیب سوختگی حرارتی بستری شده در بخش اورژانس بیمارستان مطهری که حداکثر 4 ساعت از سوختگی آنها گذشته بود انجام شد. گروه شاهد از میان افراد سالم انتخاب شدند. چک لیستی شامل اطلاعات دموگرافیک، سابقه بیماری های قبلی، نتایج آزمایشات و اقدامات پاراکلینیک و سطح سرمی آنزیم پاراکسوناز برای دو گروه مورد مطالعه تکمیل گردید. در نهایت با استفاده از نرم افزار آماری SPSS 19 اقدام به آنالیز آماری و مقایسه نتایج بین دو گروه شد. يافته ها: 33  بیمار مبتلا به سوختگی حرارتی با 53 فرد سالم به عنوان گروه شاهد مورد مقایسه قرار گرفتند. میانگین سنی در گروه کنترل برابر 09/9±61/36 سال و در گروه دچار سوختگی 52/11±69/37 سال بود (632/0=p). میانگین درصد سوختگی بیماران مورد مطالعه 37/23 ± 76/30 (100-3) درصد بود. دو گروه در مورد ویژگی های پایه با هم اختلاف معنی داری نداشتند (05/0 > p). میانگین سطح سرمی آنزیم پاراکسوناز در گروه مورد و شاهد به ترتیب 80/136 ± 52/228 و 08/149 ± 65/350 واحد بین المللی در لیتر بود (001/0p <). ارتباط معنی داری بین سطح فعالیت پاراکسونازی بیماران دچار سوختگی و درصد سوختگی مشاهده نشد (532/0 = p). نتایج آنالیز زیر گروه ها حاکی از تاثیر مخدوش کننده معنی دار سطح آلبومین و کلسترول با دانسیته بالا در سطح فعالیت آنزیم پاراکسوناز-1 بود. نتيجه گيری: بر اساس نتایج مطالعه حاضر به نظر می رسد که علی رغم پایین بودن سطح فعالیت آنتی اکسیدانی پاراکسوناز-1 در بیماران دچار سوختگی حرارتی، با توجه به پایین بودن سطح آلبومین و کلسترول با دانسیته بالا در این بیماران نمی توان سوختگی را به عنوان تنها عامل دخیل در این امر دانست.Introduction: An increase in oxidant concentration or a drop in anti-oxidants leads to an imbalance in oxidant/anti-oxidant equilibrium and a condition called oxidative stress. It seems that recovery from anti-oxidant decrease in this situation can help reduce the effects of the disease and accelerating recovery. Therefore, the present study was designed aiming to evaluate changes in serum paraoxonase-1 levels in thermal burn patients. Methods:This prospective case-control study was carried out from July to October 2014 on thermal burn patient hospitalized in the emergency department of Motahari Hospital, within 4 hours of burning. The control group were healthy people. A checklist consisting of demographic data, medical history, test results, paraclinical measures taken, and serum paraoxonase-1 level was filled for both groups. Finally, SPSS version 19 was used for statistical analysis and comparing the results between the 2 groups. Results: 33 thermal burn patients were compared with 53 healthy people as the control group. Mean age was 36.61 ± 9.09 years in control group and 37.69 ± 11.52 years in burn group (p = 0.632). Mean burn percentage in patients was 30.76 ± 23.37 (3 – 100). The 2 groups were not significantly different regarding baseline characteristics (p > 0.05). Mean serum paraoxonase-1 level in case and control groups were 228.52 ± 136.8 and 350.65 ± 149.08 IU/lit, respectively (p < 0.001). No significant correlation was detected between paraoxonase1 activity in thermal burn patients and their burn percentage (p = 0.532). Subgroup analysis results revealed the significant confounding effect of albumin and high density cholesterol levels on paraoxonase1 activity. Conclusion: Based on the results of the present study, it seems that although the level of paraoxonase-1 anti-oxidative activity in thermal burn patients is low, since albumin and high-density cholesterol levels are low, burn might not be the only cause.