The outcomes of head trauma due to road traffic accident in hospitalized elderly patients

Introduction: Head trauma is one of the most important causes of death in trauma centers. In particular, treatment of head injury in the elderly seems more complicated than that of the young and middle aged. This study aimed to identify the outcomes of head trauma due to road traffic accidents (RTAs) in elderly patients. Materials and Methods: In a descriptive-analytical study, records of 294 elderly patients with head trauma due to RTA retrieved from health information system were reviewed using a checklist. The outcomes of patients were evaluated using the Glasgow Outcome Scale. Complete recovery and partial disability were considered as favorable outcomes, whereas severe disability, vegetative state, and death were defined as unfavorable outcomes. Descriptive factors and adjusted coefficients were calculated using SPSS software. Results: Of 294 elderly patients, 77.2 were men. About half of the road accidents had occurred in urban areas (58.8). Less than half of the injured elderly were pedestrian (44.9). The mean Glasgow Coma Scale of patients equaled 13.42 ± 3.29. Unfavorable outcomes were observed only in 20.4 of the patients. There were significant differences in head injury severity between the groups with favorable and unfavorable outcomes (P Conclusion: The results of our study mentioned that most of the elderly who had accidents were pedestrian, most of which occurred in the cities. Moderate and severe head injuries in patients had unfavorable clinical outcome

Incidence of Spinal Cord Injury in Traumatic Patients Admitted to a Trauma Referral Center in Guilan

Background & Aim: Patients with spinal cord injury (SCI) impose a heavy burden on health care system. Awareness on prevalence and incidence of SCI is important because this would show the necessity of prevention. This study aimed to investigate the epidemiology and types of traumatic spinal cord injuries in a trauma referral center in Guilan. Methods & Materials/Patients: This is a descriptive study which was conducted on patients with spinal cord trauma using a questionnaire during one year. The questionnaire included demographic information, injured spinal cord area, mechanism of injury, and type of neural damage based on ASIA scale. The data were analyzed using SPSS18 and descriptive statistics. Results: Out of 76 study patients, 68 (88.2%) were men with mean age of 35.2 ± 1.45 years. The most common cause of SCI was motor vehicle accidents (MVA) (48.7%). 34 patients (44.7%) had cervical spine injury and in 23 patients (30.3%), thoraco-lumbar injuries caused SCI. 29.7% of patients suffered from paraplegia and 10.8% quadriplegia. 25 patients (38.5%) had complete SCI. 7 patients with SCI (9.2%) died during hospitalization. In this study, increased age was identified as a risk factor for death. In 4 of these patients (57.1%) cervical SCI was the underlying cause of death. Conclusion: Young men were the group at highest risk and the most mechanism leading to SCI was motor vehicle accidents. Many of these accidents are preventable; thus, more attention should be devoted to safety policies based on needs of the vulnerable groups. Besides, comprehensive education program with clear and practical goals should be developed

The Role of Surgical Treatment in Traumatic Subdural Hygroma: A Pilot Study

Background and Aim: Traumatic subdural hygroma is the accumulation of CSF (cerebrospinal fluid) in subdural space following head trauma. The mass effect of hygroma on brain can impinge on consciousness. There are still many ambiguities on indications of hygroma surgery. This is an 11-year follow-up study which involves the patients suffering traumatic subdural hygroma who underwent surgery. Methods & Materials/Patients: In this retrospective study, clinical records of 16 patients who were operated due to traumatic subdural hygroma were studied. The data from existing records in the hospital were collected and analyzed. They were then analyzed by Repeated Measures ANOVA using SPSS (Version 18). The differences were considered statistically significant at P≤0.05. Results: In this study, there were 13 men (81.3%) and 3 women (18.7%) (Mean age=62 years old). In 87.75% of patients, hygroma was diagnosed 6 days after head injury. It wasunilateral in majority of patients (56.3%) and located in fronto-parietal area (81.3%). The most frequent concomitant injuries were contusions (25%) and subarachnoid hemorrhage (18.8%), respectively. GCS trend on admission and at discharge was significantly different fromthat of hygroma formation (P<0.05). One-fourth of patients had recurrence of hygroma after surgery. All patients (except one) had good outcome. Conclusion: Subdural hygroma is a delayed lesion and surgical treatment improves the level of consciousness (LOC) in afflicted patients

Solutions to Implement Wearing Helmet Legislation: A Content Analysis

INTRODUCTION Due to the unsafe design of this type of vehicle, motorcyclists die approximately 28 times more often than car occupants [1]. The increasing trend of motorcycle accidents has been emphasized in several studies [1-3]. A significant number of motorcyclists do not follow traffic rules. Wearing a helmet is one of the most important rules [4]. Enforcing wearing helmet legislation has increased helmet use [5] and prevented serious motorcyclist injuries [6]. After canceling the mandatory wearing of helmets in some countries, the death rate of these users has increased by 25-28% [7, 8]. It has been reported that the use of helmets in Iran among motorcyclists is about 30% and that of passengers is 10% which indicates the low use of helmets [9]. The use of standard helmets has significantly prevented the fractures of the middle face of Iranians [10]. Of course, the lack of seriousness of the police and regulatory bodies aggravates the disobedience of this group [11]. Few studies have shown that the police avoid fining these motorcyclists due to reasons such as lack of motivation and work pressure, and recommend solutions such as increasing the number of cameras in cities, automatic identification of motorcycles, helmets, and license plates [12]. AIM(s) The purpose of this study was to explain the proposed solutions to solve the problem of implementing wearing helmet legislation from the perspective of regulatory bodies and motorcyclists. RESEARCH TYPE This qualitative study is of the contractual content analysis type. RESEARCH SOCIETY, PLACE & TIME This study was conducted by the method of Graham and Lundman (2004) [13] in Rasht, Iran in 2021. The participants were from Gilan, Iran, and had at least one year of work experience with motorcycle or at least three years of motorcycle riding experience. SAMPLING METHOD & NUMBER To identify the employees of the regulatory bodies, the method of brainstorming and fishbone diagrams were used. The rest of the participants were selected by snowball method. The selection of the samples was done by the principle of maximum diversity and the participants were selected from different ages, sex, education, job, and work experience categories to provide a diverse range of experiences. Sampling continued until information saturation, i.e. no formation of classes and sub-classes and new information. METHOD The interviews were conducted by an interviewer experienced in qualitative research. The time and place of the interview were chosen by the participants. In-depth and semi-structured interviews were conducted with an interview guide. To facilitate communication, it first started with demographic questions, then the main question titled "What are the effective ways to enforce wearing helmet legislation among motorcyclists?" was raised and then participants were asked about their experiences of the solutions, ways of better implementation of wearing helmet legislation, and probing questions to clarify more details. The duration of the interview was between 45 and 60 minutes, and a second interview was conducted with three people to clarify ambiguous points. ETHICAL PERMISSION This study was conducted after obtaining the code of ethics from the Research Vice-Chancellor of Gilan, IranUniversity of Medical Sciences (IR.GUMS.REC.1398.517). STATISTICAL ANALYSIS The process of data analysis was based on the method of Graham and colleagues in 2004, according to which these steps were carried out: implementing the interviews after reviewing them several times to find a correct understanding, extracting meaningful units, classifying compact units, and choosing a suitable label for them, sorting sub-categories, and choosing a suitable title that can cover the resulting categories [13]. Guba and Lincoln's four evaluative criteria were also used to strengthen the results of the qualitative part [14]. FINDING by TEXT Saturation was achieved in the sample of 17, but the sampling was completed with 20 participants. There were 9 participants from regulatory bodies, 4 university faculty members, 3 traffic policemen, and 4 motorcyclists. All of them were male and the rest of their demographic characteristics are given in the table (Table 1). Solutions for implementing the wearing helmet legislation in four categories named; hard, correction, support, and soft solutions were revealed in 14 subclasses and 55 codes as described in Table 2. MAIN COMPARISION to the SIMILAR STUDIES The results of this study were included in four categories: the use of hard, corrective, support, and soft solutions. The first category was hard solutions. The participants believed that fines, strictures, and determination to enforce them by the regulatory authorities have a great impact on the enforcement of the helmet legislation. In a similar study, helmet use by motorcyclists was significantly associated with police stations at intersections, and motorcyclists who crossed police-monitored intersections were more likely to wear helmets [15]. Even those participants who believed in the effectiveness of education, mentioned education first and then strictness next to it. This can be done by various methods, including the adoption of new laws, and strict enforcement of the law with higher fines [16]. Therefore, wearing helmet legislation for motorcyclists can be enforced by using emphatic strategies [15, 17]. The second class extracted was corrective solutions. Similarly, some studies have recommended the adoption of new laws for motorcyclists and the modification of previous laws [16, 18], and broader legislation is recommended in addition to changing existing laws to improve helmet use [19]. There is a need to reform driver's license processes, because having a driver's license is the most important factor that affects the driver's attitude and makes them comply with the rules of wearing a helmet [20]. Therefore, like a study in Nepal, the evidence shows that it is necessary to reform, organize and redefine motorcycling laws in Iran [17]. The solutions of the next level were law enforcement and motorcyclist support. These results reveal that the problems of law enforcement, including not having enough employees, high volume of work, and low living conditions should be considered. The need to support the police by people and organizations has been emphasized before [21]. There is ample evidence that helmet laws are effective in increasing helmet use and reducing injuries [22, 23]. In a previous study, the experiences of medical workers in Bandar Abbas, Iran, showed that in the implementation of wearing helmet legislation, the individual, social, family, economic and cultural factors of the motorcyclist should be taken into account [24]. Therefore, by eliminating the deficiencies in the human and financial resources of the regulatory bodies and the proper management of existing resources, some of the problems of the traffic police and driving can be solved and death and serious injuries to motorcyclists can be prevented. Increasing the number of cameras in cities that increase the ability to identify motorcyclists without helmets is also recommended. This task is done using vehicle identification, helmet identification, and automatic license plate recognition [12]. Finally, soft solutions were the fourth category. A study in Iran has shown that motorcyclists who do not have driver's license used drugs significantly more and had personality disorders and depression [25]. In a study in Malaysia, a significant percentage of motorcyclists did not wear helmets properly, and most of the child passengers did not wear helmets. Therefore, despite the legal approval of wearing a helmet for motorcyclists and passengers, there is a lack of public awareness of the safety and benefits of using a helmet and a lack of adequate and appropriate implementation [2]. In this regard, the importance of education along with the application of the law, which is one of the results of this class, becomes clear. According to the previous emphasis, a driver must have a certified skill license, and the knowledge of the motorcyclist and the severity of the law are introduced as the two main influencing factors [26]. In a grounded theory study reported in Kerman, Iran, policies and intervention programs to control injuries and promote safety among motorcyclists should focus on socio-cultural barriers to helmet use in general and changing motorcyclists' attitudes toward mortality in particular [27 ]. LIMITATIONS One of the limitations of the present study is the limitations related to qualitative studies, which quantitative data such as the frequency of experiences cannot be obtained and presented. SUGGESTIONS It is suggested to extract the experiences of the heads and elders of the country's traffic in this matter through interviews for further studies. CONCLUSIONS There are four categories of solutions for implementing wearing helmet legislation from the point of view of policymakers, police, and motorcyclists. The use of hard solutions such as the diligence and seriousness of the regulatory bodies in implementing the law on wearing helmets and corrective solutions such as drafting new laws and amending existing laws, support solutions such as supporting the police and motorcyclists, and finally, soft solutions such as education and culturalizing and the use of mass media are effective in implementing these laws. CLINICAL & PRACTICAL TIPS in POLICE MEDICINE The police and employees who are responsible for enforcing the wearing helmet legislation on motorcyclists should try to use all kinds of legal solutions. However, besides these golden solutions, the use of gentle and soft solutions such as education and culturalizing should be considered. In this regard, the duties of policymakers are to formulate new laws and amend existing laws, to support the police and motorcyclists. ACKNOWLEDGMENTS We would like to thank Gilan University of Medical Sciences, which provided the financial costs of this research project. We are also grateful to all participants in this research, including motorcyclists and regulatory bodies. CONFLICT of INTEREST The authors state that there is no conflict of interest in the present study. FUNDING SOURCES This article was completed with the financial support of Gilan University of Medical Sciences

Hydrocephalus in Patients With Head Trauma: A Series of 14 Patients

Background and Aim: Hydrocephalus can cause ventricular expansion, which if not treated promptly, can result in brain damage. The hydrocephalus-induced damage is not fully improved, even by means of surgical procedures, leading to permanent damages to the brain. Methods and Materials/Patients: The aim of this study was to evaluate the demographic characteristics as well as hydrocephalus in patients with head trauma in Poursina Hospital, Rasht. The information including age, sex, Glasgow Coma Scale (GCS), trauma mechanism and accompanying brain injuries on admission were recorded. Patients with hydrocephalus diagnosed by CT scan underwent further investigation and therapeutic approaches. The treatment-related results were collected based on the GOS scale. Finally, the data were entered into SPSS version 18, and the results were analyzed by Fisher’s exact test, and Independent t-test. Results: Of the 548 patients, hydrocephalus was observed in 14 patients (2.6%). The mean age of the patients was 44.07±24.48 years old. 31.1% of men (14 cases) had hydrocephalus, while none of women suffered from this complication. Car accidents (12 people) and fall (2 people) were identified as causes of incident in hydrocephalus patients. Head injury severity in most patients with hydrocephalus was mild (n=7, GCS=13-15) and moderate (n=6, GCS=9-12), and severe (n=1, GCS=3-8). Subarachnoid hemorrhage (n=5) and then epidural hematoma (n=4) and intracerebral hemorrhage (n=4) had the most severe damage to the skull. Most patients (n=11) were treated by surgery. Three patients recovered completely. Moderate disability, severe disability, vegetative state, and death occurred in 3, 2, 1, and 5 Patients, respectively. According to independent t-test, there is a statistically significant relationship between Glasgow Coma Scale and hydrocephalus (P=0.03). Fisher’s exact test also showed a statistically significant relationship between intracerebral hemorrhage (P=0.045) and intraventricular hemorrhage (P=0.013) on admission with hydrocephalic incidence. Conclusion: This complication was mostly observed in young traumatic patients (younger than 40 years of age) and in patients with mild head injury. Therefore, it is necessary to pay attention to these people in order to detect hydrocephalus, if any, as soon as possible, and these patients be treated appropriately