Seat Belt Usage in Injured Car Occupants: Injury Patterns, Severity and Outcome After Two Main Car Accident Mechanisms in Kashan, Iran, 2012

Background: Road traffic accidents (RTAs) are the main public health problems in Iran. The seat belts, which are vehicle safety devices, are imperative to reduce the risk of severe injuries and mortality. Objectives: The aim of the study was to evaluate injury patterns, severity and outcome among belted and unbelted car occupants who were injured in car accidents. Patients and Methods: This cross-sectional prospective study was performed on all car occupants injured in RTAs (n = 822) who were transported to hospital and hospitalized for more than 24 hours from March 2012 to March 2013. Demographic profile of the patients, including age, gender, position in the vehicle, the use of seat belts, type of car crashes, injured body regions, revised trauma score (RTS), Glasgow coma score (GCS), duration of hospital stay and mortality rate were analyzed by descriptive analysis, chi-square and independent t-test. P < 0.05 was considered significant. Results: A total of 560 patients used seat belts (68.1%). The unbelted occupants were younger (28 years vs. 38 years) and had more frequently sustained head, abdomen and multiple injuries (P = 0.01, P = 0.01 and P = 0.009, respectively). Also, these patients had significantly lower GCS and elongated hospitalization and higher death rate (P = 0.001, P = 0.001 and P = 0.05, respectively). Tendency of severe head trauma and low RTS and death were increased in unbelted occupants in car rollover accident mechanisms (P = 0.001, P = 0.01 and P = 0.008, respectively). Conclusions: During car crashes, especially car rollover, unbelted occupants are more likely to sustain multiple severe injuries and death. Law enforcement of the seat belt usage for all occupants (front and rear seat) is obligatory to reduce severe injuries sustained as a result of car accidents, especially in vehicles with low safety

Blunt Traumatic Hernia of Diaphragm With Late Presentation

Background: Diaphragmatic hernia after blunt trauma is an uncommon and often undiagnosed condition. Objectives: We aimed to review patients who presented with delayed blunt traumatic hernia of diaphragm. Patients and Methods: In this retrospective study, the medical records of six patients treated for blunt diaphragmatic hernias who were admitted to Kashan Shahid Beheshti hospital between June 2007 and June 2011 were analyzed. Results: Six patients with mean age of 41 years were included in the study. Male to female ratio was 2:1. Mean duration between trauma and admission to the hospital was 6.5 years (2 – 26 years). Five patients had left-sided diaphragmatic hernia. Chest X-ray was obtained from all patients which was diagnostic in 50 percent of the cases (n = 4). Additional diagnostic imaging with computerized tomography (CT) was used in six patients and upper gastrointestinal (GI) contrast study was performed in one patient. All patients underwent thoracotomy incision. Mesh repair was utilized in one patient. The mean hospitalization time was 14.1 days. There was one postoperative death (16.7%). Conclusions: Late presentation of blunt diaphragmatic hernia is an uncommon and challenging situation for the surgeon. Prompt diagnosis and treatment prevent serious morbidity and mortality associated with complications such as gangrene and perforation of herniated organ

Chest Injury Evaluation and Management in Two Major Trauma Centers of Isfahan Province, IR Iran

Background:: Chest trauma is responsible for 50% of deaths due to trauma. This kind of death usually occurs immediately after the trauma has occurred. Objectives:: The aim of this study was to evaluate the various aspects of chest trauma in patients admitted to two main trauma centers located in the Isfahan Province, Iran. Patients and Methods:: During a six month period, a cross-sectional study of 100 patients who had sustained a chest injury was carried out. Data, including; age, sex, time of accident, trauma mechanism, organ injury, hospitalization length, complications, and patient outcomes were recorded and analyzed. Results:: The mean ages of the patients were 24.7 ± 3.1 years. Men were injured four times more often than the women. Blunt trauma was the most common type of injury. The incidence of hemothorax was 38% in blunt traumas, and 45% (P = 0.01) in penetrating ones. The incidence of pneumothorax was 43% in blunt traumas and 20% in penetrating ones (P = 0.03). The length of hospitalization was 7.2 ± 3.2 days for blunt and 10.1 ± 3.1 days for penetrating chest traumas. Five patients (5%) died during hospitalization, three of those deaths were due to arterial injuries and two cases were due to lung contusions. Conclusions:: Since hemothorax is the main complication of blunt chest trauma in young men, we recommend that special consideration needs to be made to any case of chest trauma, especially blunt chest injuries

Pre-Hospital Trauma Care in Road Traffic Accidents in Kashan, Iran

Background: Iran has one of the highest rates of road traffic accidents (RTAs) worldwide. Pre-hospital trauma care can help minimize many instances of traffic-related mortality and morbidity. Objectives: The aim of this study was to assess the characteristics of pre-hospital care in patients who were injured in RTAs, admitted to hospital. The focus was mainly directed at evaluating pre-hospital trauma care provided in city streets and roads out of the city. Patients and Methods: This retrospective study was carried out on all trauma patients, transported by the emergency medical service (EMS) system, who were admitted to Kashan Shahid-Beheshti hospital during the period from March 2011 to March 2012. The patients’ demographic data, location of accident, damaged organs, mechanism of injury, injury severity, pre-hospital times (response, scene, transport), pre-hospital interventions and outcomes, were extracted from the data registry and analyzed through descriptive statistics using SPSS 18 software. Results: Findings of this study showed that, 75% of RTAs occurred on city streets (n = 1 251). Motor-car accidents were the most frequent mechanism of RTA on city streets (n = 525) (42%), while car rollover was the most frequent mechanism of RTA on roads out of the city (n = 155) (44.4%). The mean pre-hospital time intervals (min); response, scene, and transport for all patients were 6.6 ± 3.1, 10.7 ± 5 and 13 ± 9.8, respectively. The mean pre-hospital time intervals (response, scene, transport) in roads out of the city were higher than those in city streets. There was a significant difference (P = 0.04) in the mortality rates due to RTAs between city streets (n = 46) and roads out of the city (n = 32). Conclusions: In comparison with road traffic accidents on city streets, trauma patients in RTAs on roads out of the city have longer pre-hospital time intervals and more severe injuries; therefore this group needs more pre-hospital resuscitation interventions

Prehospital care and in-hospital mortality of trauma patients in Iran

Introduction The aim of this study was to determine the effect of prehospital time and advanced trauma life support interventions for trauma patients transported to an Iranian Trauma Center. Methods This study was a retrospective study of trauma victims presenting to a trauma center in central Iran by Emergency Medical Services (EMS) and hospitalized more than 24 hours. Demographic and injury characteristics were obtained, including accident location, damaged organs, injury mechanism, injury severity score, prehospital times (response, scene, and transport), interventions and in-hospital outcome. Results Two thousand patients were studied with an average age of 36.3 (SD = 20.8) years; 83.1 were male. One hundred twenty patients (6.1) died during hospitalization. The mean response time, at scene time and transport time were 6.6 (SD = 3), 11.1 (SD = 5.2) and 12.8 (SD = 9.4), respectively. There was a significant association of longer transport time to worse outcome (P =.02). There was a trend for patients with transport times >10 minutes to die (OR: 0.8; 95 CI, 0.1-6.59). Advanced Life Support (ALS) interventions were applied for patients with severe injuries (Revised Trauma Score ©7) and ALS intervention was associated with more time on scene. There was a positive association of survival with ALS interventions applied in suburban areas (P =.001). Conclusion In-hospital trauma mortality was more common for patients with severe injuries and long prehospital transport times. While more severely injured patients received ALS interventions and died, these interventions were associated with positive survival trends when conducted in suburban and out-of-city road locations with long transport times. Copyright © World Association for Disaster and Emergency Medicine 2014

Epidemiology of livestock-related injuries in a major trauma center in Kashan, Iran.

Livestock-related injuries are one of the important factors causing morbidity and mortality in patients admitted to hospital. Treatment of these patients is still a major problem in health care system. The aim of current study was to assess the epidemiology of livestock-related injuries in a major trauma center in Iran from 2006 to 2011. In a prospective study, patients with livestock-related injuries who were consecutively admitted to the trauma center in Kashan, Iran between 2006 and 2011 were evaluated. The data collected included patient's demographics, place and nature of accident, damaged organ, educational level, transport and outcome. Data were expressed as mean +/- standard deviation. A total of 129 patients were included in this study, accounting for 0.3 of all trauma admission (40 273 cases). The mean age was (55.27 +/- 14.45) years. Men were affected four times more than women. Falling down from livestock is the main mechanism of trauma in all groups. Upper and lower extremities were most frequently injured (n equal to 72), followed by the head, neck and spine (n equal to 33 for each). There was one death resulting from livestock-related injury in this study. Despite the low incidence, livestock-related injuries can damage major organs of human body and therefore appropriate training program to increase the safety awareness in home and outdoor is very important

A seven-year study on head injury in infants, Iran - - the changing pattern

Objective Head injury (HI) is the leading cause of mortality and life-long disability in infants. Infants have different anatomical and pathophysiological brain structures from other age groups. The aim of this study was to survey infant HI patients admitted to Shahid Behest Hospital in Kashan, Iran from 2004 to 2010, and to identify the causes of HIs in this age group. Methods In this retrospective study, all HI patients under the age of two who were hospitalized for more than 24 hours between January 2004 and January 2010 were enrolled in the study. Demographic, etiologic, and injury data were collected and a descriptive analysis was performed. Results Infants comprised 20.8 of all children (under 15 years old) with HIs and 65.1 of the injuries occurred in the home. Falls were the most common cause of injury (63.4). In hospital mortality was 6.6 per 100 000 infants. A decreasing trend was seen in home events, but HIs caused by traffic accidents were increasing during the study period. The amount of HI infants resulting from car accidents has tripled from the years 2004 to 2010. Conclusion Although home events and falling are the main causes of infant HIs and need attention, our study showed an increase of HIs caused by road traffic accidents, especially by car accidents, thus legislation for the implementation of protective equipment such as child safety seats and programs is urgently needed. © 2014 Daping hospital and the Research Institute of Surgery of the Third Military Medical University

A seven-year study on head injuries in infants, Iran---the changing pattern

OBJECTIVE: Head injury (HI) is the leading cause of mortality and life-long disability in infants. Infants have different anatomical and pathophysiological brain structures from other age groups. The aim of this study was to survey infant HI patients admitted to Shahid Behest Hospital in Kashan, Iran from 2004 to 2010, and to identify the causes of HIs in this age group. METHODS: In this retrospective study, all HI patients under the age of two who were hospitalized for more than 24 hours between January 2004 and January 2010 were enrolled in the study. Demographic, etiologic, and injury data were collected and a descriptive analysis was performed. RESULTS: Infants comprised 20.8 of all children (under 15 years old) with HIs and 65.1 of the injuries occurred in the home. Falls were the most common cause of injury (63.4). In hospital mortality was 6.6 per 100 000 infants. A decreasing trend was seen in home events, but HIs caused by traffic accidents were increasing during the study period. The amount of HI infants resulting from car accidents has tripled from the years 2004 to 2010. CONCLUSION: Although home events and falling are the main causes of infant HIs and need attention, our study showed an increase of HIs caused by road traffic accidents, especially by car accidents, thus legislation for the implementation of protective equipment such as child safety seats and programs is urgently needed

Repetitive traumatic brain injury in patients from kashan, Iran

Background: Traumatic brain injury (TBI) is a worldwide problem, especially in countries with high incidence of road traffic accident such as Iran. Patients with a single occurrence of TBI have been shown to be at increased risk to sustain future TBI Objectives: The aim of this study was to present the incidence and characteristics of repeated TBI (RTBI) in Iranian patients Patients and Methods: During one year, all admitted TBI patients with prior TBI history were enrolled into the study. In each patient data such as age, gender, past medical history, injury cause, anatomic site of injury, TBI severity, clinical findings and CT sca findings were collected Results: RTBI comprised 2.5 of TBI cases (41 of 1629). The incidence of RTBI per 100,000 individuals per years was 9.7. The mai cause of RTBI was road traffic accident (68.3); 9.7 of cases had preexisting seizure/epilepsy disorder; 36.6 of patients with RTB had pervious ICU admission due to severe TBI. Ten patients had Glasgow coma scale (GCS) - 13 (24.4). Seizure was seen in seve patients (17.1). Thirty-nine percent of patients with RTBI had associated injuries. Eleven patients had abnormal CT scan finding (26.9) Conclusions: Considering the high incidence of trauma in developing countries, RTBI may also be more common compared wit that of developed countries. This mandates a newer approach to preventive strategies, particularly in those with a previous experienc of head injury

Perforated acute appendicitis in a pre-term neonate

Acute appendicitis is a common occurrence in childhood, but this diagnosis is considered rarely in differential diagnosis of acute abdomen in the neonatal period because its occurrence is very rare in neonates. We report a 20-day- old afghan female baby that was admitted to neonatal intensive care unit, because of irritability and abdominal distension. Complete ultrasound of abdomen and pelvis was normal. In plain Radiographs of chest and abdomen with the exception of Air-filled stomach and intestine, there was no abnormality. Due to the lack of improvement and severe abdominal distension, she was transmitted to the operating room and Surgical exploration revealed perforated appendix. Appendicitis should be considered in the differential diagnosis for a neonate with abdominal distension and bilious vomiting and needs strong clinical suspicion. © 2013, Iranian Red Crescent Medical Journal