Reviewing blunt abdominal injuries in the National Trauma Registry of Iran

To the Editor-in-ChiefWe read with interest Chardouli et al.’s paper entitled “A review on using ultrasound for evaluation of pediatric blunt abdominal trauma” and enjoyed it a lot. Now, we intend to add some of the results of our registry to their invaluable article.The National Trauma Registry of Iran was launched in 2016 at Sina Trauma and Surgery Research Center, and 24 different hospitals from various provinces collaborated in this project. Happily, more than 32,000 patients have been included so far, 4603 of which belong to Sina Hospital. Furthermore, ample evidence shows that blunt abdominal injury is one of the most common presentations in the emergency rooms. Hence, we analyzed our data to find the severity of blunt abdominal injuries compared to other injuries. Among 4603 patients, 208 people had blunt trauma, and 17 were in the abdominal region. The mean injury severity score (ISS) of patients with blunt abdominal injuries was 1.5 (standard deviation (SD)=1.1). Also, the mean ISS of patients with abdominal injuries with other mechanisms (other than blunt traumas) was 3.3 (SD=2.5). The difference was statistically significant (P=0.005). Moreover, the median of ISS among patients with blunt abdominal injuries was 1.0 (interquartile range (IQR)=0.0). Also, the median of ISS among patients with abdominal injuries with other mechanisms was 4.0 (IQR=3.0).All in all, our results show that if injuries are classified into two body regions of abdominal and others, and two mechanisms of blunt and others, blunt abdominal injuries can be less severe than injuries caused by other mechanisms and in other body regions

Reviewing brachial plexus injury in a trauma registry center

Dear editor We read with interest Abdolrazaghi and his colleague’s paper entitled ‘’ Brachial plexus injury following blunt trauma; an anatomical variation in electrodiagnostic findings’’ and enjoyed it a lot. They presented a brachial plexus injury (BPI) case, which was rare in clinical practice because blunt traumas did not commonly cause BPI. There is ample evidence that most cases are men and adolescents aged 15 to 25 years, and the main mechanism of injury (70%) is motor vehicle accidents. As BPI is increasing, we will provide some epidemiologic and clinical characteristics of our cases registered at Sina Hospital, affiliated with the National Trauma Registry of Iran (NTRI). The Sina Trauma and Surgery Research Center launched the NTRI in 2016 and first recorded the related data from Sina Hospital. As the registry expanded, the NTRI included some other Iranian hospitals from different cities in the next step. The inclusion criteria were discussed elsewhere. We have registered 10 cases of BPI since 2016 at Sina Hospital. All of them were men, ranging from 19 to 45 years. The cause of injury was cut/stab in nine and road traffic accidents in one patient; seven were intentional, and most were due to interpersonal violence. Five of the injuries happened outdoors, three cases in commercial and service departments, and two at homes. Furthermore, the median injury severity score (ISS) was 5.0 (IQR=1). All of the patients had surgical operations. No death or need for ventilators was reported. Only one patient needed intensive care unit (ICU) admission and stayed for three days in the ward. We hope this information can be helpful for the Frontiers in Emergency Medicine’s readers to know more about BPI and can compare similarities and differences between our cases and the others included in the literature

Effects of mustard gas on immune system of exposed Iranian people: a review of conducted studies

     Exposure to high dosages of sulfur mustard (SM) can cause bone marrow depression, immune system suppression, impairment of the immune functions, and eventually results in diseases due to secondary immune disorders. In this article, we have studied the effects of this poison on Iranian veterans by analysis of related published studies. In a systematic search, the effects of SM gas on Iranian victims were reviewed. We used known international medical databases such as   ISI, Medline, Scopus and Iranian databases such as Iranmedex and Irandoc. About 350 published articles were assessed. Among them, 43 articles were related to immunologic field. No special evaluation was conducted on the quality of the reviewed manuscripts and the credit of journal was considered sufficient. In accomplished studies conducted on Iranian people, both cellular and humoral immunity were affected. The reported changes were as follows:  increasing the number of inflammatory cells in chronic phase which indicates ongoing active alveolitis, neutrophils (in chronic bronchitis), eosinophils, CRP titer, RF titer, IgG (especially in asthmatic patterns) ,IgM , Ig E, IL-6, TFG-beta1target protein in bronchoalveolar lavage fluid, and decreasing the number of leukocytes , lymphocytes, natural killer cells (NKCs), IL-8and IL-6 in blood. Eventually, in reported changes, chemo taxis factors, plasma opsonins and  nitroblue tetrazolium (NBT) test were normal. In sever and prolonged exposure to mustard gas, the immune system would be suppressed. Therefore, the victims should be monitored for infections and even cancers

The Minimum Dataset and Inclusion Criteria for the National Trauma Registry of Iran: A Qualitative Study

Background Burden of injuries is an important public health problem, especially in developing countries. However, a national standard tool for data collection of trauma registry has not been developed in Iran yet. Objectives The present study aimed to describe the steps undertaken in the development of the minimum dataset (MDS) and define the inclusion and exclusion criteria for a case of trauma registry by the national trauma registry of Iran (NTRI). Methods The working group consists of sixteen elected expert representatives from seven established countrywide active trauma research centers. Following a structured extensive review of the literature, the working party identified the data variables that included key registry goals for pre-hospital and hospital, outcome and quality assurance information. We used data variables from three trauma registry centers: National trauma data standard questionnaire, European trauma care (UT stein version), and Sina trauma and surgery research center. Then, we performed two email surveys and three focus group discussions and adapted, modified and finally developed the optimized MDS in order to prepare the quality care registry for injured patients. Results The finalized MDS consisted of 109 data variables including demographic information (n = 24), injury information (n = 19), prehospital information (n = 26), emergency department information (n = 25), hospital procedures (n = 2), diagnosis (n = 2), injury severity (n = 3), outcomes (n = 5), financial (n = 2), and quality assurance (n = 1). For a patient sustained one or more traumatic injury in a defined diagnostic ICD-10 codes, the inclusion criteria considered as one of the followings: If the patient stayed > 24 hours in the hospital, any death after hospital arrival, any transfer from another hospital during the first 24 hours from injury. Conclusions This study presents how we developed the MDS in order to uniform data reporting in the NTRI and define our inclusion and exclusion criteria for trauma registry. Applying the MDS and the case definition in pilot studies are needed in next steps

The association between the outcomes of trauma, education and some socio-economic indicators

Background: There are many debates on socioeconomic indicators influencing trauma outcomes.Objectives: This study aimed to determine the association between education as a socioeconomic indicator and trauma outcomes.Methods: This descriptive-analytical study was conducted on 30,448 trauma patients during 2016-2021. The data were based on the minimum dataset of the National Trauma Registry of Iran (NTRI) from six different trauma centers in various cities of the country. The variables used in this study included age, education level, marital status, cause of injury, Glasgow Coma Scale (GCS), intensive care unit (ICU) admission, Injury Severity Score (ISS), and in-hospital mortality. Logistic regression was used to investigate the association between independent variables and trauma outcomes.Results: The study included 30,448 trauma patients with male predominance (75.8%). The mean age was 36.9 years. The most frequent education level was secondary education, with 14,228 (46.6%). Education levels had significant relationships with ISS, death, and ICU admission (P<0.001). Moreover, after applying the multiple logistic regression, the odds of deaths for trauma patients with no formal, primary, and secondary education levels were 3.36, 5.03, and 3.65 times, respectively, more than the odds of deaths at the higher education level after controlling for other factors (all Ps<0.05). However, there were no such relationships between education levels and the odds of ICU admission.Conclusion: Findings of the present study showed a significant association between the education levels and trauma outcomes. Adjusted for other covariates, the chance of death for trauma patients with no formal, primary, or secondary education levels was higher than that at the higher education level

Burden of obesity in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study

Mokdad AH, El Bcheraoui C, Afshin A, et al. Burden of obesity in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 study. INTERNATIONAL JOURNAL OF PUBLIC HEALTH. 2018;63(Suppl. 1):165-176.We used the Global Burden of Disease (GBD) 2015 study results to explore the burden of high body mass index (BMI) in the Eastern Mediterranean Region (EMR). We estimated the prevalence of overweight and obesity among children (2-19 years) and adults (20 years) in 1980 and 2015. The burden of disease related to high BMI was calculated using the GBD comparative risk assessment approach. The prevalence of obesity increased for adults from 15.1% (95% UI 13.4-16.9) in 1980 to 20.7% (95% UI 18.8-22.8) in 2015. It increased from 4.1% (95% UI 2.9-5.5) to 4.9% (95% UI 3.6-6.4) for the same period among children. In 2015, there were 417,115 deaths and 14,448,548 disability-adjusted life years (DALYs) attributable to high BMI in EMR, which constitute about 10 and 6.3% of total deaths and DALYs, respectively, for all ages. This is the first study to estimate trends in obesity burden for the EMR from 1980 to 2015. We call for EMR countries to invest more resources in prevention and health promotion efforts to reduce this burden

Epidemiology of injuries from fire, heat and hot substances : global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study

Background Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. Methods We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. Results Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). Conclusions The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.Peer reviewe

The burden of unintentional drowning : global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study

Background Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017. Methods Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning. Results Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes. Conclusions There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low- and middle-income countries.Peer reviewe

Neonatal, infant, and under-5 mortality and morbidity burden in the Eastern Mediterranean region: findings from the Global Burden of Disease 2015 study

Objectives Although substantial reductions in under-5 mortality have been observed during the past 35 years, progress in the Eastern Mediterranean Region (EMR) has been uneven. This paper provides an overview of child mortality and morbidity in the EMR based on the Global Burden of Disease (GBD) study. Methods We used GBD 2015 study results to explore under-5 mortality and morbidity in EMR countries. Results In 2015, 755,844 (95% uncertainty interval (UI) 712,064–801,565) children under 5 died in the EMR. In the early neonatal category, deaths in the EMR decreased by 22.4%, compared to 42.4% globally. The rate of years of life lost per 100,000 population under 5 decreased 54.38% from 177,537 (173,812–181,463) in 1990 to 80,985 (76,308–85,876) in 2015; the rate of years lived with disability decreased by 0.57% in the EMR compared to 9.97% globally. Conclusions Our findings call for accelerated action to decrease child morbidity and mortality in the EMR. Governments and organizations should coordinate efforts to address this burden. Political commitment is needed to ensure that child health receives the resources needed to end preventable deaths