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

Innovation of a new silicone prosthesis for inguinal hernioplasty : new method for silicone prosthesis production, a preliminary study

Purpose: The main strategy in inguinal hernia repair is mesh hernioplasty (specially prolene mesh): Pain in anterior femoral, inguinal and scrotal-areas, Mainly due to sensory-nerve-injury in the very regions and was deferen injury are the-main complications reported following repairing inguinal hernia. In:this study we decided to use semiliquid silicone in order to form it in an in-vivo prosthesis production method to perform hernioplasty. Methods: In this technique, silicone Was produced through Room Temperature Vulcanization (RTV) technique, which is feasible in the; room temperature. The produced semiliquid polymer was shaped in the inguinal canal in six cadavers. Result : While the prostheses adequately covered all the anatomic area Of the canal with an acceptable thickness in all of the cases, a Satisfactory shape was developed in four cases. While 15-20 cc of silicone was-needed to cover all anatomic areas properly the hardness equal to 15 was achieved after curing process. Conclusion: New silicone prosthesis forms satisfyingly in the, inguinal canal and can protect it by encapsulation mechanism. It is soft with no risk of damage to the nerves or vat. It is inert and has no toxicity to the adjacent tissue. This technique of silicone remodeling can also be used in other fields of surgery such as plastic or vascular surgery

Impact of Diabetes Mellitus on Peripheral Vascular Disease Concomitant with Coronary

Background: The aim of this study was to evaluate the impact of diabetes mellitus (DM) on peripheral vascular disease (PVD) in patients with coronary artery disease (CAD). Methods: A total of 13702 consecutive patients who underwent coronary artery bypass grafting (CABG) at Tehran Heart Center between January 2002 and March 2007 were included in this study. The demographic data, PVD, and outcome of these patients were reviewed. CABG patients before surgery were detected for PVD (stenosis ≥70% in the abdominal aorta; renal, carotid, and iliac arteries; or any other peripheral vascular system) with physical examination and past medical history. The suspected cases of PVD were, thereafter, confirmed via Doppler sonography or invasive angiography. Results: This study recruited 4344 diabetic patients (mean age 59.30±8.7 years) and 9358 non-diabetic patients (mean age 58.42±9.9 years). The diabetics were significantly older and had a higher incidence of PVD (2.7% vs. 1.8%), female gender, hypertension, renal failure, smoking, and dyslipidemia than the non-diabetics (P<0.05). There was no significant difference between the two groups with regard to family history and left main disease. Also, the mean ejection fraction (EF) was 48.85%±10.4 and 49.35%±10. In the patients with and without DM, respectively; and the difference was significant (P=0.008). The in-hospital mortality rate (mortality over a 30-day post-operative period) was 1.8% in the diabetics and 0.7% in the non-diabetics (P<0.001). In the multivariate analysis, PVD, left main disease, age, female gender, and EF were significant in the development of mortality amongst the diabetic patients with a respective odds ratio of 4.17, 5.54, 1.03, 2.86, and 0.95 (P≤0.050). In the multivariate logistic regression analysis, PVD was significantly higher in the diabetics than in those without DM (OR=1.283, 95% CI: 1.001- 1.644; P=0.049). In the diabetic patients, carotid (1.13% vs. 0.83%), subclavian (0.05% vs. 0.02%), femoral (0.18% vs. 0.09%), renal (0.62% vs. 0.25%), and tibialis (0.16% vs. 0.06%) arteries had a higher incidence of stenosis than those in the non-diabetics. Conclusion: We conclude that in diabetic patients with concomitant CAD, special attention must be directed towards the diagnosis of PVD using physical examination, Doppler sonography; and where needed, CT-angiography or invasive angiography. Also, in risk assessment, the presence of PVD should be strongly considered for CAD patients

Animal-related injuries in hospitalized patients

Introduction: Injury from animal attacks is an important public health problem with high morbidity and mortality. As we cannot neglect or underestimate these hazardous conditions, we aimed to assess animal-related injuries in Iranian patients and compare the results.Methods: In this cross-sectional study conducted on data from the National Trauma Registry of Iran, trauma patients admitted to the hospital due to animal attacks from January 15, 2018, to November 1, 2021, were assessed. A checklist gathered data consisting of baseline characteristics such as sex, age, activity, place at the time of the attack, and injury site. In addition, we extracted the clinical features of these patients, including injury severity score, Glasgow coma scale, intensive care unit (ICU) admission, hospital length of stay, surgery, and discharge status.Results: One hundred thirty-one patients were registered in the study. Most of the patients were male (80.9%), aged 16 to 44 years (59.5%), and encountered animal attacks when they were in agricultural areas (45%). Ninety-six patients (73.3%) underwent surgery, and three were hospitalized in ICUs. We recorded 172 injuries, consisting of 92 (53.5%) injuries in the upper extremities as the most common region of the body. The males were aged 16-44 years (66%), and the females were aged 45-65 (52%) (P=0.005). Fifty percent of males and 24% of females were injured in the agricultural areas. Moreover, 24% of females and 6.6% of males were injured at home.Conclusion: This study showed a high incidence animal attacks in Iran. Most injuries were in middle aged males and in the agricultural area

Tehran cohort study (TeCS) on cardiovascular diseases, injury, and mental health: Design, methods, and recruitment data.

Cardiovascular disease, mental health, and injury are among the top health issues globally. In Tehran Cohort Study, we aimed to determine the prevalence, incidence, and trend of cardiovascular diseases, psychiatric symptoms, injury, and risk factors in Tehran households. We enrolled 4215 households in the recruitment phase from March 2016 to March 2019. Demographic characteristics, past medical history, medications, and familial history of the participants were collected. Rose angina pectoris, general health Questionnaire-28 (GHQ-28), and injury questionnaires were completed. Fasting blood samples were collected to measure routine biochemistry and store samples in the biobank. Anthropometric and physiological measurements and electrocardiograms were performed. The participants are followed every three years for up to 12 years. In total, 8296 individuals participated in the cardiovascular section, 10247 completed the GHQ-28, and 4167 households completed the injury questionnaire. The mean age of the participants was 48.2 (16.41), and 46.5% were male. 64.3% of recruited individuals had no symptoms of psychiatric disorders, and 3729 (89.5%) households did not have any severe injury requiring treatment. The participants diversity and their invaluable data will help us provide a general picture of the current prevalence and incidence of the main study objectives

Epidemiology of Fatal Injuries among Patients Admitted at Sina Hospital, the National Trauma Registry of Iran, 2016-2019

Introduction: Injuries cause high rates of mortality and harm to millions of people annually.&nbsp;Objective: The aims of this study were to assess some characteristics of hospitalized trauma patients and determine the variables which were associated with increased rates of mortality.&nbsp;Methods: Data were extracted from the National Trauma Registry of Iran (NTRI) data bank. Among all trauma patients admitted to Sina Hospital, those who had one of the following were registered in the NTRI: hospitalization for more than 24 hours, death less than 24 hours in the hospital, and transferring from the intensive care unit (ICU) of another hospital. Recorded data relating to the interval between 24 July 2016 and 10 October 2019 were analyzed.&nbsp;Results: A total number of 3430 patients were studied, of whom 78 (0.02%) did not survive. The mean age of survivors was 38.4 (±18.5) and it was 58.1 (±23.7) for non-survivors (p&lt;0.001). The mean Glasgow coma scale (GCS) of survivors was 14.9 (±0.7) and it was 11.7 (±4.4) for non-survivors (p&lt;0.001). The most important predictors of death were ICU admission (OR 4.31; 95% CI 1.65-11.26) and not having surgical operation (OR 6.08; 95% CI 2.30-16.03). The injuries with higher injury severity score (ISS) had higher risks of death (OR 1.20; 95% CI 1.06-1.36).&nbsp;Conclusions: In this study, Road Traffic Crashes (RTCs) were the main cause of injuries. The elder age, lower GCS score, ICU admission, higher ISS and not having surgical operation were the worst factors of death. More studies are needed to reveal other prognostic factors of fatal injuries

Comparison of nine trauma scoring systems in prediction of inhospital outcomes of pediatric trauma patients: a multicenter study

Abstract Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice