Efficacy of new scoring system for diagnosis of abdominal injury after blunt abdominal trauma in patients referred to emergency department / 中华创伤杂志(英文版)

PURPOSE@#The blunt abdominal trauma (BAT) is a common emergency and is significantly associated with morbidity and mortality. Our study was conducted to achieve the goal that a new scoring system could be used for the BAT patients.@*METHODS@#The statistical population of this study was 1000 patients with BAT referred to emergency department of Imam Hossein Hospital, Tehran, Iran. Sampling was carried out in a convenience non-random manner and continued to reach the required sample size. All the patients with BAT due to road traffic accidents, falls, and other direct blunt traumas such as punctures and kickbacks were included in the study. Exclusion criteria were after 3 months of pregnancy, under the age of 18, warfarin taking, no reliable medical history providing and penetrating trauma. The study questionnaire was based on BAT scoring system. The data were analyzed by SPSS V20 software. The receiver operating characteristic curve was used to analyze the effectiveness of the new scoring system in predicting the BAT patients' outcome.@*RESULTS@#The mean age of the patients (n = 1000) was (35.79 ± 13.09) years. The mean score of patients was (6.29 ± 5.80). Based on this scoring system, the patients were divided into three categories. The first group was patients at low risk with score of less than 8, the second group was patients at moderate risk with score of 8-12 and the third group was patients at high risk with score of 12-24. The score of 661 (66.1%) patients were low, 109 (10.9%) were moderate and 230 (23%) had a high score. The association between hip fracture and abdominal tenderness with abdominal injury was significant (p < 0.001). Cronbach's alpha was 0.76 showing the reliability of this questionnaire to predict the future of patients.@*CONCLUSIONS@#The study tool has a sensitivity to predict the BAT patients' outcome, and has a proper specificity that can be used to reduce the use of harmful modalities such as computed tomography scan.

effect of emergency department overcrowding on efficiency of emergency medicine residents' education

Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding [EDO] on the training of emergency medicine residents [EMR] is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR's education. In this cross-sectional study, the effects of overcrowding on EMR's education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs. The crowding level was calculated based on the national emergency department overcrowding scale [NEDOCS]. The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. 130 questionnaires were filled out during 61 shifts. 47 [77.05%] shifts were overcrowded. The attend's ability to teach was not affected by overcrowding in the resuscitation room [p=0.008]. The similar results were seen regarding the attend's training ability in the acute care unit. It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs

New scoring system for intra-abdominal injury diagnosis after blunt trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>An accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma.</p><p><b>METHODS</b>This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chi-square test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β) was given based on the contribution of each of them. Scoring system was developed based on the obtained total β of each factor.</p><p><b>RESULTS</b>Altogether 261 patients (80.1% male) were enrolled (48 cases of IAI). A 24-point blunt abdominal trauma scoring system (BATSS) was developed. Patients were divided into three groups including low (score<8), moderate (8≤score<12) and high risk (score≥12). In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%). Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%). The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%).</p><p><b>CONCLUSION</b>The present scoring system furnishes a high precision and reproducible diagnostic tool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.</p>