Analysis of Shahid Rajaee hospital administrative data on injuries resulting from car accidents in Shiraz, Iran: 2011-2014 data / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>The administrative data from trauma centers could serve as potential sources of invaluable information while studying epidemiologic features of car accidents. In this cross-sectional analysis of Shahid Rajaee hospital administrative data, we aimed to evaluate patients injured in car accidents in terms of age, gender, injury severity, injured body regions and hospitalization outcome in the recent four years (2011-2014).</p><p><b>METHODS</b>The hospital registry was accessed at Shiraz Trauma Research Center (Shiraz, Iran) and the admission's unit data were merged with the information gathered upon discharge. A total number of 27,222 car accident patients aged over 15 years with International Classification of Diseases 10th revision (ICD-10) external causes of injury codes (V40.9-V49.9) were analyzed. Injury severity score and injured body regions were determined based on converting ICD-10 injury codes to Abbreviated Injury Scale (AIS-98) severity codes using a domestically developed electronic algorithm. A binary logistic regression model was applied to the data to examine the contribution of all independent variables to in-hospital mortality.</p><p><b>RESULTS</b>Men accounted for 68.9% of the injuries and the male to female ratio was 2.2:1. The age of the studied population was (34 ± 15) years, with more than 77.2% of the population located in the 15-45 years old age group. Head and neck was the most commonly injured body region (39.0%) followed by extremities (27.2%). Injury severity score (ISS) was calculated for 13,152 (48.3%) patients, of whom, 80.9% had severity scores less than 9. There were 332 patients (1.2%) admitted to the intensive care units and 422 in-hospital fatalities (1.5%) were recorded during the study period. Age above 65 years [OR = 7.4, 95% CI (5.0-10.9)], ISS above 16 [OR = 9.1, 95% CI (5.5-14.9)], sustaining a thoracic injury [OR = 7.4, 95% CI (4.6-11.9)] and head injury [OR = 4.9, 95% CI (3.1-7.6)] were the most important independent predictors of death following car accidents.</p><p><b>CONCLUSION</b>Hospital administrative databases of this hospital could be used as reliable sources of information in providing epidemiologic reports of car accidents in terms of severity and outcomes. Improving the quality of recordings at hospital databases is an important initial step towards more comprehensive injury surveillance in Fars, Iran.</p>

Necessity of admissions in selected teaching university affiliated and private hospitals during 2007 in Shiraz, Iran

The use of acute hospital beds is an issue of concern both to policy-makers and practitioners. In most countries attempts are underway to improve efficiency in this sector. One of the most widely used instruments for assessing inappropriate hospital use is the Appropriateness Evaluation Protocol, which consists of a set of standards based on objective criteria relating the condition of the patient to the clinical services received. The aim of this study was to measure inappropriateness of admission and inpatient stays at four major hospitals in Shiraz, Iran. The results showed that 22% of the total admissions in four hospitals were rated as inappropriate. The most as well as the least inappropriate admissions were found in both teaching university affiliated hospitals. Our data has shown that a total of 29.6% [average 6.40%] of the hospital stays in the study population were judged to be inappropriate. The result of the Least Significant Difference Test indicated a significant association between the mean days of inappropriate stay and turn of admission in all hospitals. In the four hospitals, a significant association was observed between the inappropriateness of hospital stay, costs, and length of stay. Considering the findings of this study, in addition to other studies in Iran and other countries, we can conclude that the factors involving inappropriate admission of patients to hospitals are mostly similar. In order to solve this problem we can use strategies such as: improving the performance of the referral system, using standard criteria for an appropriate evaluation protocol by the medical staff, and extending outpatient diagnostic services to reduce inappropriate hospitalization

effects of ETT suction education on the knowledge and performance of intensive care nurses

Many neonates require oxygen therapy and mechanical ventilation and endotracheal tube [ETT] suction is a vital protocol for the maintenance of artificial airway patency But suctioning is associated with serious complications including hypoxia. Despite some existing protocols nurses still use it injudiciously in pediatric and neonatal patient groups. Therefore, continuing education has been regarded as a tool to cope with the fast changes in care methods and improving nursing Professional standards. The study was conducted to evaluate the training and educational needs in nurses working with NICUs affiliated to the Shiraz University of Medical Sciences to increase their potential with regards to ETT suctioning. An experimental interventional study. NICUs affiliated to the Shiraz University of Medical Sciences, Shiraz [Iran] during 2006. Sample size was 50 persons caring for neonates with ETTs under mechanical ventilation. Using systematic random allocation, they were divided into study and control groups. Data collection was done by a test with 30 points to evaluate knowledge and a check list with 47 points to evaluate performance. After random allocation, the subjects' knowledge was evaluated. Then, ETT suction education was given to the test group and NICU infection control education was given to the controls. Two days and two months after the intervention, the subjects were re-evaluated. The results were compared. Man-Whitney test showed that the level of knowledge between the two groups at the beginning of the study had no significant difference [p = 0.71], while the average score in the two groups 2 days and 2 months after the intervention [education] had significant difference [p = 0.001]. There was a significant difference 2 days and 2 months after intervention in the performance. It can be concluded that education significantly increases the level of knowledge and degree of performance of neonatal endotracheal tube suctioning; however, with the passage of time, the levels fall, necessitating the need for continued education in this matter