Predicting mortality, hospital length of stay and need for surgery in pediatric trauma patients / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Pediatric trauma is one of the major health problems around the world which threats the life of children. The survival of injured children depends upon appropriate care, accurate triage and effective emergent surgery. The objective of this study was to determine the predictive values of injury severity score (ISS), new injury severity score (NISS) and revised trauma score (RTS) on children's mortality, hospitalization and need for surgery.</p><p><b>METHODS</b>In this study, records of trauma patients under 15 years old transported from a trauma scene to emergency department of Poursina hospital from 2010 to 2011 were included. Statistical analysis was applied to determine the ISS, NISS and RTS ability in predicting the outcomes of interest.</p><p><b>RESULTS</b>There were 588 records in hospital registry system. The mean age of the patients was (7.3 ± 3.8) years, and 62.1% (n = 365) of patients were male. RTS was the more ability score to predict mortality with an area under curve (AUC) of 0.99 (95% CI, 0.99-1). In the hospital length of stay (LOS), ISS was best predictor for both the hospital LOS with AUC of 0.72 (95% CI, 0.67-0.76) and need for surgical surgery with AUC of 0.94 (95% CI, 0.90-0.98).</p><p><b>CONCLUSION</b>RTS as a physiological scoring system has a higher predicting AUC value in predicting mortality. The anatomic scoring systems of ISS and NISS have good performance in predicting of hospital LOS and need for surgery outcomes.</p>

Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level / 한국역학회지

OBJECTIVES: The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program's important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis.METHODS: Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated.RESULTS: Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%).CONCLUSIONS: The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.

Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level / 한국역학회지

OBJECTIVES: The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program's important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis. METHODS: Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated. RESULTS: Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%). CONCLUSIONS: The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.

Predictors of post-traumatic stress disorder among victims of serious motor vehicle accidents

Background: Compelling evidence has shown that motor vehicle accidents have an enormous impact on mental health. Post-traumatic Stress Disorder [PTSD] is one of the most common psychological consequences in adult survivors of accidents, so it is important to understand the prevalence and predictors of this issue since delay causes damage to crucial daily functioning. This study aimed at investigating the prevalence and predictors of PTSD after motor vehicle accident

Methods: This cross-sectional study was conducted on 528 injured patients six weeks to six months after motor vehicle accident in Imam Reza Clinic of Poursina hospital, Rasht in 2015. Data collection tools were three questionnaires including post-traumatic stress-self report [PSS], Beck Depression Inventory [BDI-II], and the Numeric Rating Scale [NRS] for pain. The data were analyzed in SPSS [Version 19] using Chi-square, Fischer's exact test and multivariate logistic regression. Significance level was considered P

Results: The prevalence of PTSD and depression was 30.49% and 19.89% in participants, respectively. Chi-square test indicated a significant relationship among age [P=0.02], sex [P<0.001], education level [P<0.001], work status [P<0.001] and PTSD. Participants who reported pain [P<0.001] and depression [P<0.001] were more likely to have high score of PTSD than the others. Multivariate logistic regression showed this significance in sex, depression, age, educational status and pain, as constant risk factors in developing PTSD after accident

Conclusion: This study suggests that primary care setting should be readily prompted for diagnosis of these disorders in non-treatment seeking individuals in the community

Psycho-social and mental variables and post-traumatic stress disorder in traffic accident survivors in Northern Iran

Objective: To assess the psycho-social and mental variables associated with post-traumatic stress disorder [PTSD] in a series of Iranian patients

Methods: A total of 528 eligible accident survivors in pre-sampling of a randomized controlled trial targeting PTSD were included in this cross-sectional study. Psycho-social characteristics associated to PTSD were explored in these survivors in an outpatient clinic. They completed the questionnaires via interview between six weeks to six months after accident. Data collection tools were PSS [DSM-V version] for PTSD and BDI-II for depression and a researcher-made questionnaire for psycho-social variables

Results: There was a significant association between PTSD and the following variables; family communication, current depression, return to work, history of death of relatives, witnessed the death, length of amnesia, hospitalization, injured situation, and accident severity. Multivariate logistic regression indicated that some variables were associated with PTSD such as accident severity, [p<0.001], injured situation, [p<0.001], current depression, [p<0.001], RTW [p<0.001], and family communication [p=0.01]

Conclusion: Psychiatric nursing prevention efforts is best directed toward motorcycle depressed drivers with severe accident and poor family communication who do not return to work. Thus, routine assessment of PTSD, depression and psycho-social variables after traffic accidents must be taken into account

comparison between therapeutic effect of granulocyte colony-stimulating factor and methylprednisolone in treatment of patients with acute traumatic spinal cord injury

Background and Aim: Spinal cord injury [SCI] is one of the worst kinds of traumatic injuries with remarkable social and economic effects on communities

Methods and Materials/Patients: In this prospective randomized clinical trial, 122 patients with traumatic spinal cord injury were admitted to Poursina hospital within 48 hours of injury to compare granulocyte colony stimulating factor [G-CSF] and high-dose methylprednisolone as neuroprotective therapy

Results: In this research, 122 patients were studied out of whom 62 patients were included in the granulociote colony-stimulating factor [G-CSF] group with a mean age of 40.4, and 60 patients in the methylprednisolone group with an average age of 40.10 years. 55 out of 122 patients [45%] were completely paralyzed [Grade AIS:A] and 67 [55%] were with incomplete spinal injury [Grade AIS:B,C,D]. The average American spinal injury association [ASIA] sensory scores in the two groups were similarly compared in the same four time intervals, and p values were 0.7, 0.3, 0.2, and 0.1. They were not statistically significant

Conclusion: According to the results, the G-CSF was shown to be beneficial in average ASIA motor and sensory scores in the two groups of male patients at six months of onset of G-CSF treatment [p value=0.04], and average ASIA motor scores improvement in the falls subgroup patients also differed significantly within six months of onset of G-CSF treatment [p value=0.03]. A multicentre prospective randomized clinical trial to compare the placebo effect with G-CSF protocol's treatment, and also assessment of the cost benefits of the common medical treatment versus G-CSF are needed

Hydatid disease of the cervical spine mimicking traumatic burst fracture

Background and Importance: Hydatid disease of the spine is rare but constitutes approximately 50% of bone involvement cases in human hydatidosis. It is a severe condition associated with a high rate of morbidity, disability and mortality

Case Presentation: In the present paper, we report an intriguing case of cervical spinal hydatid disease mimicking traumatic burst fracture

Conclusion: A high degree of suspicion combined with good-quality neuroimaging is important for early and correct diagnosis. Because of the location and the potential for progression, spinal hydatid disease surgical treatment is the mainstay of treatment

Pharmacotherapy to improve the acquired aphasia following brain damages: a review study

Background and Aim: using pharmaceutical agents in treatment of aphasia has caught the attention of many neurologists and neuroscientists. This short review study has sought the role of pharmacotherapy in treatment of aphasia, a linguistic impairment after acquired brain lesions. The pharmacological principles and mechanisms related to the effects of drugs used in aphasia rehabilitation are pointed. Then, some evidence of clinical trials on different drugs in this field is presented

Methods and Materials/Patients: a comprehensive search in databases including MEDLINE, Cochrane, PubMed, Scopus, EMBASE, Science Direct on experimental studies and clinical trials associated with pharmacotherapy of aphasia after neurological damages was performed

Results: pharmacological interventions through manipulating neurochemical levels in synapses, the pre- and postsynaptic spaces and even inside neurons start to modulate the disturbed balance of neurotransmitters due to brain lesions. Pharmacotherapy is based on the principle that drugs via balancing the molecular signaling cascades triggered due to neuronal damage can restore the function of neurons, facilitate the brain plasticity process and improve the linguistic deficits in aphasic patients. Among the drugs that have been studied in treatment of aphasia, those acting on central cholinergic and glutamergic systems were more effective and led to better clinical outcomes

Conclusion: although existing evidence has proved the pivotal role of pharmacotherapy in treatment of aphasia after acquired brain lesions in adults, further research is required to assure the clinicians in using pharmacotherapy as a standard approach in treatment of aphasia

Curb the pain of spondylolisthesis; comparing posterolateral fusion with posterior lumbar interbody fusion

Background and Aim: the purpose of this study was to evaluate and compare the pain of patients with spondylolisthesis who had undergone either of the surgery techniques: posterolateral fusion [PLF] or posterior lumbar interbody fusion [PLIF]

Methods and Materials/Patients: in a prospective observational study, 102 surgical candidates with low grade degenerative and isthmic spondylolisthesis were enrolled from 2012 to 2014. The observed patients were into two groups: PLF and PLIF. Assessing of pain has been done by a questionnaire using Visual Analogue Scale [VAS] scores. The questionnaire was completed by all patients before surgery, the day after surgery, after six months and after one year

Results: there were no statistically significant differences in terms of age and sex distribution, type of spondylolisthesis and pre-operation pain between groups [p>0.05]. Comparison of the mean VAS scores of two groups over the whole study period showed a significant statistical difference [p-value<0.05], although comparison of VAS at three points in time showed a mixed result. VAS scores showed no significant differences between two groups before surgery, the day after surgery and one year after surgery [p>0.05], but the difference of mean VAS scores between groups 6 months after surgery was statistically significant [p<0.05]. Analyzing the course of VAS scores over the study period showed a descending pattern for either of the groups [p<0.0001]

Conclusion: both surgical fusion techniques [PLF and PLIF] showed to be effective in treating low grade degenerative and isthmic spondylolisthesis, but PLIF was related to better outcome with respect to pain control

Investigation of surgery characteristics in patents with spondylolisthesis, Rasht, Iran from 2006 to 2011

Background and Aim: spondylolisthesis is a visible deformity in lumbosacral region with vertebral slip and fracture or other deformities of pars interarticularis. This study aims at investigating the characteristics of spondylolisthesis surgery in operated patients

Methods and Materials/Patients: this is a retrospective study which included all the patients who had undergone spondylolisthesis surgery by one same surgeon from 2006 to 2011. Demographic characteristics such as age, gender, and surgery information including type of spondylolisthesis, incision site, laminectomy site, foraminotomy site, fixation site of vertebra and site of vertebral disc evacuation were collected. The data were analyzed using SPSS [Version16]

Results: 52 of 63 enrolled patients were women [82.5%] and 11 men [17.5%] with mean age of 49.6 years. Based on frequency, spondylolisthesis types were 60 degenerative [95.2%], 2 post-surgical [3.2%] and 1 post-traumatic [1.6%], respectively. 58 patients had spondylolisthesis only in one vertebra and 5 patients in two vertebrae. The total number of slipped vertebrae was 68, in which slip was seen in L3, L4 or L5 vertebrae. In 42 patients, laminectomy was performed only in one vertebra, in 19 patients in two vertebrae, in 1 patient in three vertebrae and in 1 patient in five vertebrae. The total number of vertebrae with foraminotomy was 106. The highest frequency of foraminotomy was seen in L5, L4, and S1 vertebrae, respectively. Except in one case, the rest 62 patients underwent fixation surgery in two or three vertebrae

Conclusion: based on the results, the frequency of spondylolisthesis was approximately five times in women compared to men. The most common type was degenerative spondylolisthesis. Type of surgery was fixation with pedicle screw and fusion

role of surgical treatment in traumatic subdural hygroma: a pilot study

Background and Aim: traumatic subdural hygroma is the accumulation of CSF [cerebrospinal fluid] in subdural space following head trauma. The mass effect of hygroma on brain can impinge on consciousness. There are still many ambiguities on indications of hygroma surgery. This is an 11-year follow-up study which involves the patients suffering traumatic subdural hygroma who underwent surgery

Methods and Materials/Patients: in this retrospective study, clinical records of 16 patients who were operated due to traumatic subdural hygroma were studied. The data from existing records in the hospital were collected and analyzed. They were then analyzed by Repeated Measures ANOVA using SPSS [Version 18]. The differences were considered statistically significant at P

Results: in this study, there were 13 men [81.3%] and 3 women [18.7%] [Mean age=62 years old]. In 87.75% of patients, hygroma was diagnosed 6 days after head injury. It wasunilateral in majority of patients [56.3%] and located in fronto-parietal area [81.3%]. The most frequent concomitant injuries were contusions [25%] and subarachnoid hemorrhage [18.8%], respectively. GCS trend on admission and at discharge was significantly different fromthat of hygroma formation [P<0.05]. One-fourth of patients had recurrence of hygroma after surgery. All patients [except one] had good outcome

Conclusion: subdural hygroma is a delayed lesion and surgical treatment improves the level of consciousness [LOC] in afflicted patients

Microscopic transsphenoidal surgery for pituitary adenomas in children and adolescents

Background and Aim: we described the presentation, management and subsequent treatment outcomes of children and adolescents diagnosed with a pituitary adenoma in a joint neuroendocrine setting followed up by a single service as well as assessing long-term outcomes in terms of endocrine status and neurology symptoms

Methods and Materials/Patients: a total of 21 participants with histologically verified pituitary adenoma between January 2011 and June 2014 were studied. Patients' data from clinical, radiological and pathological records were analyzed using SPSS [Version 16]

Results: all these children and adolescents with pituitary adenomas were managed with microscopic transsphenoidal surgery. The most common symptom was Cushing [47.6%, n=10]. The functional type [76.2%, n=16] was more than the non-functional. The post-operative control MRI of most of them was clear [90.5%, n=19]. The lab control of most of them was normal [76.2%, n=16]. Apoplexy was seen in 5 patients [33.8%]. Gross-total resection [GTR; 100% tumor removal as judged by early post-operative imaging] was achieved in 19 cases. Only one of these patients showed evidence of radiologic recurrence

Conclusion: in our study, all patients underwent microscopic transsphenoidal surgery due to limitation of endoscopic approach in pediatric and avoided wide anatomical deficit. Doing a comparative study between these two approaches will bring about promising results

Glioblastoma multiforme: a signal hospital experience

Background and Aim: glioblastoma multiforme [GBM], the highest grade glioma [grade IV], is the most malignant form of astrocytoma in adults. This study aimed at evaluating the relationship between demographic, clinical and medical factors with GBM outcome

Methods and Materials/Patients: through a cross-sectional design, 58 patients with newly diagnosed GBM were studied from 1999 to 2015 in Guilan province [North of Iran]. Demographic, clinical and medical data including age, gender, score of Karnofsky Performance Scale [KPS], status at discharge, extent of resection [EOR] and administration of post-operative radio-chemotherapy were recorded in an individual questionnaire. The data were analyzed using chi-square and fisher exact tests

Results: of all patients, 35 [60.3%] cases were men and 23 [39.7%] were women. Age range [at the time of diagnosis of GBM] was 18-82 years [54.86+/-16.34]. The most common side and location of tumor were left hemisphere and frontal lobe, respectively. 41 patients [70.7%] received total surgical resection. Half of patients were treated with simultaneous post-operative radiation therapy and chemotherapy.11 [19%] of all cases died. About 41 [70.6%] of patients demonstrated KPS 50-70

Conclusion: GBM is a frequent malignant brain tumor with male predominance and high occurrence in age range of ?50 years. The number of dead patients increases with decreased KPS. Total surgical resection followed by concomitant radiation therapy and chemotherapy were common standard therapeutic regimens

Epidemiology of pediatric head trauma in Guilan

Head injury [HI] is preventable and knowledge of the epidemiology of children's HI is essential for developing preventive strategies. The aim of this study was to survey pediatric HI patients admitted to emergency wards at Poursina Hospital in Rasht, Iran, from 2009 to 2010, and to identify the cause of HI in these children. In this retrospective study, all HI patients under the age of 18 who were admitted to emergency wards between March 2009 and March 2010 were enrolled in the study. Demographic, etiologic, and injury data were collected and a descriptive analysis was performed. A total of 668 patients were included in this study. The mean age was 10.4 +/- 5.3 years. The most frequent cause of HI was traffic accidents. The mean Glasgow Coma Scale [GCS] score was 14.5 +/- 1.6. The ratio of boys to girls was approximately 3 to 1. The ratio of boys to girls increased with increasing age [P < 0.01]. Moreover, an association was found between age at injury and etiology of HI as well as a significant association between age at injury and the place of event [P < 0.01]. The incidence of childhood HI due to traffic accidents is high [81% of pediatric trauma cases]. Thus, motorcyclist education and improvement in traffic engineering for pedestrians and bicyclists should be included in prevention programs