Incidence and pattern of traumatic spine injury in a single level I trauma center of southern Iran / 中华创伤杂志(英文版)

PURPOSE@#Spine injury is one of the leading causes of death and mortality worldwide. The objective of this study was to determine the incidence, pattern and outcome of trauma patients with spine injury referred to the largest trauma center in southern Iran during the last 3 years.@*METHODS@#This is a cross-sectional study conducted between March 2018 and June 2021 in the largest trauma center in the southern Iran. The data collection form included the age, sex, injury location (cervical, thoracic, and lumbar), cause of injury (traffic accidents, falls, and assaults), length of hospital stay, injured segment of spine injury, severity of injury, and outcome. Statistical analyzes were performed using SPSS software version 24.@*RESULTS@#Totally 776 cases of spine injury were identified. The spine injury rate was 17.0%, and the mortality rate was 15.5%. Cervical spine injury (20.4%) more often occulted in motorcycle accident, and thoracic spine injury (20.1%) occulted in falls. The highest and lowest rates of spine injurys were related to lumbar spine injury (30.2%) and cervical spine injury (21.5%), respectively. There was a statistically significant relationship between the mechanism of injury and the location of spine injury (p < 0.001). And patients with lumbar spine injury had the highest mortality rate (16.7%). Injury severity score (OR= 1.041, p < 0.001) and length of stay (OR = 1.018, p < 0.001) were strong predictors of mortality in trauma patients with spine injury.@*CONCLUSION@#The results of the study showed that the incidence of traumatic spine injury rate was approximately 17.0% in southern of Iran. Road traffic injury and falls are the common mechanism of injury to spine. It is important to improve the safety of roads, and passengers, as well as work environment, and improve the quality of cars. Also, paying attention to the pattern of spine injury may assist to prevent the missing diagnosis of spine injury in multiple trauma patients.

Investigating the prevalence of and predictive and risk factors for pulmonary embolism in patients with COVID-19 in Nemazee Teaching Hospital

Background@#Pulmonary thromboembolism (PTE) is a significant contributing factor to vascular diseases.This study aimed to determine the prevalence of pulmonary thromboembolism and its predisposing factors in patients with COVID-19. @*Methods@#This cross-sectional study included 284 patients with COVID-19 who were admitted to Nemazee Teaching Hospital (Shiraz, Iran) between June and August 2021. All patients were diagnosed with COVID-19 by a physician based on clinical symptoms or positive polymerase chain reaction (PCR) test results. The collected data included demographic data and laboratory findings. Data were analyzed using the SPSS software. P ≤0.05 was considered statistically significant. @*Results@#There was a significant difference in the mean age between the PTE group and non-PTE group (P=0.037). Moreover, the PTE group had a significantly higher prevalence of hypertension (36.7% vs. 21.8%, P=0.019), myocardial infarction (4.5% vs. 0%, P=0.006), and stroke (23.9% vs. 4.9%, P =0.0001). Direct bilirubin (P =0.03) and albumin (P =0.04) levels significantly differed between the PTE and non-PTE groups. Notably, there was a significant difference in the partial thromboplastin time (P =0.04) between the PTE and non-PTE groups. A regression analysis indicated that age (OR, 1.02; 95% CI, 1.00‒1.004; P =0.005), blood pressure (OR, 2.07; 95% CI, 1.12‒3.85; P=0.02), heart attack (OR, 1.02; 95% CI, 1.28‒6.06; P =0.009), and albumin level (OR, 0.39; 95% CI, 0.16‒0.97; P =0.04) were all independent predictors of PTE development. @*Conclusion@#Regression analysis revealed that age, blood pressure, heart attack, and albumin levels were independent predictors of PTE.

Mortality Prediction from Hospital-Acquired Infections in Trauma Patients Using an Unbalanced Dataset / 대한의료정보학회지

Objectives@#Machine learning has been widely used to predict diseases, and it is used to derive impressive knowledge in the healthcare domain. Our objective was to predict in-hospital mortality from hospital-acquired infections in trauma patients on an unbalanced dataset. @*Methods@#Our study was a cross-sectional analysis on trauma patients with hospital-acquired infections who were admitted to Shiraz Trauma Hospital from March 20, 2017, to March 21, 2018. The study data was obtained from the surveillance hospital infection database. The data included sex, age, mechanism of injury, body region injured, severity score, type of intervention, infection day after admission, and microorganism causes of infections. We developed our mortality prediction model by random under-sampling, random over-sampling, clustering (k-mean)-C5.0, SMOTE-C5.0, ADASYN-C5.5, SMOTE-SVM, ADASYN-SVM, SMOTE-ANN, and ADASYN-ANN among hospital-acquired infections in trauma patients. All mortality predictions were conducted by IBM SPSS Modeler 18. @*Results@#We studied 549 individuals with hospital-acquired infections in a trauma hospital in Shiraz during 2017 and 2018. Prediction accuracy before balancing of the dataset was 86.16%. In contrast, the prediction accuracy for the balanced dataset achieved by random under-sampling, random over-sampling, clustering (k-mean)-C5.0, SMOTE-C5.0, ADASYN-C5.5, and SMOTE-SVM was 70.69%, 94.74%, 93.02%, 93.66%, 90.93%, and 100%, respectively. @*Conclusions@#Our findings demonstrate that cleaning an unbalanced dataset increases the accuracy of the classification model. Also, predicting mortality by a clustered under-sampling approach was more precise in comparison to random under-sampling and random over-sampling methods.

What factors affect length of hospital stay among trauma patients? A single-center study, Southwestern Iran / 中华创伤杂志(英文版)

PURPOSE@#Trauma is a major health concern. Length of hospital stay (LOS) has been targeted as an important metric to assess trauma care. This study aims to evaluate the risk factors that affect LOS among trauma patients in a trauma center in Southwestern Iran.@*METHODS@#This cross-sectional study was conducted on patients admitted to Rajaee Trauma Center, Shiraz, Iran between January 1, 2018 and December 30, 2018. The inclusion criteria were age above 15 years and having traffic accident injuries, including car, motorcycle and pedestrian injury mechanisms. The exclusion criteria were existing diseases including cardiovascular, cerebral, renal, and pulmonary diseases prior to this study, dead upon arrival or within 48 h after admission, and stay at the hospital for less than 6 h. The risk variables analyzed for prolonged LOS were age, gender, mechanism of traffic accident injury, infection during hospital stay, type of injury, injury severity score, surgery during hospitalization, and survival. Poisson regression was performed to evaluate the partial effects of each covariate on trauma hospitalization (≥3 days as longer stay).@*RESULTS@#This study was conducted on 14,054 patients with traffic accident injury and the mean age was (33.89 ± 15.78) years. Additionally, 74.35% of the patients were male, with male to female ratio of 2.90. The result of Poisson regression indicated that male patients, higher age, combination of thoracic injuries, onset of infected sites, and surgery patients were more susceptible to have a longer LOS. Considering the site of injury, patients with face injuries followed by those with thorax injuries had the highest means of LOS (3.74 days and 3.36 days, respectively). Simultaneous existence of surgical intervention and infection in a patient had the greatest impact on prolonged LOS.@*CONCLUSION@#This study identified that age, gender, mechanism of injury, infection, type of injury, survival, and ISS could lead to prolongation of LOS, but the affect can be reduced by eliminating modifiable risk factors.

Severity and injury characteristics among matched hospitalized motorcycle drivers and their passengers / 中华创伤杂志(英文版)

PURPOSE@#After car accident, motorcycle accident ranks as the second leading cause of traffic fatality in Iran. This study aimed to compare the severity and clinical presentations between drivers and passengers under the same injury circumstance.@*METHODS@#This study was conducted in the trauma center of Shiraz, Iran in 2017. Data on demographics, triage level, blood pressure, respiratory rate, Glasgow coma scale (GCS), injured body region, injury severity score (ISS), revised trauma score (RTS), and result of accident were compared between pairs of drivers and passengers. The agreement of any type of injury between drivers and passengers evaluated by Kappa test.@*RESULTS@#This study included 143 matched pairs of drivers and passengers. Most of the pairs (84.5%) did not use helmet and 77.2% of the riders do not have driving license. ISS was significantly higher in drivers than passengers. In the unmatched pairs, drivers and passengers showed no difference in sustaining injuries in the face, head & neck, chest and soft tissue, but drivers were found more likely to suffer from injuries in the abdomen, extremities, pelvis and spine than passengers. Once one part of the matched pair suffered injury in the head & neck, face, chest, abdomen, extremities and soft tissue & skin injury, the probability that the other part had an injury in the same region was 50%, 9%, 13%, 7%, 22% and 34% respectively. Kappa value for these body regions was 0.006, 0.009, -0.006, 0.068, 0.063 and 0.001, respectively, which was significant in abdomen and extremities.@*CONCLUSION@#Although drivers had higher level of injury severity and some different injury distributions, we recommend equal treatment to drivers and passengers. We also recommend related authorities to develop policies on helmet use, driving license and third-party insurance.

A study of mortality risk factors among trauma referrals to trauma center, Shiraz, Iran, 2017 / 中华创伤杂志(英文版)

PURPOSE@#Trauma is well known as one of the main causes of death and disability throughout the world. Identifying the risk factors for mortality in trauma patients can significantly improve the quality of care and patient outcomes, as well as reducing mortality rates.@*METHODS@#In this retrospective cohort study, systematic randomization was used to select 849 patients referred to the main trauma center of south of Iran during a period of six months (February 2017-July 2017); the patients' case files were evaluated in terms of demographic information, pre- and post-accident conditions, clinical conditions at the time of admission and finally, accident outcomes. A logistic regression model was used to analyze the role of factors affecting mortality among subjects.@*RESULTS@#Among subjects, 60.4% were in the age-group of 15-39 years. There was a 10.4% mortality rate among patients and motor-vehicle accidents were the most common mechanism of injury (66.7%). Aging led to increased risk of fatality in this study. For each unit increase in Glasgow coma scale (GCS), risk of death decreased by about 40% (odds ratio (OR) = 0.63, 95% confidence interval (CI): 0.59-0.67). For each unit increase in injury severe score (ISS), risk of death increased by 10% (OR = 1.11%, 95% CI: 1.08-1.14) and for each unit increase in trauma revised injury severity score (TRISS), there was 18% decrease in the risk of fatality (OR = 0.82, 95% CI: 0.71-0.88).@*CONCLUSION@#The most common cause of trauma and the most common cause of death from trauma was traffic accidents. It was also found that an increase in the ISS index increases the risk of death in trauma patients, but the increase in GCS, revised trauma score (RTS) and TRISS indices reduces the risk of death in trauma patients. The TRISS indicator is better predictor of traumatic death than other indicators.

Risk factors of mortality in nosocomial infected traumatic patients in a trauma referral center in south of Iran / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Trauma-related injuries are the leading cause of death worldwide. Some risk factors make traumatic patients susceptible to infection. Furthermore, some mortality risk factors, including length of hospitalization and increasing age, were detected in non-traumatic infected patients. This study aimed to assess mortality risk factors among nosocomial infected traumatic patients in Rajaee trauma center, Shiraz, Iran.</p><p><b>METHODS</b>This prospective cohort study was conducted during a period of 2 years since April 2015 to March 2017 in Rajaee hospital, which is the center of emergency medical services for traumatic injuries in Shiraz, Iran. Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance system criteria were applied to define 5 types of nosocomial infections. The variables analyzed as the risk factors of infection and mortality included sex, age, mechanism of injury, site of injury, injury severity score (ISS), surgical intervention, length of hospitalization, intensive care unit (ICU) admission, and type of pathogen. Then, the incidence of nosocomial infection and also risk factors of mortality in traumatic patients were evaluated. All data analyses were performed using the statistical package for social sciences, version 15 (SPSS Inc., Chicago) and p ≤ 0.05 is considered to be statistically significant.</p><p><b>RESULTS</b>The incidence of nosocomial infection was 7.2% (p < 0.001). Pneumonia was the most common type of infection detected in our study. Infection led to a 7.8-fold increase in mortality of the traumatic patients (p < 0.001). Admission in intensive care units and old age were the main risk factors of mortality in infected traumatic patients. Old age, gunshot and motor vehicle accidents, trauma to extremities and abdomen, higher injury severity score, and prolonged hospitalization, made the traumatic patients more susceptible to infection.</p><p><b>CONCLUSION</b>The really high incidence of nosocomial infection in traumatic patients in Iran depends on some risk factors that should be considered. Also infection increases the mortality rate in the traumatic patients, which could be reduced by eliminating its risk factors.</p>

Analysis of risk factors with hospital mortality in pedestrian injured patients; A dataset analysis of a level-I trauma center in southern iran

Objective: To determine the indicators predicting the hospital mortality in pedestrian injured patients admitted to a level I trauma center in Southern Iran

Methods: This case control study was conducted in a Level-I trauma hospital in Shiraz. We selected all survived pedestrians who were admitted in the hospital with duration of admission more than 24 hours in one year from March 2016 to February 2017 as control group and compared with all non-survived pedestrian patients who expired in the hospital according to clinical from March 2012 to February 2017. Multiple logistic regression was performed to identify factors of hospital effect on pedestrian mortality and results expressed by Odds Ratios and their confidence intervals [CI] of 95%

Results: A total of 424 survived pedestrian injured patients were compare to 117 non-survived one. Their mean of survived and non-survived patients were 43.79]19.37 and 56.76]18.55 years respectively of which 361 [66.7%] and 180 [33.3%] were men and women, respectively. We found that the gender does not have any relation with hospital mortality [p=0.275]. Followed by, age is in relevance with mortality. Glasgow Coma Scale [GCS], Injury Severity Score [ISS], blood urea nitrogen [BUN], platelet [PLT], potassium [K] and hemoglobin [Hb] are significant factor which are associated with mortality. According to logistic analysis GCS 24 [p<0.001], thrombocytopenia <150,000 [p<0.001], and hypokalemia <3.5 [p=0.01] were independently associated with hospital mortality. Among them, GCS

Conclusion: The results suggest that GCS score, ISS, hemoglobin level, platelet count, BUN and potassium level might be independent factors associated with hospital mortality in pedestrian injured patients

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>

Epidemiology and outcome determinants of pedestrian injuries in a level I trauma center in southern Iran; a cross-sectional study

Objective: to epidemiologically assess the accidents and incidents in the injured pedestrians referred to Shahid Rajaee Hospital, Shiraz in order to provide basic preventive strategies and reduce injuries and fatalities caused by traffic accidents in pedestrians

Methods: this cross-sectional study was conducted on 5840 injured pedestrians referred to Shahid Rajaee Hospital, Shiraz from 2009 to 2014. The baseline characteristic including the demographic and clinical information, the mechanism of injury, injury severity score [ISS] and outcome determinants. We also recorded the outcome measures and the mortality. Multivariate logistic regression analysis was performed to investigate the factors related to mortality rate and Length of Stay [LOS] in hospital

Results: in our study, the history of 5840 injured pedestrians was analyzed. The mean age of the patients was 41.3219.21+/- years. Multivariate logistic regression indicated that mortality increased with age. Moreover, the odds of mortality was more in patients with Injury Severity Score [ISS] between 16 and 24 [OR: 12.94, 95% CI [3.78-32.66], p=0.001] and injuries in the head and neck [OR: 7.92, 95% CI [4.18-14.99], p=0.020]. LOS in hospital was also higher in patients with ISS>25 [OR: 16.65, 95%CI [10.68-25.96], p=0.001]

Conclusion: pedestrians have always been one of the most vulnerable road users. Our study indicated that the adverse consequences and mortalities in pedestrians increased with age. Hence, approaches are required to improve primary prevention programs and reduce deaths and injuries due to this major public health problem

performance of Trauma Research Centers of Iran during the past 10 years; a science monitor survey

Objective: To compare and evaluation of scores of trauma research center of Shiraz University of Medical Sciences in Iran with other trauma research centers in Iran

Methods: The assessment scores of each center were gathered from Iran medical research and Ministry of Health and Medical Education website. Each score is recorded in helical year which is defined from the 21[th] of March of every year until the 20[th] of March of the next. They are ranked and scored by knowledge production, capacity development, and research projects

Results: The total evaluation scores of the trauma research center of Iran's Universities of Medical Sciences have increased from establishment. The highest increase in assessment scores was related to Tehran Trauma Research Center. An upward trend was observed in the total indicators of knowledge production index of all the trauma research centers from 2001/2002 to 2011/2012. An ascending trend was showed in the published articles score of Shiraz and Kashan Trauma Research Centers through the recent years

Conclusion: The increasing trend in scores of trauma research centers in Iran indicated a significant role in the knowledge production but it is need to find barriers of research and doing interventional projects to promote trauma care and prevention

Diagnostic accuracy of magnetic resonance angiography for detection of intracranial aneurysms in patients with acute subarachnoid hemorrhage; a comparison to digital subtraction angiography

Objectives: To determine the diagnostic accuracy of magnetic resonance angiography [MRA] compared to intra-arterial digital subtraction angiography [DSA] in detection of intracranial aneurysms in those suffering from acute subarachnoid hemorrhage [SAH]

Methods: This observational diagnostic study was performed at a tertiary teaching hospital and reference center in Shiraz, Iran. We included 55 patients who presented to our center with the diagnosis of acute SAH. All the patients underwent MRA and DSA during their hospital course in order to detect the intracranial aneurysms. The time-of-flight MRA protocol was used and the results were compared to the results of DSA as the gold standard test. Sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] were calculated for MRA

Results: The mean age of the patients was 46.3 +/- 7.9 including 26 [47.3%%] men and 29 [52.7%] women. In 46 patients, 51 intracranial aneurysms were diagnosed by DSA [5 patients had two aneurysms]. No evidence of intracranial aneurysm was found in 9 patients with subarachnoid hemorrhage. MRA correctly identified 42 of the 51 aneurysms [sensitivity 82%] and missed 9 small aneurysms [less than 10 mm]. MRA revealed one false-positive finding, resulting in a specificity of 88.8%. The PPG and NPV for MRA were 97% and 47%, respectively. The diagnostic accuracy per aneurysm was 0.83 for MRA

Conclusion: High sensitivity and specificity of MRA compared to DSA in diagnosis of intracranial aneurysms in those with acute SAH indicate that MRA could be reliably used as a diagnostic tool for this purpose. However we cannot recommend it as a routine substitute for DSA before surgery

Point prevalence and risk factors of hospital acquired infections in a cluster of university-affiliated hospitals in Shiraz, Iran

Hospital-acquired infections [HAIs] are critical and mostly preventable complications that occur in hospitalized patients and lead to major health and economic burdens. Most of the information on HAI risk factors and the recommended preventive measures is based on data acquired from only a few countries. The aim of this point prevalence HAI study conducted in Shiraz, Iran, was to study the local epidemiology of HAIs and the major risk factors for acquiring HAIs in a Middle-Eastern region. The study employed four identical point prevalence surveys in eight university hospitals, each consisting of 60-700 beds. The study was conducted during all four season of 2008-2009. All of the patients admitted for >/= 48 h were studied, although the patients admitted to emergency wards were excluded. A standardized data collection form that included name, age, gender, presence or absence of HAI, administration of any antibiotics, insertion of a central line, use of an endotracheal tube, mechanical ventilation, and use of an urinary catheter was completed for each patient. The HAI definitions used in this study were based on the US National Nosocomial Infection Surveillance [NNIS] guidelines. Data from 3450 patients were prospectively collected and analyzed. The overall HAI prevalence was 9.4%. The most common HAIs were blood stream infections [2.5%], surgical site infections [2.4%], urinary tract infections [1.4%], and pneumonia [1.3%]. A logistic regression analysis showed that the odds ratio OR for males rather than females acquiring infections was 1.56 [95% confidence interval [CI] 1.21-2.02]. Other HAI risk factors included using a central intravascular catheter, adjusted OR of 3.86 [95% CI 2.38-6.26], and using an urinary catheter, adjusted OR of 3.06 [95% CI 2.19-4.28]. Being admitted to an ICU was not an independent HAI risk factor. For all HAIs, the OR of acquiring infection was 3.24 [95% CI 2.34-4.47] in the patients with hospital stays longer than eight days. A high discrepancy between HAIs and antibiotic use was observed. Antibiotics were administered to 71% of the patients, but only 9.4% of the patients also had at least one documented infection. This point prevalence study showed that HAIs are frequent in Shiraz university hospitals, and that the proportion of patients receiving antibiotics is high. The results imply that more primary prevention efforts are necessary to address HAIs associated with using indwelling devices and to prevent surgical site infections