Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Thoracic injuries are responsible for 25% of deaths of blunt traumas. Chest X-ray (CXR) is the first diagnostic method in patients with blunt trauma. The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT) in hemodynamically stable patients with blunt chest trauma.</p><p><b>METHODS</b>Study was conducted at the emergency department of Sina Hospital from March 2011 to March 2012. Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included. All patients underwent the same diagnostic protocol which consisted of physical examination, CXR and CT scan respectively.</p><p><b>RESULTS</b>Two hundreds patients (84% male and 16% female) were included with a mean age of (37.9+/-13.7) years. Rib fracture was the most common finding of CXR (12.5%) and CT scan (25.5%). The sensitivity of CXR for hemothorax, thoracolumbar vertebra fractures and rib fractures were 20%, 49% and 49%, respectively. Pneumothorax, foreign body, emphysema, pulmonary contusion, liver hematoma and sternum fracture were not diagnosed with CXR alone.</p><p><b>CONCLUSION</b>Applying CT scan as the first-line diagnostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome.</p>

Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA) cardiac arrest and predicting the resuscitation outcomes.</p><p><b>METHODS</b>In this prospective interventional study, patients presenting with PEA cardiac arrest were randomized into two groups. In Group A, ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity, right ventricle dilation, left ventricle function, pericardial effusion/tamponade and IVC size along with the advanced cardiac life support (ACLS) protocol. Patients in Group B solely underwent ACLS protocol without applying echocardiography. The presence or absence of mechanical ventricular activity (MVA) and evidences of PEA reversible causes were recorded. The return of spontaneous circulation (ROSC) and death were evaluated in both groups.</p><p><b>RESULTS</b>One hundred patients with the mean age of (58+/-6.1) years were enrolled in this study. Fifty patients (Group A) had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR). Among them, 7 patients (14%) had pericardial effusion, 11 (22%) had hypovolemia, and 39 (78%) were revealed the presence of MVA. In the pseudo PEA subgroup (presence of MVA), 43% had ROSC (positive predictive value) and in the true PEA subgroup with cardiac standstill (absence of MVA), there was no recorded ROSC (negative predictive value). Among patients in Group B, no reversible etiology was detected. There was no significant difference in resuscitation results between Groups A and B observed (P equal to 0.52).</p><p><b>CONCLUSION</b>Bedside echocardiography can identify some reversible causes of PEA. However, there are no significant changes in survival outcome between the echo group and those with traditional CPR.</p>

[Assessment of emergency department with emergency medicine specialists regard to ministry of health standards in Tehran]

Emergency Departments [ED] are the heart of hospitals and they have unique and essential position in health care systems. In ED, the actions should be fast, high quality and effective. So we decided to evaluate the ED in which the Emergency Medicine attending and residents are working and compare the ED with Ministry of Health standards. in this descriptive cross-sectional study, 7 governmental hospitals in Tehran which had Emergency Medicine residents and specialists system assesed and compared with standards of Ministry of Health. The SPSS software was used for analysis. Frequency tables and bar chart were achieved by this software. Considering the 19 main factors, 91.85% of standards were protected. In one of the hospitals the whole standards were protected and the lower rate of protection was 75 per cent. Three parameters [clerk WC, medical documents and emergency drugs] were perfect in all of hospitals but isolation room and physical architecture gained lower rate. [71.4 and 80.71 per cent respectively]. With regard to Ministry of Health standards, it seems the conditions of EDs are favorable but these standards are not perfect and should be revised. Also application of Emergency Medicine specialty in ED might result in improvement of standards

Evaluating clinical abdominal scoring system in predicting the necessity of laparotomy in blunt abdominal trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVES</b>Trauma is among the leading causes of death. Medical management of blunt abdominal trauma (BAT) relies on judging patients for whom laparotomy is mandatory. This study aimed to determine BAT patients'signs, as well as paraclinical data, and to clarify the accuracy, sensitivity, specificity, positive and negative predictive value of clinical abdominal scoring system (CASS), a new scoring system based on clinical signs, in predicting whether a BAT patient needs laparotomy or not.</p><p><b>METHODS</b>Totally 400 patients suspected of BAT that arrived at the emergency department of two university hospitals in Tehran from March 20, 2007 to March 19, 2009 were included in this study. They were evaluated for age, sex, type of trauma, systolic blood pressure, Glasgow coma scale (GCS), pulse rate, time of presentation after trauma, abdominal clinical findings, respiratory rate, temperature, hemoglobin (Hb) concentration, focused abdominal sonography in trauma (FAST) and CASS.</p><p><b>RESULTS</b>Our measurements showed that CASS had an accuracy of 94%, sensitivity of 100%, specificity of 88%, positive predictive value of 90% and negative predictive value of 100% in determining the necessity of laparotomy in BAT patients. Moreover, in our analysis, systolic blood pressure, GCS, pulse rate, Hb concentration, time of presentation after trauma, abdominal clinical findings and FAST were also shown to be helpful in confirming the need for laparotomy (P less than 0.05).</p><p><b>CONCLUSION</b>CASS is a promising scoring system in rapid detection of the need for laparotomy as well as in minimizing auxiliary expense for further evaluation in BAT patients, thus to promote the cost-benefit ratio and accuracy of diagnosis.</p>