Comparison of chest CT scan findings between COVID-19 and pulmonary contusion in trauma patients based on RSNA criteria: Established novel criteria for trauma victims / 中华创伤杂志(英文版)

PROPOSE@#In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.@*METHODS@#All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP.@*RESULTS@#In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP.@*CONCLUSION@#We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.

Do clinical and paraclinical findings have the power to predict critical conditions of injured patients after traumatic injury resuscitation? Using data mining artificial intelligence / 中华创伤杂志(英文版)

PURPOSE@#The triage and initial care of injured patients and a subsequent right level of care is paramount for an overall outcome after traumatic injury. Early recognition of patients is an important case of such decision-making with risk of worse prognosis. This article is to answer if clinical and paraclinical signs can predict the critical conditions of injured patients after traumatic injury resuscitation.@*METHODS@#The study included 1107 trauma patients, 16 years and older. The patients were trauma victims of Levels I and II triage and admitted to the Rajaee (Emtiaz) Trauma Hospital, Shiraz, in 2014-2015. The cross-industry process for data mining methodology and modeling was used for assessing the best early clinical and paraclinical variables to predict the patients' prognosis. Five modeling methods including the support vector machine, K-nearest neighbor algorithms, Bagging and Adaboost, and the neural network were compared by some evaluation criteria.@*RESULTS@#Learning algorithms can predict the deterioration of injured patients by monitoring the Bagging and SVM models with 99% accuracy. The most-fitted variables were Glasgow Coma Scale score, base deficit, and diastolic blood pressure especially after initial resuscitation in the algorithms for overall outcome predictions.@*CONCLUSION@#Data mining could help in triage, initial treatment, and further decision-making for outcome measures in trauma patients. Clinical and paraclinical variables after resuscitation could predict short-term outcomes much better than variables on arrival. With artificial intelligence modeling system, diastolic blood pressure after resuscitation has a greater association with predicting early mortality rather than systolic blood pressure after resuscitation. Artificial intelligence monitoring may have a role in trauma care and should be further investigated.

Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran / 中华创伤杂志(英文版)

PURPOSE@#Traumatic hemorrhagic shock is a life-threatening event worldwide. Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α, IL-1. The primary treatment in these cases is hydration with crystalloids, which has both benefits and complications. The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics, coagulation profiles, and blood gases in such patients.@*METHODS@#In this cross-sectional study, patients were divided into two groups: femoral fracture group and non-femoral group. The hemodynamic status, coagulation profile, and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later. Data were analyzed by t-test and ANOVA with repeated data and paired samples t-test.@*RESULTS@#A total of 681 trauma patients (605 men and 76 women) participated in this study, including 69 (86.3%) men and 11 (13.8%) women in femoral fracture group and 536 men (89.2%) and 65 women (10.8%) in non-femoral group. The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later. Blood gases decreased in the fracture group despite fluid therapy (p < 0.003), and the coagulation profile worsened although the change was not statistically significant.@*CONCLUSION@#The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine. If there is evidence of clinical shock, excessive crystalloid infusion (limited to 1 L) should be avoided, and blood and blood products should be started as soon as possible.

predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness: the experience of a resource-limited centre

Objective: To determine the predictive value of repeated abdominal ultrasonography in patients with multiple trauma and decreased level of consciousness [LOC]

Methods: This prospective cross-sectional study was conducted over a six-month period at Shahid Rajaee Trauma Hospital, Shiraz, Iran. We included hemodynamically stable blunt abdominal trauma patients with a decreased LOC [Glasgow Coma Scale

Results: Overall 80 patients with mean age of 37.75 +/- 18.67 years were included. There were 17 [21.3%] women and 63 [78.8%] men among the patients. Compared with the CT-Scan, the first ultrasonography showed a sensitivity of 60%, specificity of 80%, PPV of 16.60%, NPV of 96.80%, and a diagnostic accuracy of 70%. The same values for the second ultrasonographic study were 80%, 79%, 20%, 98%, and 79%, respectively. In 4 [5%] patients whose first ultrasonography and CT scan results were negative, the second ultrasonography was positive for injury

Conclusion: In patients with blunt trauma to the abdomen, when the only indication of abdominal CT scan is a decreased LOC, two ultrasonographic studies can replace a CT imaging

Administration of intravenous infliximab for prevention of peritoneal adhesions formation in rats

Objectives: To investigate the effects of intravenous infliximab in preventing the formation of peritoneal adhesions in an animal model of rat

Methods: This was an experimental study being performed in animal laboratory of Shiraz University of Medical Sciences during 2012. Sixty albino rats were randomly assigned in to three groups by Random Design Method. The first group received single infliximab injection [n=20], the second one received double infliximab injection [n=20] and the third received nothing [n=20], after receiving intra-peritoneal injection of talc for induction of peritoneal adhesions. All the animals were sacrificed after 6 weeks and the peritoneal adhesions were evaluated according to Nair classification

Results: We observed that the mean adhesion grade was lower in those who received double dose of infliximib when compared to single dose and controls. However the difference did not reach a significant value [p=0.178]. The grade of peritoneal adhesion was also comparable between the three study groups [p=0.103]. The mean number of 1st WBC count was also comparable between three study groups [p=0.382]. We observed that 2 nd WBC count was also comparable between two study groups [p=0.317]

Conclusion: Administration of intravenous infliximab after intraabdominal surgicalprocedures would not prevent the formation of peritoneal adhesions in animal model of albino rat

Correlation between success rates of cardiopulmonary cerebral resuscitation and the educational level of the team leader; a cross-sectional study

Objectives: To determine the correlation between the success rates of the cardiopulmonary cerebral resuscitation [CPCR] and the team's leader education and skill level in Shiraz, southern Iran

Method: This cross-sectional study was conducted during a 6-month period from October 2007 to March 2008 in Nemazee hospital of Shiraz. We included all the patients who underwent CPCR due to cardiopulmonary arrest in emergency room of Nemazee hospital during the study period. We recorded the rates of return of spontaneous circulation [ROSC] and discharge rate [DR] of all the patients. The correlation between these two parameters and the team leader's education and skill level was evaluated

Results: Overall we included total number 600 patients among whom there were 349 men [58.1%] and 251 [41.8%] women with mean age of 58.9 +/- 42.6. We found that 270 [45.1%] patients had ROSC, while 330 [54.9%] patients died. Overall 18 [6.6%] patients were discharged from hospital [3% of all participants]. We found that the ROSC was significantly higher in those with specialist leader [anesthesiologist or pediatrician] when compared to those in whom CPCR was conducted by technicians [55.2% vs. 30.7%; p=0.001]

Conclusion: Conducting CPCR by persons with higher medical degrees resulted in higher rate of ROSC but not in more discharge rate. Inspite of the fact that the rate of ROSC following CPCR was closely analogous to that of developed countries, discharge rate was lower. This indicates that in our region, much more attention needs to be paid to post-resuscitation care and organizing training programs and to cover more resuscitation by CPCR team, conducted by the specialists

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