Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran / 中华创伤杂志(英文版)

PURPOSE@#Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries.@*METHODS@#The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset.@*RESULTS@#The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003).@*CONCLUSION@#Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.

National Spinal Cord Injury Registry of Iran (NSCIR-IR) - a critical appraisal of its strengths and weaknesses / 中华创伤杂志(英文版)

The National Spinal Cord Injury Registry of Iran (NSCIR-IR) is a not-for-profit, hospital-based, and prospective observational registry that appraises the quality of care, long-term outcomes and the personal and psychological burden of traumatic spinal cord injury in Iran. Benchmarking validity in every registry includes rigorous attention to data quality. Data quality assurance is essential for any registry to make sure that correct patients are being enrolled and that the data being collected are valid. We reviewed strengths and weaknesses of the NSCIR-IR while considering the methodological guidelines and recommendations for efficient and rational governance of patient registries. In summary, the steering committee, funded and maintained by the Ministry of Health and Medical Education of Iran, the international collaborations, continued staff training, suitable data quality, and the ethical approval are considered to be the strengths of the registry, while limited human and financial resources, poor interoperability with other health systems, and time-consuming processes are among its main weaknesses.

Road traffic deaths in Kashan region, Iran: An eight-year study (2006-2013) / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>The aim of this study was to analyze the trend of road traffic fatalities in Kashan Region, Iran, in a period of eight years.</p><p><b>METHODS</b>Through a cross-sectional study, all road traffic deaths classified under the V01V99 codes according to ICD-10 in Kashan region, central Iran, from March 2006 to March 2013 and population data were collected from the registration system of Kashan University of Medical Sciences. Years of lost life (YLL) and mortality rates were calculated regarding age, gender and year of the accident. Generalized linear model (GLM) with Poisson log-linear link was used to evaluate the effects of the mentioned variables on mortality rate.</p><p><b>RESULTS</b>During the period of the study (8 years), 928 people (767 men) died due to road traffic injuries (RTIs). The total YLL was 20,818. The mortality rate due to RTIs has been declined constantly from 43.1 in March 2006 to 21.1 per 100,000 in March 2013. The highest mortality rate was found in the age group of over 60 years old and the lowest in the age group of 0-14 years old. Both mortality rate and YLL was greater in men than in women. Poisson regression showed that age, gender and year of the accidents had a significant effect on mortality rate (p < 0.001).</p><p><b>CONCLUSION</b>Although there has been a constant decline of mortality rate in Kashan area within the study period, the value remains higher than the mean level of Eastern Mediterranean region and the global average, which is a notable fact for policymakers and authorities.</p>

Effects of pregabalin and gabapentin on postoperative pain and opioid consumption after laparoscopic cholecystectomy / 대한마취과학회지

BACKGROUND: Gabapentin and pregabalin are antiepileptic drugs that are also used for chronic pain treatment. This study evaluated the effects of pregabalin and gabapentin on postoperative pain in patients undergoing laparoscopic cholecystectomy. METHODS: A total of 108 candidates for elective laparoscopic cholecystectomy were randomly assigned to gabapentin (n = 36), pregabalin (n = 36), and placebo (n = 36) groups. Patients received 800 mg of gabapentin or 150 mg of pregabalin orally one hour before surgery. Postoperative analgesia was administered by pethidine via patient-controlled analgesia. The amount of opioid consumed, number of nausea events, vomiting, and pain scores at 2, 6, 12, and 24 hours after surgery were recorded. RESULTS: The gabapentin and pregabalin groups had significantly lower pain intensity than the placebo group, and pain intensity in the pregabalin group decreased more compared to the gabapentin group. The mean amount of pethidine consumption in the placebo group was significantly higher than in the gabapentin and pregabalin groups. CONCLUSIONS: A single dose of gabapentin or pregabalin decreased postoperative pain and nausea, as well as vomiting and opioid consumption after laparoscopic cholecystectomy. Moreover, the findings revealed that pregabalin was superior to gabapentin for reducing postoperative pain.

Knowledge discovery from patients' behavior via clustering-classification algorithms based on weighted eRFM and CLV model: an empirical study in public health care services

The rapid growing of information technology [IT] motivates and makes competitive advantages in health care industry. Nowadays, many hospitals try to build a successful customer relationship management [CRM] to recognize target and potential patients, increase patient loyalty and satisfaction and finally maximize their profitability. Many hospitals have large data warehouses containing customer demographic and transactions information. Data mining techniques can be used to analyze this data and discover hidden knowledge of customers. This research develops an extended RFM model, namely RFML [added parameter: Length] based on health care services for a public sector hospital in Iran with the idea that there is contrast between patient and customer loyalty, to estimate customer life time value [CLV] for each patient. We used Two-step and K-means algorithms as clustering methods and Decision tree [CHAID] as classification technique to segment the patients to find out target, potential and loyal customers in order to implement strengthen CRM. Two approaches are used for classification: first, the result of clustering is considered as Decision attribute in classification process and second, the result of segmentation based on CLV value of patients [estimated by RFML] is considered as Decision attribute. Finally the results of CHAID algorithm show the significant hidden rules and identify existing patterns of hospital consumers

Invading of intrauterine contraceptive device into the sigmoid colon through uterine perforation caused by a blunt trauma / 中华创伤杂志(英文版)

Intrauterine contraceptive device (IUCD) is relatively safe but still with some serious risks. Uterus perforation is rare and would be fatal. A case of Cu-7 IUCD invading into the sigmoid colon through uterine perforation caused by a pelvic blunt trauma was presented. Our case showed that uterus perforation by an IUCD could induce utero-sigmoid fistula which is likely to be missed. Imaging is required when the patients with IUCD present abdominal pain, particularly with a history of trauma.

A seven-year study on head injuries in infants, Iran---the changing pattern / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Head injury (HI) is the leading cause of mortality and life-long disability in infants. Infants have different anatomical and pathophysiological brain structures from other age groups. The aim of this study was to survey infant HI patients admitted to Shahid Behest Hospital in Kashan, Iran from 2004 to 2010, and to identify the causes of HIs in this age group.</p><p><b>METHODS</b>In this retrospective study, all HI patients under the age of two who were hospitalized for more than 24 hours between January 2004 and January 2010 were enrolled in the study. Demographic, etiologic, and injury data were collected and a descriptive analysis was performed.</p><p><b>RESULTS</b>Infants comprised 20.8% of all children (under 15 years old) with HIs and 65.1% of the injuries occurred in the home. Falls were the most common cause of injury (63.4%). In hospital mortality was 6.6 per 100 000 infants. A decreasing trend was seen in home events, but HIs caused by traffic accidents were increasing during the study period. The amount of HI infants resulting from car accidents has tripled from the years 2004 to 2010.</p><p><b>CONCLUSION</b>Although home events and falling are the main causes of infant HIs and need attention, our study showed an increase of HIs caused by road traffic accidents, especially by car accidents, thus legislation for the implementation of protective equipment such as child safety seats and programs is urgently needed.</p>

Epidemiology of livestock-related injuries in a major trauma center in Kashan, Iran / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Livestock-related injuries are one of the important factors causing morbidity and mortality in patients admitted to hospital. Treatment of these patients is still a major problem in health care system. The aim of current study was to assess the epidemiology of livestock-related injuries in a major trauma center in Iran from 2006 to 2011.</p><p><b>METHODS</b>In a prospective study, patients with livestock-related injuries who were consecutively admitted to the trauma center in Kashan, Iran between 2006 and 2011 were evaluated. The data collected included patient's demographics, place and nature of accident, damaged organ, educational level, transport and outcome. Data were expressed as mean +/- standard deviation.</p><p><b>RESULTS</b>A total of 129 patients were included in this study, accounting for 0.3% of all trauma admission (40 273 cases). The mean age was (55.27 +/- 14.45) years. Men were affected four times more than women. Falling down from livestock is the main mechanism of trauma in all groups. Upper and lower extremities were most frequently injured (n equal to 72), followed by the head, neck and spine (n equal to 33 for each). There was one death resulting from livestock-related injury in this study.</p><p><b>CONCLUSION</b>Despite the low incidence, livestock-related injuries can damage major organs of human body and therefore appropriate training program to increase the safety awareness in home and outdoor is very important.</p>

Epidemiology of pediatric burn injuries in Isfahan, Iran

Burns are major cause of death and disability worldwide, particularly in the developing countries. The aim of this study was to determine the incidence and causes of burns in children under the age of 15 years in Isfahan province, Iran. All children admitted to the burn center of Isfahan, the largest city in central Iran, between 2007 and 2009 were enrolled in this study. We analyzed the data on age, sex, location, cause and spread of the burn, duration of admission, and cause of mortality. Out of 2229 burn patients, 1014 [45.5%] were under the age of 15, indicating an annual incidence of 50 in 100,000 children. Of the 1014 patients, 610 [60%] were boys and 404 [40%] were girls; the male-to-female ratio was 1.5:1. Most of the patients were in the age range of 3 to 6 years. Scald was the most common type of burn injury [51.8%]. Six-hundred and sixty-eight cases [65.7%] were from urban areas, while 346 [34.3%] were from rural areas. Fifty-six patients [5.5%] died. Burn injury is a major health concern in the pediatric age group, and specific consideration and planning are required for its management

Simple and safe packing method for high-grade liver injuries

Injury to the liver is a commonly encountered problem in trauma cases and is a frequent cause of morbidity and mortality. Because gauze packing is easy to use and has the potential for rapid hemorrhage control, it is the most commonly used method for patients with severe liver injuries, particularly those with coagulopathy. In this study, OpSite sheets were used to make three-layer packs for decreasing the complication associated with removing gauze packing. Twenty male patients with grade IV or V liver injuries that required laparotomy were enrolled in the study. Ten patients were treated using conventional packing, while the other 10 were treated using the three-layer pack. In the case group, the liver was mobilized as much as possible. The three-layer pack was then placed at the site of liver damage and extended onto the liver surface, and the other pads were placed on top of this pad. After 72 h, reoperation was performed, the packs were removed, and the packs causing injury were recorded. Additionally, if rebleeding due to the adhesive bands of the pack was observed, the blood was suctioned and bleeding volume was measured. Data were analyzed using the Mann-Whitney test. Patients in the case and control groups were similar in age and admission vital signs. During the second operation, the bleeding volumes measured in the case and control groups were 66 +/- 27.01 mL and 152 +/- 85.4 mL, respectively. There was some padinduced damage after the removal of the pad in the control group. Our study has provided a simple and safe packing method for high-grade liver injuries