Original/Research Article


Introduction: Advanced cardiac resuscitation and treatment of cardiac arrest are important issues that emergency medical assistants should be fully acquainted with. The purpose of this project is to compare the two methods of face-to-face training and the use of messaging services (which have the ability to share audio and video, such as WhatsApp).


Methods: In this study, emergency medicine assistants were randomly divided into two groups for cardiopulmonary resuscitation training. The control group did the in-person training as a scenario design and in the second group the resuscitation training was done as a scenario design in the WhatsApp messenger group in absentia. Pre-test and post-test were performed from both groups. Test scores were calculated and statistically analyzed.


Results: Comparison of sexual frequency, comparison of mean year of residency, comparison of frequency of CPR, and mean age of the two groups did not show a significant difference. Also, the mean percentage of CPR test scores did not show a significant difference between the two groups before and after training. But the mean percentage of CPR test scores in the intervention group before and after training showed a significant difference. The mean percentage of CPR test scores in the control group before and after training was significantly different. Also, if we enter the post-test as a dependent variable and the two groups as an independent variable and the pre-test as covariance in the ANCOVA formula, there is a significant difference between the two groups in the post-test. (P-value = 0.002)


Discussion: Scenario-based education on adult resuscitation through group discussion with messaging software is more effective on assistants. For future studies, a study with a larger sample size over a longer period of time is recommended.

Evaluation of the Complaints of Inpatients’ Falling Down Referred to Fars Province General Administration of Forensic Medicine from 2013 to 2019

Aghdas Shadmehr, Alireza Doroudchi, Mohammad Zarenezhad, Zahra Zareie, Navid Kalani, Lohrasb Taheri

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e4
https://doi.org/10.22037/ijem.v9i1.37991

Introduction: Falling is one of the most common events that threats physical and psychological safety in patients, as well a factor that increases duration of hospitalization and treatment costs. Unfortunately, there is a little relatively evidence of reports of factors contributing to inpatient falls or the effectiveness of hospital fall prevention programs. Therefore, this study was conducted to determine the most important factors affecting complaints of hospital beds during treatment referred to forensic medicine in Fars province during the years from 2011 to 2019.


Material & Methods: This study was a descriptive cross-sectional and retrospective study. All cases of complaining of falling out of a hospital bed during treatment referred to forensic medicine in Fars province during the years from 2011 to 2019 were reviewed and the information contained in them was collected and recorded based on the prepared checklist. After collecting the data, the information was converted into a sheet code and analyzed by SPSS software version 21 and descriptive statistical aspirations.


Results: The results of the present study showed that more falls occurred in men and in the age group over 70 years. Also, most cases of bed falls occurred in the morning shift (45.9%) witnessed falls in the majority of cases, nurses (55.7%) and (55.7%) of patients after the fall alone was not able to ask.


Conclusion: Given the high rate of falling patients’ incidence, it is essential to offer effective management strategies to provide more safety situation for patients.

Assessment of the Relationship of Cranial and Facial Bone Fractures with Brain Consequences in Patients with Head Trauma Presenting to the Emergency Room of Pursina Educational & Medical Center From 2015 To 2017

Payman Asadi, Seyyed Mahdi Zia Ziabari, Behzad Zohrevandi, Ali Khalighi Sigarudi, {Enayatollah Homaei Rad, Sama Dabagh, Fatame Asadi Shekofti, Siamak Rimaz

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e5
https://doi.org/10.22037/ijem.v9i1.37917

Introduction: Traumatic brain injury is one of the leading causes of death and disability. Traumatic brain injuries have multifactorial injury mechanisms and are often associated with other injuries. A large proportion of patients who suffer from traumatic brain injury also have facial injuries. Due to the anatomical proximity of the face and skull, patients with facial injuries are expected to be at higher risk for brain injuries. The present study was performed with the aim of investigating the relationship between facial and cranial fractures and brain consequence in head trauma patients.


Methods: This is an analytical cross-sectional study. The study population consisted of patients with skull and facial injuries due to head trauma. Fractures of the skull and face were classified into two categories: mandibular and middle part of the face. Brain consequence was considered as intracranial concussion and injury. Age, sex, mechanism of trauma, time and type of fracture, associated clinical symptoms, and level of consciousness of patients were recorded. Data were analyzed using STATA software.


Results: Out of 1625 patients with head injuries, 958 (60%) suffered facial and skull fractures. 700 people (71%) suffered brain injuries following a head injury, of which only 29% had no brain consequences. 50% of brain outcomes following facial and cranial bone fractures together, cranial bone fractures accounted for 29%, and facial fractures accounted for 21% of total brain outcomes. Most patients had brain concussions. Local pain was the most common symptom (75.2%). Overall, 36% of all facial fractures and 88% of skull fractures resulted in brain outcome.


Conclusion: There is a direct relationship between cranial and facial bone fractures and brain consequences in head trauma patients and concussion was the most common brain outcome in these patients. Urgent and timely measures are required in patients with skull and facial bone fractures to reduce the consequences and brain damage.

Introduction: Today, paraclinical tests play an important role in diagnosis and treatment of trauma patients. The present study was performed with the aim of evaluating unnecessary requests for routine tests in patients with abdominal and chest trauma (ACT) in the emergency room of Besat Hospital in Hamadan, Iran.


Methods: In this cross-sectional study, 400 patients with ACT, referring to the emergency department of Besat Hospital in Hamadan in 2020, were selected using census method. Then the number and type of tests and their effect on disease outcome were examined. Data were analyzed using SPSS version 23 and Kruskal-Wallis and Spearman correlation coefficients.


Results: In the present study, the mean age of patients was 46.05±18.92 years, 75.5% were male and 24.5% were female. Frequency of essential tests (. 81.7% of the necessary tests and 94.8% of the unnecessary tests had yielded negative results. There was no significant relationship between the number of unnecessary tests requested and the type of trauma or day and shift of presentation to the department. But there was a significant relationship between the number of unnecessary tests requested and age, sex, length of hospital stay, and the final outcome (P <0.001).


Conclusion: In this study, requests for unnecessary tests was more than requests for necessary tests in patients with ACT. Planning to optimize the current system of requesting tests and collaboration between physicians and laboratory specialists can minimize the inadequacy of the tests.

Introduction: It remains a challenge to provide optimal sedation for patients on mechanical ventilation in ICU. Traditionally, Midazolam has been the most commonly administered sedative drug for ICU patients worldwide. Dexmedetomidine is a newer sedative used for ICU sedation having better hemodynamic stability and no respiratory depressant effect.


Methods: This was a parallel randomized, double-blind study. Study population was intensive care unit patients undergoing mechanical ventilation. All the 33 patients received 1 μg/kg IV dexmedetomidine over 10 minutes followed by a maintenance infusion of 0.5 μg/kg/h dexmedetomidine. After 24 hours patients received 0.05 mg/kg midazolam followed by a maintenance infusion of 0.1 mg/kg/h. The dosage of sedative was changed according to the outcome of maintaining a target sedation level of RASS  0 to -1. The cardiovascular and ABG parameters and quality of ventilation were measured at baseline, 12 and 24 hours after sedation.


Results: 28 patients (84.8%) were men and 5 (15.2) were women. The mean age of the patients was 36.12±69.74 years. Systolic blood pressure (P<0.005), diastolic blood pressure (P=0.003), mean arterial pressure (P=0.02) and heart rate (P=0.003) were significantly higher in Midazolam group at 24 hours. In addition, O2 saturation was significantly different between dexmedetomidine and midazolam at 12 hours (P=0.03) and 24 hours (P=0.001). ABG parameters were similar between two sedatives.


Conclusions: The results of this study showed that dexmedetomidine has better hemodynamic effects than midazolam. Also, the effects of dexmedetomidine and Midazolam on lung mechanics are the same.

Optimizing Service Provision Process in the Emergency Department Using Value Flow Mapping and Simulation; a Qualitative Study

Kamran Heidari, Mahmoud Reza Ahmadi, Mohammad Mehdi Forouzanfar, Behrooz Hashemi, Saeed Safari

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e10
https://doi.org/10.22037/ijem.v9i1.38410

Introduction: In addition to having high costs, making changes to any of the wards in medical centers requires legal coordination and accepting many risks to prevent a decline in quantity and quality of health care provision. The present study was performed with the aim of evaluating optimization of service provision in the emergency department (ED) using value flow mapping and simulation.


Methods: In the present qualitative study, initially, the processes in the ED of Shohadaye Tajrish hospital were drawn and a graphic model was built for simulating the processes. To perform simulation, in addition to the sequence of activities, the time required for each activity, waiting time, present resources, and etc. were extracted as the inputs of the simulation model. Then, after determining the mean time frames obtained, intended scenarios of the emergency team were executed on the simulated model so that the best scenario can be determined by comparing the outputs of each scenario.


Results: Based on the patient flow map, the patient’s journey in the ED begins from the first visit and continues until discharge. Stages such as asking for consultations or visits by other services, laboratory test requests, imaging requests, and asking for medications are passed during this time. Results of analyzing the flow of 60 patients showed that in this department, the mean time interval between first visit to first laboratory test was 58.5 minutes, mean interval between requesting the first laboratory test and its implementation was 28.4 minutes, mean interval between the first visit and computed tomography (CT) scan request was 45.8 minutes, mean interval between CT scan request and its performance was 16.3 minutes, mean interval between the first visit to asking for medication was 46.2 minutes, and, finally, mean interval between the first visit to discharge was 275 minutes (4 hours 35 minutes). The overall ED flow might be optimized through: having one senior nurse and physician for all patients in a supervision unit; having an information systems that makes observation of capacity and flow in the ED and all the hospital possible; having patient sites that are observable from central positions, while preserving privacy; easy access to acute care unit, radiology, and other acute care spaces; easy access to clinical history of patients from other hospitals and primary care.


Conclusion: It seems that solutions for improving health care provision for patients and increasing patient safety can be reached through drawing patient flow map in the ED and using smart modeling.

Comparison of Alvarado Score and Ultrasound Diagnostic Efficacy in the Case of Acute Appendicitis

Samiramis Pourmotabed, Hamed Mosavat, Abbas Moradi, رسول سلیمی

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e11
https://doi.org/10.22037/ijem.v9i1.36090

Introduction: Acute appendicitis is one of the most common causes of abdominal pain and is an emergency surgical procedure. Appropriate and early diagnosis of appendicitis followed by immidiate and proper action can significantly reduce its mortality rate and disability. Due to the high prevalence of negative appendectomy cases, the aim of present study was the comparison of Alvarado score and ultrasound diagnostic efficacy in the case of acute appendicitis


Methods: This cross-sectional study was performed on patients referred to the emergency department of Hamadan Besat hospital during 1397-1397 who underwent appendectomy with the final diagnosis of acute appendicitis. The data of this study were collected by file reading method and sampling was done using census method.  Extracted data from patients' records included signs and symptoms of clinical examination, laboratory findings, ultrasound results, and pathological findings after appendectomy. Alvarado score was calculated based on clinical and laboratory findings. The final result of Alvarado score and sonography was compared with the result of pathology report as the gold standard and the indices of sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated.


Results: Out of 100 patients studied, 51 were female and 49 were male. The mean age of patients was 24.24 ± 13.99 years. Compared with the pathology report, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Alvarado score in diagnosing acute appendicitis were 92.9%, 75.0%, 89.8%, 33.3% and 84.5%, respectively and for ultrasound were 0.60%, 50.5%, 89.5%, 15.0% and 58.8%, respectively.


Conclusion: The Alvarado score is very helpful in the clinical decisions of acute appendicitis in suspected patients and its diagnostic efficacy is higher than ultrasound. However, with the help of both diagnostic methods (Alvarado score and ultrasound), diagnostic accuracy may be increased.

Introduction: Reporting blood transfusion reactions in trauma patients is effective in better disease management. In this study, the rate of acute reactions related to blood transfusion in trauma patients receiving blood at Besat Educational and Medical Center in Hamadan was investigated.


Methods: In this cross-sectional study, by available sampling method, medical records of 245 trauma patients over 18 years old in Besat Hospital in Hamadan in 1399 in terms of history of allergic reactions, type of blood transfusion product, vital signs and .. Checked out. SPSS version 23 and paired t-test and Monte Carlo test were used to analyze the data. P. Value value <0.05 was considered significant.


Results: The mean age of the patients was 41.53 ± 17.34 years, 80% male, 20% female, 91% blunt trauma, 9% penetrating. Out of 245 patients, 13 (3.5%) had a reaction (3.7% allergy and 1.6% non-hemolytic fever). Mean temperature, systolic blood pressure, diastolic blood pressure and respiratory rate of trauma patients receiving blood were significantly increased and the number of pulses decreased before receiving blood. There was no significant relationship between blood transfusion response in trauma patients with the type of trauma, age of patients, gender, blood type, Rh and the presence or absence of disease.


Conclusion: Allergic reaction and non-hemolytic hemorrhage were the most common in trauma patients. It seems that therefore, understanding the causes and strategies to reduce their rate in trauma patients requires further studies.

Introduction: One of the competencies required by nurses and physicians to provide effective care in urgent situations is teamwork skills. This study aimed to investigate the attitudes and performance of the cardiopulmonary resuscitation team members of emergency departments in relation to teamwork during resuscitation.


Methods: This is a cross-sectional study that was conducted from October to February 2016 in 7 teaching hospitals in Tabriz, Iran. A total of 147 nurses and 126 physicians from emergency departments were randomly recruited in this study. Research tool consisted of 3 parts including, questionnaires in demographics, Teamwork Attitudes Questionnaire and performance team work scale. The data were analyzed using SPSS 21 software.


Results: The mean age of nurses was 31.25 ± 5.19 and physicians was 36.17 ± 5.68. The majority of nurses (41.5%) and physicians (32.5%) had participated in CPR more than 20 times. The mean score of attitudes of nurses was 120.98 ± 9.23 and physicians was 119.95 ± 9.29 and their overall attitudes towards teamwork was optimal (P = 0.001). The mean performance score of nurses was 46.14 ± 2.49 and that of physicians was 46.48 ± 2.14 at the desired level (P = 0.001).


Discussion: In urgent situations such as CPR, communication and coordination of resuscitation team members play an important role in the outcome of operation. Promoting and encouraging a positive attitude and performance towards teamwork, team training and mental preparation for work can be a valuable and low-cost solution to increase resuscitation team members’ work efficiency and ultimately improve the quality of patient care.

Investigating the Causes of Hospitalization of the Elderly in Imam Khomeini Hospital in Jiroft, Iran, in 2018

Yasin sohrani, elaheh salarpour, Ehsan Goroei Sardu, Sina Heydari, Hossein Rafeie, Athare Fallahi, Habibe Vaziri Nasab, Shiva Kargar, Salman Daneshi

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e14
https://doi.org/10.22037/ijem.v9i1.37897

Introduction: With age, the prevalence of diseases, especially chronic diseases, increases in the elderly and, therefore, the elderly are the main recipients of health services. This study was done with the aim of determining the causes of hospitalization of the elderly in Imam Khomeini Hospital, Jiroft, Iran.


Methods: This research was cross-sectional-descriptive. 358 elderly people, who referred to Imam Khomeini Hospital in Jiroft in 2018, were selected, using random sampling, and examined. The required information was extracted from patients' records and recorded in a researcher-made checklist. Data were analyzed using SPSS software version 20 and descriptive and analytical statistical tests.


Results: The findings of this study showed that 152 (42.5%) of the research samples were in the age range of 60-69 years. The most common chief complaints of the study samples were shortness of breath (14.5%), chest pain (11.5%), and vision loss (11.2%), respectively. The most common causes of hospitalization were cataracts (11.2%), angina pectoris (8.1%), and heart failure (6.1%), respectively.


Conclusion: The most common causes of hospitalization of patients were cataract and angina pectoris. It seems that it is necessary to include the essential educational and screening programs in these fields in the integrated health care program for the elderly.

Introduction: Assessing the severity of injury and the factors affecting the prognosis of trauma patients will lead to better management. This study was performed to investigate the relationship between leukocyte count and level of consciousness in trauma patients.


Methods: This descriptive cross-sectional study was performed on the records of 126 patients admitted to the emergency department of Be'sat Hospital in Hamadan in 2020-2021. Before prescribing any medication, blood samples were drawn to determine the number of leukocytes using a cell counter. At the same time, the level of consciousness was recorded based on the Glasgow Coma Scale (GCS) and the relationship between the two was examined.


Results: The total number of trauma patients was 126 (67.5% male and 32.5% female). Their mean age was 37.71± 12.78 years. Traumas were mostly blunt (78.6%) and multiple trauma (45.2%). The frequency of leukocytosis was 27.8%, with a mean leukocyte count of 9526±3470 per microliter of blood. There was a significant correlation between level of consciousness and leukocyte count 12 hours after admission (r = 0.663, P <0001). There was also a significant relationship between leukocyte count and trauma outcome (P <0.001). 81.8% of the patients were discharged in good condition and 7.1% died.


Conclusion: In trauma patients, a positive correlation was observed between peripheral blood leukocyte count and level of consciousness. Considering the relationship between leukocyte count and the final outcome of trauma patients, this biomarker can be used to determine the relative prognosis of patients in supplementary studies.

Introduction: COVID-19 is a major occupational health challenge. People in many occupations are at high risk; there is no doubt that health personnel، especially emergency nurses، who are at the forefront of the fight against this disease، not only experience lots of stress at work but also have a high risk of infection، which in turn exposes them to psychological problems such as anxiety and burnout.


Methods: This cross-sectional study was performed in 2020، using census method، on all nurses working in the emergency rooms of hospital affiliated with Zahedan University of Medical Sciences (150 nurses)، Ali Ibn Abi Talib، Khatam Al-Anbia، Bouali، and Ali Asghar hospitals in Zahedan، during the COVID-19 epidemic. The data collection tool had two parts; the first part included the Anxiety Scale in Coronavirus Disease (CDAS) questionnaire، and the second part was the Maslach Questionnaire to measure burnout.


Results: The findings of our study showed that 63.7% of emergency nurses had anxiety and there was a statistically significant relationship between anxiety and young age، female gender، fewer children، fewer working years، employment for mandatory post-graduation service، having underlying illness، the death of a family member due to coronavirus، and burnout. The mean burnout score was 77.81 ± 23.61 (24 to 116)، and burnout had a statistically significant relationship with female gender، fewer children، fewer working years، employment for mandatory post-graduation service، death of a family member due to coronavirus، and anxiety.


Conclusion: Based on the findings of this study، it was found that the prevalence of both variables، namely anxiety due to COVID-19 and job burnout، is high، and there is a significant relationship between the two.

Introduction: Asthma is a chronic disease usually characterized by periodic wheezing, coughs, and shortness of breath as a result of hyper responsiveness and inflammation of the airway. The purpose of this study was to assess the correlation between the results of single breath counting and peak expiratory flow rate methods in evaluation of pulmonary function among patients presenting to the emergency department with acute asthma attack.


Methods: This cross-sectional study was performed on 33 patients with complaint of acute asthma attack before and after the initial treatment, peak flowmetry, and Single Breath Counting (SBC) were performed. A checklist including age, sex, respiratory rate, blood oxygen saturation, asthma severity, SBC, and Peak Expiratory Flow Rate (PEFR) was filled out before and after treatment. Statistical analysis was performed to evaluate the relationship between data using SPSS v.26.


Results: 33 patients, including 13 women and 20 men with the mean age of 32.39 ± 10.58 years were studied. Statistical analysis showed a significant direct linear relationship between SBC and PEFR ​​before and after treatment, percentage of oxygen saturation changes, and between percentage of SBC changes with PEFR (r = 0.933, r = 0.915, and r = 0.892, respectively) and a significant inverse linear relationship was observed between PEFR and SBC with asthma severity (P <0.05). There was no significant inverse linear relationship between SBC and the percentage of changes in respiratory rate (r = -0.279, P> 0.05).


Conclusion: The results can indicate the competency of SBC to replace PEFR in evaluation of pulmonary function in adult patients presenting to the emergency department with acute asthma attack.

Epidemiology of Trauma in Children Under 5 Years Old Admitted to Imam Reza Hospital during 2021-22

Rozita Khatamian, Molod Fogerdi, Zahra Sourosh, Afsane Shahbazi

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e19
https://doi.org/10.22037/ijem.v9i1.38580

Introduction: Trauma is one of the most important preventable causes of child mortality and morbidity around the world and in Iran. Given the vulnerability of children, knowledge of epidemiological information regarding trauma in this age group helps to carefully plan for preventing these events. Therefore, this study was performed to evaluate the epidemiology of trauma in children under 5 years of age referring to the emergency department of Imam Reza Hospital in Birjand.


Methods: This descriptive epidemiological study was performed on 415 children under 5 years old, who referred to the emergency department of Imam Reza Hospital in Birjand from March 2021 to March 2022 due to trauma. Using a checklist, the patients’ demographic information including: age, sex, number of children in the family, parents’ education level, parents' marital status, mother's job, mother's age, the presence of a disabled person in the family, and Type of home (apartment, house), as well as the cause, time, and place of the trauma, the pattern of trauma, and the anatomical site of the trauma were gathered in an interview with the child. Finally, the outcome of trauma at the time of patient’s discharge was evaluated and then, SPSS Software version 20 was used to perform descriptive analysis on the obtained data.


Results: Data of 415 children were gathered. 249 cases (60%) were boys, 164 cases (39.5%) were at the age of 5 years, 332 (80%) had siblings, 220 (53%) were injured between 4 pm and midnight, in 223 cases (53.7%) trauma had occurred at home, 238 (57.3%) traumas were due to falling, 364 cases (87.7%) had blunt traumas, 186 cases (44.8%) had sustained head and face injuries. Parents of 394 cases (94.9%) were still married, 132 mothers (31.8%) and 128 fathers (30.8%) had education higher than high school diploma, 361 mothers (78%) were housewives, and 242 mothers (58.3%) were more than 35 years old. In 404 families (97.3%), there was no disabled person and 241 cases (58.1%) lived in houses that had a yard. 344 cases (82.9%) were discharged from the hospital with complete recovery.


Conclusions: Since the traumas had most commonly taken place at home and due to falling, dangers for children can be prevented by safeguarding houses and improving the awareness of parents.


 

Introduction: BNP increases in certain pathological conditions such as hypertension, renal failure, myocardial infarction, atrial fibrillation, chronic obstructive pulmonary disease (COPD), acute respiratory distress syndrome (ARDS), cirrhosis, etc. Some of them are among the clinical conditions pointing to hypertensive emergency and also its side effects. Therefore, in this study, we aimed to investigate the effeciency of this variable as a diagnostic variable in patients with emergency hypertension.


Methods: In this prospective study, 100 patients presenting to the emergency center of Adalatian Hospital, Mashhad, Iran, who had blood pressure equal to or greater than 180/110 mmHg at the time of triage and initial visit were included in the study. In order to evaluate damage to the target organs and the possible diagnosis of emergency hypertension, they were examined by an emergency medicine specialist or resident and the necessary tests were performed. For this purpose, serum levels of blood urea nitrogen (BUN), creatinine (Cr), and TPI/Immune thrombocytopenic purpura (ITP) were checked and a complete neurological examination was performed on patients to determine the presence of focal or generalized neurological defects or the presence of pathology (intracerebral hemorrhage (ICH), ischemia) on brain computed tomography (CT) scan. Patients' eyes were also examined for retinal vascular damage with an ophthalmoscope, and electrocardiogram (ECG) was also taken. Patients were divided into two groups based on the results: emergency hypertension and non-emergency hypertension. Meaning, if the criteria for emergency hypertension (target organ damage) were met, they were placed in the end organ dysfunction (EOD) group or hypertensive emergency (HE) group, and otherwise, they were placed in the group without EOD or hypertensive urgency (HU) group. Data analysis was performed using SPSS version 16 and descriptive and inferential statistics tests.


Results: There was no statistically significant difference between the two groups in terms of age and gender (P> 0.05). Based on the tests performed on samples taken from the patients, in the case group BNP level was 6144.81 ± 3052.42 pg/mL and in the control group it was 4835.42 ± 3135.02 pg/mL. The results of T test showed that there was no statistically significant difference between the two groups (P = 0.941). Based on calculations performed, at the cut-off point of 180, BNP can predict kidney damage with 100% sensitivity and 41% specificity. Although specificity and positive predictive value are not high at this cut-off point, but sensitivity and negative predictive value are acceptable, which makes it suitable for screening.


Conclusion: The results of our study showed that BNP test did not have high specificity or positive predictive value, but it had acceptable sensitivity and negative predictive value, which makes it suitable for screening. Therefore, this test can be used as a supplement to other examinations and cardiovascular and renal tests.

Serum Levels of proBNP in Patients with Acute Attack of Chronic Obstructive Pulmonary Disease with and without Heart Failure

Ehsan Bolvardi, Mojtaba Tavasoli, Majid Jalal Yazdi, Negar Morovatdar, Maryam Panahi, Mahdi Foroughian, Reza Akhavan

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e21
https://doi.org/10.22037/ijem.v9i1.38585

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory disorders. Various studies have been conducted to evaluate the predictive power of proBNP (pro-brain natriuretic peptide) in heart diseases. The aim of this study was to compare the serum level of proBNP in patients with acute attack of chronic obstructive pulmonary disease with and without heart failure.


Methods: This cross-sectional study was conducted on 112 patients who presented to the Adalatian Emergency Department of Imam Reza Hospital of Mashhad University of Medical Sciences in 2016 and 2017. The serum level of proBNP was measured. Patients were subjected to echocardiography and Ejection Fraction evaluation by an experienced cardiologist using the image point HX echocardiography device. Finally, patients with and without heart failure were compared using SPSS version 16 software.


Results: 75 patients (66.96%) did not have heart failure and 37 patients (33.04%) had heart failure. Basic characteristics including age, gender, smoking, and drug abuse were not significantly different between the two groups. However, the average number of hospitalizations was 3.2 ± 1.6 in patients with heart failure and 1.7 ± 0.8 in those without heart failure (P=0.001). The average proBNP level in patients with heart failure (16702.1 ± 6660.0 pg/dL) was significantly higher than that of patients without heart failure (1396.8 ± 161.2 pg/dL) (P=0.001).


Conclusion: The level of proBNP is significantly higher in COPD patients with heart failure, and the number of hospitalizations is also significantly higher in these patients.

The Relationship between Hemoglobin Level and Mortality Rate in Patients with Traumatic Brain Injury Presenting to the Emergency Department of Poursina Hospital in Rasht in 2017

Zoheir Reihanian, Payman Asadi, Siamak Rimaz, Ehsan Kazemnezhad Leyli, Abdolkarim Sheikhpour, Vahid Shirzad Siboni, Behzad Zohrevandi

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e22
https://doi.org/10.22037/ijem.v9i1.38641

Introduction: Traumatic brain injuries are one of the main causes of death and disability worldwide. Anemia may lead to worse outcomes in patients with traumatic brain injury. Considering that there have been limited studies on the role of anemia and blood transfusion in primary resuscitation of patients with traumatic brain injuries, the purpose of this study was to investigate the relationship between hemoglobin level and mortality rate in patients suffering from this condition.


Methods: This is a retrospective analytical cross-sectional study. The study population consisted of patients with traumatic brain injuries admitted to the emergency department of Poursina Hospital in Rasht, Iran, in 2017. Patients were classified into two groups, according to blood hemoglobin level, anemic (Hb ≤10) and non-anemic (Hb>10). Age, sex, clinical information, treatment measures, duration of hospitalization, and mortality rate in these two groups were recorded and compared. Also, in order to determine the risk factors for mortality in patients with traumatic brain injury, the above variables, along with laboratory findings, were compared in the two groups of patients with survival and death. Data were analyzed using SPSS21 software, and descriptive and inferential statistical tests.


Results: The total number of participants in the study was 297 (249 (83.8%) male and 48 (16.2%) female), with a mean age of 41.8 ± 22.3 years. 120 (40.4%) patients had anemia. Patients without anemia had higher levels of consciousness than those with anemia (P <0.001). There was a statistically significant difference between the anemic and non-anemic patients in terms of the use of vasopressor and patient status at discharge (P <0.0001). The number of packed cells received showed a statistically significant difference between the patients with and without anemia (P <0.0001). Multivariate analysis based on logistic regression model showed that the duration of hospitalization, hypotension, blood transfusion, and hypothermia are risk factors associated with mortality.


Conclusion: The results of this study showed that although anemia is not a predictor of mortality, but blood transfusion is one of the most important factors associated with mortality in patients with traumatic brain injury.

Evaluation of the Incidence of Depression among Residents Studying in Zahedan University of Medical Sciences during the COVID-19 Pandemic; A Cross-sectional Study

Maryam Ziaei, Amirsadra Mohammadi, Mahjoubeh Keykha, Ali Abdolrazaghnejad, Alireza Bahmani

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e23
https://doi.org/10.22037/ijem.v9i1.38825

Introduction: The Coronavirus disease 2019 (COVID-19) started in Wuhan, Hubei province of China, and after a short period, it spread throughout China and many other countries. Being in an environment infected with the virus causing COVID-19 has led to widespread psychological disorders such as anxiety, depression, stress, and sleep problems in many hospital staff and students. Especially, medical and dental students experienced significant mental stress during the COVID-19 era, due to academic pressure, being exposed to infection and night shifts and lack of sleep, which affected their mental health. During this time, medical students, including residents who underwent training in hospitals, had to endure long shifts with meager wages, which made the situation more complicated. Considering the importance of the topic, we decided to investigate the level of depression and factors affecting depression among the residents working in Ali Ibn Abi Talib and Khatam Al Anbia Hospitals in Zahedan, Iran.


Methods: This is a cross-sectional study, which was carried out as a census of students of any age and gender enrolled in residency programs, who were working in Ali Ibn Abi Talib and Khatam Al Anbia Hospitals, Zahedan, Iran, during the COVID-19 pandemic in the first three months of 2022. The tool used for collecting information for depression grading was Hamilton's checklist and questionnaire, and the effect of factors such as gender, level of education, place of residence, field of study, marital status, direct contact with COVID-19 patients, and the hospital they were working in on depression among residents was investigated. The collected data were analyzed using SPSS software.


Results: This research was conducted on all residents undergoing training in Ali Ibn Abi Talib and Khatam Al Anbia teaching hospitals in Zahedan, Iran, using the census method. The included residents were aged 29 to 60 years, with an average age (standard deviation) of 34.38 (5.866) years. Thirty-three were men, and 47 were women. The results of the research showed that the average depression score of the residents is 17.52, which indicates moderate depression among them. There was a significant relationship between being single (p-value=0.011) and direct contact with COVID-19 patients (p-value=0.003) with depression.


Conclusion: The results of the present study showed the high prevalence of depression among residents during the COVID-19 pandemic, and the high rate of depression was more prominent in female residents, single residents, obstetrics and gynecology residents, non-native residents, and residents in direct contact with COVID-19 patients.

Assessing the Status of pre-Hospital Emergency Ambulance Equipment in Khorramabad city based on the Standard of Iranian Ministry of Health in 2021

بهزاد مرادی; Sajad Yarahmadi, Mehrdad Valipour, Naser Javadi; Nasrin Galehdar

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e24
https://doi.org/10.22037/ijem.v9i1.39183

Introduction: Pre-hospital emergency bases need appropriate equipment and facilities to provide appropriate and satisfactory services. Therefore, the present study was designed and conducted with the aim of comparing the status of pre-hospital emergency service in Khorramabad with the standard of pre-hospital emergency equipment determined by the Ministry of Health (latest edition).


Methods: This descriptive-analytical cross-sectional study was performed in 2021. Census method was used for inclusion of participants from 13 urban and road pre-hospital emergency bases in Khorramabad. The status of the equipment was checked and determined based on the standard checklist. To analyze the data, SPSS software version 23 was used and analysis was performed using descriptive and analytical statistics. P-value less than 0.05 was considered statistically significant.


Results: The average score of medical equipment was 337 (48.4%), for non-medical equipment it was 28 (38.9%), and in total, pre-hospital emergency bases received only 365 points (48%) of medical and non-medical equipment standard. There was a significant relationship between the educational degree of the base manager and the average total score of the equipment (P = 0.025). Work experience of the base manager (P = 0.45), the employment status of the base manager (P = 0.796), the type of base (P = 0.524), and base age (P = 0.808) had no significant relationship with the mean total score of the equipment.


Conclusion: The status of equipment in pre-hospital emergency ambulances is far from the standards and this factor can reduce the quality of pre-hospital emergency services. More attention needs to be paid to controlling the condition of pre-hospital emergency ambulance equipment.

a Investigating the Level of Safety and Preparedness of Hospitals in Guilan Province in Dealing with Accidents and Disasters in 2021

Seyyed Mohammad Mehdi Baki Hashemi, Payman Asadi, Sajed Bakhshi Dizaj

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e25
https://doi.org/10.22037/ijem.v9i1.39341

Introduction: Safety against disasters and accidents is one of the basic components of preparedness planning for dealing with disasters and it is important for controlling complications or minimizing the risks. The purpose of this research is to analyze the level of safety of Guilan province’s hospitals in dealing with accidents and disasters.


Methods: In this cross-sectional, descriptive-analytical study, all hospitals affiliated to Guilan University of Medical Sciences or Social Security Organization, and private centers of Guilan province in 2021, which were 35 hospitals in total, were evaluated regarding safety and preparedness for facing disasters and accidents. The data was collected using the 150-question national standard tool checklist for evaluating hospital safety index, and the results were presented in the form of points in each component and overall score, preparedness rank, and comparison with the overall average of the province.


Results: The average relative preparedness in the studied hospitals in facing disasters was 65.66%. The 25 hospitals affiliated to Guilan university of Medical Sciences had 62.36% preparedness and 10 private hospitals affiliated to social insurance had 73.89% preparedness. Out of the 25 hospitals affiliated to Guilan University of Medical Sciences, 3 hospitals had good preparedness, 17 hospitals had average preparedness, and 5 hospitals were had poor preparedness, and among private hospitals and those affiliated to Social Security Organization, 6 hospitals had good preparedness and 2 hospitals had average preparedness.


Conclusion: A significant portion of the hospitals in Guilan province, like other hospitals in the country, have inadequate preparedness in the face of disasters, and it is necessary and vital to pay attention to the improvement of hospital preparedness in all its dimensions in order to adequately deal with accidents and disasters.

Introduction: Today, the coronavirus has covered the whole world and has affected not only the body of the patients but also their psyche. Patient satisfaction is one of the quality indicators of health care in medical centers in all countries. The present study investigated the level of patients hospitalized in the wards of Covid-19 hospitals affiliated with Zahedan University of Medical Sciences from December 21, 2020, to June 21, 2021.


Materials and Methods: The present study was cross-sectional-analytical and included the evaluation of the level of satisfaction with the services provided to 194 patients with covid-19 hospitalized in affiliated hospitals of Zahedan city from December 21, 2020, to June 21, 2021. The sampling method was easy and accessible. To collect information, a questionnaire including questions to measure the level of satisfaction of the patients was prepared and provided to the patients. The questionnaire consisted of two parts; one part included personal information, including age, gender, marital status, level of education, and the department and hospital where the people were admitted. The second part included questions about the patient's level of satisfaction with the services and conditions of the hospital and the department where they were admitted. Statistical analysis was done using an independent t-test, Mann-Whitney, ANOVA, or Kruskal-Wallis Statistical analysis was done using IMB SPSS V20.0 software, and an alpha error value less than 0.05 was considered significant.


Results: A total of 194 people were included in the study. The highest level of satisfaction was related to the speed of file filing and the guidance of the receptionist (78.9%), the lighting of the room (77.3%), the behavior and attitude of the nurses (69.1%), and the quality of the hospital food (60.3%). Also, the lowest level of satisfaction was related to the cooling and heating system of the room (13.9%), facilities and facilities of the room (6.7%), and hygiene and cleanliness of different parts of the department (2.6%).


Conclusion: There is no significant relationship between insurance, marriage, and gender with the level of patient satisfaction. But a meaningful relationship between education, ward, and hospital with the level of patient satisfaction has been observed. Considering the average level of patient satisfaction, to reach a high level of happiness, it is possible to take steps to improve the quality of medical and non-medical services and increase the satisfaction of patients by strengthening the positive points and also analyzing cases of patient dissatisfaction.

Introduction: Medical errors are a serious problem for healthcare organizations. Although foreign bodies remain after surgery, although it is not a common complication, it is always threatening and can cause serious and dangerous complications for patients. This study has been conducted with the aim of investigating the complaints of residual medical devices referred to the General Department of Forensic Medicine of Fars province from 2011 to 2019.


Method: This study was descriptive-cross-sectional and retrospective. All the complaint files about the devices left during medical treatment referred to the General Department of Forensic Medicine of Fars province from 2011 to 2019 were investigated and the information contained in them was collected and recorded based on the prepared checklist. After data collection, the information was converted into sheet code and analyzed by SPSS version 21 software and descriptive statistical tests.


Result: In this study, 35 cases were examined from 2011 to 2019. 54.3% of the plaintiffs were women and the rest were men. Women's specialty (37.1%) had the highest frequency of complaints about residual devices during treatment, and the most complaints about residual devices were related to caesarean section (37.19%) and inguinal hernia (20%). Almost half of the remaining devices were gas (51.4%). In the majority of complaints, the location of the remaining devices during treatment was in the pelvis (0.40%) and abdomen (37.1%).


Conclusion: Considering the most frequent type of retained foreign bodies and also more frequent involved surgery wards besides detection methods for RFB, a mixed of preventing protocols such as regular counting of devices, post-operative X-ray with radiopaque markers and exact evaluation of surgery site should be employed to reduce the occurrence of retained foreign bodies and its complications.

Survey of Knowledge, Attitude, and Practice of Female Employees of Health Centers in Jiroft about Breast Cancer Screening in 2018

Yasin Sohrani, Hamzeh Mohammadi Sardoo, Asma Amiri Domari; Nima Korkinejad; elaheh salarpour

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e28
https://doi.org/10.22037/ijem.v9i1.39010

Introduction: Given the key role of health professionals in educating women on breast cancer screening programs, it seems necessary to implement plans to improve the  levels of awareness, attitudes, beliefs and, consequently, the performance of this group regarding breast cancer prevention programs. The aim of this study was to investigate the knowledge, attitude and practice of female employees of health centers in Jiroft about breast cancer screening in 2018.


Methods: This research is a cross-sectional descriptive study, in which the study population was female employees of health centers in Jiroft. Sampling was done using the census method. A short, standardized questionnaire, previously used by Khani et al., was used to collect data. Data were analyzed using SPSS software and descriptive and analytical statistical tests.


Results: Among the 216 questionnaires collected (154 urban and 62 rural), the mean knowledge and attitude scores of the subjects, including health workers, midwives, and nurses, were 7.02 out of 20 and 36.7 out of 50, respectively. In terms of performance, 40.7% (88 people) had never had a breast self-examination and 76.4% (165 people) had never performed a clinical breast examination on patients, and 91.2% (197 people) had never had a mammogram.


Conclusion: The level of knowledge and attitude of the subjects was at an average level based on the obtained scores of 7.02 and 36.7, respectively, and their performance was poor and unacceptable. Given that female employees of health centers can improve the behaviors of the community, the implementation of regular and codified educational programs on breast cancer prevention, especially breast self-examination, clinical breast examination, and mammography, for this group seems necessary.

Prevalence of Normal Pathology among Patients Operated with Diagnosis of Acute Appendicitis in Jiroft

Hamzeh Mohammadi Sardoo; Yasin Sohrani; elaheh salarpour; Hossein Rafeie, Seyedeh Mahsa Hoseyni Tabar, Shiva Kargar, Salman Daneshi; Asma Amiri Domari

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e29
https://doi.org/10.22037/ijem.v9i1.38959

Introduction: Acute appendicitis is one of the most common causes of abdominal surgery, the diagnosis of which is made mostly based on clinical symptoms and imaging, leading to appendectomy surgery; but in some cases, the post-operation results show that there has been no appendicitis. This is called a negative or normal appendectomy. This study was performed with the aim of evaluating the frequency of normal pathology in patients who underwent surgery with the diagnosis of acute appendicitis in Imam Khomeini Hospital in Jiroft, Iran.


Methods: This study was a cross-sectional (descriptive-analytical) study. 95 patients undergoing surgery with diagnosis of acute appendicitis in Imam Khomeini Hospital in Jiroft in 2019 were selected using census method and entered the study. The required information was extracted from the patients' medical records and recorded in a researcher-made checklist. The collected data were analyzed using descriptive statistics and Independent t-test,chi-square, and Fisher's test with SPSS version 18 statistical software.


Results: 48.5% of the participants were male and 51.5% were female. Normal appendectomy was observed in 9 patients (9.5%). The frequency distribution of negative appendectomy was statistically significant based on the age of the patients and was more common at the age of 30 to 50 years (P = 0.027) .The other studied variables had no correlation with normal appendectomy.


Conclusion: The results of the present study showed that a normal appendectomy is observed in one in ten patients undergoing surgery, which shows more favorable results in Jiroft compared to other statistics provided. Correct and regular use of assessment methods can help significantly reduce the rate of negative appendicectomy.

Introduction: The correct triage of patients based on the severity of their situation can reduce the crowding of patients in the emergency department and reduce complications and mortality among patients. One of the important tools to check the accuracy of triage by nurses and physicians is the emergency severity index.


 This study was conducted with the aim of determining the accuracy of triage by nurses and physicians, using Emergency Severity Index and factors related to it, in patients referring to trauma emergency unit in Zanjan, Iran.


Methods: This descriptive cross-sectional study was conducted on 378 patients who referred to the emergency department of a teaching hospital in 2019. The data collection tool was a questionnaire that consisted of demographic information and the Emergency Severity Index triage evaluation form. The data were analyzed using SPSS version 16 statistical software and chi-square/Fisher's exact test, and analysis of variance test. A significance level of less than 0.05 was considered.


Results: The present study showed that nurses did 84.4% correct triage and physicians did 90.5% correct triage. Most errors were in the form of under-triage, the rate of which was 10.3% and 7.4% among nurses and physicians, respectively. Nurses had 18.6% triage error cases and physicians had 9.5% triage error cases (P<0.05). There was a statistically significant difference in the accuracy of nurses' triage based on their work experience, retraining period, and the patient's waiting time before assignment (P<0.05). However, the accuracy of physicians' triage did not show a statistically significant difference based on the demographic characteristics of physicians and patients (P>0.05).


Conclusion:  In this study, under-triage was the most common triage error made by nurses and physicians. Health care workers should know that under-triage can have irreparable consequences for patients. Therefore, it is recommended to periodically hold trainings to update the knowledge of health care professionals regarding triage.

Introduction: Patient satisfaction with services is generally considered the main component of quality of care and can be described as the subjective perception of service quality resulting from the matching of expectations about services with actual experience and results. Therefore, the purpose of this study is to investigate the level of satisfaction of hospitalized patients with a definite or suspected diagnosis of covid-19 from the care staff of covid-19 wards.


Methods: In this cross-sectional descriptive study, 172 patients with covid-19 who were admitted to Peymaniyeh Hospital in Jahrom city in 2019 with the diagnosis of corona virus disease were examined. The data collection tool in this study included two questionnaires for demographic information (age, sex, underlying disease, duration of hospitalization, etc.) and a satisfaction questionnaire for the medical staff. Data analysis was done using spss software version 21 and descriptive and inferential statistical tests.


Results: The most frequent age was 31-40 years old (22.1%). The satisfaction level of the majority of hospitalized patients from the treatment staff was high, 133 patients (77.3%), the satisfaction level of 37 patients (21.5%) was average, and the satisfaction level of only 2 patients (1.2%) was low.


Conclusion: Based on the results of the present study, the level of satisfaction of the majority of patients was reported at a high level. However, the demographic variables (age, sex, marriage, education, occupation, economic status, etc.) of the patients did not have a statistically significant relationship with the level of satisfaction of hospitalized patients with a definite or suspected diagnosis of Covid-19 from the medical staff. Therefore, by implementing continuous training programs and investigating cases of dissatisfaction, we can try to improve the satisfaction of patients as much as possible.

Introduction: Due to the prevalence of new coronavirus in the world and Iran, access to reliable information about patients and the trend of disease outbreaks are necessary to control the disease at the community level, which is important by using systems Regular registration of patient information in the form of a register will be possible. In the present study, the translation and validation of the case registration form of patients with the new coronavirus (COVID-19) provided by the World Center for Disease Control and Prevention were performed.


Methods: In the present study, which is a study on the development of the executive scientific system, after translating the case registration form of patients with new coronavirus (COVID-19) to evaluate its reliability in a sample of 24 patients with new coronavirus methods Cronbach's alpha, Richardson's code and paired and individual correlation test were used. CVI and CVR determination was used to determine the content validity of the patient registration form based on the opinion of the panel of experts.


Results: In the present study, the information of 24 patients admitted to the coronary ward of Peymanieh Hospital in Jahrom was recorded using the case registration form of patients with new coronavirus. In multiple-choice questions, Cronbach's alpha was higher than 0.7 and 0.735, which was appropriate. Correlation coefficients also showed high and proportional values. Richardson's Koder test also confirmed the reliability with a statistic of 0.718. All questions were in good validity according to the panel of experts, except for 4 questions that had a CVR of 0.2 and were removed according to the experts. The overall CVI was calculated to be 0.828, which is acceptable and appropriate.


Conclusion: In the present study, a localized form of case registration of new coronavirus patients was presented, which can help to create coherence in the patient information registration system.

Final Diagnosis, Diagnostic Procedures, and Disease Course in Elderly Patients with General Weakness Referring to the Emergency Department; a Cross-sectional Descriptive Study

Mahdi Foroughian, Maryam Sobhani, Roohie Farzaneh, Monavvar Afzal Aghaee, Somayyeh Ahmadnezhad, Maryam Panahi, Hamid Reza Reihani

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e33
https://doi.org/10.22037/ijem.v9i1.39746

Introduction: General weakness and fatigue are among the most common complaints in neurological, psychological, and medical diseases. which can have various causes, some of which are life-threatening. Therefore, the present study was conducted with the aim of evaluating the final diagnosis, diagnostic measures, and disease course in elderly patients with general weakness.


Methods: This cross-sectional descriptive study was conducted from October 2015 to October 2016 in the emergency department of Imam Reza Hospital, Mashhad, Iran. All elderly patients over 60 years of age who referred to the emergency department of Imam Reza Hospital with general weakness and did not have a specific diagnosis were included in the study. Demographic information, underlying diseases, medications, and the diagnostic and therapeutic measures taken for them from the moment of arrival until the time of discharge or death were recorded in the checklist prepared for this purpose. Data analysis was done using SPSS software version 11.5 and descriptive (number, percentage, mean and standard deviation) and inferential (Mann-Whitney, chi-square, t-test) statistical tests.


Results: The average age of the participants in the study was 79.84 ± 8.6 years. The mean hemoglobin and white blood cell count (WBC) of the patients in the emergency room were higher than in the ward. Also, the platelets and international normalized ratio (INR) of people in the emergency department were higher. The median of onset of weakness in people was 7 (4-10) days. The duration of hospitalization of patients in the emergency room was 34.68 ± 21.7 hours and the duration of hospitalization in the ward was 6.06 ± 2.9 days. Also, the duration of hospitalization in ICU was 10.29 ± 5.2 days. Urinary tract infection (UTI) and electrolyte disorders were the most common diagnoses.


Conclusion: Based on the results of the present study, the highest mortality rate belonged to the ICU, ward, and emergency room, respectively. In addition, the highest discharge rates were observed in the emergency room, ward and ICU, respectively. Therefore, it seems that in the mentioned departments, it is very important to pay more attention to the patients in order to prevent further complications and the imposition of additional costs on the patients and the treatment system.

Evaluating Benefites and Disadvantages of Care Transition in Emergency Departments in Tehran

Gholamreza Masoumi, Melika avazabadian , Arezou Dehghani, Peiman Hafezimoghaddam

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e34
https://doi.org/10.22037/ijem.v9i1.39127

Introduction: Field and clinical studies show that care transition after the relevant service is determined is one of the ways to deal with overcrowding in the emergency room. In addition, this method will reduce the workload of emergency physicians and even other personnel such as nurses and assistant nurses. However, some physicians believe that due to legal aspects, transition of patients’ care is not a suitable option. Because of the importance of this issue in managing the emergency rooms all over Iran and improving the quality of the services provided, and also, due to the lack of any study on the advantages and disadvantages of care transition, this research was conducted.


Methods: This qualitative content analysis study was conducted in 2020-2021 to investigate the advantages and disadvantages of patient care transition in emergency rooms in Tehran. 17 experts and medical managers at the Ministry of Health, university, and hospital levels and experts in emergency medicine were interviewed and asked to explain their opinions in this regard in a semi-structured interview. All the interviews were recorded with the permission of the participants and their text was transcribed verbatim and analyzed by the researchers using the content analysis method.


Results: In the present study, 423 initial codes were extracted in the initial analysis, and after removing duplicate codes, the number of final codes reached 218. After reviewing and analyzing the data, advantages, and disadvantages were categorized into three main categories. Also, the benefits included 3 categories and 10 sub-categories. Patients’ status category (3 subcategories of patient care services, patient hoteling, medical errors), physicians’ status category (3 subcategories of physicians’ accountability, impact on the practical experience of physicians, physicians’ differences), and emergency department management category (occupancy of beds, emergency department income, educational opportunities for Emergency medicine, management of emergency medicine).


Conclusion: According to the studies and analyses performed, care transition has more disadvantages from the viewpoint of emergency medicine and affects the management and performance of the emergency department, the performance of physicians and residents, and the condition of patients. Considering the significant disadvantages of this process and the decrease in service quality and patient satisfaction, as well as the dissatisfaction of the treatment staff, the existing guidelines need to be revised.

Modeling the Impact of some Variables the COVID-19 Severe with CART Algorithm in Mashhad University of Medical Sciences

Mostafa Boskabadi, Monavar Afzalaghaee, Nasrin Talkhi, Zahra Jamalian, Ehsan Musa Farkhani, Habibollah Esmaily

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e36
https://doi.org/10.22037/ijem.v9i1.39540

Introduction: Considering that the new corona virus (COVID -19) is still prevalent, one of the important concerns is the variables affecting the severity of the corona disease in the health of society. In this study, the CART algorithm was fitted to predict and determine the status of patients infected with COVID-19 in Mashhad University of Medical Sciences.


Methods: This paper is a cross sectional-analytical study. Datasets were obtained from all of the people referred for the disease of COVID -19 collected at the Sinai system during the second peak and the fourth peak of the disease in Mashhad University of Medical Sciences. Data analysis was performed using JMP statistical software version 13. Then for modeling, data mining methods and CART algorithm are used.


Results: The descriptive findings of our study showed that 6% of patients with positive PCR suffer from severe disease of COVID-19. The age variable was very important in the severity of the disease. The age of 60 years old is the cut-off point for the severity of the disease, which increases COVID-19 severe from about 3% under the age of 60 to about 18% over the age of 60. The diseases of heart, kidney, respiratory, blood fat, and diabetes were other important variables.


Conclusion: The results of the CART model showed that for the age under 60 years the variables of heart disease, age, diabetes, respiratory disease, fat, gender, and kidney, and for the age over 60 years the variables of age, heart disease, kidney, respiratory and diabetes were respectively the most critical risk factors. According to the ROC curve, the fitted model has a good performance for COVID-19 severe disease, so it increases up to 6 times the prediction of the COVID-19 severe disease.


 

A Comparative Study of Immediate and Delayed Supine Position on Hemodynamic Changes of Patients Undergoing Hemorrhoid and Fischer Surgery under Spinal Anesthesia

Hasan Zabetian, Mohammad Hasan Damshenas, Navid Kalani, Mojtaba Ghaedi, Lohrasb Taheri, Seyede Sakine Mosavi, Mohammad Sadegh Sanie Jahromi

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e37
https://doi.org/10.22037/ijem.v9i1.39921

Introduction: Spinal anesthesia is generally used for surgeries related to the lower abdomen, perineum, and lower limbs. The purpose of this study is to compare immediate and delayed supine positions on the hemodynamic changes of patients undergoing hemorrhoid and Fischer surgeries under spinal anesthesia.


Methods: The present study is a case-control study that was conducted on 60 patients who were candidates for hemorrhoid and fissure surgery in Motahari Hospital of Jahrom city by a specific surgeon. Patients were randomly assigned to one of two groups of 30 people in the immediate and delayed supine positions. After the spinal anesthesia, the patients in the delayed supine position group were kept in a sitting position for 3-5 minutes and then assumed the surgical position. In the immediate supine position group, the patients were placed in the supine position after receiving spinal anesthesia and were ready for surgery. Systolic blood pressure, diastolic blood pressure, respiration, arterial oxygen saturation, and pulse of the patient were measured and recorded before and immediately after the position and at 10, 5, 15, 30, 45, 60, and 90 minutes after the position. Data analysis was done using descriptive and inferential statistics tests at a significance level of P<0.05.


Results: The study groups were similar in terms of age and body mass index variables. The mean trend of systolic and diastolic blood pressure in the immediate supine position and delayed supine position groups showed a significant difference from the time before spinal anesthesia to 90 minutes after the operation (P<0.001). The trend of mean MAP and heart rate in the immediate supine position and delayed supine position groups showed a significant difference from the time before spinal anesthesia to 90 minutes after the operation (P<0.001). The amount of ephedrine consumed in the delayed supine position group (10%) was significantly lower than in the immediate supine position group (50%) (P=0.003).


Conclusion: The present study has indicated that the use of a delayed supine position can significantly reduce the number of hemodynamic changes over time compared to the immediate supine position and minimize the amount of ephedrine used to compensate for pressure drop.

The effect of Jahrom Nurses' Attitude on Knowledge sharing in the Acceptance of Clinical Information Technology Systems

Sara Daniali, Abdol Azim Jokar, Saead Razavi, Mohammad Hossein Sedaghatnia, Maryam Azmoodeh, Navid Kalani

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e38
https://doi.org/10.22037/ijem.v9i1.39928

Introduction: Health information systems include the interaction between people, processes, and technology in order to support operations and management in providing essential information to improve the quality of health care services. Since nurses are one of the main pillars of serving patients in hospitals, they should play an active role in sharing their knowledge and information. Therefore, the purpose of this study is to the effect of Jahrom nurses' attitude on knowledge sharing in the adoption of clinical information technology systems.


Methods: This cross-sectional descriptive study was conducted on nurses working in educational and therapeutic hospitals in Jahrom city. The data collection tools in this study were two demographic information questionnaires and a knowledge sharing questionnaire on the acceptance of clinical information technology systems. Data analysis was done using SPSS version 21 software and using descriptive and inferential statistical tests at a significance level of P<0.05.


Results: 129 nurses from Jahrom participated in the study. The majority of participants in the study were female (67.4%) and married (58.9%) and worked in rotating shifts (83.7%). The attitude of the majority of nurses in Jahrom was at the realistic level of 81 people (62.8%) and the attitude of the rest was average. Among the dimensions of Jahrom nurses' attitude towards knowledge sharing in the adoption of clinical information technology systems, the lowest mean is related to the dimension of jeopardizing professional independence and the highest mean is related to the dimension of attitude towards knowledge sharing.


Conclusion: According to the findings of this research, the type of attitude towards knowledge sharing, jeopardizing professional independence and higher education level, directly affects the attitude of nurses towards clinical information technology systems and information sharing systems. Because the use of knowledge sharing systems and new technologies can increase the utilization of nurses in hospitals and treatment environments.

Epidemiologic Evaluation of Mortality of Children aged 2 to 15 years Referring to the Emergency Department of Imam Khomeini Hospital in Jiroft in 2016-2019

Ehsan Goroei Sardu, Fatemeh Sadat Mirrashidi , Zobeydeh Refieinezhad, Foozieh Rafati, Akbar MehrAlizadeh, Samira Rezaei, Seyed Nakisa Mousavi, Salman Daneshi, Yasin Sohrani, Kivash Hushmandi

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e39
https://doi.org/10.22037/ijem.v9i1.39313

Introduction: One of the important indicators of development and health in countries is the child mortality rate. In recent years, the child mortality rate in Iran has decreased; yet, it remains higher than other developing countries. Therefore, this study epidemiologically investigates mortality of children aged 2 - 15 years referring to the emergency department of Imam Khomeini Hospital in Jiroft, Iran, in 2016-2019.


Methods: The present study is a descriptive-analytical cross-sectional study. In this study, 84 cases were reviewed. A researcher referred to the archives of Imam Khomeini Hospital in Jiroft, extracted the information of all deceased patients, and entered them in the checklists, and patients whose files were incomplete were excluded from the study. Lastly, the information was analyzed using SPSS 22 software and descriptive statistics (frequency distribution tables and graphs) and inferential statistics (Chi-square test).


Results: The mean age of the studied children was 7.4 ± 4.8 years. Minimum age was 2 and maximum age was 15 years. The most common causes of death in children were: unintentional accidents with 50 cases (59.5%), non-congenital diseases with 17 cases (20.2%), congenital diseases with 14 cases (16.7%), and, finally, intentional incidents with 3 patients (3.6%). Also, 56 (66.7%) of the children lived in rural areas and 28 children (33.3%) lived in urban regions.


Conclusion: The results illustrated that the most common cause of death among children referring to Imam Khomeini Hospital in Jiroft was unintentional accidents, which is preventable and can be reduced to some extent. Therefore, designing interventions and educating parents and children about the prevention of accidents and raising the awareness of parents about the signs and symptoms of diseases seem necessary for reducing child mortality. In addition, measures should be taken to prevent child mortality through cooperation of all relevant organizations.

Introduction: Spiritual intelligence leads to understanding between people, calmness, and management of changes. The spiritual intelligence of emergency personnel May affects the correct performance of emergency procedures. This type of intelligence exists in all people, but due to the challenging working conditions of medical staff in the emergency department and the need to do the best work at the best time, it Can be more important. The objective of this study was to evaluate the effect of spiritual intelligence on efficacy of health personnel in the emergency department.


Methods: This study was a descriptive cross-sectional study that was performed on 83 medical personnel working in the emergency department of Poursina educational, research and therapeutic center, in Rasht, Iran, in 2021. The sampling method was census. The data were collected using a tool that consisted of demographic characteristics and King's questionnaire. Data were analyzed using SPSS24 software and descriptive statistical methods (frequency, percentage, mean and standard deviation) and Kolmogorov-Smirnov, independent T-test, Pearson test and analysis of variance. The significance level was considered P <0.05.


Results: The mean age of the research participants was 29.15±7.39 years and 47 (56.6%) of participants were female. The findings of the present study showed that people with higher spiritual intelligence had better occupational efficiency than others (P<0.001), but there was no statistically significant relationship between spiritual intelligence with age, sex, marital status, and education.


Conclusion: Medical personnel who had higher spiritual intelligence were more efficient than others. Apart from the effect of spiritual intelligence on reducing people's stress, improving the spiritual intelligence of personnel in critical departments such as emergency can increase their efficiency, especially in difficult situations that require management.

Investigating the awareness and performance of mothers against acute respiratory infections in children of Jahrom city

Sara Matin, Negar Shaterian, Navid Kalani, Masoud Ghanei, Ehsan Rahmanian

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e43
https://doi.org/10.22037/ijem.v9i1.39831

Introduction: Acute respiratory infection is one of the main causes of children's diseases, which often leads to serious health complications and deaths of children under five years of age. Therefore, the purpose of this study is to investigate the awareness and performance of mothers against acute respiratory infections in children in Jahrom city.


Methodology: In this descriptive-cross-sectional study, 75 children with acute respiratory infections referred to Jahrom Art Clinic in 1401 were conducted. The data collection tool in this study includes demographic information questionnaire and mothers' awareness and performance questionnaire regarding children's acute fecal infections.


Results: The average age of mothers participating in this study is 35±4.77. The majority of mothers (54.8%) stated that they do not know about the danger signs. There is a significant difference in self-efficacy variables, measures taken when contracting a respiratory infection, measures taken when contracting diarrhea, and measures taken when a child has fever and seizures between mothers of different age groups (P<0.05). In the field of measures at the time of respiratory infection, the highest score belonged to mothers aged 35 to 40 years. In the field of actions at the time of diarrhea, the highest score belonged to mothers aged 35 to 40 years. In the field of measures taken when the child has fever and convulsions, the highest score belonged to mothers of the same age group. In response to the question, "What do you do if there are signs of danger in your child?" Most of the mothers stated that they go to the doctor or medical centers (70.7% urgently and 28% non-urgently).


Conclusion: The results of the present study indicate that the level of performance of mothers against acute respiratory infections in their children requires the attitude and knowledge of mothers, which are also related to the level of education and age of mothers. Therefore, setting up educational programs for mothers to educate children about danger signs such as respiratory infections, diarrhea, fever, and convulsions should be at the discretion of educational and health centers.

Evaluation of Suspected Patients to COVID-19 Triage Status: a Cross-Sectional Descriptive Study

Leila Sayadi, Amin Hosseini, Sara Pakzad, Samira Norouzrajabi, Mehrnaz Keramati Kerman, Ali karimi Rozveh

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e44
https://doi.org/10.22037/ijem.v9i1.40064

Introduction: Proper and effective triage of patients suspected to COVID-19, the diagnosis of their high risk situation and then hospitalization in order to carry out treatment measures are of particular importance. This study was conducted with the aim of determining the triage status of patients suspected of COVID-19.


Methods: This descriptive cross-sectional study was performed in the period between April and June 2020 in one of hospitals in Tehran. Triage information related to 1010 patients suspected of COVID 19 were assessed. Some of these patients were hospitalized and the rest were advised to rest at home. Clinical, laboratory and survival or death data of hospitalized patients were collected from their hospital documenttaion. Patients who were discharged from triage without the need for medical intervention and were advised to rest at home were contacted by phone. Then their condition after discharge from triage, re-referral to other hospitals due to the symptoms of the disease, other symptoms that appeared at home, and treatment measures performed in case of re-referral to the hospital were asked. The collected data was analyzed using descriptive statistics and logistic regression modeling and t-test and chi-square statistical tests using SPSS 16.


Results: The results showed that among the 1010 assessed patients, 360 people (35.5%) were admitted to the hospital with a definite diagnosis of COVID-19, and 650 people (64.5%) did not need to be hospitalized according to the triage performed. Among the 650 patients sent home, the information of 57.5% of the patients could not be followed up due to the lack of answering the phone, and only 276 people (42.5%) answered the phone call, and none of them needed hospitalization in other hospitals. Among the patients admitted to the hospital, 14.8% had died. The results of adjusted odds ratio based on multivariate logistic regression modeling for predictors of mortality showed that after adjusting the variables in the model, none of the variables showed a significant relationship with mortality (P>0.05 in all cases).


Conclusion: Results showed that all patients who were admitted to the hospital after triage were finally infected with COVID-19. Other patients who did not require hospitalization and were advised to rest at home were not hospitalized in other medical centers either. The results showed that the triage performed for patients was able to identify COVID 19 critically ill patients who need hospitalization.

Review Article


Ethical Distress and its Related Components in Emergency Department Employees: a Systematic Review

Hamid Zamani Moghaddam, Majid Vatankhah, Marzieh Haghbeen, Samaneh Abiri, Lohrasb Taheri, Roohie Farzaneh

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e3
https://doi.org/10.22037/ijem.v9i1.37946

Introduction: Moral distress is one of the hidden moral challenges in providing nursing care services that occurs in conditions of impossibility to perform the right job despite knowing its correctness. This challenge is greater among nurses in wards with more acute conditions, such as the emergency department. This study was conducted with the aim of systematically reviewing moral distress and its related components in studies conducted on emergency department employees.


Methods: This research is based on a systematic review that evaluates the quality of articles using the STROBE standard checklist. Preliminary studies were conducted through articles in Persian language databases; SID, Iranmedex, Magiran and English language databases; Science Direct, PubMed, ProQuest, Cochrane Library, Embase, Scopus and Google Scholar; was examined. In order to access the full text of articles containing Persian keywords; Moral distress, moral stress, moral stress, moral distress, moral anxiety, moral turmoil, and emergency-related phrases were used as a combination of words; Also includes boolean search methods and OR operators and Mesh keywords; Moral Distress, Ethical Distress, Ethical unease, Ethical disquiet, Emergency were used.


Results: In the initial stage, 466 studies were studied. The researchers then reviewed the articles that had been searched, and finally, after removing duplicate, irrelevant items, qualitative studies, narrative review, and a letter to the editor; 18 researches were used to write this research. Among the studies studied, 11 Iranian articles were conducted, which shows 61.11% of the total studies; other studies have been conducted in Taiwan, China, the United States, Indonesia and Switzerland. The average moral distress of emergency department nurses was moderate and there was a significant relationship with components such as background and workload of the findings of these studies.


Conclusion: The set of studies performed on emergency department nurses is a reliable number to show the level of moral distress, but this amount of study is not reliable to obtain a model of components and variables related to moral distress. For this purpose, in addition to further research on this group of nurses, by removing the characteristics of emergency department nurses, a systematic review of all studies conducted in the field of moral distress on the nursing community can be done to achieve more accurate results.

Introduction: Skeletal muscle damage in rhabdomyolysis can cause the release of the contents of damaged myocytes into the bloodstream and acute kidney damage as a serious complication. In this syndrome, the levels of serum creatine kinase and urine myoglobin increase significantly. Better knowledge of the pathophysiology of rhabdomyolysis and its resulting acute kidney damage can help maintain kidney function by increasing treatment options.


Methods: This review study focuses on epidemiology, pathophysiology, causes, effective mechanisms, diagnosis, and management of acute renal injury following rhabdomyolysis. Any form of muscle injury can cause rhabdomyolysis. Ageing, trauma, drug abuse, and infections have been identified as the most common causes of rhabdomyolysis.


Results: Paying attention to the underlying pathology and effective mechanisms in the incidence of acute renal injury following rhabdomyolysis can play a key role in measuring the severity of injury, triage, and treatment of patients. Also, the study of biological findings can play a key role in identifying rhabdomyolysis patients at risk of acute kidney injury, predicting different stages of injury, reducing mortality and morbidity, and improving treatment protocols.


Conclusion: Rhabdomyolysis has been introduced as an important clinical challenge. Non-specific symptoms, presence of multiple causes for its onset, and systemic problems in patients complicate diagnosis and treatment. Understanding the pathology of myoglobin-induced acute kidney injury and extensive fluid therapy are the cornerstones of treatment. All physicians should be aware of the common causes, diagnosis, and treatment options because one of the most important treatment goals in these conditions is to avoid acute kidney damage.

Systematic Review of the Training Needs of Emergency Professional

Maryam Panahi, Somayeh Ahmadnezhad, Roohie Farzaneh, Morteza Talebi Doluee, Reza Akhavan, Bita Abbasi, Fatemeh Maleki

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e15
https://doi.org/10.22037/ijem.v9i1.38512

Introduction: Educational needs assessment is the first step in formulating training programs that improve the skills and knowledge of human resources and can be an important factor in ensuring the effectiveness of organizational training and improvement, as well as empowering skilled and specialized human resources, which is considered to be of great importance in the health care system. One of the most important departments providing health services is the emergency department, in which upgrading training and skills is very important and necessary due to the compactness of information, complexity of issues, and the need for high speed of operation in this department. Therefore, in this article, the educational needs of physicians and nurses in the emergency department have been explored, based on previous studies.


Methods: This research is a systematic review, in which the quality of the included articles has been evaluated using the standard STROBE checklist. Preliminary studies were conducted on articles related to the promotion of emergency medicine education and training of emergency and medical professionals, published from 2010 to 2022, retrieved through searches in Persian language databases (SID, Iranmedex, Magiran), English language databases (Science Direct, PubMed, ProQuest, Cochrane Library, Embase, Scopus), and Google Scholar Search Engine. Persian keywords used included combinations of translations of: Emergency, Medical Emergencies, Training, Continuing Education, Training Needs, Required Skills, in combination with Emergency-Related Phrases and English keywords were: Emergency, Education, Continuing Education, Educational Needs, Needs Assessment, which were combined using Boolean Search Methods and Operators including “And” and “OR”.


Results: In this study, a systematic review of the educational needs of emergency department professionals was performed. After searching in databases using appropriate keywords, 21 articles that met the inclusion criteria were analyzed. Among the evaluated studies, the highest number of studies were done in the United States (9 articles) and Iran (8 articles). The research method was descriptive-cross-sectional in 18 articles, but there were also Delphi methods and qualitative studies based on interview and content analysis among the studies. Nine studies were done on specialized areas and the rest had conducted needs assessments in general. In terms of target population, nurses, physicians, students and interns, residents, faculty members, and staff and managers, had participated in these studies.


Conclusion: Analyzing the results of studies revealed the need for education on correct and rapid diagnosis, taking immediate medical measures, providing correct and standard care, managing critical situations, and communication skills. Although education researchers have made great efforts to identify the educational needs of the emergency department over the past decade, it seems that studies performed in needs assessment studies lack the necessary coherence to introduce effective educational strategies.

An Overview of the Educational Capabilities of Augmented and Virtual reality Technology in the Emergency Department

Roohie Farzaneh, Reza Akhavan, Bita Abbasi, Seyed Reza Habibzadeh, Maryam Panahi, Fatemeh Maleki, Mahdi Foroughian, Behrang Rezvani Kakhki

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e40
https://doi.org/10.22037/ijem.v9i1.39976

Introduction: Teaching the necessary knowledge and skills in the emergency department has always faced challenges due to its importance, unique features and multidisciplinary expertise. Today, advances in information and communication technology have also revolutionized education. The purpose of this article is to investigate the feasibility and experiences of using virtual reality and augmented reality technologies in the education of the emergency department by reviewing the studies conducted in the world.


Methods: This research is based on a systematic review in which the quality of the articles was evaluated using the STROBE standard checklist. The primary studies carried out, through articles on the educational capacities of augmented and virtual reality technology in the emergency department; in Persian language databases; SID, Magiran and English language databases; Science Direct, PubMed, Scopus and Google Scholar search engine were done until the end of September 2022. Farsi keywords; Emergency, medical emergencies, education, virtual reality, augmented reality and mixed reality were used as a combination of words; Also, Boolean search methods and OR operators and Mesh keywords including: Emergency, Education, Virtual Augmented, Virtual Reality, Mixed Reality, EMS, MR, VR, AR were used.


Findings: Among the 9 reviewed studies, the largest number of extracted studies, i.e. three articles, were conducted in China. Other articles were from America, Germany, Iran and Netherlands. The research method used in 8 articles was intervention, and only one article was tool design and content analysis using the Delphi method. The types of tools used in these studies were: a wearable module on the head with two categories of movement and operation, playing virtual reality simulation videos with the help of television and virtual reality glasses, a wearable headset and two hand controllers with triggers that make hand movements. Such as grasping, pushing and turning, virtual simulated scenes, an immersive room-scale multi-user virtual reality 3D simulation environment with a virtual emergency scenario, wearable modules and mouse and keyboard prototypes, and an interactive training module. The results of the studies also showed the improvement of educational performance, enthusiasm for learning, educational satisfaction, increased skills, improved response capacity, effectiveness of education and control of emotions in emergency situations.


Conclusion: The results of this study clarified several issues: 1- The volume of studies in the field of emergency department training with the help of virtual world tools is very small. 2- Augmented reality and mixed reality tools have not yet entered the field of medical education in the emergency department. 3- These tools can cause complications and challenges in using them. 4- Most of the studies have been conducted in the last 3 years, which show that this field of educational tools to promote and improve performance due to continuous evaluations is at the beginning.

The Therapeutic Application of Augmented and Virtual reality Technology in the Emergency Department: a Review of studies Conducted in the World

Roohie Farzaneh, Reza Akhavan, Bita Abbasi, Seyed Reza Habibzadeh, Maryam Panahi, Fatemeh Maleki, Mahdi Foroughian, Behrang Rezvani Kakhki

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e41
https://doi.org/10.22037/ijem.v9i1.39975

Introduction: Advances in the field of technology in the field of virtualization today have led to the creation of tools that can easily evoke the presence of the patient in a more attractive situation than the current situation or by adding information to the real world to deepen the understanding of reality. Make Virtual reality and augmented reality technology has seriously entered the field of medicine for two decades. The emergency department has also been able to use this tool with its special features; therefore, the current research tries to have a systematic review of the therapeutic use of augmented and virtual reality technology in the emergency department.


Methodology: This research is based on a systematic review in which the quality of the articles was evaluated using the STROBE standard checklist. The primary studies carried out, through articles on the use of virtual reality and augmented reality therapy in the emergency department; in Persian language databases; SID, Iranmedex, Magiran and English language databases; Science Direct, PubMed, Scopus and Google Scholar search engines were conducted until the end of September 2022. Keywords of Emergency, Augmented Reality, Virtual Reality, Mixed Reality, Treatment, Cure, Therapy, Medical, EMS, MR, VR, and AR were considered as a combination of words.


Findings: Among the 14 reviewed studies, the largest number of extracted studies with 4 articles were conducted in Canada; and mostly it was a randomized and controlled prospective intervention method. Most of the studies with 10 articles were in the field of providing emergency services to children and adolescents under 18 years of age, and the effective components of virtualization technology were: reducing pain, managing anxiety and distress, improving hemodynamic parameters, and controlling fear and anger. Among the reviewed articles, none of the studies used augmented reality or mixed reality tools.


Conclusion: The results of the collected studies on the use of virtualization therapy show that so far this tool has had significant effects on controlling emotions and improving hemodynamic parameters. Analyzing the mechanism of the effect of virtual reality in different groups can help to establish a cause and effect relationship and the targeted use of these tools. It is also necessary to design these tools in such a way that their use does not prevent the normal procedures in the emergency department.

Letter to Editor


Titie : Check of the epidemiologic out come 500 patient with trauma and corona in outpatient and hospitalization

Abdoreza Baniani, Parvin Kashani, Hamidreza Hatamabadi, Behrooz Hashemi, Mohammad Mehdi Forouzanfar, Soroosh Baniani

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e7
https://doi.org/10.22037/ijem.v9i1.37716

بیش از دو سال از شروع پاندمی کرونا می گذرد و هنوز زوایای زیادی از این بیماری برای نظام سلامت مجهول مانده است. این بیماری بار مالی و جانی قابل توجهی را به کشورها تحمیل نموده و قسمت عمده ای از تحقیقات نظام سلامت را معطوف به خود ساخته است. بر اساس گزارشات رسمی، تا روز ۱۵بهمن ۱۴۰۰ در مجموع ۲۲۴ کشور جهان درگیر کرونا بوده اند که مجموع مبتلایان سراسر جهان ۳۸۹ میلیون نفر و در ایران ۶۴۳۸۰۰۰ نفر و مجموع جانباختگان جهان    ۵۷۳۲۰۰۰ نفر و در ایران  ۱۳۲۶۲۴ نفر رسیده است.

Case Report


Penetrating Neck Trauma with a Knife; a Case Report

Hosein Asadi, امیر احمد عربزاده, مهزاد یوسفیان, فرهاد غیبتی

Iranian Journal of Emergency Medicine, Vol. 9 No. 1 (2022), , Page e2
https://doi.org/10.22037/ijem.v9i1.37745

Managing neck trauma is a challenging issue in the emergency department. Stable-appearing patients may suffer from vascular, laryngeal, or neurologic complications. The patient was a 41-year-old man who was transported to the hospital by a pre-hospital emergency medical service, following a fight and stabbing in the II area of the neck on the right side. The site of the trauma was the middle part of the right side of the neck. The patient was fully conscious. He had spontaneous speech and his airway was open. The patient was transferred to the operating room after the initial procedures in the emergency department. during surgery, the knife was removed from the neck. Clinical management and providing a suitable platform to accelerate the process of interventions can have a favorable effect on the prognosis of patients.

Graves' disease is the most common cause of hyperthyroidism in all age groups, although due to the decrease in the incidence of classic hyperthyroid symptoms and Graves' disease and uncommon symptoms in the elderly, timely diagnosis and treatment of the disease are often complicated. For this reason, mortality and morbidity rate increases in the aged groups. This article discusses a case report of an elderly patient who went to the emergency room with progressive dysphagia of solids and liquids and was admitted to the gastroenterology department. In the subsequent follow-ups, the response to the treatment was visible in the patient, and the patient's dysphagia was resolved mainly, which shows the high importance of thyroid tests in the el. Timely diagnosis in this age group will reduce mortality.