Original/Research Article

Epidemiologic Study of Animal Bite in Rasht County, Guilan Province, Iran’s North, 2012

Behzad Zohrevandi, Payman Asadi, Vahid Monsef Kasmaie, Hosna Tajik, Masoome Sadat Fatemi

Iranian Journal of Emergency Medicine, Vol. 1 No. 1 (2014), 6 Mordad 2014, Page 11-15

Introduction: Animal bite because of following killing infections such as Rabies is considered as one of the health problem issues in Iran and other countries. Although extensive progressions have been achieved in prevention and treatment areas, spread of animal bite still has an increasing rate and large amount of costs have been annually spent to provide vaccine and anti-bodies. This study was done with the aim of epidemiologic evaluation of animal bite in Rasht county, Guilan province, Iran, 2012. Methods: In a prospective cross- sectional study, the related data of whole animal bite cases were gathered in terms of demographic information (age, sex, and occupation), animal species, animal dependency (wild, domesticated, unknown), habitant, part of body bitten, season, and type of wound. Results: Totally 1014 cases (72.5%) of animal bite were reported. The mean age of studied population was 33.63±17.81 years. The most cases of animal bite were related to dog (79.2%), domestic animals (88.3%), village habitants (61.3%), hand (55.2%), spring season (29.8%), and superficial type of wound (64.3%). The patients bitten from the face area were younger than those injured in other sites (p=0.001). The bitten individuals by other animals were younger than people bitten by cat or dog (p=0.002). Conclusion: The results of the present study showed that the incidence of animal bite was higher in spring season, by domestic dogs, among men in rural area, and as superficial wounds in the 20-29 age group. The animal bite has a relation with gender, age, and habitant. Animal bite has been yet considered as one of the public health problems and training activities could have a significant role to control such cases.

The Quality of Patients’ Files Documentation in Emergency Department; a Cross Sectional Study

Mehrdad Esmailian, Mohammad Nasr-Esfahani, Amir-Sajad Brahimi

Iranian Journal of Emergency Medicine, Vol. 1 No. 1 (2014), 6 Mordad 2014, Page 16-21

Introduction: Emergency departments as one of the most important wards of hospitals, provide the emergency therapeutic care to decrease the mortality and disability rates among patients. The management and evaluation of emergency activities are possible through timely, accurate, and complete registration of information, based on standard rules. Thus, the aim of this research was detecting the observance rate of documentation standards in the emergency department of Al-Zahra Hospital, Isfahan, to find patients’ files documentation failures and eliminate them. Methods: I This was a cross sectional study performed in the emergency department of Al-Zahra Hospital, Isfahan, 2009. For data gathering, a checklist included 23 questions in two parts was used. The first and second parts had 9 and 14 questions to detect observance rate of patients’ characteristics documentation and nurse reports documentation, respectively. Based on Likert scale, the answer of each option includes blank (score 1), illegible (score 2), incomplete (score 3), and complete (score 4). Therefore, the minimum and maximum reachable scores were determined 9-36 in the documentation of patients’ characteristics and 14-56 in the nurse reports. Data was analyzed using SPSS 8 and Chi-squared test and Fisher’s exact test were applied to compare qualitative data. Student’s t-test was used to compare quantitative information, too. P<0.05 was considered as significant. Results: 300 documents were studied in this research. The average of reached score in the quality assessment of patients record completion was 24.66±17 (15-34), (the maximum reachable score was 36). The total score of emergency patients records was 61.8±4.8 (45-74) from total of 92 reachable scores. The average of total reached score for nurse reports was 37.2±3.7 (28-46), (with the maximum reachable score of 56). No significant difference was seen in the accuracy of patients’ documentation according to referring shift (p=0.37) and being close or not (p=0.61). Conclusion: Based on findings of the present study, status and quality of observance in registration standards of files did not have desirable level. So that most of failures in recording of patients’ characteristics were related to registrations on the file and other indexes; the comments’ signs with date and time documentation and also finishing the comments by the physician were seen, too. Most of documentation failures in nurse reports were related to not finishing the end of report with a straight line, lack of explanation about the cause, status, and type of refer, and not enough statements regarding the patient’s general condition.

Cause and Final Outcome of Trauma in Patients Referred to the Emergency Department; a Cross Sectional Study

Majid Zamani, Mehrdad Esmailian, Maryam Sadat Mirazimi, Maede Ebrahimian, Keihan Golshani

Iranian Journal of Emergency Medicine, Vol. 1 No. 1 (2014), 6 Mordad 2014, Page 22-27

Introduction: Today trauma is considered as the first cause of death and disability of active population in developed and developing countries. Using preventive procedures in trauma events are effective when acute information and statistics present regarding types of trauma and their outcomes in the society. Thus, the present study was designed to assess the prevalence of trauma reasons and its outcome in traumatic patients hospitalized in three emergency departments of Isfahan, Iran. Methods: This cross- sectional study was performed on 1363 patients referred to three emergency departments of Isfahan during October, November, and December of 2010. Data collecting was done by using a checklist including demographic data, trauma mechanism and location, patients' transportation, anatomic site of injury, and patients' outcome after 24 hours. The data was analyzed using SPSS 16. Results: 1363 traumatic patients with mean age of 30.5 ±17.35 years (73.6% male) were studied. The mean time from event to reaching the ambulance was 9±7.81 minutes and average time of patient's transportation to the hospital 27.07±14.49. Motor vehicle crashes and falling from height were the most common trauma mechanisms and mortality (p<0.001). The rate of mortality and hospitalization in men respectively were 7 and 3.4 times more than women, (p=0.04). 1235 patients (90.6%) were discharged with good general condition. The rate of mortality and intensive care need were estimated 0.66% (9 patients) and 6.82% (93 patients), respectively. The most numbers of death were happened in 15-24 years (p<0.001) and the most hospitalizations in 25-44 years (p<0.001). Chest and head traumas were the most common causes of death. Conclusion: The study shows that motor vehicle crashes and falling form height in more than 80% of cases were the most frequent causes of trauma in patients referred to the emergency departments of these three hospitals. Also, the above mentioned were the most frequent mechanisms of trauma in died and intensive care needed patients. Above 90% of patients were discharged with good general condition.

Disposition of Patients Before and After Establishment of Emergency Medicine Specialists

Payman Asadi, Vahid Monsef Kasmaie, Behzad Zohrevandi, Seyyed Mahdi Zia Ziabari, Baharan Beikzadeh Marzbani

Iranian Journal of Emergency Medicine, Vol. 1 No. 1 (2014), 6 Mordad 2014, Page 28-33

Introduction: Emergency department (ED) as the fundamental part of hospital has a specific importance due to admitting the most various and sensitive group of patients. The aim of the ED is presenting services with highest quality in the least time. To reach this goal establishment of an emergency medicine specialist who performs assessment, resuscitation, stabilization, detection, and maintenance of emergency patients is noteworthy. The aim of this study was evaluating the effect of establishing the emergency medicine specialists on the performance of ED in Poursina Hospital, Rasht, Iran.  Methods: In this cross-sectional study files of all patients hospitalized in the ED of Poursina, Rasht, Iran, through 2005-2012 were evaluated. Variables such as age, gender, cause of refer and number of hospitalization, number of discharging from department, percentage of bed occupation and daily bed occupation, time of hospitalization, number of discharging under six hours, number of transportation to other wards or hospitals, and the rate of bed circulation in the ED were assessed, too. Data was gathered through hospital information system and analyzed using SPSS 20. Results: Through 2005 to 2012 number of admitted patients in the ED has increased so that the most admitted number was related to 2012 (p=0.0001). The present of discharged patients under six hours and the rate of direct discharging before the presence of emergency medicine specialists have increased from 15.5% and 58.9% to 23.4% and 61.2% in after their presence, respectively(p=0.001). Transporting to other wards and hospitals were also decreased from 41.1% to 38.8% (p=0.0001). The occupied beds percentage after presenting of emergency medicine specialists has noticeably decreased compared to the past, while bed turnover rate increased. In other words, the bed turnover mean has increased from 354.5±108.4 during 2005-2008 to 637.7±30.8 through 2009-2012 (p=0.002). Also, during 2005-2008 the hospitalization mean of the patient has remarkably decreased from 1.08±0.44 days to 0.35±0.05 days in 2009-2012 (p=0.021). The occupied bed mean before and after the presence of emergency medicine specialists were 12173±3453 and 6217±219, respectively, showed a descending trend into the past (p=0.018). Conclusion: It seems that presenting of emergency medicine specialists in health system leads to improve the service delivery to patients and decrease the waiting time.  Also with decreasing the waiting time of patients and timely disposition, more prepared beds can be accessible in the ED for future admission.

The Epidemiology of Extremity Fractures in Trauma Patients of Shahid Beheshti Hospital, Babol, 2001-2006

Naser Janmohammadi, Mohammad Montazeri, Esmaeil Akbarnezhad

Iranian Journal of Emergency Medicine, Vol. 1 No. 1 (2014), 6 Mordad 2014, Page 34-39

Introduction: Trauma is recognized as one of the most causes of mortality in developing countries and the most important reasons of disability in active and productive population as well as its economic and social shocks. Extremity fracture is one of the most common complications of trauma inflict upon the human and involves an extensive part of health center facilities. Thus, the present study was aimed to assess the epidemiology of lower and upper extremity fractures of hospitalized patients in Shahid Beheshti hospital, Babol, Iran. Methods: This cross-sectional study was performed on patients with extremity fractures who had hospitalized in the Shahid Beheshti hospital, Babol, through 2001-2006. The required information included age, gender, type of fracture, and trauma mechanism were extracted from documents and registered in the prepared questionnaire. Data was analyzed using SPSS 18. Results: During six years study, 3507 trauma patients with extremity fracture had been hospitalized (75.9% was male). The mean age of studied patients was 33.7±21.8. Six hundred and nineteen (17.7%) fracture cases was as open status. Hip fracture was the most common fracture type (34.6%). Trauma mechanism in 1701 (48.5%) was car accident, 671 (19.1%) motorcycle accident, 608 (17.3%) stumble, 466 (13.3%) fall from height, and 61 (1.7%) other cases. The most common site of fracture in car and motorcycle accidents was leg (38.8% and 52.5% respectively) and in stumble and fall from height was hip (46.8% and 30.9% respectively). Conclusion: The findings of this project revealed that the most common type of extremity fracture in trauma patients in the age groups of upper and lower of 60 were hip and leg, respectively. Furthermore, the most incidence mechanism of such fractures was motorcycle accident.

The Effect of Education on the Knowledge and Practice of Emergency Department’s Nurses Regarding the Patients’ Triage

Mohammad Kalantarimeibidi, Alireza Yadollahi, Samira Esfandiari

Iranian Journal of Emergency Medicine, Vol. 1 No. 1 (2014), 6 Mordad 2014, Page 40-44

Introduction: Emergency department as one of the most important wards of the hospital confronts with lots of referring patients. Timely service presentation in this ward depends on efficient and effective functions of its personnel. Thus, this study was aimed to evaluate the effect of education on the knowledge and practice of emergency department’s nurses in the patients’ triage field. Methods: In this cross-sectional study, the knowledge and practice of 50 nurses was evaluated before and after of 9 hours educational workshop regarding patients’ triage based on the emergency severity index (ESI). Persons who had at least six months work experience in the emergency department and did not participate in any triage workshop during the six years before starting the project were entered to the study. Data gathering was performed through preparing three questionnaires separately included demographic information as well as assessment of knowledge and practice. Evaluated demographic characteristics were age, gender, marital status, work history, academic degree, type of employment, work shift, and average of work shift weekly. To assess the knowledge and practice, two separate questionnaires were used that their reliability and validity were confirmed before. Data was analyzed using SPSS 16 and appropriate analytic tests. P<0.05 was considered as statistically significant. Results: The average knowledge scores of nurses reached from 7.5±2.1 to 14±1.6 (p= 0.001, r=0.49) after education. Also the average scores of participants increased from 31.8±9.9 to 69.7±8.1 (p= 0.001, r=0.87).  There was no significant relationship between characteristics of nurses and their knowledge scores in six weeks after education (p>0.05). While it was seen between the work history of nursing (p=0.038), working in emergency department (p=0.001), as well as type of employment (p=0.019) and average scores of practice within six weeks after education. No significant relation was seen between academic degree, marital status, and gender of participants and average scores of knowledge and practice during six weeks after finishing the educational workshop. Conclusion: It seems that education has a positive effect on increasing the knowledge and practice of emergency department’s nurses regarding the triage of patients by ESI. Therefore, expanding the theoretical and practical courses of education is essential to improve the knowledge and quality of service presentation.

Causes of Prolonged Length of Stay for Patients Referred to the Emergency Department; a Cross-Sectional Study

Mohammad Nasr-Esfahani, Mehrdad Esmailian, Maryam Nasri

Iranian Journal of Emergency Medicine, Vol. 1 No. 1 (2014), 6 Mordad 2014, Page 45-49

Introduction: Prolonged length of stay and failure to timely disposition of patients in the emergency department (ED) lead to negative impact on the quality of service presentation, increasing dissatisfaction, and finally violence. Therefore, assessing the causes of prolonged length of stay for patients in this ward and presenting some applicable solutions against it, can significantly help improving the quality of services and more satisfaction of patients. The present study was designed with the aim of evaluating the causes of prolonged length of stay for patients in the ED. Methods: In a cross-sectional study, the causes of prolonged length of stay for admitted patients were assessed in the ED of Alzahra Hospital, Esfahan, Iran, during the fall 2010. A checklist was prepared with 11 cases included: age, gender, triage level, the time of receiving admission code and discharging from ED, the chief compliant of patient, hospitalization and discharge services, date of hospitalization, and the outcome for all patients. The lack of available bed in the ward, request for doing tests and unnecessary consultations, delay in entering the samples to the laboratory, delay in visit and disposition of patients by senior resident on duty, need to therapeutic proceedings by another service, delay in informing the resident of the related service, lack of coordination between the other wards and ED for patient's transportation, and financial inability of the patient were considered as the probable causes of prolonged length of stay. Finally, gathered data was analyzed by using SPSS version 18.

Results: 95 (18.8%) patients had prolonged ED length of stay (>6 hours) with the hospitalization mean of 10.4±5.5 hours. Prolonged length of stay cases were significantly higher in patients under 30 years old (p=0.0001), in weekends (p=0.05), and second level triage (p=0.01). The most mean of prolonged length of stay were related to the surgery service with 20.0±21.2 hours, multi-service hospitalization with 16.7±12.1, neurosurgery with 15.6±15.1, internal with 14.2±16.1, orthopedic with 13.09±5.7, infectious with 13.4±13.1, and neurology with 6.7±3.0 (p=0/001). The most common causes of prolonged length of stay for patients were related to prolonged consultation time, need to a therapeutic performance by another service, lack of available bed in other ward, and delay in disposition of patients by other services (p=0.03).

Conclusion: Based on results of the present study, patients younger than 30 years, hospitalized in surgery services, multi-service, neurosurgery, internal, and hospitalized in weekend days had significantly higher prolonged length of stay in the ED. Also, increasing the consultations' time and disposition of patients following performance of a therapeutic proceeding by another service are other reasons of the prolonged length of stay for ED patients.


Review Article

History and Guideline of Emergency Medicine Residency Discipline in Shahid Beheshti University of Medical Sciences, Iran; Review of 2014

مجید شجاعی, حمید کریمان, حمیدرضا حاتم آبادی, نیتا سبزقبایی, علی ارحمی دولت آبادی, مصطفی علوی مقدم, محمد مهدی فروزانفر, حجت درخشانفر, سعید صفری

Iranian Journal of Emergency Medicine, Vol. 1 No. 1 (2014), 6 Mordad 2014, Page 2-10

Introduction: Since many years ago several problems have been felt in emergency departments (ED) of hospitals. In fact, none of physicians in the hospital have accepted the direct responsibility of patients’ management in the EDs and emergency wards of University centers have been managed by residents of various disciplines. Thus, the first line of therapy does not have guardian and several consultants with various specialists have been performed regarding patient’s management. The necessity of physician training was noticed for the first time in 1950 and after 24 years in 1974, the academic emergency medicine was established in United States of America (USA) in response to people expectations for overnight accessibility to specialized and quality medical cares. It was performed with foundation of the first period of resident’s training in emergency medicine discipline at University of Cincinnati, Ohio. At beginning, specialists of different fields such as internal medicine, surgery, anesthesia, orthopedics, and neurosurgery initiated the training of emergency medicine residents together which could be responsible to most of referees. Finally, with formal accepting the specialty board in 1978, this field has been officially identified as the 23th discipline in USA. Today the EDs of most hospitals in European and American countries has been managing by emergency medicine specialists which leads to improve the quality of education and treatment, significantly. Also in Iran the request of establishing this major has been presented in the secretariat of the council for graduate medical education for the first time in 1996. This request was approved and principles of its initiating recognized officially by the ministry of health. But, considering to lack of an appropriate infrastructure, it postponed until 2000 that again this discipline was missioned for initiating to the council for graduate medical education by the minister and its outcome was directly declared to him. Lastly, in ministry time of Dr. Farhadi in 2001 this major was initiated for the first time in Iran University of Medical Sciences. The present report was addressed to the education guideline of emergency medicine at Shahid Beheshti University of Medical Sciences besides evaluating the formation history of emergency medicine discipline in Iran. 

Letter to Editor

Unwritten Science Seems to Have Never Existed

Saeed Safari

Iranian Journal of Emergency Medicine, Vol. 1 No. 1 (2014), 6 Mordad 2014, Page 1

After successful launching of the first English Journal in the field of emergency medicine named “Emergency” in 2013, the emergency medicine department of Shahid Beheshti University of Medical Sciences has attempted to publish the first Persian language journal named “Iranian Journal of Emergency Medicine”. This journal is a quarterly journal that will publish articles in the field of emergency medicine including: all internal and operational emergencies, critical care, disaster medicine, trauma, environmental diseases, toxicology and forensic medicine, pediatric emergency medicine, emergency medical services, emergency nursing, health policy and ethics, and other related topics. Believing that public access to information can lead to easier exchange and faster development and production of science, the policy makers of this journal adhere to open access policy.