Original/Research Article

Predictive Factors of Hospitalization and Dialysis Requirement in Alcohol Poisoning; a Cross-Sectional Study

Ali Tagizadieh, Payman Moharamzadeh, Mahboob Pouraghaei, Rouzbeh R Ghafouri, Kavous Shahsavari Nia

Iranian Journal of Emergency Medicine, Vol. 2 No. 1 (2015), 28 Esfand 2015, Page 11-19

Introduction: Alcohol abuse is one of the health problems that all societies have involved with. Although in Iran the percent of alcohol consuming due to social and cultural preventions is lesser that other countries, its outcome and predictive factors are not accessible. Thus, this study was designed with the aim of determining the consequences of alcohol consuming and finding its effective factors in Tabriz. Method: This cross-sectional study has been done through September 2013 to July 2014 in Sina Hospital, Tabriz, Iran. All individuals with alcohol poisoning referred to the emergency department were included in the study. Demographic and clinical factors of patients, laboratory tests, dialysis and hospitalization in hospital wards were evaluated. Finally, independent effective factors for dialysis and hospitalization were assessed by using multivariate logistic regression.Results: At the end, 81(91.4% male) patients with the mean age of 27.9±10.4 years were entered to the study. Ten (12.3%) patients needed dialysis and 34 (42.0%) were hospitalized. Increasing the serum creatinine level (OR-1.6; 95% Cl: 1.004-2.4; p-0.048) and time interval between consumption until referring to the emergency (OR-1.1; 95% Cl: 1.03-1.15; p-0.004) were the independent predictive factors of dialysis. Also, predictive agents of hospitalization included smoking (OR-3.4; 95% Cl: 1.6-5.5; p-0.01) and need to do dialysis (OR-7.9; 95% Cl: 5.4-10.5; p<0.001). Conclusion: In the present project 12.3% of patients needed dialysis. Increasing the serum creatinine and time interval between alcohol consuming until referring to the emergency were the most important predictive factors. In addition, the probability of hospitalization for smoking and dialyzed poisoned persons in hospital wards was more than other patients.

Failure Mode and Effect Analysis in Increasing the Revenue of Emergency Department

Farhad Rahmati, Ali Shahrami, Alireza Baratloo, Behrooz Hashemi, Nastaran Sadat Mahdavi, Saeed Safari, Hamidreza Hatamabadi

Iranian Journal of Emergency Medicine, Vol. 2 No. 1 (2015), 28 Esfand 2015, Page 20-27

Introduction: Successful performance of emergency department(ED) is one of the important indications of increasing the satisfaction among referees. The insurance of such successful performance is fiscal discipline and avoiding from non-beneficial activities in this department. Therefore, the increasing revenue of emergency department is one of the interested goals of hospital management system. According to above-mentioned, the researchers assessed problems lead to loss the revenue of ED and eliminate them by using failure mode and effects analysis (FMEA).

Methods: This was the prospective cohort study performed during 18 months, set in 6 phases. In the first phase, the failures were determined and some solutions suggested to eliminate them. During 2-5 phases, based on the prioritizing the problems, solutions were performed. In the sixth phase, final assessment of the study was done. Finally, the feedback of system’s revenue was evaluated and data analyzed using repeated measure ANOVA.

Results: Lack of recording the consuming instrument and attribution of separate codes for emergency services of hospitalized patients were the most important failures that lead to decrease the revenue of ED. Such elimination caused to 75.9% increase in revenue within a month (df = 1.6; F = 84.0; p<0.0001).  Totally, 18 months following the eliminating of failures caused to 328.2% increase in the revenue of ED (df = 15.9; F = 215; p<0.0001).

Conclusion: The findings of the present study shows that failure mode and effect analysis, can be used as a safe and effected method to reduce the expenses of ED and increase its revenue.

Job Burnout Status among Pre-Hospital Emergency Technicians

Zohre Moradi, Ahmad Ali Eslami, Akbar Hasanzadeh

Iranian Journal of Emergency Medicine, Vol. 2 No. 1 (2015), 28 Esfand 2015, Page 28-32

Introduction: Since pre-hospital emergency staff, who play a vital role in saving peoples’ lives, work under a lot of pressure, determining the rate and dangers of their job burnout is very important. Therefore, this study was carried out to determine the job burnout rate of the pre-hospital emergency staff in Isfahan, Iran. Methods: In this cross-sectional study, all of the pre-hospital emergency staff in all emergency operation centers in Isfahan were included. Using the standard Maslach burnout inventory questionnaire, the job burnout rate of emergency technicians was measured. The studied aspects were frequency and intensity of emotional exhaustion, depersonalization and personal accomplishment feeling, which were then divided into 3 levels (low, average and high) according to the intensity and frequency of these feelings. Results: In the end, 68 technicians were involved in this study (Mean age 26.97±7.7; 42.6% single). Regarding intensity, their mean emotional exhaustion score was 25.59±20.39, depersonalization score was 10.57±7.83 and personal accomplishment feeling was 34.6±8.46. Moreover, the mean emotional exhaustion frequency was 21.21±11.95 (low level), depersonalization frequency was 8.94±5.43 (low level) and personal accomplishment feeling frequency was 26.82±5.72 (high level). Conclusion: The data obtained in this study shows that the pre-hospital emergency technicians in Isfahan show average levels of emotional exhaustion and depersonalization intensity and frequency and feel highly unaccomplished.

Evaluation of Performance Indexes of Emergency Department

Alireza Baratloo, Farhad Rahmati, Mohammad Mehdi Forouzanfar, Behrooz Hashemi, Maryam Motamedi, Saeed Safari

Iranian Journal of Emergency Medicine, Vol. 2 No. 1 (2015), 28 Esfand 2015, Page 33-38

Introduction: The importance of evaluating performance indicators in the emergency department, as one of the most important departments of hospital, is obvious to everyone. Therefore, in this study we aimed to appraise the five performance indicators, approved by the ministry of health, in Shohadaye Tajrish hospital, Tehran, Iran. Methods: In a descriptive cross-sectional study based on the profiles of all the patients admitted to the emergency department, performance indicators in the emergency department were evaluated. The study was divided into 2 parts about the establishment of emergency medicine system and training the medical staff: the first 6 months of 1392 and the second. Then these 2 periods were compared using Mann-Whitney U test while P< 0.05 was considered as the level of significance. Results: Of the studied indicators, mean triage time was 6.04 minutes in the first 6 months which was reduced to 1.5 minutes in the second 6 months (p=0.016). In addition, the percentage of patients who moved out of the department in 12 hours was lowered from 97.3% in the first period to 90.4% in the second (p=0.004). While, the percentage of patients who were decided upon in 6 hours (p=0.2), unsuccessful CPR percentage (p=0.34) and patients discharged against medical advice (p=0.42) showed no significant difference. Conclusion: The results of this study showed that the establishment of the emergency medicine system in the emergency department could lead to more efficient triage. Due to the differences made after their establishment including: different pattern of the patients admitted, increased stay of the patients in the department due to their need for prolonged intensive care, a raise in patient referral to the hospital by pre-hospital services and a higher percentage of occupied hospital beds, other indicators have not shown a significant improvement.

An Epidemiologic Study of Trauma in Elderly Diabetic Patients; a Preliminary Report

Behzad Zohrevandi, Payman Asadi, Vahid Monsef Kasmaei, Seyyed Mahdi Zia Ziabari, Hosna Tajik, Forouzan Marefati

Iranian Journal of Emergency Medicine, Vol. 2 No. 1 (2015), 28 Esfand 2015, Page 39-44

Introduction: Elderly diabetic patients are prone to trauma due to background illnesses or physical disabilities. In the present epidemiologic study, we aimed to evaluate pattern of trauma in elderly diabetic patients referred to the emergency department of Poorsina Hospital, Rasht, Iran, 2011. Methods: This cross-sectional study was performed on the diabetic patients over 60 years old. Demographic data, trauma characteristics, mortality, need for blood transfusion, and the time interval between admission and death, were gathered. Finally, the risk factors of the mortality were evaluated. P<0.05 was considered as the significance level. Results: 268 patients with mean age of 69.94±7.18 years were evaluated (58.6% female). Most common trauma mechanism was same level falling (40.3%); most common location for trauma was urban streets (35.8%); most common anatomic site were extremities (45.6%); and the season with highest trauma occurrence was winter (28%). 14.2% of the patients needed blood transfusion and 6.3% of the patients finally died. Mean hospitalization duration in the department was 3.72±5.14 days (between 6 hours to 53 days). There was a significant correlation between mortality of the elderly diabetic patients and sex (p=0.012), anatomic site of trauma (p=0.047), number of injured site (p=0.030), need for blood transfusion (p<0.001), systolic blood pressure < 90 mmHg (p=0.017) and heart rate >100/minute (p<0.001). Conclusion: The results of this study, show that the most common trauma mechanism was same level falling, the most common site of trauma was streets and other places in the city, most common anatomic site for trauma were extremities; the season with highest trauma occurrence was winter. There was a significant correlation between mortality of patients and sex , anatomic site of trauma, number of injured site, need for blood transfusion , systolic blood pressure < 90 mmHg and heart rate >100/minute.

Review Article

Hospital and Pre-Hospital Triage Systems in Disaster and Normal Conditions; a Review Article

Saeed Safari, Farhad Rahmati, Alireza Baratloo, Maryam Motamedi, Mohammad Mehdi Forouzanfar, Behrooz Hashemi, Alireza Majidi

Iranian Journal of Emergency Medicine, Vol. 2 No. 1 (2015), 28 Esfand 2015, Page 2-10

Triage is a priority classification system based on the severity of problem to do the best therapeutic proceedings for patients in the less time. A triage system should be performed in a way which can make a decision with high accuracy and in the least time for each patient. Simplicity and reliability of the performance are the most important features of a standard triage system. An appropriate triage causes to increase the quality of health care services and patients’ satisfaction rate, decrease the waiting time as well as mortality rate, and increase the yield and efficiency of emergency wards along with reducing the related expenses. Considering to the above statements, in the present study the history of triage formation was evaluated and categorizing of all triage systems regarding prehospital and hospital as well as triage in normal and critical conditions were assessed, too.

Letter to Editor

Brief Report

Cause of Death in Emergency Department; a Brief Report

Gholamreza Faridaalaee, Farshid Nikzad, Seyed Hesam Rahmani

Iranian Journal of Emergency Medicine, Vol. 2 No. 1 (2015), 28 Esfand 2015, Page 45-48

Introduction: This epidemiologic study was aimed to identify the causes of death in the emergency department of Imam Khomeini hospital in Urmia, Iran. Methods: This cross sectional study was carried out on the profiles of all of the dead patients in the emergency department of Imam Khomeini Hospital in Urmia, Iran who were admitted from April 2013 to March 2014. Demographic data and causes of death were extracted and were then statistically analyzed using SPSS 21. Results: During the studied year, 396 patients were dead in the emergency department, 207 of which were studied (68% male). Mean age for the dead patients was 63.1±5.2 years (minimum 3 and maximum 94). 159 patients were dead in the first 24 hours after admission and 48 in the next 24 hours. The most common causes of death were figured to be respiratory illnesses (27.5%), heart diseases (21.3%) and trauma (14%). Conclusion: Based on the results of this study, it seems that respiratory illnesses, heart diseases and trauma are the most common causes of death in the emergency department. Therefore, proper planning, educating the staff and equipping the department appropriately can be effective in reducing the death rate.

Evaluating the Relationship between Rib Fractures and the Probability of Abdominal Trauma; a Brief Report

Vahid Monsef Kasmaei, Behzad Zohrevandi, Payman Asadi, Lida Salehi

Iranian Journal of Emergency Medicine, Vol. 2 No. 1 (2015), 28 Esfand 2015, Page 49-53

Introduction: Trauma is one of the most important causes of death in patients under 40 years of age and the third common cause of death regardless of age. Rib cage damages are one of the major reasons for death in the early minutes post-trauma. Therefore, the present study aimed to evaluate the frequency of intra-abdominal injury in the patients with rib fracture who were referred to emergency department. Methods: This cross-sectional study included 60 patients with rib fractures who were admitted to the emergency department of Poorsina Hospital, Rasht, Iran, from March 2011 to March2012. A checklist was filled out for all the patients including age, sex, trauma mechanism, side and site of fracture, the number of broken ribs, the results of abdominal ultrasonography, the need for laparotomy and mortality. The collected data were classified based on descriptive statistics and analyzed using SPSS 16. Results: 60 patients with the mean age of 47.26±13.71 years were admitted to the emergency department during this time (81.7% male). The most common mechanism of trauma was car accident [22(36.7%]. Among these 60 patients, 71 rib fractures in 3 levels of chest (upper, middle, lower) were detected and 50 (83.3%) in the same area. Mean number of fractured ribs was 2.85±2.2 (minimum: 1, maximum 10). In 3 (5%) patients, fracture was on both sides. The results of abdominal ultrasonography in 7 (11.7%) patients were positive. The number of fractured ribs (p=0.017) and the area of the fracture (p=0.048) showed a significant correlation with the presence of intra-abdominal free fluid. The fracture of more than 2 ribs directly correlated with the possibility of intra-abdominal hemorrhage (p<0.0001). Conclusion: Based on the results of this study, it seems that the number and area of the fractured ribs directly and significantly correlate with the probability of abdominal trauma based on the results of abdominal ultrasonography.

Case Report

A Case of Plasmodium Falciparum Malaria in a 28-Year-Old Man Referred to the Emergency Department

Farhad Heidari, Saeed Majidinejad, Mehrsa Taheri

Iranian Journal of Emergency Medicine, Vol. 2 No. 1 (2015), 28 Esfand 2015, Page 54-57

Malaria is a parasite disease associated with fever and about half of the world population is at risk. According to the reports of World Organization Center (WHO), about 207 million cases of clinical manifestation of malaria happened in 2012, which followed with 627,000 deaths. Considering to presence of malaria-endemic areas in Iran, several efforts have been performed recently to control and eradication of malaria in terms of country programs. Despite of reducing the incidence rate, few cases of malaria have been reported yet. Therefore, the present report was done with the aim of remembering the model of referring, clinical signs, as well as diagnostic and therapeutic procedures of patients suffered malaria