Original/Research Article

Pediatric Trauma Patients in Imam Hossein Emergency Department; an Epidemiologic Study

Ali Arhami Dolatabadi, Nasibeh Mohseninia, Marzieh Amiri, Hassan Motamed, Aliasghar Halimi Asl

Iranian Journal of Emergency Medicine, Vol. 3 No. 1 (2016), 9 February 2016, Page 8-4

Introduction: Trauma is one of the most important reasons that children visit emergency departments (ED) and is the most common cause of disability and mortality among them. Having epidemiological information on trauma in this age range, aids in accurate planning for prevention of these events. Therefore, the present study aimed to evaluate the epidemiology of trauma in pediatric trauma patients presented to ED. Methods: In a retrospective cross-sectional study using census method, the profiles of children presented to the trauma unit in ED of Imam Hossein Hospital, Tehran, Iran during 2011 and 2012 were evaluated. Data regarding age, sex, time and mechanism of trauma, anatomic site of trauma, measures taken, and outcome were gathered and descriptively analyzed using SPSS 16. Results: Data from the clinical profiles of 547 children were gathered using census method and evaluated (69.3% male). 169 (30.9%) cases had occurred in summer and 322 (58.9%) had visited between 4 PM and 12 AM. Car accidents with 286 (52.3%) cases were the most common mechanism, and head and neck area was the most common anatomic site of trauma. Finally, 537 (98.2%) children were discharged with a good general condition and 10 (1.8%) died. Most common traumas leading to death were chest and abdominal traumas (14.3%) and no significant relationship was detected between mortality and trauma mechanism (p = 0.845) or timing (p = 0.895). Conclusion: Based on the findings of the present study, most trauma cases under the age of 14 presented to ED of Imam Hossein Hospital, Tehran, Iran, were boys, in summer, between 4 PM and 12 AM, and car accident-related. 1.8% of traumas led to mortality, the most common causes being chest and abdominal traumas. 

Serum Paraoxonase-1 Changes in Thermal Burn Patients

Afshin Amini, Hamid Reza Hatamabadi, Mohsen Parvareshi Hamrah, Saeed Safari

Iranian Journal of Emergency Medicine, Vol. 3 No. 1 (2016), 9 February 2016, Page 14-9

Introduction: An increase in oxidant concentration or a drop in anti-oxidants leads to an imbalance in oxidant/anti-oxidant equilibrium and a condition called oxidative stress. It seems that recovery from anti-oxidant decrease in this situation can help reduce the effects of the disease and accelerating recovery. Therefore, the present study was designed aiming to evaluate changes in serum paraoxonase-1 levels in thermal burn patients. Methods:This prospective case-control study was carried out from July to October 2014 on thermal burn patient hospitalized in the emergency department of Motahari Hospital, within 4 hours of burning. The control group were healthy people. A checklist consisting of demographic data, medical history, test results, paraclinical measures taken, and serum paraoxonase-1 level was filled for both groups. Finally, SPSS version 19 was used for statistical analysis and comparing the results between the 2 groups. Results: 33 thermal burn patients were compared with 53 healthy people as the control group. Mean age was 36.61 ± 9.09 years in control group and 37.69 ± 11.52 years in burn group (p = 0.632). Mean burn percentage in patients was 30.76 ± 23.37 (3 – 100). The 2 groups were not significantly different regarding baseline characteristics (p > 0.05). Mean serum paraoxonase-1 level in case and control groups were 228.52 ± 136.8 and 350.65 ± 149.08 IU/lit, respectively (p < 0.001). No significant correlation was detected between paraoxonase1 activity in thermal burn patients and their burn percentage (p = 0.532). Subgroup analysis results revealed the significant confounding effect of albumin and high density cholesterol levels on paraoxonase1 activity. Conclusion: Based on the results of the present study, it seems that although the level of paraoxonase-1 anti-oxidative activity in thermal burn patients is low, since albumin and high-density cholesterol levels are low, burn might not be the only cause. 

Knowledge and Practice of Nurses Regarding Patients’ Triage in Emergency Department

Samanesadat Javadi, Tahere Salimi, Mohammad Taghi Sareban, Mohammad Ali Dehghani

Iranian Journal of Emergency Medicine, Vol. 3 No. 1 (2016), 9 February 2016, Page 22-15

Introduction: Determining patients’ treatment priority based on the severity of their condition, and choosing the best treatment for the highest possible number of patients in the shortest time is called triage. Although triage has only been used in Iranian hospitals since a few years ago, almost all hospital emergency services over the country currently have this unit. Nurses are responsible for triaging patients, but there is little data on their knowledge and quality of practice in this regard. Therefore, this study was aimed to assess the knowledge level and practice of emergency department (ED) nurses regarding hospital triage. Methods: This study is a prospective cross-sectional one, carried out with the aim of evaluating the knowledge level and practice of nurses regarding hospital triage. Simple random sampling was used to select ED nurses from teaching hospitals in Yazd province. Data were gathered using a questionnaire, validity and reliability of which had been confirmed before. The questionnaire comprised of 3 parts, 11 demographic questions, 15 questions evaluating knowledge, and 10 assessing practice. Data were analyzed using SPSS 16.0 and descriptive and inferential statistical tests.  Results: A total of 45 questionnaires were filled and gathered. 62.2% of cases were male with the mean age of 35.92 ± 5.74 years, and 37.8% were female with the mean age of 30.82 ± 7.37 years. Mean age of all participants was 34 ± 6.80 years. Mean work experience of the studied nurses was 10.07 ± 6.89 years and their mean work experience in ED was 5.31 ± 4.70 years. Evaluation of the second part, regarding their knowledge, revealed that 42.07% of the answers to the questions were correct and their mean score was 6.33 ± 1.96. In addition, their practice assessment showed that 50.44% of the answers given in this part were right and their mean score in this regard was 5 ± 1.47. In total, 45.33% of the answers given by the participants were correct regarding the scenarios. Mean overall score (sum of the scores obtained from knowledge and practice parts) for the participants was 11.33 ± 2.50. Statistical analysis found a significant correlation only between the working shift and the knowledge score (p = 0.003). Conclusion: It seems that the knowledge and experience of the nurses working in EDs of centers under supervision of Shahid Sadoughi University of Medical Sciences, Yazd, Iran, regarding triage, is below average. Consequently, it is suggested to hold special retraining courses in the field of triage for the staff in order to improve the quality of care. 

Epidemiology of Head and Neck Fractures Caused by Motorcycle Accidents

Ali Ramouz, Mahdie Hosseini, Samad Shams Vahdati

Iranian Journal of Emergency Medicine, Vol. 3 No. 1 (2016), 9 February 2016, Page 27-23

Introduction: Injuries resulting from motor-vehicle accidents are a growing burden to health all over the world. Each year, many people get severely injured or die due to road traffic accidents. Therefore, we aimed to evaluate the demographics of head and neck fractures caused by motorcycle accidents. Methods: In the present retrospective cross-sectional study, all the patients who were referred to emergency department, during the time from March 2013 to March 2014, with head and neck injuries due to motorcycle accidents were included using census sampling. A checklist consisting of demographic data, trauma mechanism, time of trauma, being the driver or the passenger, using safety equipment, head and neck fractures, accompanying injuries, imaging findings, and final outcome was filled for all patients using their medical files, and the data were used for descriptive analysis. Results: 386 patients with the mean age of 28.4 ± 10.79 years were evaluated (84.4% male). Most of the patients were under 30 years old (p = 0.001). Spring, with 152 (39.4%) cases, had the highest rate of accidents among the seasons. 223 (57.8%) accidents happened in the daytime (p = 0.037). Only 191 (49.5%) patients had used helmets. The most frequent fracture was cervical vertebrae fracture with 61 (15.8%) cases. Finally, 207 (53.6%) of the patients were discharged from emergency department after diagnostic and therapeutic measures were taken. 175 (45.4%) cases were hospitalized in other departments for further treatments and were later discharged with good general condition. 4 (1%) cases of mortality were recorded. Conclusion: The results of the present epidemiologic study reveal that the prevalence of head and neck fractures in motorcycle accidents is higher in young people, male sex, and those who do not use safety equipment. The most common site for head and neck fractures are cervical vertebrae, skull, and face bones, respectively. 

Cause and Outcome of Preventable Accidents in the Elderly; an Epidemiologic Study

Monavvar Afzal Aghaei, Saleheh Norouzi, Ali Khorsand Vakilzadeh, Fatemeh Abedi

Iranian Journal of Emergency Medicine, Vol. 3 No. 1 (2016), 9 February 2016, Page 33-28

Introduction: With the growing population of the elderly in societies, the medical problems of this age range also increases. Preventable accidents are among these problems. More than 5 million people die as the result of these injuries each year. Therefore, the present study was done aiming to evaluate the causes and outcomes of preventable accidents in the elderly.

Methods: The present study is a retrospective cross-sectional one, performed on elderly patients admitted to a hospital during 2 years. Required data were gathered using census method via a checklist consisting of demographic data, cause of the accident, length of hospital stay, number of times revisiting the hospital, and final outcome. Data were then descriptively analyzed using SPSS 16 statistical software.

Results: 2336 patients with the mean age of 72.24 ± 9.02 years were evaluated (50.7% female). The most common causes of accidents were falling with 1033 (44.2%) cases, intentional poisoning with 382 (16.4%) cases, and unintentional poisoning with 360 (15.4%) cases, respectively. Mean length of hospital stay was 5 ± 7.7 days. 144 (6.2%) elderly patients died during the study period. Type of accident (p < 0.001) and final outcome (p < 0.001) were significantly different between the sexes.

Conclusion: Based on the findings of the present study, falling, intentional poisoning and unintentional poisoning, respectively, were the most common causes of preventable accidents in the studied elderly population. Most cases were discharged after partial recovery and the 3 afore-mentioned causes had higher prevalence in women. The most frequent outcomes were complete recovery in poisoning, partial recovery in falling, and death in poisoning and burn.

Epidemiology of Upper Extremity Trauma in Patients Visiting the Emergency Department

Ali Arhami Dolatabadi, Negar Ebrahimzadeh, Afshin Amini, Majid Shojaee, Marzieh Amiri

Iranian Journal of Emergency Medicine, Vol. 3 No. 1 (2016), 9 February 2016, Page 39-34

Introduction: Considering its high prevalence and cost as well as frequent complications, trauma is one of the major health problems in Iran. Knowing the epidemiologic characteristics of these patients could be helpful in arrangement for decreasing the burden of disease. This study was aimed to evaluate the epidemiology of upper extremity trauma among patients visiting trauma unit of emergency department (ED). Methods: The present cross-sectional study was done using census method on all patients with upper extremity trauma visiting the ED of Imam Hossein Hospital, Tehran, Iran in 2012. Required data were gathered using a checklist consisting of questions regarding demographic data (age, sex), trauma mechanism, time of trauma, type of trauma, and therapeutic measures taken. Gathered data were statistically analyzed via SPSS version 19.0. Results: 751 patients with the mean age of 27 ± 7.6 years were evaluated. 616 (82%) patients were male and the highest frequency belonged to the age range of 20 – 30 years with 248 (33%) cases. 339 (45.1%) accidents had occurred between 8 AM and 4 PM. Injury caused by motorcycle accidents was the most common mechanism of trauma among those evaluated with 185 (24.6%) cases. 575 (76.6%) cases had an isolated extremity trauma and 176 (23.4%) had multiple trauma that included extremity trauma. The most prevalent injuries that needed surgical intervention were distal radius fracture with 143 (34%) cases, soft tissue injury with 75 (17.8%) cases, and isolated ulna fracture with 46 (10.9%) cases. Conclusion: Based on the results of this study, the most common cases of upper extremity trauma occurred in men, age range of 20 – 30 years, spring, and between 8 AM and 4 PM. The most common trauma mechanism was motorcycle accident and distal radius fracture was the most prevalent injury that needed surgical intervention.

Letter to Editor

Emergency Medicine; a Review of the Past and a Look to the Future

Ali Bidari, Hamid Reza Hatamabadi

Iranian Journal of Emergency Medicine, Vol. 3 No. 1 (2016), 9 February 2016, Page 3-1

Before establishment of emergency medicine specialty around the world, emergency departments (ED) were deemed unimportant and long waiting time and misdiagnosis were common. However, the need for specialty in this regard was sensed during the 1960s and 1970s and it was established in the 80s and 90s. In Iran, establishment of emergency medicine in 2001 has revolutionized patient care. Although emergency physicians face some challenges, the most important thing is carrying out their responsibilities. An emergency physician should be responsible and reliable and people have a high expectation of them. In this letter, authors tried to briefly review the history of emergency medicine establishment in Iran and look into the future by discussing some challenges of this specialty. 

Case Report

Pneumomediastinum a Rare but Important Cause of Acute Chest Pain; a Case Report

Maryam Motamedi, Maryam Janati, Sona Ziaei

Iranian Journal of Emergency Medicine, Vol. 3 No. 1 (2016), 9 February 2016, Page 43-40

Spontaneous pneumomediastinum is a rare condition, which is usually benign and self-limiting. Its main presentation is sudden retrosternal pain that may occur following valsalva maneuver, vomiting, frequent cough, heavy exercise, marijuana inhalation, trauma, and intubation. Given the low prevalence and importance of paying attention to spontaneous pneumomediastinum in screening patients presented to the emergency department with acute chest pain, here we will introduce a 17-year-old patient with chief complaint of chest pain and final diagnosis of spontaneous pneumomediastinum. 


Evidence Based Medicine; Pre and Post test Probabilities and Fagan’s Nomogram

Saeed Safari, Alireza Baratloo

Iranian Journal of Emergency Medicine, Vol. 3 No. 1 (2016), 9 February 2016, Page 46-44

Emergency physicians face numerous questions regarding proper management of patients and selection of the best laboratory test or imaging every day. Knowledge on screening performance characteristics of the diagnostic tools used in this department plays an important role in finding the answers to these questions. We assessed these characteristics in the previous parts of educational article series in Emergency journal. In the present manuscript, we will describe how to use these screening characteristics for selecting the right diagnostic tools.