Blunt Traumatic Cervical Spine Fractures in Iran

Background: Blunt traumatic cervical spine fractures (TCSF) are serious injuries which may be associated with considerable mortality and morbidity. We describe the epidemiology of blunt traumatic cervical spine fracture in Iran over a definable time period. Methods: In a cross-sectional study, the data including the distribution of TCSF, demographics, mechanisms, abbreviated injury scale (AIS), spinal cord associated injuries and final outcome of patients, was extracted from the Iranian national trauma registry database in target hospitals in eight major cities of Iran from 1999 to 2004. The Chi square test was used to compare mortality and one-way ANOVA was used to compare ISS amongst the categories of TCSF. Results: TCSF was identified in 120 cases, of these 70.8% were male. Their mean age was 36.6 ± 17.2 years. The overall incidence of TCSF among all trauma patients was 0.7% (95%CI: 0.61% - 0.88%). The TCSF incidence among all spine fractured patients was 19.38% (95%CI: 16.34% - 22.72%). The most common mechanism of TCSF was a motor vehicle collision (66.7%). The overall percentage of in-hospital death for TCSF was 12.6%. There were no statistically significant difference in death and injury severity scores (ISS) among TCSF categories (p > 0.05). Spinal cord and root injuries occurred in 34.9% and 2.4% of TCSF, respectively. Conclusions: Preventive strategies need to be developed in order to reduce the number and severity of TCSF in the general Iranian population.

Risk of permanent medical impairment after road traffic crashes: A systematic review

Purpose:To systematically review the risk of permanent disability related to road traffic injuries(RTIs)and to determine the implications for future research regarding permanent impairment following road traffic crashes.Methods:We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement.An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020.Two teams include 2 reviewers each,screened independently the titles/abstracts,and after that,reviewed the full text of the included studies.The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology(STROBE)checklist.A third reviewer was assessed any discrepancy and all data of included studies were extracted.Finally,the data were systematically analyzed,and the related data were interpreted.Results:Five out of 16 studies were evaluated as high-quality according to the STROBE checklist.Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005.Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2%to 23%for car occupants and 2.8%to 46%for cyclists.Seven studies reported the risk of permanent medical impairment of the different body regions.Eleven studies stated the most common body region to develop permanent impairment,of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured.Conclusion:The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world.This would facilitate decisionmaking about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.

Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries:A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran(NSCIR-IR)data

Purpose:To identify risk factors for developing pressure ulcers(PUs)in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries(SCIs).Methods:Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran(NSCIR-IR)from individuals with traumatic spinal fractures with or without SCIs,in-clusive of the hospital stay from admission to discharge.Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay.The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification.In addition to PU,following data were also extracted from the NSCIR-IR datasets during the period of 2015-2021:age,sex,Glasgow coma scale score at admission,having SCIs,marital status,surgery for a spinal fracture,American Spinal Injury Association impairment scale(AIS),urinary incontinence,level of education,admitted center,length of stay in the intensive care unit(ICU),hypertension,respiratory diseases,consumption of ciga-rettes,diabetes mellitus and length of stay in the hospital.Logistic regression models were used to es-timate the unadjusted and adjusted odds ratio(OR)with 95%confidence intervals(CI).Results:Altogether 2785 participants with traumatic spinal fractures were included.Among them,87(3.1%)developed PU during their hospital stay and 392(14.1%)had SCIs.In the SCI population,63(16.1%)developed PU during hospital stay.Univariate logistic regression for the whole sample showed that marital status,having SCIs,urinary incontinence,level of education,treating center,number of days in the ICU,age,and Glasgow coma scale score were significant predictors for PUs.However,further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center,marital status,having SCIs,and the number of days in the ICU.For the subgroup of individuals with SCIs,marital status,AIS,urinary incontinence,level of education,the treating center,the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis.After adjustment in the multivariate model,the treating center,marital status(singles vs.marrieds,OR=3.06,95%CI:1.55-6.03,p=0.001),and number of days in the ICU(OR=1.06,95%Cl:1.04-1.09,p<0.001)maintained significance.Conclusions:These data confirm that individuals with traumatic spinal fractures and SCIs,especially single young patients who suffer from urinary incontinence,grades A-D by AIS,prolonged ICU stay,and more extended hospitalization are at increased risk for PUs;as a result strategies to minimize PU development need further refinement.

Comparing epidemiologic features,outcomes,and diagnostic and therapeutic procedures of traumatic patients before and during COVID-19 pandemic:Data from the National Trauma Registry of Iran

Purpose:To prepare for future possible communicable disease epidemics/pandemics,health care providers should know how the COVID-19 pandemic influenced injured patients.This study aimed to compare epidemiologic features,outcomes,and diagnostic and therapeutic procedures of trauma patients admitted to a university-affiliated hospital before and during the pandemic.Methods:This retrospective study was performed on data from the National Trauma Registry of Iran.All injured patients admitted to the hospital from July 25,2016 to March 10,2021 were included in the study.The patients were excluded if they had hospital length of stay less than 24 h.The injury outcomes,trauma mechanisms,and therapeutic and diagnostic procedures of the 2 periods:before(from July 25,2016 to February 18,2020)and during(from February 19,2020 to March 10,2021)COVID-19 pandemic were compared.All analyses were performed using STATA version 14.0 software(Stata Corporation,College Station,TX).Results:Totally,5014 patients were included in the registry.Of them,773(15.4%)were registered after the beginning of the COVID-19 pandemic on February 19,2020,while 4241 were registered before that.Gender,education level,and cause of injury were significantly different among the patients before and after the beginning of the pandemic(p<0.001).In the≤15 years and≥65 years age groups,injuries decreased significantly during the COVID-19 pandemic(p<0.001).The frequency of intensive care unit(ICU)admission decreased from 694(16.4%)to 88(11.4%)(p<0.001).The mean length of stay at the hospital(days)and at the ICU(days)declined as follow:8.3(SD=17.2)vs.5.5(SD=6.1),p<0.001 and 7.5(SD=11.5)vs.4.5(SD=6.3),p<0.022.The frequency of diagnostic and therapeutic procedures before and during the pandemic was as follows,respectively:ultrasonography 905(21.3%)vs.417(53.9%)(p<0.001),echocardiography 313(7.4%)vs.107(13.8%)(p<0.001),angiography 1597(37.7%)vs.534(69.1%)(p<0.001),MRI 166(3.9%)vs.51(6.6%)(p<0.001),surgery 3407(80.3%)vs.654(84.6%)(p<0.001),and internal/external fixation 1215(28.6%)vs.336(43.5%)(p<0.001).Conclusion:The pandemic affected the epidemiology of traumatic patients in terms of gender,age,educational level,and trauma mechanism.It changed the outcomes of injured patients:ICU admission,length of stay at the hospital and ICU decreased.The patients received more diagnostic and therapeutic procedures during the pandemic.To be more precise,more research is needed on the details.

Comparison of ultrasonography and radiography in diagnosis of rib fractures

Purpose： Rib fractures are the most common skeletal thoracic injuries resulting from blunt chest trauma. Half of the rib fractures are not detected upon a precise physical evaluation and radiographs. Recently ultrasonography （USG） has been investigated to detect rib fractures. But based on literature the usefulness of USG varies widely. This study was conducted to investigate the role of USG in the detection of possible rib fractures in comparison with radiography. Methods： In this cross-sectional study, consecutive patients with minor blunt chest trauma and suspected rib fractures presenting in Imam Reza Hospital located in Mashhad-Iran, between April 2013 and October 2013 were assessed by USG and radiography. The radiography was performed in a posteroanterior （PA） chest projection and oblique rib view centered over the area of trauma. The time duration spent in taking USG and radiography were recorded. The prevalence and location of fractures revealed by USG and radiography were compared. Results： Sixty-one suspected patients were assessed. The male to female ratio was 2.4：1 （43 men and 18 women） with a mean ± SD age of （44.3 ± 19.7） years. There were totally 59 rib fractures in 38 （62.3%） patients based on radiography and USG, while 23 （37.7%） patients had no diagnostic evidence of rib lesions. USG revealed 58 rib fractures in 33 （54.1%） of 61 suspected patients and radiographs revealed 32 rib fractures in 20 （32.8%） of 61 patients. A total of 58 （98.3%） rib fractures were detected by USG, whereas oblique rib view and PA chest radiography showed 27 （45.8%） and 24 （40.7%） rib fractures, respectively. The average duration of USG was （12 ± 3） min （range 7e17 min）, whereas the duration of radiography was （27 ± 6） min （range 15-37 min）. The kappa coefficient showed a low level of agreement between both USG and PA chest radiography （kappa coefficient=0.28）, and between USG and oblique rib view （kappa coefficient=0.32）. Conclusion： USG discloses more fractures than radiography in most patients presenting with suspected rib fractures. Moreover USG requires significantly less time than radiography.

Trauma care system in Iran

Objective： The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function. Methods： The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers. Results： Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure （regarding staff, maintenance, financial resources）, it is not yet established in our system of trauma care. Conclusions： It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.

Evaluating clinical abdominal scoring system in predicting the necessity of laparotomy in blunt abdominal trauma

Objectives： Trauma is among the leading causes of death. Medical management of blunt abdominal trauma （BAT） relies on judging patients for whom laparotomy is mandatory. This study aimed to determine BAT patients＇ signs, as well as paraclinical data, and to clarify the accuracy, sensitivity, specificity, positive and negative predictive value of clinical abdominal scoring system （CASS）, a new scoring system based on clinical signs, in predicting whether a BAT patient needs laparotomy or not. Methods： Totally 400 patients suspected of BAT that arrived at the emergency department of two university hospitals in Tehran from March 20, 2007 to March 19, 2009 were included in this study. They were evaluated for age, sex, type of trauma, systolic blood pressure, Glasgow coma scale （GCS）, pulse rate, time of presentation after trauma, abdomial clinical findings, respiratory rate, temperature, hemoglobin （Hb） concentration, focused abdominal sonography in trauma （FAST） and CASS. Results： Our measurements showed that CASS had an accuracy of 94%, sensitivity of 100%, specificity of 88%, positive predictive value of 90% and negative predictive value of 100% in determining the necessity of laparotomy in BAT patients. Moreover, in our analysis, systolic blood pressure, GCS, pulse rate, Hb concentration, time of presentation after trauma, abdominal clinical findings and FAST were also shown to be helpful in confirming the need for laparotomy （P〈0.05）. Conclusion： CASS is a promising scoring system in rapid detection of the need for laparotomy as well as in minimizing auxiliary expense for further evaluation in BAT patients, thus to promote the cost-benefit ratio and accuracy of diagnosis.

The effect of tranexamic acid in traumatic brain injury： A randomized controlled trial

Purpose： Traumatic brain injury （TBI） is a leading cause of death and disability, lntracranial hemorrhage （ICH） secondary to TBI is associated with a high risk of coagulopathy which leads to increasing risk of hemorrhage growth and higher mortality rate. Therefore, antifibrinolytic agents such as tranexamic acid （TA） might reduce traumatic ICH. The aim of the present study was to investigate the extent of ICH growth after TA administration in TBI patients. Methods： This single-blind randomized controlled trial was conducted on patients with traumatic ICH （with less than 30 ml） referring to the emergency department of Vali-Asr Hospital, Arak, Iran in 2014. Patients, based on the inclusion and exclusion criteria, were divided into intervention and control groups （40 patients each）. All patients received a conservative treatment for ICH, as well as either intravenous TA or placebo. The extent of ICH growth as the primary outcome was measured by brain cr scan after 48 h. Results： Although brain CT scan showed a significant increase in hemorrhage volume in both groups after 48 h, it was significantly less in the TA group than in the control group （p = 0.04）. The mean total hemorrhage expansion was （1.7 ± 9.7） ml and （4.3 ± 12.9） ml in TA and placebo groups, respectively （p 〈 0.001）. Conclusion： It has been established that TA, as an effective hospital-based treatment for acute TBI, could reduce ICH growth. Larger studies are needed to compare the effectiveness of different doses.

Echocardiography integrated ACLS protocol versus con- ventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest

Objective： To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity （PEA） cardiac arrest and pre dicting the resuscitation outcomes. Methods： In this prospective interventional study, pa tients presenting with PEA cardiac arrest were randomized into two groups. In Group A, ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity, right ventricle dilation, left ventricle function, peri cardial effusion/tamponade and IVC size along with the ad vanced cardiac life support （ACLS） protocol. Patients in Group B solely underwent ACLS protocol without applying echocardiography. The presence or absence of mechanical ventricular activity （MVA） and evidences of PEA reversible causes were recorded. The return of spontaneous circulation （ROSC） and death were evaluated in both groups. Results： One hundred patients with the mean age of （58±6.1） years were enrolled in this study. Fifty patients（Group A） had echocardiography detected in parallel with cardiopulmonary resuscitation （CPR）. Among them, 7 pa tients （14%） had pericardial effusion, 11 （22%） had hypovolemia, and 39 （78%） were revealed the presence of MVA. In the pseudo PEA subgroup （presence of MVA）, 43% had ROSC （positive predictive value） and in the true PEA subgroup with cardiac standstill （absence of MVA）, there was no recorded ROSC （negative predictive value）. Among patients in Group B, no reversible etiology was detected. There was no significant difference in resuscitation results between Groups A and B observed （P=0.52）. Conclusion： Bedside echocardiography can identify some reversible causes of PEA. However, there are no sig nificant changes in survival outcome between the echo group and those with traditional CPR.

Effect of Advanced Trauma Life Support program on medical interns＇ performance in simulated trauma patient management

Objective： Since appropriate and time- table methods in trauma care have an important impact on patients＇ outcome, we evaluated the effect of Advanced Trauma Life Support （ATLS） program on medical interns＇ performance in simulated trauma patient management. Methods： A descriptive and analytical study before and after the training was conducted on 24 randomly se- lected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed in- terns＇ clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant. Results： Our findings showed that interns＇ ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns＇ clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations （P〈0.001, P=0.016 and P=0.01 respectively）. Conclusion： ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

National Spinal Cord Injury Registry of Iran(NSCIR-IR)-a critical appraisal of its strengths and weaknesses

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

Epidemiology and short-term mortality in traumatic patients admitted to Shariati Hospital in Iran between 2012 and 2013

Purpose： Trauma is an inevitable part of the health burden in every country. Both the preventive and rehabilitative aspects of traumatic injuries are expensive. Since most of the injuries happen in low- and middle-income developing countries, a judicious allocation of the limited resources to the most cost- efficient strategies is necessary. The present study was designed to report the causes of trauma, injured body regions, trauma severity scores and the one year survival rate of a randomly selected sample of trauma patients in a major referral hospital in Tehran, Iran. Methods： We chose and analyzed a random subgroup of traumatic patients admitted during the one- year period of May 2012 to May 2013 to Shariati Hospital, a major University Teaching Hospital in Tehran, Iran. Patients who stayed at the hospital for less than 24 h were excluded. In total, 73 traumatic patients were registered. The mean age was （40.19 ＋ 20.34） years and 6Z1% of them were male. Results： In general, the most common cause of injury was falls （47.9%）, followed by road traffic crashes （RTCs, 40.8%）. Assault and exposure to inanimate mechanical forces each were only associated with 5.6% of all injuries. The only cause of injury in ages of more than 65 years was fall. The most common cause of injury in ages between 15 and 45 years was RTCs. During the study, two deaths occurred： one was at ICU and the other was at home. The most commonly injured body region was the head （23.8%）, followed by the elbow and forearm （19%）, hip and thigh （15.9%）, and multiple body regions （14.3%）. The mean abbreviated injury score was 2.23 ± 1.02; injury severity index was 7.26 ± 7.06; and revised trauma score was 7.84, calculated for 38 patients. Conclusion： Prevention strategy of traumatic injury should focus on falls and RTCs, which are respec- tively the most common cause of trauma in older aged people and young males.

Assessment of mechanism, type and severity of injury in multiple trauma patients： A cross sectional study of a trauma center in Iran

Purpose： To accurately assess the mechanism, type and severity of injury in Iranian multiple trauma patients of a trauma center. Methods： Patients with multiple traumas referring to the emergency department of Hasheminejad University Hospital in Mashhad, lran, entered this cross sectional study from March 2013 to December 2013. All the patients with injury severity score （ISS） 〉 9 were included in this study. Data analysis was performed by SPSS software （Version 11.5） and P values less than 0.05 were considered as significant differences. Results： Among the 6306 hospitalized trauma patients during this period, 148 had ISS〉9. The male fe- male ratio was 80%. The mean age of the patients was （33.5 m 19.3） years. And 71% of the patients were younger than 44 years old. There were 19 （13%） deaths from which 68.5% were older than 44 years old. The mean transfer time from the injury scene to hospital was （55 e 26） minutes. The most frequent mechanisms of injury were motorcycle crashes and falling from height, which together included 66.2% of all the injuries. A total of 84% of hospital deaths occurred after the first 24 h of hospitalization. Head and neck were the most common body injured areas with a prevalence of 111 cases （75%）. Conclusion： Motorcycle crashes have high frequency in lran. Since most victims are young males, injury prevention strategies should be considered to reduce the burden of injuries.

Impact of intravenous acetaminophen therapy on the necessity of cervical spine imaging in patients with cervical spine trauma

Objective：We evaluated a new hypothesis of acetaminophen therapy to reduce the necessity of imaging in patients with probable traumatic cervical spine injury.Methods：Patients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen （15 mg/kg） intravenously after cervical spine immobilization.Then,all the patients underwent plain radiography and computerized tomography of the cervical spine.The outcome measure was the presence of traumatic cervical spine injury.Sixty minutes after acetaminophen infusion,posterior midline cervical tendemess was reassessed.Results：Of 1 309 patients,41 had traumatic cervical spine injuries based on imaging.Sixty minutes after infusion,posterior midline cervical tenderness was eliminated in 1 041 patients,none of whom had abnormal imaging.Conclusion：Patients with cervical spine trauma do not need imaging if posterior midline cervical tendemess is eliminated after acetaminophen infusion.This analgesia could be considered as a diagnostic and therapeutic intervention.

Strengthening Injury Surveillance System in Iran

Objective： To strengthen the current Injury Surveillance System （IS System） in order to better monitor injury conditions, improve protection ways and promote safety. Methods： At first we carried out a study to evaluate the frameworks of IS System in the developed countries. Then all the available documents from World Health Organization, Eastern Mediterranean Regional Organization, as well as Minister of Health and Medical Education concerning Iran were reviewed. Later a national stakeholder＇s consultation was held to collect opinions and views. A national workshop was also intended for provincial representatives from 41 universities to identify the barriers and limitations of the existing program and further to strengthen injury surveillance. Results： The evaluation of the current IS System revealed many problems, mainly presented as lack of accurate pre- and post-hospital death registry, need of precise injury data registry in outpatient medical centers, incomplete injury data registry in hospitals and lack of accuracy in definition of variables in injury registry. The five main characteristics of current IS System including flexibility, acceptability, simplicity, usefulness and timeliness were evaluated as moderate by experts.Conclusions： Major revisions must be considered in the current IS System in Iran. The following elements should be added to the questionnaire： identifier, manner of arrival to the hospital, situation of the injured patient, consumption of alcohol and opioids, other involved participants in the accident, intention, severity and site of injury, side effects of surgery and medication, as well as one month follow-up results. Data should be collected from 10% of all hospitals in Iran and analyzed every 3 months. Simultaneously data should be online to be retrieved by researches.

Spinal cord injury in Parkour sport （free runn,ng）： a rare case report

A 24-year-old male was transferred to the emergency department while being in the state of quadriplegia with a history of performing Parkour sport, which is also called double front flip. Neurological examination revealed that the patient＇s muscle power was 0/5 at all extremities. The patient did not show any sense of light touch or pain in his extremities. In radiological studies, cervical spine X-ray and CT scan images showed C4-C5 subluxation with bilateral locked facets and spinal cord injury. The results of this very rare case study revealed that exercising Parkour sport without taking into account safety standards could result in irreversible injuries to the cervical spinal cord with fatal outcome.

Spinal cord injuries from road traffic crashes in southeastern Iran

Objective ： To analyze the data of patients with spinal cord injury （SCI） induced by road traffic crashes in southeastern Iran for better understanding the pattern of these injuries and therefore for better designing health system planning. Methods ： In this historical cohort study, the patients who had been transferred to Level I trauma center in southeastern Iran due to road traffic accidents with radiographic documented SCI were evaluated. Results： Among 64 patients with SCI, 38 patients （59.4 %, 36 males and 2 females, aged 27.42 years ± 9.44 years on average） were injured by road traffic accidents. Car and motorcycle accidents were responsible for 26 cases （68.4%） and 12 cases （31.6%）, respectively. And 31patients （81. 6%） had complete SCI. Conus medularis （T12-L2 ） was the most affected level. Conclusions： Results are discussed in terms of preventive measures, specifically those concerning the use of restraint and helmet and driving behavior. This study should be extended nationally to gain a larger case series so that the SCI risk of particular vehicle configurations, considering other crash factors, can be more precisely quantified and the characteristics for low occurrence of SCI can be more precisely identified.

Effects of neurofeedback on the short-term memory and continuous attention of patients with moderate traumatic brain injury： A preliminary randomized controlled clinical trial

Purpose： There are some studies which showed neurofeedback therapy （NET） can be effective in clients with traumatic brain injury （TBI） history. However, randomized controlled clinical trials are still needed for evaluation of this treatment as a standard option. This preliminary study was aimed to evaluate the effect of NET on continuous attention （CA） and short-term memory （STM） of clients with moderate TBI using a randomized controlled clinical trial （RCT）. Methods： In this preliminary RCT, seventeen eligible patients with moderate TBl were randomly allo- cated in two intervention and control groups. All the patients were evaluated for CA and STM using the visual continuous attention test and Wechsler memory scale-4th edition （WMS-IV） test, respectively, both at the time of inclusion to the project and four weeks later. The intervention group participated in 20 sessions of NFT through the first four weeks. Conversely, the control group participated in the same NF sessions from the fifth week to eighth week of the project. Results： Eight subjects in the intervention group and five subjects in the control group completed the study. The mean and standard deviation of participants＇ age were （26.75 ~ 15.16） years and （2Z60 ＋_ 8.17） years in experiment and control groups, respectively. All of the subjects were male. No significant improvement was observed in any variables of the visual continuous attention test and WMS-IV test between two groups （p _~ 0.05）. Conclusion： Based on our literature review, it seems that our study is the only study performed on the effect of NET on TBl patients with control group. NET has no effect on CA and STM in patients with moderate TBI. More RCTs with large sample sizes, more sessions of treatment, longer time of follow-up and different orotocols are recommended.

Reasons for delayed spinal cord decompression in individuals with traumatic spinal cord injuries in Iran:A qualitative study from the perspective of neurosurgeons

Purpose:The median time from the event leading to the spinal cord injury(SCI)to the time of decompressive surgery is estimated to be 6.9 days in Iran,which is much longer than the proposed ideal time(less than 24 h)in published guidelines.The current qualitative study aimed to determine the reasons for the observed decompression surgery delay in Iran from the perspective of neurosurgeons.Methods:This qualitative study is designed to perform content analysis on the gathered data from face-to-face semi-structured interviews with 12 Iranian neurosurgeons.Results:The findings of the current study suggest that patient-related factors constitute more than half of the codes extracted from the interviews.Overall,the type of injury,presence of polytrauma,and surgeons’’wrong attitude are the main factors causing delayed spinal cord decompression in Iranian patients from the perspective of neurosurgeons.Other notable factors include delay in transferring patients to the trauma center,delay in availability of necessary equipment,and scarce medical personnel.Conclusion:In the perspective of neurosurgeons,the type of injury,presence of polytrauma,and surgeons’’wrong attitude are the leading reasons for delayed decompressive surgery of individuals with SCI in Iran.

Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital,the National Trauma Registry of Iran

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