Situation analysis of trauma based on Arizona trauma center standards in university hospitals of Tehran, Iran

Objective: Injuries are common and important problem in Tehran, capital of Iran. Although therapeutic centers are not essentially established following the constructional principles of developed countries, the present opportunities and equipments have to be used properly. We should recognize and reduce the deficits based on the global standards.This study deliberates the trauma resources and capacities in university hospitals of Tehran based on Arizona trauma center standards, which are suitable for the assessment of trauma centers.Methods: Forty-one university hospitals in Tehran were evaluated for their conformity with "Arizona trauma center standards" in 2008. A structured interview was arranged with the "Educational Supervisor" of all hospitals regarding their institutional organization, departments, clini-cal capabilities, clinical qualifications, facilities and resources, rehabilitation services, performance improvement, continuing education, prevention, research and additional requirements for pediatric trauma patients. Relative frequencies and percentages were calculated and Student's t test was used to compare the mean values.Results: Forty-one hospitals had the average of 77.7 (50.7%) standards from 153 Arizona trauma center standards and these standards were present in 97.5 out of 153 (63.7%) in 17 general hospitals. Based on the subgroups of the standards, 64.8% items of hospital resources and capabilities were considered as a subgroup with the maximum criteria, and 17.7% items of research section as another subgroup with the minimum standards.Conclusions: On the basis of our findings, no hospital meet all the Arizona trauma center standards completely. The hospitals as trauma centers at different levels must be promoted to manage trauma patients desirably.

Comparison of road traffic fatalities and injuries in Iran with other countries

Objective： To compare fatalities and injuries in road traffic crashes （RTC） in Iran with other countries. Methods： Data were obtained from national health sources of Iran. These data included population number, registered motor-vehicles number, number of RTCs and consequent fatalities and injuries from 1997 to 2006. Results： RTC fatality and injury rates increased from 1997 to 2005, but decreased in 2006. The overall men/women ratio in the RTC fatalities was 4.2：1. High RTC fatality rate of 39 per 100 000 population in Iran was almost the same as some other developing countries. In Iran, RTC fatalities in recent years were almost twice as much as the highest rate among the European countries. Conclusions： This investigation shows that in spite of reduction of RTC fatality in Iran in 2006, it is still one of the highest in the world. Moreover, this paper describes the state of RTC-related parameters in a developing country in comparison with the developed countries.

Spinal fractures resulting from traumatic injuries

Objective： To illustrate mechanisms of spine fractures and the pattern of spinal injuries characterized by the major mechanisms in urban population of Iran. Methods： Data regarding spinal injuries including demographics, mechanism and level of spinal injury, abbreviated injury score, associated injuries and final fate of the patients were extracted from the Iranian national trauma registry database from 1999 to 2004. Results： A total of 619 patients with traumatic spine fractures were identified, of whom 68.5% were males. The peak frequency of these injuries occurred in the 21-40 year age-group. Accidental falls and road traffic crashes （RTCs） were the most common mechanisms of spinal fractures （47.2% and 44.1%, respectively）. RTCs tended to occur in younger patients compared with accidental falls. The most common spinal region for spinal fracture was the lumbar spine （53.63%）. Cervical spine fractures were significantly more common in RTCs, while lumbar spine fractures were more common in accidental falls （P〈0.001）. A total of 171 （27.6%）patients had associated non-spinal injuries, of whom 127 had associated extremity injuries, and 55 had head injuries. Thirty-six （5.6%） patients had spinal cord injury （SCI）.The injury severity score of the RTC group was significantly higher than that of accidental falls （P=-0.002）. Fifteen （4%） patients died of traumatic injuries. The rate of death was significantly higher in RTCs compared with accidental falls （5.1% vs 2.1%, P=0.039）. Conclusions： The patterns of spinal fractures are similar to those reported from developed countries. RTCs tend to affect the younger age population and are associated with a higher degree of associated injuries and mortality than accidental falls. Therefore preventive strategies should be based on reduction of the number and severity of RTCs.

Patterns of extremity traumas leading to amputation in Iran： results of Iranian National Trauma Project

Objective： To determine the patterns of traumatic extremity injuries leading to amputation in Iran. Methods： Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation. This project was conducted in 8 major cities during 2000-2004. Results： Of 17 753 traumatic patients, 164 （0.92%） had injuries to the extremities that resulted in the limb amputation. Of these, 143 （87.2%） were men. The patient＇s mean age was 29.0 years ± 15.4 years and the highest incidence was seen in the age group of 21 to 30 years （34.1%）. One hundred and four cases were occupational accidents （63.4%）. Blunt trauma was in 54.9% of the cases. The most common reasons for amputation were respectively stabbings （37.8%） and crush injuries （31.7%）. Amputation of hand fingers was the most frequent type of amputation （125 cases, 76,2 %）. One patient died from severe associated iniuries. Conclusions： This study shows the patterns of traumatic limb amputation in Iran, a developing country. Results of this study may be used in preventive strategic planning.

Chest injury in victims of Bam earthquake

Objective： To analyze the data of trauma patients with thoracic injury in the earthquake of Bam admitted to hospitals of Tehran University of Medical Science （ TUMS ） for better understanding the type and consequence of thoracic injuries in a major earthquake. Methods： After Barn earthquake registering 6.5 on the Richter scale, 526 trauma patients were admitted to hospitals of TUMS. Among them, 53 patients sustained thoracic injury. Results： This group was composed of 21 females （39.6%） and 32 males （60.4%）. Fifteen patients （28.3%） had isolated chest injuries. Rib fracture （36.4 % ） was the most common injury in our patients and haemo/pneumothorax （ 25.5 % ） followed. Superficial injury was the most common accompanying injury. Multiple- trauma patients with chest injury had higher injury severity score （ISS） versus patients with isolated chest injury （P =0.003）. Conclusions： Chest wall injuries and haemo/ pneumothorax comprise a considerable number of injuries in survival victims of earthquakes. Consequently, the majority of these patients can be treated with observation or tube thoracostomy. We should train and equip the health workers and members of rescue teams to treat and manage these patients in the field.

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.

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.

Effect of mild head injury on intelligence in Zahedan, Iran

Objective： To investigate the effects of mild head injury （HI） on the victims＇ intelligence by measuring their intelligence quotient （IQ）.Methods： This cohort study was performed in Khatamol-Anbia Hospital, Zahedan, Iran and the IQs of 30 mild HI patients were measured right after the injury （IQ0） and six months later （IQ6）. The IQs of 90 close relatives of the patients were also measured at the same period of time as the non-exposure group. The IQs were measured with Wechsler adult intelligence scale-revised （WAIS-R）. The IQ0, IQ6 and their differences （IQ change） were compared in HI patients and their relatives using the Student＇s t test.Results： The mean IQ0 of the HI patients was similar to their relatives. The IQ6 of HI patients appeared to be less than those of their relatives. Moreover, the IQ6 of the HI patients appeared to be less than their initial scores. HI was associated with more decrease in IQ6 compared with IQ0and the female subjects showed more decrease in IQ6 compared with their IQ0.Conclusion： HI seems to be associated with decrease in IQ six months after the injury and it is more evident in female HI patients.

Paraclinical findings in Iranian veterans exposed to sulfur mustard gas： A literature review

Objective： Sulfur mustard （SM） causes various systemic disturbances in human beings. This study aimed to assess paraclinical changes caused by exposure to SM gas in Iranian veterans during the war between lraq and lran. Methods： A literature review was carried out in international and national medical databases including ISI, Medline, Scopus, lranmedex and lrandoc. Both Earsi and English literature were searched. Results： Search of the literature yielded 422 medical articles related to SM poisoning. Among them, 30 relevant articles were thoroughly reviewed. The most important reported complications were leuko- penia, neutropenia, lymphopenia, eosinophilia, thromboc^topenia, increased bleeding time, positive C- reactive protein （CRP）, rheumatoid factor （RF）, antinuclear antibody （ANA）, decreased T helper cells, natural killer cells, IL6, and IL8 levels, elevation of serum immunoglobulins, decreased levels ofT3, T4 and cortisol, increased level of adrenocorticotropic hormone （ACTH）, proteinuria, hematuria, and elevated liver enzymes. Also, there were some changes in chest assessments, Conclusions： SM causes profound systemic complications in victims, even years after exposure. The paraclinical changes can be observed in hematology, immune system, biochemistry, hormonal profile and some imaging studies.