hamid kariman

Predicting the outcome is one of the most frequent and important issues when approaching patients with intracranial hemorrhage (ICH).

This study aimed to evaluate the correlation of SUSPEKT score variables plus electrocardiogram (ECG) abnormalities with one-month mortality of patients with ICH presenting to emergency department (ED).

In this cohort study, adult patients presenting to the EDs of three educational hospitals, during one year, were followed and their one-month mortality rate as well as independent predictors of outcome among the variables of SUSPEKT score plus electrocardiography findings were evaluated.

One hundred seventy-sevenpatients with the mean age of 63.07±14.89 years were studied (59.9%). The most common locations of intra-parenchymal hemorrhage were basal ganglia (53.7%) and cortex (36.2%). Ninety-two(52.0%) of cases had at least one ECG abnormality. The most frequent ECG abnormalities were ST segment depression (20.3%), T wave inversion (16.4%), and left ventricular hypertrophy (14.7%). Thirty(16.9%) cases died during the 30-day follow-up. Survived and non-survived cases were significantly different regarding the location of intra-parenchymal hemorrhage (p < 0.0001), presence of intraventricular hemorrhage (IVH) (p = 0.007), ST segment elevation (p < 0.0001), bradycardia (p < 0.0001), tachycardia (p <0.0001), arterial fibrillation (p < 0.0001), blood sugar (p = 0.044), and serumlevel of potassium (p = 0.022).

The location of hemorrhage (basal ganglia), higher blood sugar, and presence of ECG abnormalities (ST segment elevation, tachycardia, bradycardia, atrial fibrillation) were among the independent predictors of one-month mortality of ICH patients in this study.

It seems that computed tomography (CT) scan, which does not have the limitations of plain cervicalspine radiography, can be considered as the first line modality in decision-making for patients with necktrauma and performing radiography can be omitted. The findings of the present study on 100 patientsover the age of 16 years with stable hemodynamics, who presented to a university affiliated trauma centerin Tehran, Iran, following multiple trauma indicated an overall agreement of 79% between radiographyand CT scan findings based on the calculation of kappa coefficient (p = 0.001). In addition, sensitivity ofradiography in detection of injuries in this study was estimated as 82% and its specificity was estimatedas 76%. It seems that the role of plain radiography in evaluation of neck traumas should be revised as ithas low accuracy, especially where CT scan is available

The aim of the present study was to evaluate the efficiency and success rate in training air duct piping using laryngoscope video, considering the importance of air duct piping and claiming more success of direct laryngoscope video method with direct laryngoscope.

In the current interventional study, we enrolled 157 medical interns without any intubation experience in the Emergency Department of Imam Hussein Hospital during 2016. Individuals were divided into two groups: the first group, worked with the direct laryngoscopy, and the second group learned to work with the video laryngoscope. To evaluate and to compare the data in two training modalities, the performance of the individuals including seeing vocal cord, proper positioning, correct posture to the moulage, handling and correct insertion of the laryngoscope, and the successful intubation were recorded. All analyses were performed using SPSS, version 19.

Time of intubation and observing vocal cord in the group trained with video laryngoscope was lower than those in the direct laryngoscopy group (23.3±6.8 vs. 28.8±6.4 and 21.9±5.2 vs. 26.9±5.6 sec, respectively; P-value for both=0.001). Furthermore, failure in observing the vocal cords in the direct laryngoscopy group was higher than those in the video laryngoscope group (23.5 vs. 14.5%, P-value=0.217). The percentages of standing in the correct position in the video laryngoscope and direct laryngoscopy group were 85.5 and 66.7%, respectively (P=0.014).

It seems that given the time spent on intubation and the time of observing vocal cord in the group trained with video laryngoscope in comparison with the group who was prepared with a direct laryngoscope, applying video laryngoscope may have better effects in educating medical interns.

Readmission is defined as a patient being admitted to the hospital again within a specific period, with or without previous surgery or medication program. The current study was designed with the purpose of assessing causes of readmission to emergency department.

This study is a retrospective cross-sectional study that was performed on patients who were readmitted to emergency department of Imam Hossein Hospital, Tehran, Iran, in 2019 using random sampling.

240 cases with the mean age of 50.47 ± 20.84 years were evaluated (59.6% male, 82.9% married). 60.4% of patients had a length of hospital stay less than one day, in 22.5% cases length of hospital stay was between 1 and 5 days, in 7.5% between it was 5 and 10 days, and in 9.6% cases it was more than 10 days. 61.7% had a history of special diseases, most of them (23%) had a history of heart disease and 38.3% had no history of disease. The most common causes of readmission were recurrence of disease (21.7%), persistence of pain (17.9%) and incorrect diagnosis (5.8%). There was no statistically significant relationship between age (p = 0.26), sex (p = 0.24), level of education (p = 0.26), drug addiction (p = 0.77), or time of discharge in the first visit (p = 0.55) and cause of readmission. However, there was a significant relationship between type of discharge (with physician’s opinion/against medical advice) in the first visit and the reason for readmission (p = 0.02) .

The Results showed that the most common causes of readmission were recurrence of disease, persistence of pain and incorrect diagnosis, respectively. Most of the patients were married men between the ages of 30 and 60 years without college education. There was a significant relationship between the type of discharge in the first visit and the cause of readmission.

Each imaging technique has a special application and usage, and should be used in the right situation. Physicians choose the type of imaging technique by considering the type of tissue and the benefits and disadvantages of the imaging method as well as its financial burden on the patient. The aim of this study was to estimate the cost of imaging tests performed in the emergency department (ED) of an educational hospital and determine their financial burden on both the patients and the healthcare system of the country.

This retrospective descriptive cross-sectional single-center study was conducted in Shohadaye Tajrish, an educational hospital, during one year. The study population consisted of all patients who had undergone some type of imaging (CT scan, ultrasound, radiography, magnetic resonance imaging [MRI]) in the ED. The information was collected using a predesigned checklist. The costs of a variety of imaging methods for patients referred to the ED were calculated using different types of accounting units and PACS system.

The number of patients who visited the ED of the studied hospital during a one year period was 63507. The total cost of performing different types of imaging methods in the studied center throughout the one-year target period was 44018695695 Rials (≃$US 423745) (59.27% of which was spent on CT scan, 16.09% on ultrasound, 13.75% on plain radiography and 10.87% on MRI).

According to the collected data, the total cost of radiology was 44018695695 Rials. The highest cost was related to CT scan modality, and the lowest belonged to MRI.

Antimicrobial resistance among uropathogens causing community-acquired urinary tract infections (UTIs) is a worldwide concern. It has been suggested that diabetes could be a possible cause of antibiotic resistance. This study was undertaken to identify the responsible microbial culprits for UTI in patients with different range of glycosylated hemoglobin (HbA1C)  and evaluate their corresponding resistance pattern. In a prospective study between 2013 to 2018, data related to the urine culture and sensitivity of patients who had bacteriuria were gathered. For patients with positive urine culture, HbA1C was requested and correlations between HbA1C level with microorganism and its susceptibility were evaluated. In total, 121 patients were recruited. All study participants were female.The mean age of the patients was 50.2 ± 22.5 (range 19-96) . All study participants were of the same race. Fifteen (12.4%) out of 121 patients were diabetics. There were no difference between bacteriology of UTIs in diabetic and nondiabetic patients with the preponderance being caused by E. coli and other gram-negative organisms but, there were positive association between HbA1C and resistance to Nalidixic acid and Gentamicin. Our study supports the findings that  diabetes in itself could be a possible cause of antibiotic resistance to some antimicrobial agents.

Predicting the outcome of patientswith intracranial hemorrhage (ICH) is the area of interest for in charge physicians aswell as patients and their associates. This study aimed to evaluate the accuracy of SUSPEKT score in predicting one-month outcome of patients with hemorrhagic stroke.

This prospective cross sectional study was conducted on > 18 years old patients with non-traumatic supra-tentorial ICH admitted to emergency department, from February 2017 to January 2018. SUSPEKT score was measured for each patient and its screening performance characteristics in prediction of one-month mortality were calculated.

169 cases with the mean age of 63.09 § 15.45 (21 – 96) years were studied (56.8% male). After one month follow up 47 (27.8%) cases had died, 30 (17.7%) cases were bed ridden, and 72 (42.6%) could walk without help or with a cane. Non-survived patients had significantly larger intra-ventricular hemorrhage (IVH) (p < 0.001) and hematoma (p < 0.001) volume, higher serumglucose (p < 0.001) and blood pressure (p = 0.028), higher frequency of IVH (p < 0.001), and higher WBC count (p = 0.037). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SUSPEKT score at the 65 cut point were 82.97% (95% CI: 68.65% – 91.86%), 74.59% (95% CI: 65.76% – 81.84%), 55.71% (95% CI: 43.38% – 67.40%), and 91.91% (95% CI: 84.23% – 96.16%), respectively.

Total accuracy of SUSPEKT score in predicting one-month mortality of non- traumatic ICH patients is in good range and it has 82%sensitivity and 92%NPV in this regard. It seems thatwe need further studies before applying the score in routine practice.

Need for procedural sedation and analgesia (PSA) is felt in emergency department (ED) more and more each day. This study aimed to compare the effectiveness of low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination with regular dose of propofol and fentanyl combination for induction of deep sedation. In this single-blind clinical trial, candidate patients for sedation and analgesia aged more than 15 and less than 60 years old, with pain score ≥6 were allocated to one of the groups using block randomization and were compared regarding onset of action, recovery time, and probable side effects. 125 patients with the mean age of 37.8 ± 14.3 years were randomly allocated to each group. 100% of the patients in group 1 (5 drugs) and 56.5% of the patients in group 2 (2 drugs) were deeply sedated in the 3rd minute after injection. The 2 groups were significantly different regarding onset of action (p = 0.440), recovery time (p = 0.018), and treatment failure (p < 0.001). Low-dose fentanyl, propofol, midazolam, ketamine and lidocaine combination was more successful in induction of deep sedation compared to regular dose of propofol and fentanyl combination. Recovery time was a little longer in this group and both groups were similar regarding drug side effects and effect on vital signs.

Finding a fast-acting compound with minimal side-effects to induce a safe and efficient analgesia with short or medium duration of action is of great interest in the emergency department. The present study has been designed with the aim of comparing the effect of midazolam + fentanyl + lidocaine combination with midazolam + fentanyl + placebo in pain management of anterior shoulder dislocation reduction. The present two-arm parallel double-blind randomized controlled trial was performed on patients who presented to emergency department with anterior shoulder dislocation. Patients were randomly allocated to the 2 treatment groups of midazolam + fentanyl + placebo (double-drug group) and midazolam + fentanyl + intravenous (IV) lidocaine (triple-drug group). Then outcomes such as treatment success rate and side-effects following prescription of drugs were compared between the 2 groups. 100 patients were included in the present study (50 patients in each group; mean age of the studied patients 27.3±8.9 years; 93.0% male). Using the double-drug regimen led to 35 (70%) cases of complete analgesia, while this rate in the triple-drug group was 41 (82%) cases (p=0.16). The calculated number needed to treat was 9 cases. This means that about one in every 9 patients in treatment arm will benefit from the treatment. The most important side-effects observed included dysrhythmia (1 patient in double drug and 1 patient in triple-drug group), apnea (2 patients in each group) and SPO2<90% (2 patients in triple-drug group) (p=0.78). Number needed to harm was 25 cases. In other words, for each 25 patients treated with the triple drug regimen, 1 case of SPO2<90% is observed. Findings of the present study showed that adding IV lidocaine to IV midazolam + fentanyl drug combination does not provide additional analgesia in sedation for anterior shoulder reduction.

Pro-brain natriuretic peptide (Pro-BNP) can act as an independent predictor of mortality in septic patients. This study aimed to compare the diagnostic accuracy of pro-BNP and Mortality in Emergency Department Sepsis (MEDS) score in this regard. This cross-sectional study was conducted on > 14 years old sepsis patients of an emergency department (ED), during 2 years. The level of Pro-BNP and MEDS score were measured for all eligible patients and considering one-month mortality as reference, screening performance characteristics of the two tests were compared using SPSS 21 and STATS 11. 121 patients with the mean age of 75.87±11.82 years were studied (55.4% male). 85 (70.25%) patients had moderate to high probability of mortality according to MEDS score. The mean Pro-BNP levels of survivor and non-survivor patients were 489.69 ± 327.47 and 3954.98 ± 2717.85 pg/ml, respectively (p < 0.0001). Sensitivity and specificity of Pro-BNP (in 1000 pg/ml cut off) and MEDS score (in level 3) in prediction of 1-month mortality were 93.6 (83.7-97.9), 94.8 (84.7-98.6), 65.0 (51.9-76.3), and 98.2 (89.5-99.9), respectively. Area under the ROC curve of the two tests were 97.36 (95% CI: 92.92-94.48) and 92.31 (95% CI: 86.35-96.53), respectively (p = 0.0543). Pro-BNP and MEDS score both have excellent diagnostic accuracy in predicting 1-month mortality of sepsis patients. However, considering the higher sensitivity as well as availability and ease of calculation, it seems that Pro-BNP can be considered an appropriate tool for screening patients with high risk of mortality following sepsis in ED.

Continuous evaluation, supervision and improvement of the performance of emergency departments (EDs) are done using 5 emergency performance indices (EPI), which are significantly affected by various factors including inward and outward flow of patients, number of ED personnel being in proportion to the number of patients, rapid decision making, the rate of overcrowding in the ED and so on. Since health sector evolution plan (HSEP) can affect the performance of the ED by changing the mentioned factors, we decided to compare these indices in a 5-year period before and after the execution of this program. In this cross-sectional study, all performance indices of ED were calculated and analyzed using parametric and non-parametric tests from one year before to four years after the execution of HSEP. Data were analyzed using SPSS statistical software version 21.0 and all tests were considered significant at 0.05. By continuous execution of HSEP, the total number of ED visits increased in levels 2 and 5 and decreased in level 4. The percentages of patients discharged within 6 hours and discharge against medical advice improved. Mean triage time in all levels, the percentage of patients leaving the ED within 12 hours, unsuccessful cardiopulmonary resuscitation, mean time interval between triage and the first visit in triage levels 3 and 4, and mean time interval between presentation and execution of orders by the nurse in all levels increased. Execution of HSEP can affect performance indices of ED.

Pain is a frequent complaint of patients who are referred to the emergency department (ED), which is ignored or mismanaged and, almost always, approached in terms of determining the cause of pain instead of pain management. Pain management is a challenging issue in the ED. This study was conducted to determine the effect of emergency resident’s education about pain assessment and pain-relief drugs in the improvement in pain management.
A clinical audit was carried out during the year 2015 in the ED of Imam Hossein Hospital, Tehran, Iran. All patients over 16-year-old who had been complaining of pain or another complaint that included pain were eligible. Data were collected using a preformed checklist. One senior emergency medicine resident was responsible for filling the checklist. In the first phase, patients were enrolled into the study and were divided into two groups according to whether they had or did not have a pain management order. In the second phase, the first- and second-year emergency medicine residents were trained during the various classes that they were required to attend, through a workshop conducted by experienced professors, and based on existing valid guidelines. In the third phase, patients were enrolled into the study, and the same checklists were completed.
A total of 803 patients (401 before training and 402 after) were assessed. The mean age of the patients before and after training of the residents was 59.19 ± 44.45 and 40.24 ± 19.40 years, respectively. Table 1 illustrates the demographic information of patients that were not significantly different before and after the training period (p > 0.05). The most common cause of pain was soft tissue injury, both before (36.3%) and after training (34.3%). The most frequent drug that was administered for pain control was morphine, both before (62.5%) and after (41.4%) training. Although the number of patients with moderate pain intensity was higher during the after-training period, pain control quality was described to be better in this group and success rate of pain control was significantly increased after training (p Findings from the present study showed that there was a significant deficiency in pain management of the admitted patients, and the most common reason for this was the physician's fear of the drug’s side effects. However, significant progress was seen after the training regarding pain management process in ED.

Treatment cost and lack of insurance are the principal reasons for patients absconding or leaving without permission from a hospital. Here we aimed to investigate the effect of the Health Transformation Plan (HTP) on patients absconding from a large general hospital in Tehran, Iran.
In this descriptive study, we considered March 2011 to April 2014 as the period before and June 2014 to March 2017 as the period after the introduction of the HTP. The data of 701 absconded patients were collected. For data analysis, the Mann-Whitney test and Interrupted Time Series model were used in STATA.12 software.
The proportion of absconding patients immediately has decreased significantly since the implementation of the HTP (P = 0.002, β = 0.342). However, during the 3-year period after the implementation of the HTP, the patient absconding rate has increased monthly by 0.12% (p = 0.019). Investigating the difference in the patient absconding rate before and after the HTP, we found that the proportion of patients absconding has significantly increased since the HTP implementation (0.011 slope; p = 0.019).
Immediately after the implementation of the HTP, the proportion of patients absconding from hospital dropped significantly. This suggests that the HTP has been effective at reducing the patient absconding rate by creating insurance coverage and reducing costs. However, the reasons for a reversal of this trend during the third year of the HTP should be further investigated.

Leaving the hospital without notice is among the problems that can inflict financial and non-financial burdens on the health care system of a country. The present study was carried out with the aim of evaluating the prevalence of leaving without notice cases in the emergency department (ED) of one of the major teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences and calculating the direct costs resulting from it.
This study was a retrospective cross-sectional one carried out during 1 year from 2016 to 2017 in one of the teaching hospitals of Tehran affiliated with Shahid Beheshti University of Medical Sciences. Sampling was performed via census method and the study population consisted of the profiles of all the patients who had left the hospital without notice or checking out after being admitted to the hospital. To gather the required data for this study, a checklist consisting of questions regarding sex, age, insurance coverage, and the amount of money they owed the hospital was used. Statistical analysis was performed using the software IBM Statistics for Windows v22 and P-value Out of the total of 39946 patients visiting the ED of the studied hospital during 1 year, 1692 (4.2%) had left the hospital without checking out. Below 30 years age range was the most common age range with 46.9% (794 patients) and 72.9% of the patients leaving without notice were men. Based on the findings obtained, male patients without insurance coverage had attempted to leave the hospital without notice more than others (p Throughout the year this study was performed, a total of 1.2% of all the visitors of the ED of a hospital affiliated with Shahid Beheshti University of Medical Sciences left the hospital without notice or checking out, which inflicted a considerable cost on the ED.

Background and Patient absconding from a hospital or leaving without permission is a major challenge with economic and social consequences for patients, healthcare staff, and society. Identification of the characteristics of absconding patients is essential to the prediction and prevention of such behaviors.
This cross sectional study was performed in a large general teaching hospital in Tehran, Iran. Data of 460 absconding patients and 460 nonabsconding patients, admitted during March 2010 - March 2016, were extracted from the hospital information system. Backward stepwise logistic regression analysis was used to describe the importance and effect of each predictor.
The findings showed that 0.4% of the patients had left the hospital without permission or notice to the staff. Addiction (OR, 27.15), lack of insurance coverage (OR, 12.39), male gender (OR, 2.14), age ≤ 40 years (OR, 1.89), and emergency admission (OR, 1.77) were predictors of absconding. Hospital financial loss amounted to 3,818,788,624 IRR ($126,283) due to this problem, with an average cost of 7,178,174 IRR ($237) per patient.
Identification of high-risk individuals, including young men, uninsured patients, and drug addicts with emergency admission warrants preventive measures. Moreover, assessment of patients by physicians or nurses upon admission, staff training and raising awareness, and use of technologies such as radiofrequency identification can be other strategies for preventing or reducing this problem.

Although significant development in the field of medicine is achieved, sepsis is still a major issue threatening humans’ lives. This study was aimed to audit the management of severe sepsis and septic shock patients in emergency department (ED) according to the present standard guidelines.

This is a prospective audit on approaching adult septic patients who were admitted to ED. The audit checklist was created based on the protocols of Surviving Sepsis Campaign and British Royal College recommendations. The mean knowledge score and the compliance rate of studied measures regarding standard protocols were calculated using SPSS version 21.

30 emergency medicine residents were audited (63.3% male). The mean knowledge score of studied residents regarding standard guidelines were 5.07 § 1.78 (IQR = 2) in pre education and 8.17 § 1.31 (IQR = 85) in post education phase (p < 0.001). There was excellent compliance with standard in 4 (22%) studied measures, good in 2 (11%), fair in 1 (6%), weak in 2 (11%), and poor in 9 (50%). 64% of poor compliance measures correlated to therapeutic factors. After training, score of 5 measures including checking vital signs in < 20 minute, central vein pressuremeasurement in < 1 hour, blood culture request, administration of vasopressor agents, and high flow O2 therapy were improved clinically, but not statistically.

The protocol adherence in management of severe sepsis and septic shock for urine output measurement, central venous pressure monitoring, administration of inotrope agents, blood transfusion, intravenous antibiotic and hydration therapy, and high flowO2 deliverywere disappointingly low. It seems trainingworkshops and implementation of Clinical audit can improve residents’ adherence to current standard guidelines regarding severe sepsis and septic shock.

Using pan or selective computed tomography (CT) scan in management of multiple trauma patient is a matter of debate. Therefore, the present study was designed aiming to compare the findings of pan and selective CT scans in management of multiple trauma patients.

This is a prospective cross-sectional study, on patients presented to the emergency department (ED) of Shohadaye Haftome Tir Hospital, Tehran, Iran, following blunt multiple trauma over a 1-year period, fromMarch 2014 toMarch 2015. Findings regarding presence or absence of injury in head, face, neck, chest, abdomen and hip were compared between patients that underwent pan and selective CT using SPSS 21.

443 patients with the mean age of 34.54 § 17.88 years were evaluated (78% male). 248 (56%) patients underwent selective CT scan and 195 (44%) underwent pan CT scan. The 2 groups were similar regarding vital signs and mean age. Mean hospital length of stay was 21.05 § 24.64 days for selective CT scan group and 18.18 § 22.75 days for the other one (p = 0.209). A significant difference was only seen regarding findings of chest injury between the 2 groups (p < 0.001). In other cases a proper overlap was seen between findings of the 2 groups.

Based on the results of the present study, it seems that doing selective CT scan yields results similar to pan CT in detection of head and face, neck and abdomen and hip injuries in multiple trauma patients. However, using pan CT in these patients led to 16% increase in detection and diagnosis of traumatic intra-thoracic injuries.

This double-blind randomized clinical trial aimed at comparing the effect of intranasal desmopressin with that of intravenous ketorolac in pain management of patients with renal colic referring to the emergency department.
The patients were randomly divided to two groups. One group received intravenous ketorolac 30 mg and intranasal normal saline, while, the other one received intranasal desmopressin 40 μg and 1 mL of intravenous distilled water. The patients’ pain was evaluated using the visual analog scale at the time of admission, 10, 30, and 60 minutes after drug administration.
Overall, 40 patients with mean age of 32.53 ± 6.91 participated in this study. Gender ratio (P = 0.288), mean age (P = 0.165), and mean pain score on arrival (P = 0.694) had no significant difference. The mean pain scores, 10, 30, and 60 minutes after drug administration in the ketorolac group was significantly lower than the desmopressin group, and decreased more rapidly (P It is likely for desmopressin to be less efficacious than ketorolac, and desmopressin leads to a significant alleviation of pain in patients with renal colic.

Strife is one of the most important health threatening happenings that leads to more than 0.5 million deaths each year, and is among the most important causes of mortality in youth. Studying it can increase knowledge on its resulting traumas and be a base for supervising these crimes. Therefore, the present study aimed to evaluate the epidemiology of strife cases presenting to emergency department (ED).
The present study is a retrospective cross-sectional one that evaluates the epidemiology of strife and violence in those presenting to the ED of Imam Hossein Hospital, Tehran, Iran, during April 2014 to January 2016. The studied variables included age, sex, time of visit, social history of the patient, trauma mechanism, anatomical site of trauma, measures taken, and final outcome.
499 patients with the mean age of 26.4 ± 8.7 were studied. 442 (88.6%) were male and 443 (88.9%) were of Iranian nationality. Based on the obtained results, 321 (64.4%) were single and 335 (67.1%) were in the 20-29 years age group. 317 (87.3%) cases had negative social habits (smoking, drinking,…) and cigarette was the most commonly used substance in cases with positive social habits. The highest frequency of ED visits happened between 4PM and 12AM (49.7%), on weekdays (73.1%), and in spring (41.9%). 283 (56.7%) of the studied cases had visited ED following penetrating trauma and 240 (48.1%) needed some kind of surgical intervention. Finally, 398 (79.8%) cases were discharged with full recovery, 81 (16.2%) were discharged against medical advice, and 4 (0.8%) died.
Based on the findings of the present study, prevalence of trauma due to strife was 16 in each 1000 visits to the trauma unit of the studied center. Most cases of strife happened in men, singles, those aged 21-30 years, in spring, on weekdays, in the evening and with penetrating trauma and about 80% were discharged from ED with full recovery.

Cardiopulmonary resuscitation (CPR) has been known in its present form since 1960. Different studies have reported variable outcomes among different countries. Therefore, the purpose of this study was to assess the rate of CPR success and the survival rate in managing cardiac arrest among patients in an educational medical center.
This cross-sectional study was performed at Imam Hosein hospital, Tehran, Iran. All patients, admitted to the emergency department with cardiac arrest between March 2007 and January 2008 were included. We used a formerly designed registration form and hospital documentation to retrieve the data of included patients. The main outcomes were the rate of CPR success and the survival rate of these patients.
Totally 855 patients were included, from which 510 (59.64%) were males. The mean age of included patients was 63 ± 17.6. The CPR process was successful among 364 (42.58%) patients. A total number of 101 (11.82%) patients were discharged from the hospital. Different factors as the cause of cardiac arrest and past medical problems affected the probability of CPR success and the survival of patients with cardiac arrest.
Survival rate at hospital discharge was less than one-third of patients and nearly half of the patients received successful CPR. More intensive care unit (ICU) facilities and educational interventions for the emergency staff and the community can enhance the survival of cardiac arrest patients in our health system.

Although using clinical scales to predict shock severity is interesting for physicians as they provide rapid evaluation without need for special equipment, they are not highly reliable. Therefore, the present study was designed with the aim of assessing the agreement between shock index and base defects as scales of determining shock severity in multiple trauma patients.
In the present prospective cross - sectional study, the agreement of shock index and base defects in determining shock severity in multiple trauma patients presenting to emergency department (ED) was assessed. Patients with blunt multiple trauma aged between 15 to 6 years with 8-15 consciousness level and without any underlying illness were enrolled and finally the data were analyzed using SPSS 20.
In total, 387 patients with the mean age of 36.31 ± 15.03 years (15 – 90) were studied (80.6% male). M ost patients were in the 21 - 30 years age group (37.7%) and the most common trauma mechanisms were car accident (50.1%) and falling from height (24.8%). In addition, 15 (3.9%) patients had systolic blood pressure 10 0/min. According to kappa coefficient, a 0.824 agreement was seen between these scales in rapid prediction of shock index. With the shock index increasing, the number of blood units received in the initial 6 hours of admission to ED for patient resuscitati on rose from 0.02 to 1.72 units.
Considering the results of the present study, it seems that shock index and base defect scales have acceptable agreement in prediction of shock severity in multiple trauma patients. This agreement increases in the 2 extremes namely normal and severe cases (level 1 and 4).

Different factors such as parents’ knowledge and attitudes regarding preventive measures (PM) have a great role in reducing children unintentional home injuries. The present study aims to evaluate the contributing factors of unintentional home injury prevention in preschool victims presented to the emergency department.
The subjects consisted of all the mothers of preschool children who were presented to the emergency department of Imam Hossein and Shohadaie-Hafte-Tir Hospitals, with unintentional home injuries, from March 2011 to February 2012. The participants were divided into two groups according to implementation of preventive measures status. The significant confounding factors of PM application was determined by chi-squared test and entered into the backward multivariate logistic regression model.
230 mothers with the mean age of 29.4 ± 5.2 years were evaluated. 225 (97.83%) of them were still married, 74 (32.17%) had high school education or higher, 122 (53.04%) were homemakers, and 31 (13.49%) worked outside the home for at least 8 hours daily. High level of knowledge (OR = 0.05; 95% CI: 0.002‒0.32; P = 0.002), appropriate attitude (OR = 0.12; 95% CI: 0.03‒0.51; P = 0.01), having at least three children (OR = 7.2; 95% CI: 1.1‒32.9; P = 0.04), daily absence of mother for at least 8 hours (OR = 9.2; 95% CI: 2.2‒35.46; P = 0.002), and a history of home injury during the previous 3 weeks (OR = 8.3; 95% CI: 2.1‒41.3; P = 0.001) were independent factors which influenced application of preventive measures.
Increasing mothers’ knowledge level and improving their attitudes were facilitating factors and mothers’ absence from the house for more than 8 hours a day and having at least 3 children were obstacles to application of preventive measures. In addition, a history of same injury during the previous 3 weeks increased the risk of repeated event.

Vertigo prevalence is estimated to be 1.8% among young adults and more than 30% in the elderly. 13-38% of the referrals of patients over 65 years old in America are due to vertigo. Vertigo does not increase the risk of mortality but it can affect the patient’s quality of life. Therefore, this study was designed to evaluate the epidemiologic characteristics of vertigo patients referred to the emergency department (ED). In this 6-month retrospective cross-sectional study, the profiles of all vertigo patients referred to the ED of Imam Hossein Hospital, Tehran, Iran, from October 2013 to March 2014 were evaluated. Demographic data and baseline characteristics of the patients were recorded and then patients were divided into central and peripheral vertigo. The correlation of history and clinical examination with vertigo type was evaluated and screening performance characteristics of history and clinical examination in differentiating central and peripheral vertigo were determined. 379 patients with the mean age of 50.69 ± 11.94 years (minimum 18 and maximum 86) were enrolled (58.13% female). There was no sex difference in vertigo incidence (p = 0.756). A significant correlation existed between older age and increase in frequency of central cases (p < 0.001). No significant difference was detected between the treatment protocols regarding ED length of stay (p = 0.72). There was a significant overlap between the initial diagnosis and the final decision based on imaging and neurologist’s final opinion (p < 0.001). In the end, 361 (95.3%) patients were discharged from ED, while 18 were disposed to the neurology ward. No case of mortality was reported. Sensitivity and specificity of history and clinical examination in differentiating central and peripheral vertigo were 99 (95% CI: 57-99) and 99 (95% CI: 97-99), respectively.

Evaluating intravascular volume is an important but complicated matter in management of critically ill patients, especially in children. Although invasive techniques have the ability to accurately estimate the intravascular volume, but they have dangerous side effects. Therefore, the present study was designed with the aim of comparing the diagnostic accuracy of sonographic diameters of inferior vena cava (IVC), aorta, internal jugular vein (IJV), and IVC/aorta ratio in identifying pediatric dehydration in children presented to the emergency department (ED).
The present prospective cross-sectional study was carried out with the aim of determining the diagnostic accuracy of sonographic diameters of IVC, IJV, and aorta, in estimation of dehydration rate for children presented to the ED with mild to moderate dehydration. Their screening performance characteristics, such as area under the ROC curve, sensitivity and specificity, were calculated and used for this purpose. The data were analyzed using STATA 11.0 and 0.05 was considered as significance level.
In the end, 54 patients were enrolled in the study (57.4% male, mean age of 4.9 ± 2.7 years). Area under the ROC curve for IVC in diagnosis of moderate dehydration in sagittal and transverse planes were 0.775 (95% CI: 0.65 – 0.91) and 0.8086 (95%CI: 0.96 – 0.93), respectively. In addition, the diameter of aorta in this regard were 0.658 (95%CI: 0.51 – 0.81) for the sagittal and 0.7126 (95% CI: 0.57 – 0.86) for the transverse plane. IJV diameter had an area under the curve of 0.7332 (95% CI: 0.59 – 0.88). Comparing the area under the ROC curves for the studied parameters showed that IVC diameter in the sagittal (p = 0.004) and transverse (p Based on the findings of the present study, it seems that IJV, IVC, and aorta diameters are not very accurate for determining the condition of pediatric dehydration, since even sonographic IVC diameter, which was more accurate than the other parameters, had a sensitivity of 81.48% and specificity of 48.15% in differentiating mild and moderate dehydration.

Evaluation of cervical spine injuries makes up a major part of trauma patient assessments. Based on the existing sources, more than 98% of the cervical spine X-rays show no positive findings. Therefore, the present clinical audit aimed to evaluate the correlation of ordered cervical spine X-rays in multiple trauma patients with NEXUS and Canadian c-spine clinical decision rules.
The present clinical audit, evaluated the correlation of cervical spine imaging orders in multiple trauma patients presented to the emergency department, with NEXUS and Canadian c-spine rules. Initially, in a pilot study, the mentioned correlation was evaluated, and afterwards the results of this phase was analyzed. Since the correlation was low, an educational training was planned for all the physicians in charge. Finally, the calculated correlations for before and after training were compared using SPSS version 21.
Before and after training, cervical spine X-ray was ordered for 98 (62.82%) and 85 (54.48%) patients, respectively. Accuracy of cervical spine X-ray orders, based on the standard clinical decision rules, increased from 100 (64.1%) cases before training, to 143 (91.7%) cases after training (p Teaching NEXUS and Canadian c-spine clinical decision rules plays a significant role in improving the correlation of cervical spine X-ray orders in multiple trauma patients with the existing standards.