مجله طب اورژانس ایران
سال هفتم شماره 1 (بهار 1399)

Bezoar are undigested substances that have remained in the gastrointestinal tract for various reasons. One of the rare complications of bezoar which has been studied in this cases seriesis gastrointestinal obstruction.

This study performed in Imam Huossein Hospital in Tehran.In this study all patients with diagnosis of small bowel obstruction who underwent surgery with bezoar as final pathology were enrolled, over a period of 2years from 2015 to 2017.Demographicand laboratory data and intraoperative findings were evaluated and analyzed in these patients.

There was 19 patients that 12 of them were female and 7 were male.The mean age of the patients was 63.84 years.15patients were referred in winter and autumn and 4 patients in spring and summer.Associated diseases include diabetes (42%),history of abdominal surgery (15 %),and hypothyroidism(5%).Extracted materials include persimmon (47%),unknown substances (38%),pomegranate (10%),hair (5%).The most common clinical symptoms include abdominal pain (87%),nausea and vomiting (80%),inability to gas passage or defecation.In physical examination findings were abdominal distention (85 %),decreased bowel sounds(52%),abdominal tenderness (48%),empty rectum in DRE (45%).Laboratory findings include leukocytosis (78%),metabolic acidosis (42 %),pre-renal azotemia (32 %).The most common sites of obstruction were last 100 cm of ileum (13 patients),jejunum (4 patients),both gastric and small intestine concurrent (2 patient).Of these patients,68% (13 patients) underwent enterotomy to remove bezoar and milking applied to 6 patients (32%).

Bezoar is one of the relatively rare causes of small bowel obstruction. In elderly patients with underlying factors for Bezoar, as well as recent history of fruit consumption with potential to form Bezoar in autumn and winter can be helpful in detecting obstruction caused by Bezoar.

To forecast the COVID-19 epidemic trend in Iran, a set of dynamic models were created. In these models, the effect of climate and community behavior change on the reproductive number is modeled. A baseline scenario is also defined as letting the epidemic grow naturally, with no prevention/control interventions. Different levels of intervention are also defined based on the extent of population isolation. Outcomes of each scenario on the number of infected cases are computed. Modeling results shows that if effective isolation occurs in 10% of the population, 307,000 individuals will be infected with COVID-19 in Iran by May 20, 2020. For an isolation rate of 25%, started since March 10, 2020, cumulative number of deaths will be 13,450 individuals by May 20, 2020. If preventive efforts can reach a 32% effective isolation rate, a considerable decrease in the number of new cases would be expected during April and May, and the total number of deaths would decrease to 8,630. If the isolation rate increases to 40%, the total number of infected individuals is expected to be 6,030 individuals. It should be acknowledged that this model predicts the number of deaths of all COVID-19 cases, including those who will not be confirmed as COVID-19, because of non-testing or death prior to COVID-19 identification. This serious health issue requires both long-term and short-term planning and arrangements. Social distancing, and identification and isolation of suspected and confirmed cases are believed to be the most important and effective control measure, and should be strengthened soon. For further details on the methodology and results of these models, please visit:

To forecast the COVID-19 epidemic trend in Iran, a set of dynamic models were created. In these models, the effect of climate and community behavior change on the reproductive number is modeled. A baseline scenario is also defined as letting the epidemic grow naturally, with no prevention/control interventions. Different levels of intervention are also defined based on the extent of population isolation. Outcomes of each scenario on the number of infected cases are computed. Modeling results shows that if effective isolation occurs in 10% of the population, 307,000 individuals will be infected with COVID-19 in Iran by May 20, 2020. For an isolation rate of 25%, started since March 10, 2020, cumulative number of deaths will be 13,450 individuals by May 20, 2020. If preventive efforts can reach a 32% effective isolation rate, a considerable decrease in the number of new cases would be expected during April and May, and the total number of deaths would decrease to 8,630. If the isolation rate increases to 40%, the total number of infected individuals is expected to be 6,030 individuals. It should be acknowledged that this model predicts the number of deaths of all COVID-19 cases, including those who will not be confirmed as COVID-19, because of non-testing or death prior to COVID-19 identification. This serious health issue requires both long-term and short-term planning and arrangements. Social distancing, and identification and isolation of suspected and confirmed cases are believed to be the most important and effective control measure, and should be strengthened soon. For further details on the methodology and results of these models, please visit:

After detection of the first confirmed cases of COVID-19 in Iran, the National Committee on COVID-19 Epidemiology in Ministry of Health and Medical Education was established. This Committee is official source of gathering, analyzing, and reporting the COVID-19 data in Iran. The data of all sources in the country including, medical care monitoring center (MCMC), Hospitals’ Information Systems (HIS), Laboratory portal, the data of the center for communicable disease control (MOH), as well as the data from community health centers are integrated and used in this regards. This factsheet contain daily situation report on coronavirus disease (covid-19) in Iran; March 23, 2020.

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.

After detection of the first confirmed cases of COVID-19 in Iran, the National Committee on COVID-19 Epidemiology in Ministry of Health and Medical Education was established. This Committee is official source of gathering, analyzing, and reporting the COVID-19 data in Iran. The data of all sources in the country including, medical care monitoring center (MCMC), Hospitals’ Information Systems (HIS), Laboratory portal, the data of the center for communicable disease control (MOH), as well as the data from community health centers are integrated and used in this regards. This factsheet contain daily situation report on coronavirus disease (covid-19) in Iran; March 25, 2020.

Trauma related to car accidents are among the most common type of trauma. The purpose of this study was to investigate the two-year road accidents of Maragheh-Hashtroud in terms of causes and factors lead to accidents.

This is a retrospective descriptive study. Sample size includes all patients with traffic accident in 2017 and 2018 consecutive years hospitalized in Amiralmomenin Hospital of Maragheh, Iran. Convenient Sampling was done. Data were analyzed using SPSS version 19.

150 injured cases were investigated. Accidents occur more often in young people and men. Failure to pay attention to traffic rules and attention and concentration disorder is the most important cause of accidents.

The human factor is the most important cause of traffic accidents, which occurs mostly due to non-observance of traffic rules and drowsiness.

The prevalence of opium consumption has known to be significant in Iran which involves healthy individuals other than associated patients.

The consumption of opium resulted from several factors such as traditional beliefs on its analgesic effects or in some chronic illnesses. Furthermore, the geographic situation of problematic neighbors is a culprit for this issue. Legislative measures and increased opium costs have led to the adulteration of opium. Lead is one of the most frequently used adulterants which has significantly led to opium lead intoxication.

The increasing number of patients with lead poisoning is a concern that raise the need to perform high-quality studies and to provide effective preventive and diagnostic guidelines.

Head trauma is one of the major causes of death and disability from traumatic injuries. Due to industrialization and increased recreational and sports facilities in cities and villages, this problem has increased in children. Considering to the importance of brain scanning results of patients with traumatic brain injury and their relation to the symptoms and mechanisms of head trauma, this study was performed to investigate the results of CT scan in children with head trauma in emergency department Besat Hospital of Hamadan.

In this descriptive-analytical study, all children with head trauma referred to the emergency department of Hamadan Besat hospital were evaluated for demographic variables, cause and outcome of trauma and CT scan results. The collected data were recorded in a researcher-made checklist and analyzed by SPSS 22 software.

In this study 248 persons with mean age of 5.38 ± 4.30 years were evaluated which 63.8 percent of them were male. Falling down (69 percent) and accidents (20.6 percent) were the two main causes of head trauma, respectively. Most CT scans results in children with head trauma were normal (89.9 percent) and the most abnormal results were fractures (4.4 percent). Most patients (75.8 percent) were discharged from the emergency department with good condition and 21 patients (8.5 percent) were admitted to other wards. Most of children (88.7 percent) had normal GCS. The patient's final outcome was significantly correlated with the cause of injury and the patient's GCS (P-value<0.01). Also, CT scan findings were significantly correlated with GCS of patients (P-value <0.01).

In this study falling down was the most common cause of trauma. Most patients had normal GCS and CT scan. The most common abnormal finding was fracture. There was a significant relationship between patient's final outcome with the cause of injury and GCS. GCS of patients was also correlated with CT scan findings.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

Femoral vein catheterization is one of the most common venous accesses for dialysis. Various complications such as bleeding and arterial damage and arterio venous fistula have been reported for this procedure. One of the rare but fatal complications of this procedure is retroperitoneal hematoma due to damage to the vein wall. The most important point in preventing these complications is the proper technique in placement of the catheter. In this study, we introduce a case of death from a very rare and potentially fatal complication of this technique, retroperitoneal hematoma.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

Adjustment of vascular fluid volume in patients with severe injuries or admission to intensive care unit is difficult and vital. The aim of this study was to determine the diagnosticsensitivity of carotid artery Doppler ultrasonography in determining the adequacy of shock therapy compared to central venous catheter in hospitals of Sanandaj in 2018.

In a descriptive-analytical study, 112 patients with hypovolemic shock (due to sepsis and ...) were evaluated in Tohid and Koswar Hospitals, Sanandaj from March to September 2018. To determine the flow intensity of carotid arteries, initially an echo device was used to collect the data since a portable ultrasonography device was not available but when it became available, the study was performed using portable ultrasonography devices. The study population included patients with hypovolemic shock (due to sepsis) presenting toTohid and Kowsar hospitals, Sanandaj during 6 months.Trauma patients and those with cardiogenic shock and embolism-related shock were excluded. After the initial training of an emergency medicine resident by a radiologist, forall patients diagnosed with hypovolemic shock, the patient's characteristicsincluding age, sex, blood pressure according topressure gauge Mercury, heart rate perminute and inner diameter of the common carotid artery insystolic mode based onDoppler ultrasound were recorded. Then, the patient was treated based on the standard procedure using central venous catheter, and each time the fluid was administered, the flow intensity of the of the common carotid artery was calculated using the measured diameter and compared with the present method/Central venous catheter.The adequacyof treatment was confirmed when central venous pressure reached 8 to 15after fluid therapy. Considering the normal distribution of quantitative data,"independent t-test" and "Pearson correlation coefficient" were used to analyze the hypotheses; and Chi-square test was used to evaluate the correlation between qualitative variables. Sensitivity and specificity were calculated using theirrespective formulas. The statistical software used was SPSS v.22. The study was approved by the ethics committee of Kurdistan University of Medical Sciences.

The results showed that 45.60% were female and the mean age of the population was 75.88 ± 10.82 years. The mean and standard deviation of the central venous pressure before and after shock therapy was6.12 ± 0.65 and 7.88 ± 1.37, respectively. The mean diameter of the artery and flow intensity before and after lifting the foot were 6.92 ± 0.65, 7.37 ± 1.48 and 8.33 ± 1.81, respectively. Sensitivity, specificity and accuracy were 65.0%, 70.0% and 74.0%,respectively. Other results of the study showed that there was a significant positive correlation between findings of intravenous catheter and Doppler ultrasonography after treatment (r = 0.288, p = 0.002).

The results of our study indicated that the sensitivity and specificity of Doppler ultrasonography were somehow acceptable in determining the adequacy of treatment, but more studies are recommended to confirm this.

Currently, due to the limitedfunding of the health care system as an industry, it is necessary to provide vital services without the least waste of time and resources, and one of these is the provision of equipment for the provision of services. The aim of this study was to determinethe availability of equipment for serving patients referred to the CPR department of Hazrat Rasoul-e-Akram Hospital in Tehran, as well as the problems associated with any pharmacy system and automated inventory system.

This descriptive cross-sectional study was performed on emergency patients in the CPR department of Rasoul-e-Akram Hospital of Iran University of Medical Sciences during the year 1397 (sample size 200) that needed emergency services. The availability time of equipment was measured intwo groups by the pharmacy method and using the automatic sales mechanism .

The average time taken to receive supplies from the time it took with the pharmacy system was 167 seconds, while it took 28.3 seconds with the automatic inventory system,which was a significant difference (p-value <0.001). The weaknesses of this system were: lack of connectivity to the Hospital HIS, inadequate equipment, crowded CPR, device charging, and lack of RFID cards .

The results showed that the use of this device for delivery of the equipment in the emergency ward increased the speed of the work, and the availability of the device for other emergency departments and its use for delivery of medication was also necessary

Multiple trauma may cause major bleeding will result in adverse clinical outcomes in the absence of proper and on time initial management in emergency department. In the present study, we aimed to synthesis the critical appraised evidences for initial management of patients with multiple trauma and major bleeding in emergency department.

This was a systematic review study. Following formulating of PICOs for clinical questions in the study, Search strategy selected to gather related evidences in Google scholar, Pubmed, Cochrane, and Trip database in English language from original articles, between 2008 to 2018.The key words were “Multiple trauma, hemorrhage, emergency treatment, therapy”. The Prisma flowchart was used to check the quality of evidences. The strength of evidences reported according to Oxford classification.

Out of 502 articles, 44 original articles were selected for final evaluation based on the search strategy criteria. Results indicated the favorable effects and safety of permissive hypotension resuscitation, using tourniquet, applying early blood transfusion, prescription of transamine, fibrinogen and factor VII on clinical outcomes of patients with multiple trauma and major bleeding in the emergency room.

Based on the study, applying permissive hypotension resuscitation, tourniquet, early blood transfusion, prescription of transamines fibrinogen and factor VII in special patients with multiple trauma and major bleeding in emergency department are recommended.

Drug interactions, as one of the most important subsets of medication errors, can lead to adverse reactions in patients. Considering the increase in drug interactions and their consequences, this study aimed to evaluate the frequency and pattern of drug interactions in patients admitted to the emergency department of a university affiliatedhospital.

This was a cross-sectional study. The study population consisted of patients referring to the Emergency Department of Imam Hossein Hospital from Aprilto the end of September 2018. 552 patients hospitalized in the emergency department of Imam Hossein Hospital were selected via random sampling and the rate of drug interactions reported in their medical profile was evaluated.

The mean age of these patients was 58.51 ± 20.05 years. Sex distribution evaluation showed that 54.4% were male. Based on the number of patients-days recorded, 34.2% had no drug interactions. The total number of interactions recorded was 1139, the highest number of which belonged to group C and the lowest number belonged to group X and A. 50% of people experienced two or less drug interactions and 75% of people experienced 4 or less drug interactions. Mean hospitalization days were 7.63 ± 6.15 days. Finally, 90.8% of patients recovered and 9.2% died.

Based on the findings of the present study, only 34.2% of the patients had no drug interactions. The total number of interactions recorded was 1139, the highest number of which belonged to group C and the lowest number belonged to group X and A. There was a significant correlation between the number of administered drugswith duration of hospitalization, final outcome and the probability of drug interactions. In addition, there was a significant correlation between type D and X drug interactions with mortality rate in patients.

Health systems today form one of the largest sectors of the world's economy. Increasing the rapidly growing costs of health care worldwide. Economic experts have challenged managers and doctors and nurses to find new ways to limit costs. The aim of this study was to compare the financial burden of services provided in the emergency department before and after implementation of the health system evolution plan in Imam Hossein، Loghman and Shohada hospitals.

The present study was multicentric analytical، before-after study، and using data from 2013 to 2015، one year before (2013) and one years after (2015) the implementation of the Health system evolution plan will be done. The statistical population is the emergency department of Imam Hossein، Loghman and Shohada Hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran. The sampling method is census. For analytical study used by SPSS software version 19.

The findings of this study showed that the health system evolution plan does not affect the average cost of services provided in hospitals (P> 0.05)، but the mean of costs of services provided in emergency department of Imam Hossein (P = 0.009) and Loghman (P = 0.02) hospital have statistical significance definition. Also، the comparison of the average number of services provided in the emergency department of Imam Hossein hospital before and after the health system evolution plan، there was significant (P = 0.048).

The health system evolution plan has been effective on the cost of services provided in the emergency department، but، on average of services provided in the emergency department has not been effective.

Emergency is one of the most important departments of the hospital and its quality of service is very important. Emergency medicine is a multidisciplinary specialty and interacts with other specialties. Ensuring the scientific and practical efficacy of emergency physicians is of paramount importance. This study examines the factors affecting residents’ academic success.

This historical cohort study was performed aiming to determine the indices predicting success among emergency medicine residents in Tehran University of Medical Sciences in gaining clinical competence by the end of their residency program. Initially, variables were extracted through a literature review and the list was discussed and completed in a session where a number of professors with experience of educational responsibilities were present. 27 criteria were included in the final questionnaire and werescored using a 5-point Likert scale. The questionnaire was sent to 150 graduated residents and response rate was recorded. Residents’ graduation score, which is given on the scale of 150, was considered as the indicator of academic success.

A total of 150 emergency medicine graduates were enrolled in the study. Of these, 95 completed the questionnaire. Fifty four were male and 55 were married. 40.35% of the married participants had children and 67.27% of their spouses had a job at the time. 68.42% of the participants lived in Tehran throughout their residency program and58.95% declared no financial problems. Twenty three had a history of serious artistic activities and 36 had a history of serious sport activities. 5 had finished the program in more than 3 years due to being failed. In the multiple regression analysis, after eliminating confounding factors, being selected as the top resident had the strongest correlation (r=7.88 P=0.001) with their certification exam scores. This was followed by artistic activity (r=4.58 P=0.03), gap between medical school graduation to residency (r=1.53, P=0.004). In addition, age (r=-.96 P=0.046), and university entrance exam rank (r=-0.0027 P=0.002) had reverse correlation with their certification exam scores.

The results of this study showed that among the studied indices, being the top resident had the most significant direct correlation with academic success. The study also found that academic success had a significant direct relationship withartistic activities and gap between medical school graduation and residency, anda significant reverse correlation with age followed by university entrance examrank.

The global spread of coronavirus 2019 (SARS-CoV-2) and various reports indicate a change in the symptoms caused by the virus and gastrointestinal symptoms becoming an important part of the diagnostic symptoms of the virus. The most common gastrointestinal symptoms include anorexia, nausea, vomiting, and abdominal pain. The probable cause of abdominal symptoms in these patients is the presence of the virus in the digestive system and stimulation of the immune system, followed by the release of inflammatory mediators leading to manifestation of symptoms in this part of the body, causing symptoms of peritoneal irritation. Due to the high physiological stress of surgery, deciding on surgery in patients infected with the virus, who have abdominal pain and a positive abdominal examination is a new challenge for physicians and medical staff. In this study, we introduce three patients with COVID-19 who underwent surgery due to abdominal pain and a positive abdominal examination for peritonitis but had normal findings in surgery, and surgery increased mortality.

Emphysematous pyelonephritis (EPN) is a urologic emergency, which needs immediate medical attention. It is a life-threatening gas-producing infection affecting the renal parenchyma. In this study, we present a 35-year-old male Afghan patient, who was admitted to the Emergency department with low-grade fever, jaundice, abdominal pain, nausea and vomiting, burning urine, and obstructive urinary symptoms. His laboratory data showed serum creatinine 5.4 mg/dl, bilirubin 10.4 mg/dl and thrombocytopenia. Abdominopelvic computed tomography (CT) scan showed gas in the right renal parenchyma and the patient was sent to the operation room with diagnosis of EPN and emergency cystostomy and nephrectomy were performed. The patient was discharged one week later in good condition. Voidingcystogram and retrograde urethrogram were scheduled and performed 2 months later, which revealed long anterior urethral stricture. Anterior urethroplasty with buccal graft was successfully performed later.

 Due to blood supply problems, the cost of blood processing, and the complications of blood transfusion, it is very important to observe the indications for blood transfusion. In addition, necessary precautions should be taken for blood transfusion. Therefore, this study was performed to evaluate the criteria for receiving blood products as well as transfusion complications in patients referring to the emergency department. 

 This study was a descriptive-analytical and cross-sectional study. All patients who referred to Imam Hossein and Shohadaye Tajrish Hospitals and needed to receive blood products during 36 months from April 2016 to March 2018 were evaluated. The data collection tool was a researcher-made checklist that included demographic characteristics, injection indication, and transfusion complications. After collection, the data were entered into SPSS statistical software version 18 and analyzed using Chi-square and Fisher's exact tests. 

 The mean age of patients was 43.51 ± 20.05 years. Sex distribution showed that 61.5% were male. The results showed that the amount of blood products consumed was 2041.28±161.309 units for all patients and 410.89±52.056 units in the emergency department. O and AB blood groups had the highest and lowest frequencies, respectively. In terms of injection indication, trauma was the most common. A difference was observed between the amounts of reserved and consumed products in the emergency department: 357.25±62.105 units for packed cells, 123.33±28.238 units for fresh frozen plasma, 71.533±21.313 units for blood platelets, and 53.78±12.069 units for cryoprecipitate. In terms of complications, shivering (22 cases) was the most common. The results showed that the difference between the mean reserve of compressed blood cells in 2016 and 2017 was significant (P = 0.029). There was also a significant difference between reserved platelete units in 2016 and 2018 (P=0.031). 

 Blood reservation should be done according to specific instructions, and quantitative and qualitative control in the field of blood reservation and consumption in medical centers is necessary. Also, reducing the number of unnecessary injections of blood product units to patients can be one of the effective factors in reducing the complications of blood transfusion.

 Due to the increase in the elderly population in Iran and the world and, of course, the increase in the number of emergency service requests by this age group, the study of the attitude towards old age among the emergency medical staff is considered as a necessity. The aim of this study was to determine the attitude towards aging and related factors in medical emergency staff. 

 In this descriptive-analytical, cross-sectional study, medical emergency staff of Golestan province were studied using census method. To collect data, the Kogan’s Attitudes Towards Older People Questionnaire was used and to analyze the data, SPSS v.18 and sample T-2 tests, Mann-Whitney, analysis of variance, and Kruskal-Wallis tests were applied at the significance level of P-value <0.05. To evaluate the goodness of fit of the model, CFI, TLI, RMSEA, and WRMR’ indices were used via the Mplus7.2 software. 

 The average score (Mean) of medical emergency staff’s attitudes towards the elderly was positive. There were significant relationships among positive attitude towards aging with marital status (P=0.007), ethnicity (P=0.018), degree of education (P=0.026) and the city of employment (P=0.001). Negative attitudes towards aging among urban emergency medical staff were significantly higher than road emergency medical staff (P=0.046). With increase in age (P=0.006) and the number of years of employment in medical emergencies (P=0.043), the score of positive attitudes towards aging increased. Personnel with Turkmen ethnicity had lower scores than personnel with Fars ethnicity in terms of prejudice score (P= 0.046). The mean score of prejudice against the elderly in single emergency medical personnel was significantly higher than married personnel (P=0.01). 

The overall attitude of the emergency medical staff of Golestan province towards aging was positive. Increase in the age and number of years of employment in medical emergencies has also been effective in creating positive attitudes towards old age.

Ultrasonography of the optic nerve might help in detecting patients’ high intracerebral pressure. Given the importance of early diagnosis for implementing therapeutic measures, non-invasive methods have received a great deal of attention among researchers, recently. The present study investigated the accuracy of optic nerve ultrasonography in differentiation of ischemic and hemorrhagic strokes in patients with cerebrovascular accident (CVA).

The present study was a descriptive analytical one. Through convenience sampling, 212 patients visiting Imam Hossein, Loghman, and Shohadaye Tajrish hospitals in 2018 were selected. The data gathering tool was a researcher-designed checklist, which consisted of demographics, clinical characteristics of the patients, and information about optic nerve diameter. Data were extracted from medical files and ultrasonography reports of the patients. The results obtained through estimating the diameter of the optic nerve sheath were analyzed in comparison with cerebral computed tomography (CT) scan findings as the golden standard. Finally, using statistical tests, sensitivity, specificity, positive/negative predictive value, and accuracy of ultrasonography in differentiating ischemic and hemorrhagic CVA were calculated.

Among the participants, 163 had ischemic CVA and 56 had hemorrhagic CVA. The mean diameter of optic nerve among the participants was 5.26±0.35 in the ischemic CVA group and 5.80±0.51 in the hemorrhagic CVA group (p=0.001). In addition, sensitivity and specificity were 86.50% (95% CI: 80.28%-91.34%) and 66.07% (52.19%-78.19%), respectively.

The results of the present study showed that in the cut-off point of 5.5, the ultrasonographic diameter of the optic nerve sheath had a sensitivity and specificity of 86.50% and 66.07%, respectively, and a mean accuracy of 81% in differentiation of ischemic and hemorrhagic CVA. Therefore, this method can be used as a non-invasive method in differentiation of ischemic and hemorrhagic CVA.

Patient rotation during chest x-ray is one of the important causes of decreased image quality and accuracy. Therefore, this study was designed and performed to calculate the accuracy of measuring the length of clavicle bones in detection of patient rotation during chest radiography.

In this diagnostic study, chest radiographs of 435 patients referring to Loghman Hakim Hospital were investigated for rotation via three

standard method (by a radiologist), measurement of clavicle bones (by emergency medicine resident), and visual method (by emergency medicine specialist). The information was recorded in a checklist and sensitivity, specificity, and positive and negative predictive values of the last two methods were calculated in comparison with the standard method for detecting patient rotation.

In comparison with the standard method, the method of measuring the length of the clavicle had a sensitivity of 88.9%, specificity of 97.6%, a positive predictive value of 99.4%, a negative predictive value of 67.8%, and an accuracy of 90.6%. The visual method had a sensitivity of 66.9%, a specificity of 71.4%, a positive predictive value 90.7%, a negative predictive value 34.1%, and an accuracy of 67.8% compared to the standard method in determining the presence or absence of chest rotation.

Overall, the findings of our study indicated that the accuracy of clavicle length measurement method is not much different from that of the standard method in detection of patient rotation and can be used as its replacement in this regard.

Introduction Hospital insurance deductions, in addition to wasting significant amounts of hospital resources and revenues and reducing hospital financial capacity, also impose additional financial burdens on the patient by increasing the costs that patient has to pay. Therefore, the present study aims to compare the status of insurance deductions before and after the implementation of productivity promotion system in Loghman and Imam Hossein (AS) hospitals in Tehran.

A descriptive-cross-sectional study with practical purposes conducted in Loghman Hakim and Imam Hossein (AS) hospitals in Tehran by random sampling classification based on the minutes of the insurance organization's meetings on 310 cases and deductions applied by the organization. Insurance in 1396 as insurance deductions before the implementation of the productivity promotion plan and 1397 as insurance deductions after the implementation of the productivity promotion plan and using spss 26 software and descriptive and average statistics methods and The independent T test has been analyzed.

The results of data analysis showed that the average social security insurance deductions include doctor's visit (P = 0.007), doctor's fee (P = 0.00), drug deduction (P = 0.011), laboratory deduction (P = 0.00) and average total deduction. (P = 0.00) in Imam Hossein (AS) Hospital, after the implementation of the productivity improvement plan, there was a statistically significant difference compared to before its implementation, which showed an increase in insurance deductions after the implementation of the productivity improvement plan. However, the amount of insurance deductions for patient consumables did not show a significant difference before and after the implementation of the productivity improvement plan (P = 0.38). Also, the average social security insurance deductions including equipment and drug deductions (P = 0.002) and the average total deductions (P = 0.004) in Loghman Hakim Hospital after the implementation of the productivity improvement plan had a statistically significant difference compared to before its implementation. It has been shown that the increase in insurance deductions after the implementation of the productivity promotion plan, while the amount of deductions for patient supplies other than medicine has not shown a significant difference before and after the implementation of the productivity promotion plan (P = 0.38). The results of the analysis of health service insurance deductions in both Imam Hossein Hospital (P = 0.81) and Loghman Hakim Hospital (P = 0.10) showed that the amount of insurance deductions later than the implementation of the productivity improvement plan compared to before Its implementation has not shown a statistically significant difference.

The productivity improvement plan has not only had no effect on reducing the amount of insurance deductions, but has also increased the amount of deductions in deductions issued by social security insurance.

Computed tomography (CT) scan is a valuable tool for diagnosis of abnormalities in brain or spinal cord as it has a high resolution in these tissues. Considering the importance of this subject, the researchers have aimed to evaluate the frequency of unnecessary CT scans performed for trauma patients in order to prevent unnecessary use of this diagnostic modality to avoid imposing probable side effects and financial burden on both the patient and the hospital.

In this cross-sectional study, through simple random sampling, participants were selected from fully conscious (Glasgow Coma Scale (GCS)=15) patients who presented to the emergency department with head trauma and underwent brain CT scan. The reasons for ordering a brain CT scan were recorded through an interview with the in-charge physician at the time of ordering this procedure, and clinical signs and demographic characteristics of the patients were also recorded using a questionnaire.

121 (81.8%) of the patients had normal CT scan, and skull fracture and hematoma were the most frequent complications found after trauma. The results also showed that in 90 (60.8%) cases, CT scan was ordered for documentation and legal purposes, and for 22 (14.9%) cases it was ordered because the patient had insisted and it was not deemed necessary by the in-charge physician, and only 26 (17.6%) were requested by the senior physician, which indicates that CT scans are not always necessary.

According to the results of this study, 18.2% of the CT scans performed on patients with mild head trauma showed at least 1 pathologic finding. Skull fracture and formation of intracranial hematoma were the most common pathologic findings in the CT scans of patients following mild head trauma. Due to the high frequency of normal CT scan results, in order to reduce the amount of radiation in patients and decrease the number of unnecessary CT scans, it is suggested to plan more strict criteria for ordering CT scans.

 Studying the causes of mortality plays the most important role in determining and evaluating the health system's effectiveness. Accordingly, this study aimed to identify the causes of death in the emergency department for planning and providing appropriate facilities to reduce mortality rate in patients. 

 This cross-sectional observational study was conducted in the Firoozgar Hospital, Tehran from April 2013 to March 2017. The clinical records of all patients who died in the emergency department through the study period were studied. The extracted demographic characteristics and causes of death were analyzed using SPSS-25 software. 

 In the last 5 years, sepsis (24.02%), out-of-hospital cardiac arrest (20.46%), acute coronary syndrome (19.48%), trauma (accidents and falls from a height) (17.78%), multi organ dysfunction (7.08%), intracranial hemorrhage (6.8%) and pulmonary embolism (4.38%) were the main causes of mortality in hospitals. 

 Sepsis, out-of-hospital cardiac arrest, ACS, trauma, multi organ dysfunction, intracranial hemorrhage and pulmonary embolism are the main causes of mortality in hospitals. The high prevalence of death causes, such as sepsis and trauma indicate that such causes should be controlled and prevented, so that by equipping the emergency departments and proper planning, life expectancy can be increased

 The pneumonia outbreak caused by COVID-19 was reported in December 2019 in Wuhan, China. In Iran, the first case of this outbreak was reported on February 20, 2017, in Qom. Primary manifestations of this disease range from asymptomatic cases to moderate infection of the upper respiratory tract and fatal pneumonia. In addition, we are aware that smoking suppresses the immune system and intensifies inflammatory responses in the lungs. On the other hand, the negative effects of smoking on orthopedic trauma surgeries are not subtle and neglectable. 

 In the present study, data of 31 orthopedic trauma patients with COVID-19 was collected by means of a questionnaire. Studied patients were classified into two groups of smokers and non-smokers: 17 had a history of smoking and 14 had no previous history of smoking. 

 The mean age of the 31 studied patients was 48.41 years, with a minimum of 17 and a maximum of 96 years. The mean age was 43.35 (with the standard deviation of 20.59) years in smokers and 54.57 (with the standard deviation of 22.69) years in non-smokers. Mean age was 56.6 (with the standard deviation of 19.33) years in patients with cough and 40.75 (with the standard deviation of 22.02) years in patients who did not cough. Evaluating need for ICU admission and oxygen therapy showed that 35.3% (6 cases) of smokers and 14.3% (2 cases) of non-smokers needed ICU and 70.6% (12 cases) of smokers and 64.3% (9 cases) of non-smokers needed oxygen therapy. We also found that the mean duration of hospitalization after the surgery was 3.5 (with the standard deviation of 3.37) days in non-smokers and 8.58 (with standard deviation 13/13) days in smokers. 

 According to the results of this article, trauma patients who coughed had a significantly higher average age, but other clinical symptoms were not significantly related to the age of the patients. Although no significant relationship was observed between smoking and orthopedic trauma, the need for ICU and oxygen after surgery as well as time interval between corona diagnosis and surgery were higher in the smoking group in comparison to the non-smoking group. It seems that smoker COVID-19 patients with orthopedic trauma need more attention during hospitalization and surgery as well as after surgery in order to reduce short-term complications and in similar conditions, they may be more likely than non-smokers to have a longer duration of hospitalization. However, more studies with larger sample size and longer follow-up time are required to further evaluate the detrimental effects of smoking.

The main goal of health system reform plan, was to provide financial support for health costs of citizens, organize hospital services and improve their quality, and provide fair access to health care. Therefore, this study aimed to evaluate patients’ satisfaction in emergency department (ED) of Imam Hossein Hospital, Tehran, after health system reform plan implementation in Iran.

The study was performed in Imam Hossein Hospital, affiliated with Shahid Beheshti University of Medical Sciences. Satisfaction of 2000 patients or their relatives was evaluated using a questionnaire designed based on topics announced by the Ministry of Health for evaluating patient satisfaction.

The highest rate of satisfaction from emergency services in the ED belonged to medical and ethical principles. Other studied topics were ranked in the following order: support during and after providing services, overall perception, products and services, and loyalty. In the treatment processes carried out in ED, services provided and preparations made for treatment can be evaluated from physical and emotional aspects, and the satisfaction in the physical aspect is significantly higher than the emotional aspect. Taking this into account can be of great help in improvement of the conditions.

Overall, after the implementation of health system reform plan, patients have been less satisfied with emotional aspect of treatment, which could be due to lack of personnel, lack of proper training, ED overcrowding, and sometimes human errors or negligence of staff. Price indices and rapid reduction of pain were among the most important items that increased overall satisfaction.

Emergency department is one of the most voluminous and most sensitive part of hospital departments, which is of particular importance and one of the most dangerous medical departments. A trained emergency physician not only will be able to guide trauma, but also can handle most other acute and non-acute issues imaginable. The aim of this study was to determine the presence of an emergency medical specialist on the bedside of patients referred to the emergency department of hospitals. The obtained results can play a significant role in planning for training physician and play important role in emergency departments of Rasool Akram, Shahdadi Haftom Tir and Firoozghar Hospitals.

In this study, 30 patients referred to the emergency department of Rasool Akram, Shahdadi Haftom Tir and Firoozghar Hospitals in 2018 were asked to provide a structured interview to determine the presence of a specialist in emergency medicine at their clinic. Also, 20 personnel of these hospitals, were interviewed about the condition of the emergency departments, before and after the establishment of emergency medicine. Data were analyzed by SPSS software.

In interviews with patients, they stated that 46.15% were visited by the doctor, 30.76% by student and 23.07% by the nurse, indicating that none of them knew that the specialist Emergency medicine has visited them. 16.66% stated that they were visited at the right time and 53.44% were dissatisfied and they reported that they did not attend the clinic at the right time for proper examination. 76.92% were satisfied with the procedure and 23.08% were dissatisfied. 54.57% were satisfied with the review and 42.43% of them were dissatisfied. 66.45% of the diagnostic quality and therapeutic measures were satisfied and 33.55% were dissatisfied. 44.26% of cases were in good condition and 55.74% were inappropriate. Also, the most important advantages of establishing emergency medicine in terms of personnel was reduction in patient mortality in emergency department, speed in disposition of patients, reducing expert advice, performing procedures by an emergency medicine specialist, reducing the patient's time in the emergency department and increasing patient satisfaction.

The presence of emergency medicine specialists improves the quality of health care services and increases patient satisfaction. By timely and accurate referral of patients to the relevant departments, time and cost of treatment are saved. Therefore, it is suggested that the establishment of emergency medicine in all emergency medical units of the country, And, for the community of people to become more familiar with this field, the necessary knowledge is also needed.

 Head trauma is one of the major causes of death and disability from traumatic injuries. Due to industrialization and increased recreational and sports facilities in cities and villages, this problem has increased in children. Considering to the importance of brain scanning results of patients with traumatic brain injury and their relation to the symptoms and mechanisms of head trauma, this study was performed to investigate the results of CT scan in children with head trauma in emergency department Besat Hospital of Hamadan. 

 In this descriptive-analytical study, all children with head trauma referred to the emergency department of Hamadan Besat hospital were evaluated for demographic variables, cause and outcome of trauma and CT scan results. The collected data were recorded in a researcher-made checklist and analyzed by SPSS 22 software. 

 In this study 248 persons with mean age of 5.38 ± 4.30 years were evaluated which 63.8 percent of them were male. Falling down (69 percent) and accidents (20.6 percent) were the two main causes of head trauma, respectively. Most CT scans results in children with head trauma were normal (89.9 percent) and the most abnormal results were fractures (4.4 percent). Most patients (75.8 percent) were discharged from the emergency department with good condition and 21 patients (8.5 percent) were admitted to other wards. Most of children (88.7 percent) had normal GCS. The patient's final outcome was significantly correlated with the cause of injury and the patient's GCS (P-value<0.01). Also, CT scan findings were significantly correlated with GCS of patients (P-value <0.01). 

 In this study falling down was the most common cause of trauma. Most patients had normal GCS and CT scan. The most common abnormal finding was fracture. There was a significant relationship between patient's final outcome with the cause of injury and GCS. GCS of patients was also correlated with CT scan findings.

Data mining techniques, including decision tree algorithms can be used for modeling and identifying those at risk of developing COVID-19. The main goal of this study is estimating the risk of death of patients due to COVID-19, using the classification and regression tree (CART) algorithm based on the observed effective factors.

This paper is an analytical study and the data of all patients with COVID-19 registered on the Kaggle site through Johns Hopkins University, was extracted. There was a total of 26,031 records from various countries. Data analysis was performed using JMP statistical software version 13. In the modeling section, decision tree algorithm and CART model were used.

The results of the classification and regression tree showed that among quantitative variables, age, the interval between hospitalization and result, the interval between onset of symptoms and test result, and the interval between hospitalization and test result, and the qualitative variable of gender were the most important factors affecting the outcome of patient treatment, respectively. According to the analysis of words, fever, cough, sore throat, fatigue, weakness, headache, chills, and runny nose, respectively, were the most common symptoms among patients with this disease.

The accuracy of the fitted model was shown to be 94.1% for experimental data and 91.1% for educational data using the area under the receiver operating characteristic (ROC) curve.