Trauma Monthly
Volume:23 Issue: 4, Jul-Aug 2018

Blunt thoracic trauma is the third most common injury in poly-trauma patients following head and extremities injuries; this study aimed to assess the prevalence of blunt chest trauma and its injury pattern, mechanism of injury, length of hospital stay, treatment period, and risk factors.

In this cross-sectional study, 7,410 patients, who referred to Shahid Rajaee hospital, during years 2010 to 2014 were selected through census sampling. The participants’ demographic data, mechanism of injury, type of thoracic injury, location of fracture, length of stay, and injury severity scores (ISS) were recorded.

Most patients were male (5498, 74.2%), 63.3% were 15 to 40 years old, and their mean age was 37.53 ± 0.21 years. The most commonly reported mechanism of injury was car accident (2,999, 40.5%) followed by falls (1,529, 20.6%, and motorbike accidents (964, 13.1%). Head, neck and thorax injuries were most common comorbidities in thorax trauma patients. The mortality rate was 1.5%. Indeed, the patients, who had rib fracture (P = 0.01) (OR3.66, CI [1.36 - 9.82]), and multiple injuries of thorax (P < 0.001) (OR 8.10, CI [3.21 - 20.73]), had a higher mortality risk.

The risk of blunt thoracic injuries was higher among specific types of injuries. Additionally, patients with blunt chest trauma, who had the risk factors of mortality required preventative measures and careful management in order to prevent traumarelated deaths.

Rapid response nursing team evaluates the patients in the early stages of clinical exacerbation and prevents unexpected cardiopulmonary arrest. The present study aimed at determining the effect of rapid response nursing team on outcome of patient care in the emergency ward.

This clinical trial was conducted on 714 patients at the emergency ward in selected hospitals affiliated to Alborz University of Medical Sciences, during 2013. The patients were randomly allocated to a control and an intervention group. The rapid response nursing team comprised of an intensive care nurse and an anesthesia technician, who were in the emergency on a 24/7 basis. If the patient’s clinical conditions deteriorated, they immediately attended to him, evaluated his clinical condition precisely, and took necessary nursing measures for the patients in the case group, yet those in the control group received the conventional treatment at the emergency ward. Patients’ conditions and the measures taken for them were precisely recorded for both groups and the data were analyzed using the SPSS 16 software.

The results of the study showed that there was a significant relationship between establishing rapid response nursing team and outcome of patient care (P = 0.028), reduced transfer to special care units (P = 0.014), and reduced level of care in the first 24 hours of admission (P = 0.001).

Given the results, the rapid response nursing team was effective in preventing unexpected cardiovascular arrests, increased successful cardiopulmonary resuscitation, and reduced transfer of patients to special care units and higher levels of care.

The aim of this study was to explore key informants’ experiences about challenges and recommendations of patient identification and tracking in past earthquakes in Iran.

A qualitative survey of key informants’ experiences and views was carried out on emergency physicians and nurses, first responders and managers of red crescent society, and emergency medical services (EMS) from March to September 2015. Semistructured interviews were performed with informants who had experience of response to past earthquakes in Iran by using a purposive sampling method. Interviews were audiotaped, transcribed, and entered into MAXQDA (version 10) for coding and content analysis. A thematic analysis of interview transcripts was undertaken.

5 themes including the crowd’s presence, lack of unified command and integrated management, deficiency of planning, shortage of managerial and information infrastructures, and human resources challenges with their subthemes were explored. Also, some solutions were explored as follows: community education, chain of command and integrated management in the disaster scene, and training the emergency medical personnel and first responders.

There are many challenges that should be solved for improving patient tracking in future disasters in Iran. Planning for proper and effective communication between agencies that have responsibility for disastermanagement is very important. Also, community education is a vital measure to familiarize them with disaster and teach them how to save lives.

Fractures are the most serious injury suffered by athletes, resulting in the greatest time recuperating from Such injuries.

To describe the difference in outcome for non-operative versus operative management of site-specific soccer-related fractures.

All fractures sustained during soccer from 2007 to 2008 within the Lothian population were prospectively recorded. Patients were followed up in August 2010, via telephone, to determine return rates and times to soccer. High incidence fractures with significant rates of surgery (Tibial Diaphysis, Ankle, Scaphoid, Clavicle, Metacarpus Distal Radius) were identified and classified according to the AO system. Outcomes of similar fracture classifications with contrasting management were compared.

Of 367 fractures identified during the study period, 20% were managed operatively. The rates of surgery for the six fractures cohorts were Tibial Diaphyseal 67%, Ankle 51%, Scaphoid 25%, Clavicle 20%, Metacarpal 11% and Distal Radial 10%. Operatively managed fractures of the Distal Radius (14 weeks vs. 9 weeks: P < 0.031), Ankle (42 weeks vs. 22 weeks: P < 0.004) and Metacarpus (18 weeks vs. 5 weeks: P < 0.001) took longer to return to soccer than non-operatively managed fractures, while operatively managed fractures of the Tibial Diaphysis took shorter to return (35 weeks vs. 45 weeks: P = 0.673). Operatively managed fractures of the Ankle (57% vs. 22%: P < 0.029), Tibial Diaphysis (89% vs. 50%: P = 0.683), Scaphoid (80% vs. 60%: P = 0.613), Clavicle (50% vs. 31%: P = 0.584), Distal Radius (50% vs. 18%: P = 0.234) and Metacarpus (67% vs. 40%: P = 0.537) had higher rates of persisting symptoms at follow-up than non-operatively managed fractures.

The role of operative management in the treatment of soccer-related fractures is specific to the location and nature of the fracture. The effect of operative management on return times to sport is fracture specific, though invariably this is associated with higher rates of persisting symptoms. The decision regarding the choice of non-operative versus operative management requires clinical judgment on an individual basis, based on the fracture location and configuration.

Theory of mind (ToM) is one of the social cognition skills. Deficits of ToM in individuals with traumatic brain injury (TBI) impact adversely on their social functioning and generally, their life style.

The current study aimed to assess ToM skill among adults with TBI. Data Sources: The terms of traumatic brain injury, head injury, closed head injury, head trauma, social cognition, theory of mind, mind reading, and adult were searched in databases of PubMed, PubMed Central, Google Scholar, ScienceDirect, Taylor and Francis Online, Willey Online Library, and Springer. Data Selection: The inclusion criteria were the recruitment of adult subjects with TBI and relevance to ToM skills. Exclusion criteria were relevance to the other social cognition (other than ToM) and non-social cognition skills in TBI, and relation to ToM skills in children and adolescents with TBI. Data Extraction: Type of study, sample size, task name, type of task, control question, and results were the main categories considered in the current review.

The current review study covered 35 articles about different types of ToM impairment in individuals with TBI. The majority of the studies were case-control comparisons on ToM in TBI populations regardless of the lesion location, including story-based tasks. TBI patients are impaired in mental state inference (ToM), and non-mental state inference.

Patients with TBI were impaired in mental tasks (ToM) and non-mental tasks (more in non-mental verbal tasks compared with non-verbal ones), which indicated that persons with TBI had no special impairment in ToM skills.

Bone defect healing in orthopedic surgery is a huge challenge. Nowadays, scaffolds are frequently used for tissue regeneration and engineering. One of these scaffolds, hydroxyapatite, is the most important inorganic material in bone, and a good option for promoting healing of bone defects. Honey has long been used for various wound healing with beneficial outcomes in the healing process. However, limited studies have addressed its use in repairing hard tissue lesions.

The aim of this study was to evaluate the effects of honey and hydroxyapatite on the restoration of bone defect in rats.

In this study, 15 adult male rats weighing 200 to 300 grams were used. Rats were randomly assigned to three groups. A segment of the radius bone twice the size of the radius bone width was removed. In the first group (N = 5), the induced defect in the right hand was replaced with autograft bone using the same piece of bone, while the left hand remained empty without any implantation. In the second group (N = 5), defect in the right hand was filled with 0.5 g of honey and in the left hand with honey and autograft bone. In the third group (N = 5), defects in the right hand were filled with granules of hydroxyapatite and those in the left hand with 0.5 g combination of granules and honey. Radiographs in rats were taken at weeks two, four, six, and eight after surgery and bone biopsy for histopathological study was performed at week eight.

Radiographs and tissue samples were statistically analyzed in terms of bone formation, union and remodeling. Analyses showed that in the second week, honey-autograft was significantly better than the other groups (P < 0.05). The honey-alone treated group at all times was weaker than others. Histopathological investigations revealed that the hydroxyapatite-alone group was significantly different from hydroxyapatite-honey, autograft, honey, and negative control counterparts in terms of bone marrow formation (P < 0.05).

Overall, this study showed that honey and hydroxyapatite alone is not effective in repairing bone defect yet in combination they function more effectively.

The current study aimed at determining the clinical effectiveness and safety of Ilizarov external fixation on the treatment of femoral supracondylar fracture.

The current retrospective case series study was conducted on patients with femoral supracondylar fracture. The patients were treated by Ilizarov technique and followed up for 1 - 6 years. The complication rate was determined by knee society score (KSS) and functional knee score (FKS).

Most of the 47 assessed patients were in the age range of 31 - 40 years (38.3%) and 83% of them were male. Average fixation time was 4.82 ± 0.96 months (range three to seven months); 40 cases (84.5%) until five months and all patients until seven months post-operation achieved complete union without major complications. The mean range of extension lack and flexion of the knee at the final follow-up were 1.91 ± 3.54 and 121.17 ± 14.45 degrees, respectively. The means of KSS and FKS at final follow-up were 90.8 ± 7.2 and 90.57 ± 8.16, respectively. Although superficial pin-tract infection was observed in 28 pin sites (59.6%), no patient developed deep infection or osteomyelitis.

The Ilizarov fixative technique can be used as an effective and available method with low complications to treat severe femoral supracondylar fractures.

Emergency departments provide continuous 24 - h health services. The working shifts required for health workers to provide high - quality and continuous services are still the subject of debate. This descriptive study compares the emergency department working shifts in Turkey with the emergency department working shifts in Iran.

This cross sectional descriptive study assesses numbers of paramedics, nurse, resident physicians, specialist physicians, faculty members, shift hours, numbers of patient admission per day, and compares the shift systems worked by emergency department staff in three hospitals providingmedical training in Turkey and emergency department staff from amedical faculty providing training in Iran.

The highest numbers of residents (N = 50) and members of teaching staff (N = 14) were observed in Tabriz - Iran Imam Reza Hospital. Resident physicians at Turkey’s Karadeniz technical University (KTU) Medical Faculty Emergency Department work 24 - h block shifts, while those in other centers work various shift patterns. The teaching staff at the Imam Reza Hospital work actively for 24 h, while those in hospitals in Turkey work actively in the daytime and are on standby in the evening. The Emergency Severity Index triage system is applied in the Imam Reza Hospital, while the three centers in Turkey use the yellow, red, and green triage coding system.

Presentation of teaching a faculty member in 24 hours in shifts and using ESI triage system with divided shift times in a day can improve emergency management by decreasing personnel burnout and increasing care satisfaction in patients.

In the article entitled “Management of Naso-Orbito-Ethmoid Fractures: A 10-Year Review” published in issue 3, vol. 22:e29230 of Trauma Monthly (1), the sentence at the end of the caption of Figure 2 is incorrectly written as “Reprinted with permission from Liau et al.’s study”, which should be eliminated. In fact, this schematic figure was originally ordered,
prepared for the main article, and published for the first time in Trauma Monthly.

Older adults are disproportionately affected by natural disasters. The literature on the health needs of older adults after natural disasters is limited.

The aim of this study was to examine the existing evidence on the health needs of older adults after disasters. This systematic review of the literature was conducted to provide an overview of what is known about the needs of older adults after natural disasters.

An electronic search of the following databases was conducted: PubMed, Cochrane, ProQuest, Web of Science, Google Scholar, and HelpAge International. The final review included 27 articles that were analyzed using qualitative content analysis to identify the health needs of older adults after natural disasters.

Limited and sparse literature exists pertaining to the health needs of older adults after natural disasters. In this study, six themes or features of health needs emerged: medical needs, psychosocial needs, assistance in activities of daily living, resources, informational needs, and protective needs. Furthermore, four categories including personal, organizational, socio-cultural, and disaster-related factors could affect the health needs of older adults after natural disasters.

Planning for older adults with diverse and special needs in disasters is very important. Health care providers should consider the older adult’s health needs and capacities in the disaster recovery