Archives of Trauma Research
Year:2012 | Volume:1 | Issue:1|Papers Count:10

From the time Abel was killed by his brother, Cain, in an assault action to his head as the first case of death on the earth, to the decapitation of the giant warrior Goliath by the young David after hurling a stone with his sling and hitting his head, to the death of many people in such natural disasters as earthquakes, like the excavated skeletons of a mother and her child in ancient Sialk Hills in Kashan-IR Iran related to more than 7000 years ago with the evidence of skull fracture in them, to the first automobile fatality of any kind in 1869 in which the scientist Mary Ward was thrown from her vehicle near a small town in County Offaly, Ireland…

Concomitant research and education are invaluable for patient care and medical practice in trauma. Elucidation of a foundation for the integration of training and service that can be combined with research in trauma is crucial, and every trauma case should be studied for this purpose. In this study, we investigated the unique features of trauma research to formulate a generic comprehensive model that can be used at any point at which one may desire to develop a research plan. The framework of this model is designed to enable proper trauma research plain in combination with the best routine trauma care. Selection of the appropriate method of study, the corresponding basic questions raised, aims, and the relevant epidemiologic context are factors that are included in this review. Furthermore, suitable sources, proper time for data collection, reliable and valid measures, and criteria for the scaling and quantification of the findings are indicated. In addition, the levels, orders, operational stages, and steps to be taken in planning research projects are logically set based on the principles of cognitive task analysis, and correspond to the entire spectrum of trauma care situations. Lastly, a measure of utility value is assigned in terms of the expected extent of efficiency and presumed level of effectiveness.

Background: The neck region contains a high density of vital organ structures within a relatively small and unprotected anatomic region, making it one of the most vulnerable areas of the body for all types of injuries.Objectives: In this article, we studied penetrating neck trauma cases in Alzahra Hospital over a 10-year period.Patients and Methods: In this retrospective, descriptive, analytical study, penetrating neck trauma cases admitted to Alzahra Hospital between April 2000 and April 2010 were analyzed for epidemiology, mechanism of trauma, zone of trauma, therapeutic method, injuries to other organs, complications, and mortality.Results: Among 192 penetrating neck injuries, the mean age at the time of injury was 25.08 ±15.02 years. Of these cases, 96.4% occurred in men. The most common mechanisms of trauma was stab wounds (85.93%). In 56.3% of penetrating neck injuries, zone 2 was involved. Neck exploration was positive in 84.4% of cases, and 52.1% of patients underwent surgery. Vascular exploration was the most common cause of surgery (67.2% of patients). The most common surgical intervention was vein ligation (50.8% of cases).In 11.98% of cases, another organ injury occurred simultaneously, and chest injury was the most common coexisting problem (65.2%). Complications were reported in 9.3% of patients, and the need for intubation was the most common complication (5.2% of patients).Mortality rate was 1.5%.Conclusions: According to the findings of this study, the most common cause of penetrating neck injuries was stab wounds, and the majority of patients were young men, therefore, preventive measures should be implemented. Because of fatal complications associated with neck injuries, we recommend early neck exploration in unstable cases or when injuries are deeper than the platysma.

Background: Head injury (HI) is preventable and knowledge of the epidemiology of children’s HI is essential for developing preventive strategies.Objectives: The aim of this study was to survey pediatric HI patients admitted to emergency wards at Poursina Hospital in Rasht, Iran, from 2009 to 2010, and to identify the cause of HI in these children.Patients and Methods: In this retrospective study, all HI patients under the age of 18 who were admitted to emergency wards between March 2009 and March 2010 were enrolled in the study. Demographic, etiologic, and injury data were collected and a descriptive analysis was performed.Results: A total of 668 patients were included in this study. The mean age was 10.4 ±5.3 years. The most frequent cause of HI was traffic accidents. The mean Glasgow Coma Scale (GCS) score was 14.5 ±1.6. The ratio of boys to girls was approximately 3 to 1. The ratio of boys to girls increased with increasing age (P<0.01). Moreover, an association was found between age at injury and etiology of HI as well as a significant association between age at injury and the place of event (P<0.01).Conclusions: The incidence of childhood HI due to traffic accidents is high (81% of pediatric trauma cases). Thus, motorcyclist education and improvement in traffic engineering for pedestrians and bicyclists should be included in prevention programs.

Background: Trauma occurs in 7% of pregnancies and is a major cause of morbidity and mortality in the mother and fetus.Objectives: The present study was conducted in Kashan in 2009–2010 to evaluate the causes of trauma in pregnancy.Patients and Methods: This descriptive study analyzed data from 32 pregnant women with trauma who were referred to the maternity hospital from 2009 to 2010. Data included age, gestational age, mother's occupation, cause of trauma, maternal-fetal complications, gravidity, and parity. The diagnosis of maternal and fetal complications was based on clinical examinations by a gynecologist and results of blood tests, urine analysis tests, and sonography. Data were analyzed as frequency distributions.Results: the causes of trauma included falling (9 cases (28.1%)), abdominal trauma (8 cases (25%)), spousal feud (3 cases (9.4%)), motorcycle accident (2 cases (6.25%)), car accident (2 cases (6.25%)), falling from a motorcycle (2 cases (6.25%)), falling or fainting resulting in head trauma (1 case (3.1%)), pain from crossing over a bump in the car (1 cases (3.1%)), and unspecified causes (4 cases (12.55%)). The causes of traumas occurred between 5 and 40 weeks of gestation. In 17.2% of the cases, trauma occurred prior to 20 weeks of gestation.However, there was no significant relationship between the cause of trauma and maternal age or gestational age. Vaginal bleeding and retroplacental clots were reported in 2 (6.25%) cases and 1 (3.1%) case, respectively.Conclusions: Nearly half of the women presenting with trauma had experienced spousal feud or domestic violence, therefore, it is necessary to recognize spousal abuse and provide adequate support to traumatized pregnant women.

Background: Burns are major cause of death and disability worldwide, particularly in the developing countries.Objectives: The aim of this study was to determine the incidence and causes of burns in children under the age of 15 years in Isfahan province, Iran.Patients and Methods: All children admitted to the burn center of Isfahan, the largest city in central Iran, between 2007 and 2009 were enrolled in this study. We analyzed the data on age, sex, location, cause and spread of the burn, duration of admission, and cause of mortality.Results: Out of 2229 burn patients, 1014 (45.5%) were under the age of 15, indicating an annual incidence of 50 in 100, 000 children. Of the 1014 patients, 610 (60%) were boys and 404 (40%) were girls; the male-to-female ratio was 1.5: 1. Most of the patients were in the age range of 3 to 6 years. Scald was the most common type of burn injury (51.8%). Sixhundred and sixty-eight cases (65.7%) were from urban areas, while 346 (34.3%) were from rural areas. Fifty-six patients (5.5%) died.Conclusions: Burn injury is a major health concern in the pediatric age group, and specific consideration and planning are required for its management.

Background: Injury to the liver is a commonly encountered problem in trauma cases and is a frequent cause of morbidity and mortality. Because gauze packing is easy to use and has the potential for rapid hemorrhage control, it is the most commonly used method for patients with severe liver injuries, particularly those with coagulopathy.Objectives: In this study, Op Site sheets were used to make three-layer packs for decreasing the complication associated with removing gauze packing.Patients and Methods: Twenty male patients with grade IV or V liver injuries that required laparotomy were enrolled in the study. Ten patients were treated using conventional packing, while the other 10 were treated using the three-layer pack. In the case group, the liver was mobilized as much as possible. The three-layer pack was then placed at the site of liver damage and extended onto the liver surface, and the other pads were placed on top of this pad. After 72 h, reoperation was performed, the packs were removed, and the packs causing injury were recorded. Additionally, if rebleeding due to the adhesive bands of the pack was observed, the blood was suctioned and bleeding volume was measured. Data were analyzed using the Mann-Whitney test.Results: Patients in the case and control groups were similar in age and admission vital signs. During the second operation, the bleeding volumes measured in the case and control groups were 66 ±27.01 mL and 152 ±85.4 mL, respectively. There was some padinduced damage after the removal of the pad in the control group.Conclusions: Our study has provided a simple and safe packing method for high-grade liver injuries.

Background: Ocular trauma is a significant health problem in pediatric patients.Objectives: The aim of this study was to analyze the characteristics of ocular-traumarelated hospitalization of children in Kashan.Patients and Methods: This descriptive, cross-sectional study included 131 children aged less than 16 years with ocular trauma, who were admitted to the Matini Hospital at the Kashan University of Medical Sciences between April 2006 and March 2009. After admission, detailed ocular examination was performed, and their ocular trauma was classified according to the International Ocular Trauma Classification and Birmingham Eye Trauma Terminology systems.Results: Mean age of the patients was 7.8 ±2.2 years (age range, 0–16 years), and male to female ratio 5: 1. The most common cause of admission was hyphema (38.1%), followed by corneoscleral laceration (27.5%). Ocular trauma most commonly occurred at home (43%), and 69% of the patients presented to the emergency room within 24 h of injury. In 30% of the patients, initial visual acuity at the time of presentation was less than 20/200 (Figure 1).Conclusions: Ocular trauma is a major cause of unilateral blindness, especially in young boys, and hence, preventive measures and education is required.

Background: Burn pain is recognized as being maximal during therapeutic procedures, and wound debridement can be more painful than the burn injury itself. Uncontrolled acute burn pain increases the stress response and the incidence of chronic pain and associated depression. Although opiates are excellent analgesics, they do not effectively prevent central sensitization to pain. The anticonvulsant gabapentin has been proven effective for treating neuropathic pain in large placebo-controlled clinical trials. Experimental and clinical studies have demonstrated antihyperalgesic effects in models with central neuronal sensitization. It has been suggested that central neuronal sensitization may play an important role in postoperative pain.Objectives: The aim of this study was to investigate the effect of gabapentin on morphine consumption and postoperative pain in burn patients undergoing resection of burn wounds.Patients and Methods: In a randomized, double-blind, placebo-controlled study, 50 burn patients received a single oral dose of gabapentin (1200mg) or placebo 2h before surgery. Anesthesia was induced with propofol and fentanyl and maintained by infus-ingpropofol, remifentanil, and 50% N2O in O2. All patients received patient-controlled analgesia with morphine at doses of 2.5 mg bolus and a lock-out time of 10 min for 24h before the operation. Pain was assessed on a visual analog scale (VAS) at rest and during movement at 1, 4, 8, 12, 16, 20, and 24 h before the operation. Heart rate, oxygen saturation, mean arterial blood pressure, respiratory rate, sedation score, and morphine consumption were studied.Results: All the enrolled patients were able to complete the study; therefore, data from 50 patients were analyzed. The VAS scores at rest and during movement at 1, 4, 8, 12, 16, 20, and 24 h after the operation were significantly lower in the gabapentin group than in the placebo group (P<0.05). Morphine consumption was significantly lessr in the gabapentin group than in the placebo group (P<0.05). Sedation scores were similar in the 2 groups at all measured times. There were no differences in adverse effects between the groups.Conclusions: A single oral dose of 1200mg gabapentin resulted in a substantial reduction in postoperative morphine consumption and pain scores after surgical debridement in burn patients.

Background: Soccer is a contact sport in which the players are frequently faced with the risk of injury. It has been shown that the force exerted on the head during heading can be as much as 500–1200 Newton (N).Objectives: The main objective of this study was to determine whether there was any relationship between the force exerted on the head and several biomechanical and anthropometrical parameters related to heading free kicks.Patients and Methods: A total of 16 semi-professional soccer players with at least 5 years experience participated in this study. The mean age, height, and weight of the study participants were 21.36 ±5.67, 178 ±5.99 cm, and 70.55 ±8.55 kg, respectively. To measure the force exerted on the heads of the players, a pressure gauge was installed on their foreheads.Each participant was asked to defend the ball using the heading technique three times. A camera with a sampling frequency of 150 frames per second was used to record the moment of impact between the ball and head during each heading event. For each participant and replicate, the ball and head velocity (m/s) as well as the angular body changes (degrees) were calculated using MATLAB and AutoCAD soft wares, respectively.Descriptive statistics, including means and standard deviations were used to describe the data. Pearson correlation coefficient (alpha=0.05) was used to examine potential relationships between the variables of interest.Results: Significant correlations existed between the force exerted on the head during heading, participant age, body mass, body fat percentage, and head perimeter (P<0.05).Conclusions: The study revealed the significance of anthropometric variables related to heading, such as age and head perimeter. Therefore, it was concluded that these variables should be considered when teaching and practicing the heading technique with players of different ages and anthropometric sizes.