Archives of Trauma Research
Year:2014 | Volume:3 | Issue:4|Papers Count:8

Background: In cities with trams as public transportation, tram tracks are often on public roads, creating a shared road situation with other road participants like cyclists. Beside the risk of direct collisions, this situation can also lead to bicycle wheels getting wedged in tram tracks, causing cyclists to fall. Objectives: The aim of this study was to gain more insight in the injury pattern of this trauma mechanism and to draw attention to the risks of the infrastructural situation with on-road tram tracks.Patients and Methods: A one-year, prospective, observational cohort study was conducted. All patients admitted after presentation to the emergency department of a level 1 trauma center, who got injured because their bicycle wheels got wedged in tram tracks, were included. Data were collected on patient demographics, type of injury and treatment.Results: Ten patients were included. Six were male. The mean age was 38 years. Six patients required surgery, mostly because of extremity injuries. Mean duration of admission was 4 days. Mean injury severity score was 13. One patient died as a result of the injuries sustained in the accident. Conclusions: Tram tracks on public roads are potentially dangerous and can lead to serious injuries and even mortality amongst cyclist. Operative intervention is frequently needed.

Background: Hospital emergency departments (EDs) are as barometers of the health care system. Crowded EDs threaten delivery of timely care. Prolonged ED wait times reduce the quality of care and increase adverse and sometimes irreversible events. Objectives: The purpose of this study was to determine the patients' waiting time at Namazi and Shahid Faghihi hospitals in Shiraz, Iran.Patients and Methods: This analytical cross-sectional study was conducted in two phases from December 2012 to May 2013. First, the researcher attended the EDs of the two hospitals and recorded the information of 900 patients who entered the ED, including arrival time, level of triage, and time of first visit by physician. Then, among patients admitted to the ED units, 273 were followed and waiting times for the first physician order in the referral unit and the commencement of clinical interventions (defined as check time by the nurse) were recorded.Results: The median waiting time from arrival to first visit by physician for the 900 patients included in the study was 8 (5-14) minutes [median (interquartile range)]. For the patients admitted to referral units, waiting time was 84 (43-145) minutes for the physician order and 85 (45-147) minutes for the commencement of first clinical intervention; 75% of the patients in triage level I, 84.6% in triage level II, and 95.6% in triage level III were visited within the target time limit. Conclusions: Waiting time for commencement of clinical action in patients admitted to the EDs was considerably high for patients with higher priorities; so, rapid care of critically ill patients, identified during the triage process, should be emphasized.

Introduction: Unilateral anterior shoulder dislocation is one of the most common problems encountered in orthopedic practice. However, simultaneous bilateral anterior dislocation of the shoulders is quite rare.Case Presentation: We report a case of a 75-year-old woman presented with simultaneous bilateral anterior shoulder dislocation following a trauma, complicated with a traction injury to the posterior cord of the brachial plexus. Conclusions: Bilateral anterior shoulder dislocation is very rare. The excessive traction force during closed reduction may lead to nerve palsy. Clear documentation of neurovascular status and adequate imaging before and after a reduction should be performed.

Traumatic chest injury is one the most important factors for total morbidity and mortality in traumatized emergency patients (1). Chest trauma is the cause of 20% to 25% of the trauma-related deaths per year in the United States and is the leading cause of death in the first four decades of life (2). Traumatic chest injuries often occur in combination with other severe injuries, such as head, brain, extremity and abdominal injuries (3). Traumatic chest trauma can occur after car and motor accident, assaults, falls and explosive blasts via a variety of different mechanisms. Overall, car and motor accidents account for 70% to 80% of all thoracic injuries (4).

Dear editor: Suspicion of scaphoid fracture is a common topic in emergency medicine. If the radiograph is inconclusive, or there are typical symptoms suggestive of a scaphoid fracture despite a negative radiograph, further investigation with cross-sectional imaging is advocated. Because of its availability, computed tomography (CT) is the primary imaging method in most departments. In recent meta-analyses, CT has a pooled sensitivity of 93% and pooled specify of 99% to diagnose the scaphoid fracture (1). There are only sparse data about the prevalence of other carpal fractures in patients undergoing imaging the scaphoid with CT after trauma and the therapeutic consequences of these fractures.

Background: Discrepancy between X-ray readings of emergency physicians (EPs) versus radiologists was reported between 0.95% and 16.8% in different studies. The discordance was even higher when specific studies such as chest X-rays (CXR) were probed.Objectives: This prospective study was conducted to assess the discrepancies between emergency and radiology departments with respect to interpretation of the traumatic chest X-rays.Patients and Methods: This prospective study was conducted in Shohadaye Tajrish Hospital, Tehran, Iran, from March to April 2014. Based on Advanced Trauma Life Support (ATLS) guidelines, plain chest radiography (CXR) was ordered for all patients in two standard views of posterior-anterior and lateral. All CXRs were interpreted by a corresponding emergency medicine specialist and a radiologist blind to the clinical findings of the patients. Finally, the results of two interpretations were compared. Accuracy, sensitivity, specificity, and predictive values of traumatic CXR interpretation were calculated by EPs with 95% of confidence interval (CI).Results: The evaluation of EPs was identical to that of the radiologists in 89.5% of the cases. Ninety-eight percent (98%) indicated total agreement and 1.5 percent total disagreement.Conclusions: There is a high agreement between EPs and radiologists in CXR interpretations in Shohadaye Tajrish Hospital. Thus, EPs can substitute radiologists in the emergency department. More improvements are recommended to achieve the standard level of agreement.

Background: School bullying, the most common type of school violence, comprises a spectrum of aggressive behaviors that involve both perpetrators and victims.Objectives: The current study aimed to investigate the extent and nature of school bullying among middle school students in the North of Iran.Patients and Methods: A cross-sectional study was conducted on a sample of 834 Iranian middle school students. Participants completed a self-report anonymous questionnaire measuring bullying and victimization (Iranian-Olweus bullying questionnaire). Descriptive statistics and the Pearson's chi-squared test and multinomial logistic regressions with area, gender and grade variables were applied.Results: Prevalence rates of bullying behaviors based on the cut-off point at 2 or 3 times a month were 5.4% for only bully, 22.1% for only victim and 11% for both bully-victim. The prevalence of each form of victimization were 24.7% verbal, 15% relational, 10.3% physical and for each form of bullies 11% verbal, 5.3% relational, 6.4% physical. Boys were more involved in all forms of bullying behaviors. The students from rural areas were more involved in bullying.The most common places of victimization were the playground or athletic fields. The majority of victims were bullied by their classmates.Conclusions: Different forms of bullying have a distinct nature and the epidemiological pattern indicates that bullying exists in the Iranian schools. Thus, the effective bullying prevention and appropriate intervention programs are recommended.

Background: Recently, investigations have indicated that caring of a chronically ill family member strongly influences the health status and the quality of life (QOL) of the caregiving family members. Objectives: The purpose of this study was to examine the relationship between health-related QOL of veterans with chronic spinal cord injury and their caregiving spouses.Patients and Methods: We designed a cross-sectional study including two groups; veterans with chronic spinal cord injury and their caregiving wives who were living in the city of Mashhad, Iran. The patients with spinal cord injury were veterans from the Iran-Iraq war (1980-1988). All the participants filled out the short form 36 (SF-36) health survey questionnaire. A Pearson correlation coefficient was calculated for the scales of the two groups.Results: The mean age and standard deviation of veterans and their spouses were 48.5±5.9 and 44.8±7.2, respectively and their number of children ranged between 0-6. Our data analysis showed that there was a significant difference between the two groups in some domains of the SF-36, including PF, MH, PCS, MCS, BP and GH (P<0.05), but there was no significant difference in RP, VT, SF and RE between the two groups. Conclusions: The results indicate that a decrease in health status level of veterans, physically and mentally, can affect the health-related QOL of their caregiving spouses.