Archives of Trauma Research
Year:2014 | Volume:3 | Issue:1|Papers Count:10

Dear Editor: I read with interest the article entitled Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study and was impressed by the scientific rigor and level of detailed observation. This is especially admirable in a study performed at the front line of burn surgery. Gabapentin appears to have a role to play in the reduction of pain and opiate usage during major burns surgery. It is worth, however, bringing the readers' attention to another key role for the drug in burn which is not mentioned in the discussion. Gabapentin also has an important role in the management of burn-induced itch.

Development of the science has paved a very slow and sometimes fluctuating way during the human life. Medicine with its complicated cultural, religious, and social aspects is not an exception to this rule. Most of our knowledge about the diseases and their impact on human is our understandings and explanations on the base of nowadays science. There is no specific and definite record about them by our ancestors before three thousand years ago and very vague as well as confusing data up to about two hundred years ago. On the base of the archeological findings, we suppose that disease process has a background history of about seventy-two million years. This estimation is based on the bony deformities and healed fractures found in fossils of a dinosaur called Gorgosaurus. Paleopathologic evaluation of the animal directed to the possibility of a cerebellar tumor which supposedly had resulted in its instability and repeated fallings and fractures. This process continues with the findings of many trapanized human skulls from different ages with evidence of healing (1); optimistically, it is supposed that they are therapeutic interventions.

Background: Roux-en-Y gastric bypass surgery (RYGBP) is one of the most common bariatric surgeries, which is being performed using various techniques like gastrojejunostomy by hand swen, linear or circular stapler. Abdominal pain is a common complaint following laparoscopic gastric bypass procedure (LGBP), which has different aetiologies, such as overeating, adhesion, internal herniation, bile reflux and many more. In this study LGBP was performed in an ante-colic ante-gastric pattern in a double loop manner and the prevalence and distribution of pain in morbidly obese patients undergoing LGBP was assessed. Objectives: The aim of this study was to analyze the distribution and frequency of post LGBP pain in morbidly obese patients.Patients and Methods: This study was performed on 190 morbidly obese patients referred to Hazrat Rasoul Hospital in Tehran. After LGBP, pain was measured in the following intervals: 24 hours, one week and one month after the operation. Before the operation onset, 2 mg Keflin and 5000 IU subcutaneous heparin were administered as prophylaxis. LGBP was performed using five ports including: one 11 mm port was placed 15-20 cm far from the xiphoid, one 12-mm port in mid-clavicular line at the level of camera port, one 5-mm port in subcostal area in ante-axillary region in the left, another 5-mm port in the right mid-clavicular area and a 5-mm port in sub-xyphoid. All operations were done by the same team. Staple was used for all anastomoses and hand sewn technique to close the staple insertion site. The mesenteric defect was left open and no effort was made to repair it.Results: The results of this study showed that 99.94% of the patients had complains of pain in the first 24 hours of post operation, about 60% after one week and 29.5% still had pain after one month. In addition, left upper quadrant (LUQ) was found to be the most prevalent site for the pain in 53.7% of the patients in the first 24 hours, 59.6% after one week and 16.8% after one month (except for obscure pain) with a significance of<0.05. Conclusions: In this study, the authors analyzed the location and disturbance level of pain after LGBP, which could serve as a cornerstone for further researches. The authors suggest that long-term follow-up (for more than a year after operation) should be considered in future studies and also the relationship between the drainage site and pain should be investigated.

Background: Variables derived from electroencephalogram like cerebral state index (CSI) have been used to monitor the anesthesia depth during general anesthesia. Observed evidences show such variables have also been used as a detector of brain death or outcome predictor in traumatic brain-injured (TBI) patients.Objectives: The current study was designed to determine the correlation between Glasgow coma score (GCS) and CSI among TBI patients.Patients and Methods: In 60 brain-injured patients who did not need and receive sedatives, GCS and CSI were daily measured during the first ten days of their hospital stay. Correlation between GCS and CSI was studied using the Pearson's correlation test. The Gamma agreement coefficient was also calculated between the two variables for the first day of hospitalization.Results: A significant correlation coefficient of 0.611-0.796 was observed between CSI and GCS in a ten-day period of the study (P<0.001). Gamma agreement coefficient was 0.79 (P<0.001) for CSI and GCS for the first day of hospitalization. An increased daily correlation was observed in both CSI and GCS values. However, this increase was less significant in CSI compared with the GCS.Conclusions: A statistically significant correlation and agreement was found between GCS and CSI in the brain-injured patients and GCS was also found to be more consistent and reliable compared with CSI.

Background: Acute low back pain is a common cause for presentation to the emergency department (ED). Since benign etiologies account for 95% of cases, red flags are used to identify sinister causes that require prompt management.Objectives: We assessed the effectiveness of red flag signs used in the ED to identify spinal cord and cauda equine compression.Patients and Methods: It was a retrospective cohort study of 206 patients with acute back pain admitted from the ED. The presence or absence of the red flag symptoms was assessed against evidence of spinal cord or cauda equina compression on magnetic resonance imaging (MRI).Results: Overall, 32 (15.5%) patients had compression on MRI. Profound lower limb neurologic examination did not demonstrate a statistically significant association with this finding. The likelihood ratio (LR) for bowel and bladder dysfunction (sensitivity of 0.65 and specificity of 0.73) was 2.45. Saddle sensory disturbance (sensitivity of 0.27 and specificity of 0.87) had a LR of 2.11. When both symptoms were taken together (sensitivity of 0.27 and specificity of 0.92), they gave a LR of 3.46.Conclusions: The predictive value of the two statistically significant red flags only marginally raises the clinical suspicion of spinal cord or cauda equina compression. Effective risk stratification of patients presenting to the ED with acute back pain is crucial; however, this study did not support the use of these red flags in their current form.

Dear Editor: Regarding the article: Application of queuing theory to decrease waiting times in emergency department: Does it make sense? published in Archives of Trauma Research (1), I would like to make some comments. Although results of the study by Alavi-Moghaddam et al. using queuing theory are particularly interesting to analyze the impact of a new strategy to reduce waiting times before implementing it, all the proposals offered an increase of resources or staff: adding one or more senior emergency residents on each shift, adding one more bed to intensive care unit, adding another clerk to take electrocardiograms in ED, and expanding the laboratory staff and specialist consultants by 50%. It has been argued that adding resources is not simply sufficient to fix the flow problems in ED (2).

Background: Traumatic dental injury (TDI) in children and adolescents has become one of the most serious dental public health problems. Despite such a high prevalence of dental trauma, very less attention has been paid to TDI, its etiology, and prevention.Objectives: To determine the prevalence of anterior tooth traumatic dental injuries in 12-15-year-old school children of Panchkula district, India, and to find any correlation with the cause, gender, extent of overbite as well as over-jet, and previous treatment.Patients and Methods: A multistage sample of 12-15-year-old school children (n=810) in Panchkula district, Haryana, was selected. The children were screened using WHO criteria for oral examination and a trained dental surgeon examined the children. Those with clinical TDI were examined further for the type of traumatic injuries using Elis classification modified by Holland. Overjet and overbite were recorded. After examination, questions regarding the cause of trauma and its treatment were asked. Data were subjected to statistical analysis using the Chi square and Mantel-Haenszel tests by SPSS version 20.0.Results: The results showed that out of 810 children, 86 (10.2 %) had TDI. Males had higher prevalence of trauma than females (P<0.05). The common cause of trauma was fall (51.11%) followed by sports injuries (41.86%). Enamel-dentin fracture without pulpal involvement was the most common type of trauma and the most frequent involved teeth were maxillary central incisors. A significant association was observed between overjet and overbite and trauma. Only 3.5% of the children affected with trauma had received treatment.Conclusions: The prevalence of traumatic injuries to permanent incisors in 12-15-year-old Panchkula school children was relatively high. TDI was associated with gender, overjet, and lip competence. There was a great unmet treatment need.

Background: The Iran-Iraq imposed war lasted eight years and was one of the longest wars of the last century. Twenty-three years have passed since the war ended, but little has been discussed about the long-term results of war amputations in the literature.Objectives: In this long-term study, we have evaluated the activities of daily living among veterans with hip or hemipelvis amputations.Patients and Methods: A cross-sectional study was performed on Iran-Iraq war veterans with hip or hemipelvis amputations in Iran. Eighty-four (96.5%) veterans out of 87 registered veterans with hip or hemipelvis amputations participated in the study. The degree of independence for activities of daily living (ADL) was assessed by the Barthel index. The degree of independence for instrumental activities of daily living (IADL) was assessed by the Lawton-Brody scale.Results: The average follow-up time was 26.6±3.7 years. The average age of veterans was 44.1±7 years old. Of 84 amputees, 57 (67.85%) had limitations in at least one domain of the ADL. The most common single item that affected the patients was ascending and descending stairs seen in 45 (78.9%) veterans, followed by eating seen in 4 (7.01%) veterans. In addition, 70 (83.33%) had limitations in at least one domain of the IADL. The most common single item that affected the veterans was shopping seen in 56 (80%), followed by responsibility for own medications seen in 13 (18.57%) veterans. Spearman correlation coefficient of the sum scores of ADL and IADL showed an intermediate to strong correlation (r=0.58).Conclusions: Increasing dependency in ADL is accompanied by increasing dependency in IADL. In the past, the duty of health care providers was saving the life of veterans due to injuries while at present, because these injuries occurred in young and healthy individuals, the need for increased function is being highlighted.

Introduction: A traumatic arteriovenous fistula (AVF) after repetitive blunt trauma has not been described previously. In a 34-year-old male, the first reported case of such an injury after repetitive blunt trauma is described. Case Presentation: A 34-year-old gentleman presented with a non-healing ulcer near his medial malleolus. A bone scan was performed and then treated for presumed osteomyelitis. An arteriogram confirmed an AVF, and coil embolization was performed with complete occlusion of the AVF. Subsequently, the ulcer healed rapidly with no complication. Along with the cause of AVF, this case is notable for symptom presentation. Conclusions: Arteriovenous fistula after blunt trauma can present as a non-healing venous stasis ulcer, which could be treated noninvasively.

Background: Estimating pain in patients of intensive care unit (ICU) is essential, but because of their special situation, verbal scales cannot be used. Therefore, to estimate the level of pain, behavioral pain scale was developed by Payen in 2001.Objectives: The aim of this study was to investigate the validity and reliability of behavioral pain scale in patients with low level of consciousness due to head trauma hospitalized in ICU.Patients and Methods: This descriptive prospective study was performed in Yazd in 2013. In this study, fifty patients, including thirteen women and thirty seven men, were involved. To collect the data a questionnaire including demographic and Glasgow coma scale (GCS) information as well as a list of behavioral pain scale (BPS) were used. SPSS software (version 18) was used to analyze the data.Results: There was no significant difference in reliability proving of average score of BPS recorded by two day and night assessors (P>5). Cronbach's alpha was 85 for painful procedures and 76 for non-painful procedures. In addition, known groups’ technique (painful and non-painful procedures) was used to assess validity. The average scores were 7.75 during painful procedures and 3.28 during non-painful procedures (P=0.001). The results stated that BPS scores during these two procedures were significantly different.Conclusions: BPS in patients with low level of consciousness due to head trauma has strong reliability and validity. Therefore, this scale can be used for patients hospitalized in ICU to assess the level of pain.