Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 26 3 2021 06 01 Quality of Coding for Trauma Using ICD10 130 134 131161 10.30491/tm.2021.243773.1157 EN Reza Rabiei Associate Professor at Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Farkhondeh Asadi Associate Professor at Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hassan Emami Assistant Professor at Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Maryam Ahmadi Hosseini M.Sc. in Health Information Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Journal Article 2020 08 13 Background: The quality of coding for diagnoses and external causes of trauma to a great extend contributes to trauma classification, monitoring, and prevention. Objectives: The present study aimed to assess the trauma coding quality using ICD10. Methods: In this descriptive applied study, 591 records of trauma patients in educational hospitals affiliated to the Shahid Beheshti University of Medical Sciences (SBUM) were selected to assess coding quality based on ICD10 in 2018. Data were collected using a checklist and analyzed using IBM SPSS Statistics 20.0. Results: The mean accuracy, completeness, and quality of trauma coding were 64.5%, 70%, and 67.5%, respectively. Conclusion: High-quality coding of trauma diagnosis creates a more reliable databank which can be used for planning and policy-making aiming to prevent and reduce traumatic events. The accuracy and completeness of medical diagnoses should be regularly and periodically reviewed to ensure the quality of the codes.

https://www.traumamon.com/article_131161_fc9897e575171d36d59d2c5483e737fb.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 26 3 2021 06 01 Deltoid Ligament Reconstruction in Lateral Malleolus Fractures with Deltoid Rupture 135 140 131164 10.30491/tm.2021.246367.1169 EN Kamran Asadi Orthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Mohsen Mardani-Kivi M.D, Associate professor, Ghaem Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran 0000-0002-9437-5756 Orod Gharibi Orthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran Journal Article 2020 09 02 Background: Treatment of lateral malleolus fractures is a controversial issue, especially when is associated with deltoid ligament (DL) rupture Objectives: In the present study, the effect of DL repair in patients with lateral malleolar fractures with deltoid rupture was investigated on medial clear space (MCS), ankle-hindfoot score (AHS), and malreduction rates. Methods: 65 patients who referred with lateral malleolus fracture plus DL rupture during 2017-2018 and underwent surgery were studied. The diagnosis was conducted by a single renowned orthopedic surgeon according to physical examination, clinical, and paraclinical findings such as radiography. A questionnaire was used to record demographic information, pain severity, duration of follow-up, AO classification, pre- and postoperative MCS, AHS, and malreduction and data of the patients with and without DL reconstruction were compared using SPSS software (version 21). Results: About half of the patients (51%) were men. DL was reconstructed in 50.8% of the patients. AO category of the most (53.8%) of the patients was class-B. There was no difference between the patients with and without DL reconstruction in the frequency of fibular malreduction, mean pain severity, and AHS (P>0.05). Mean MCS was neither different between the groups before (P=0.946), nor after surgery (P=0.794). Mean change in MCS score was -2.03±0.95 and -1.94±0.95 in the groups with and without DL reconstruction, respectively (P=0.606). Conclusion: This study showed that DL reconstruction did not affect the medial clearance space. Further studies are required on stability and biomechanics to determine which injuries need surgery and which ones need conservative treatment.

https://www.traumamon.com/article_131164_2367747e6c517988a17bdf152520182c.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 26 3 2021 06 01 Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury: Single-Center Experience in a Developing Country 141 147 131730 10.30491/tm.2021.276341.1256 EN Nabil A. Al-Zoubi Department of Surgery, Vascular, Jordan University of Science and Technology, Irbid, Jordan Tagleb S. Mazahreh Department of Surgery, Vascular, Jordan University of Science and Technology, Irbid, Jordan Qusai Aljarrah Department of Surgery, Vascular, Jordan University of Science and Technology, Irbid, Jordan Nawaf J. Shatnawi Department of Surgery, Vascular, Jordan University of Science and Technology, Irbid, Jordan Shadi Hamouri Department of Surgery, Vascular, Jordan University of Science and Technology, Irbid, Jordan Emad M. Hijazi Department of Surgery, Cardiac Surgery, Jordan University of Science and Technology, Irbid, Jordan Nizar R. Alwaqfi Department of Surgery, Cardiac Surgery, Jordan University of Science and Technology, Irbid, Jordan Mamoon H. Al-Omari Department of Radiology, Jordan University of Science and Technology, Irbid, Jordan Mowafaq Heis Department of Radiology, Jordan University of Science and Technology, Irbid, Jordan Journal Article 2021 03 05 Background: Blunt thoracic aortic injury (BTAI) is a lethal condition. The most common intervention is no longer open aortic repair (OAR), it has been almost entirely replaced by thoracic aortic endovascular repair (TEVAR). Objectives: In the present study, we aimed to share our experience in emergency TEVAR and address some difficulties that have been encountered. Methods: In this retrospective study, all patients with blunt chest trauma between July 2014 and April 2020 were identified. Only patients with BTAI who were treated by emergency TEVAR were included. Demographic and clinical data were collected and analyzed. Results:A total of 657 cases of blunt chest trauma were identified. Only 7 cases were found to have BTAI who underwent emergency TEVAR; six patients (85.7%) were males, with a mean age (±SD) of 29.5±8.5 years and one as a 39-year-old female. Motor vehicle accident (MVA) was the mechanism of injury (100%). Two patients (27.6%) had grade-II, 4 patients (57.1%) had grade-III, and 1 patient (14.2%) had grade IV aortic injuries. Technical success was achieved in all cases (100%). No peri-procedural-related mortality and morbidity. No graft-related complications or re-interventions during the average follow-up of 23.3±8.6 months. Conclusions: Despite our lack of experience in OAR for BTAI, TEVAR has provided us with an alternative treatment option for this life-threatening condition. Considering the challenges that may be encountered in developing countries, our results were similar to what has been reported in the literature.

https://www.traumamon.com/article_131730_d70d3e2a056b0814ec6675cacc48bab8.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 26 3 2021 06 01 Surgical approach for management of Pertrochanteric fractures of proximal femur or hip in patients with COVID-19 148 151 131162 10.30491/tm.2021.257665.1202 EN Reza Zandi Associate professor of Department of Orthopedics, Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran 0000-0002-0095-6745 Mohammadreza Minator Sajjadi Associate professor of Department of Orthopedics, Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran Mohammad Kazem Emami Meibodi Associated Professor of Trauma Research Center and Orthopedic Department, Baqiyatallah Medical University, Tehran, Iran 0000-0003-3795-5428 Mohammad Nazari Nasab Resident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0003-2137-4733 Seyed Amirali Matini Resident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-3943-4039 Shahab Sarlak Resident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0001-6378-8032 Journal Article 2020 11 21 Background: Since the onset of the COVID-19 pandemic, adverse outcomes in patients with orthopaedic surgery have become a major concern for surgeons. In other words, the question remains whether surgery should be postponed until the patient is fully recovered or whether early surgery should be performed. Objectives: The present study sought to answer the above questions by examining the consequences of pertrochanteric fractures of the proximal femur or hip surgery in CVOID-19 patients and comparing the findings with non-COVID-19 patients. Methods: The present study reports the experience of orthopaedic surgeons on patients with pertrochanteric fractures of the proximal femur or hip candidates for surgery admitted between May and July 2020, who were divided into two groups of patients with COVID-19 (n=12) and non- COVID-19 patients (n=24). The outcomes of the surgery were determined based on the duration of surgery, time interval between surgery to complete recovery, and duration of hospitalization in the intensive care unit (ICU). Results: Comparing the postoperative outcomes across the two groups with and without COVID-19 showed no significant difference in mean time required for the patient to recover after surgery (p=0.160) or mean operation time (p=0.648). However, the length of ICU stay in those who were infected with SARS-CoV-2 was significantly longer than that observed in the non-COVID-19 group (p = 0.018) due to the need for more care and not because of postoperative complications. Conclusion: Surgical approach on fractures in patients with COVID-19 can be performed with high confidence and safety, and therefore, such surgeries should not be delayed in these patients.

https://www.traumamon.com/article_131162_bdb50e9cceca46b46083dbfd8c96618a.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 26 3 2021 06 01 Asymptomatic COVID-19 infection in multiple trauma patients: incidence and implications 152 156 131163 10.30491/tm.2021.247870.1172 EN Seyyed Saeed Khabiri Department of Orthopedic Surgery, Kermanshah University of Medical Sciences, Kermanshah, Iran 0000-0002-8906-7660 Farhad Naleini Clinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran Ronak Miladi Clinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran Mina Sadat Mosavat Clinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran Maryam Khoshbakht Radiology Department, Kermanshah University of Medical Science, Kermanshah, Iran Shokoofeh Maleki Clinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran Maryam Ghadimi Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD Soroush Baghdadi Joint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Tehran, Iran 0000-0002-3401-2355 Journal Article 2020 09 12 Background: Some studies show a chest CT scan to be superior to reverse transcription-polymerase chain reaction (RT-PCR) studies for diagnosis of COVID-19. Objectives: This study was designed to assess the prevalence of COVID-19-related lung involvement in patients admitted to our trauma center. Methods: In this retrospective study, data from a referral trauma center were reviewed from February 21, 2020, to April 10, 2020. All patients admitted to the hospital for whom a chest CT scan was performed for any reason during the study period were included. Trained physicians screened all CT scans for findings suggestive of COVID-19. Next, blinded radiologists selected CT scans with findings highly suggestive of COVID-19 involvement. The clinical course and outcome and the results of PCR for SARS-CoV-2 were recorded and assessed. Results: A total of 4200 chest CT scans were reviewed. After multiple rounds of exclusion, 24 patients with highly- suggestive findings were reviewed. Only three patients developed COVID-19 symptoms during the course of admission. PCR results were positive in 22 patients (92.6%). Conclusion: We recommend chest CT scans in trauma patients at a high risk of COVID-19 infection, as well as those requiring extensive surgical interventions. Also, a thorough review of the available CT scans before invasive procedures, preferably with the help of an expert radiologist, is highly recommended, even when the results of the COVID-19 laboratory tests are negative.

https://www.traumamon.com/article_131163_cbe2f712cdca1b69cf6b100cb7668f4e.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 26 3 2021 06 01 Air ambulance base development for responding to traffic accidents in Iran 157 166 131259 10.30491/tm.2021.279823.1273 EN Zahra Eskandari Department of Health in Emergencies and Disaster, Department of Health in Emergencies and Disasters, school of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-5425-1986 Zohreh Ghomian Department of Health in Emergencies and disasters, school of Public Health and safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran and Workplace Health Promotion Research Center (WHPRC), Shahid Beheshti University Ahmad Alibabaei Industrial Engineering-Information Technology,Assistant Professor, Shahid Beheshti University of Medical Sciences, Tehran, Iran and Visiting Assistant Professor, University of British Columbia Centre of Health Services and Policy Research (CHSPR), Hojjat Ahmadinejad National center for strategic Research in medical education, Ministry of Health and Medical Education, Tehran, Iran Sanaz Sohrabizadeh Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-9170-178X Journal Article 2021 04 06 Background: Road Traffic accidents are one of the most common accidents killing 1.35 million people annually around the globe. Approximately 86% of deaths occur from trauma before hospitalization. In such circumstances as a pre-hospital service, air ambulance can play an important role in accessing the patients and transferring them from the accident scene securing survival of patients. Objective: This study aimed to identify the affecting factors in-air ambulance response to traffic accident sites. Methods: This qualitative study conducted from November 6, 2019 to April 6, 2020, in which a semi-structured interview was carried out on 17 participants. To analyze the data of this qualitative study, the Graneheim and Lundman method was used, and a conventional content analysis approach was employed. Results: The majority 41% were in the age range of 30-40 years. Individuals with a master's or doctoral degree made up 70% of the participants. People with 11-20 years of work experience made up 52% and 58% of the participants were at the managerial level. Factors influencing the development of air ambulance bases in 6 main categories, included resources and infrastructure, training of specialized personnel, indicators and standards, information and communication, safety and security, and management factors were studied. Conclusion: Based on the findings, infrastructure improvement and allocation of resources as well as training specialized forces can play an important role in developing air ambulance bases in Iran, Further research is needed to develop a measurement tool to evaluate the affecting factors before establishing air ambulance bases in Iran.

https://www.traumamon.com/article_131259_d6458bdb72e5a8e4429391d8084d3e4a.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 26 3 2021 06 01 Optimizing care strategies for patients with trauma emergencies: a qualitative study 167 177 129584 10.30491/tm.2021.254097.1190 EN Zahra Jamshidi Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran 0000-0002-2582-9128 Kian Nourozi Tabrizi Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran 0000-0001-7439-6691 Masoud Fallahi-Khoshknab Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran 0000-0003-0507-0107 Asghar Dalvandi Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran 0000-0001-8762-7591 Fatemeh Vizeshfar Department of Nursing, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of medical sciences, Shiraz- Iran 0000-0003-1261-7318 Hamidreza Khankeh Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden 0000-0002-9532-5646 Journal Article 2020 10 23 Background: Optimizing care processes, especially in the emergency trauma departments, is considered an important issue in health care systems. Moreover, exploring strategies with the participation of stakeholders can significantly affect patient outcomes. Objectives: This study was conducted to identify, prioritize and optimize care strategies for trauma and emergency patients in Shiraz, in 2019. Methods: Data using semi-structured interviews, Focus Group Discussions, and executive meetings with managers were collected, and the prioritization matrix was used to optimize strategies. Sampling was done purposefully until data saturation. The collected data were analyzed using qualitative inductive content analysis. Results: 26 necessary corrective and preventive strategies were mentioned. After analyzing the data, various strategies such as rectifying managerial issues of the emergency system, specialized trauma nursing care, enhancing trauma emergency response preparedness, and adoption of a team approach were proposed. Conclusion: The exploration of care strategies using employee participation provides to facilitate the development of care processes, especially in complex spaces such as trauma emergency wards. Therefore, the healthcare authorities such as nurse managers should pay special attention to these strategies. Moreover, nurses should provide more effective care in the trauma emergency departments based on the appropriate and applicable strategies.

https://www.traumamon.com/article_129584_68e249c3723fb43d54724dbf2018af91.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 26 3 2021 06 01 Late Hoffa fracture of the lateral femoral condyle in an ACL reconstructed knee 178 184 131531 10.30491/tm.2021.272622.1241 EN Sujayendra Murali Assistant Professor, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India 0000-0001-6404-7906 Sandesh Madi Assistant Professor, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India Arvind Umarani Junior Resident, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India Vivek Pandey Associate Professor, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India Journal Article 2021 02 09 A 33-year-old male sustained Hoffa fracture of the lateral femoral condyle 10 months after arthroscopic reconstruction of the anterior cruciate ligament in the same knee. The ligament had been reconstructed with autologous, quadrupled hamstring graft and was anchored in the femoral tunnel with a cortical suspensory device. As the fracture line did not involve the femoral tunnel, the ACL graft was spared, and the fracture was managed by open reduction and internal fixation. Fracture union was achieved by 6 months and the patient recovered uneventfully. At the 5- year follow-up, the patient had a stable pain-free knee. This case report highlights the possibility of late lateral femoral condyle Hoffa fracture treatment via arthroscopic ACL reconstruction without extra-articular tenodesis and despite taking adequate intra-operative precautions during tunnel drilling and using a cortical suspensory device for anchoring the graft on the femoral side.

https://www.traumamon.com/article_131531_42ad2cfd604f71ab19a4d863700e4e3d.pdf