Official Publication of the National Center for Trauma ResearchTrauma Monthly2251-746426320210601Quality of Coding for Trauma Using ICD1013013413116110.30491/tm.2021.243773.1157ENReza RabieiAssociate Professor at Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranFarkhondeh AsadiAssociate Professor at Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranHassan EmamiAssistant Professor at Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranMaryam Ahmadi HosseiniM.Sc. in Health Information Technology, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IranJournal Article20200813<strong>Background:</strong> The quality of coding for diagnoses and external causes of trauma to a great extend contributes to trauma classification, monitoring, and prevention.<br /> <strong>Objectives:</strong> The present study aimed to assess the trauma coding quality using ICD10.<br /> <strong>Methods:</strong> 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.<br /> <strong>Results:</strong> The mean accuracy, completeness, and quality of trauma coding were 64.5%, 70%, and 67.5%, respectively.<br /> <strong>Conclusion:</strong> 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_13a2b1bbdbf44175c11aa7f1274e2670.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746426320210601Deltoid Ligament Reconstruction in Lateral Malleolus Fractures with Deltoid Rupture13514013116410.30491/tm.2021.246367.1169ENKamran AsadiOrthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IranMohsen Mardani-KiviM.D, Associate professor, Ghaem Clinical Research Development Unit, Guilan University of Medical Sciences, Rasht, Iran0000-0002-9437-5756Orod GharibiOrthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IranJournal Article20200902<strong>Background:</strong> Treatment of lateral malleolus fractures is a controversial issue, especially when is associated with deltoid ligament (DL) rupture<br /> <strong>Objectives:</strong> 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.<br /> <strong>Methods:</strong> 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).<br /> <strong>Results:</strong> 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).<br /> <strong>Conclusion:</strong> 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_07946555aaa5e04b724ddf40924d34ed.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746426320210601Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury: Single-Center Experience in a Developing Country14114713173010.30491/tm.2021.276341.1256ENNabil A.Al-ZoubiDepartment of Surgery, Vascular, Jordan University of Science and Technology, Irbid, Jordanorcid.org/0000-0002-2328-9383Tagleb S.MazahrehDepartment of Surgery, Vascular, Jordan University of Science and Technology, Irbid, JordanQusai AljarrahDepartment of Surgery, Vascular, Jordan University of Science and Technology, Irbid, JordanNawaf J.ShatnawiDepartment of Surgery, Vascular, Jordan University of Science and Technology, Irbid, JordanShadi HamouriDepartment of Surgery, Vascular, Jordan University of Science and Technology, Irbid, JordanEmad M.HijaziDepartment of Surgery, Cardiac Surgery, Jordan University of Science and Technology, Irbid, JordanNizar R.AlwaqfiDepartment of Surgery, Cardiac Surgery, Jordan University of Science and Technology, Irbid, JordanMamoon H.Al-OmariDepartment of Radiology, Jordan University of Science and Technology, Irbid, JordanMowafaq HeisDepartment of Radiology, Jordan University of Science and Technology, Irbid, JordanJournal Article20210305<strong>Background:</strong> 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).<br /> <strong>Objectives:</strong> In the present study, we aimed to share our experience in emergency TEVAR and address some difficulties that have been encountered.<br /> <strong>Methods: </strong>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.<br /> <strong>Results:</strong>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.<br /> <strong>Conclusions:</strong> 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_f51e32ffb624104910e66f13a704cb8e.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746426320210601Surgical approach for management of Pertrochanteric fractures of proximal femur or hip in patients with COVID-1914815113116210.30491/tm.2021.257665.1202ENReza ZandiAssociate professor of Department of Orthopedics, Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran0000-0002-0095-6745Mohammadreza Minator SajjadiAssociate professor of Department of Orthopedics, Taleghani Hospital Research Development committee, Medical school, Shahid Beheshti University of medical sciences, Tehran, Iran0000 0003 2081 7619Mohammad Kazem Emami MeibodiAssociated Professor of Trauma Research Center and Orthopedic Department, Baqiyatallah Medical University, Tehran, Iran0000-0003-3795-5428Mohammad Nazari NasabResident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0003-2137-4733Seyed Amirali MatiniResident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0002-3943-4039Shahab SarlakResident of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0001-6378-8032Journal Article20201121<strong>Background:</strong> 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.<br /> <strong>Objectives:</strong> 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.<br /> <strong>Methods:</strong> 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).<br /> <strong>Results:</strong> 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.<br /> <strong>Conclusion:</strong> 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_9032e32a1b9ac55d3de15ab369073fd4.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746426320210601Asymptomatic COVID-19 infection in multiple trauma patients: incidence and implications15215613116310.30491/tm.2021.247870.1172ENSeyyed Saeed KhabiriDepartment of Orthopedic Surgery, Kermanshah University of Medical Sciences, Kermanshah, Iran0000-0002-8906-7660Farhad NaleiniClinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, IranRonak MiladiClinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, IranMina Sadat MosavatClinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, IranMaryam KhoshbakhtRadiology Department, Kermanshah University of Medical Science, Kermanshah, IranShokoofeh MalekiClinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, IranMaryam GhadimiRussell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MDSoroush BaghdadiJoint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Tehran, Iran0000-0002-3401-2355Journal Article20200912<strong><span>Background:</span></strong> Some studies show a chest CT scan to be superior to reverse transcription-polymerase chain reaction (RT-PCR) studies for diagnosis of COVID-19.<br /> <strong><span>Objectives:</span></strong> This study was designed to assess the prevalence of COVID-19-related lung involvement in patients admitted to our trauma center.<br /> <strong><span>Methods:</span></strong> 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.<br /> <strong><span>Results:</span></strong> 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%).<br /> <strong><span>Conclusion:</span></strong> 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_8e6c68d5203b2f8c5024df526992b588.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746426320210601Air ambulance base development for responding to traffic accidents in Iran15716613125910.30491/tm.2021.279823.1273ENZahra EskandariDepartment 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, Iran0000-0002-5425-1986Zohreh GhomianDepartment 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 UniversityAhmad AlibabaeiIndustrial 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 AhmadinejadNational center for strategic Research in medical education, Ministry of Health and Medical Education, Tehran, IranSanaz SohrabizadehDepartment of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0002-9170-178XJournal Article20210406<strong>Background:</strong> 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.<br /> <strong>Objective:</strong> This study aimed to identify the affecting factors in<strong>-</strong>air ambulance response to traffic accident sites.<br /> <strong>Methods:</strong> 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.<br /> <strong>Results:</strong> 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.<br /> 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.<br /> <strong>Conclusion:</strong> 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_4fa8e28b3492080fc6aee81aa211e9b0.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746426320210601Optimizing care strategies for patients with trauma emergencies: a qualitative study16717712958410.30491/tm.2021.254097.1190ENZahra JamshidiDepartment of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran0000-0002-2582-9128Kian Nourozi TabriziDepartment of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran0000-0001-7439-6691Masoud Fallahi-KhoshknabDepartment of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran0000-0003-0507-0107Asghar DalvandiDepartment of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran0000-0001-8762-7591Fatemeh VizeshfarDepartment of Nursing, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of medical sciences, Shiraz- Iran0000-0003-1261-7318Hamidreza KhankehHealth in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden0000-0002-9532-5646Journal Article20201023<strong>Background:</strong> 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.<br /> <strong>Objectives: </strong>This study was conducted to identify, prioritize and optimize care strategies for trauma and emergency patients in Shiraz, in 2019.<br /> <strong>Methods: </strong>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.<br /> <strong>Results:</strong> 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.<br /> <strong>Conclusion:</strong> 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_f840db942fa3712954cbaf9c4bf0c502.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746426320210601Late Hoffa fracture of the lateral femoral condyle in an ACL reconstructed knee17818413153110.30491/tm.2021.272622.1241ENSujayendra MuraliAssistant Professor, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India0000-0001-6404-7906Sandesh MadiAssistant Professor, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, IndiaArvind UmaraniJunior Resident, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, IndiaVivek PandeyAssociate Professor, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, IndiaJournal Article20210209A 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.<br /> 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_346e2c15d1b3da72440698ec84ad5937.pdf