Official Publication of the National Center for Trauma ResearchTrauma Monthly2251-746427320220601Evaluation of Vascular Injuries Caused by Trauma, Surgery and Complications45946315361910.30491/tm.2022.287199.1305ENMohammad GarshasbiAssistant Professor of vascular surgery, Shohada-ye Ashayer and Shahid Chamran Hospitals, Lorestan University of Medical Sciences, Iran.Mohammad Javad MahboubiMedical student of Lorestan University of Medical Sciences, Iran.Mohammad HassaniAssistant Professor of Vascular Surgery, Department of Vascular and Endovascular Surgery, Ayatollah Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.0000-0002-8671-5191Journal Article20210520<strong>Background: </strong>Treatment of traumatic vascular lesions requires accurate and rapid diagnosis. Improper treatment and loss of time may lead to loss of limbs, or lives due to ischemia. This study aimed to evaluate various surgical methods used to treat vascular injuries.<br /><strong>Methods: </strong> This Cross-sectional study included all trauma patients referred to Shohada-e-Ashayer hospital, Khorramabad, Iran, and Shaheed Chamran hospital, Boroujerd, Iran, with vascular injury from 2015 to 2019. Demographic characteristics, duration of surgery, complications of the vascular injury, mechanism of vascular injury, type of vascular injury, location, clinical symptoms, comorbidities, and vital signs were assessed.<br /><strong>Results</strong>: Overall, 233 patients with a mean age of 29.15 ± 11.8 years (maximum 78 years and a minimum two years) and a male to female ratio of 20: 1 were included. Six patients (25.8%) were treated via venous graft and 11 cases (4.7%) by arterial ligation. Six cases (2.6%) with minor arterial injury were treated without surgical intervention. The artery was completely were removed in 135 patients (9.57%) and partialy in 83 cases (6.35%). Arterial thrombosis were seen in 70 cases (30%), intimal flap in 14 cases (6%), vascular spasm in 4 cases (7.1%), crush injury in 4 cases (7.1%), arterial fistula in 1 patient (4.0%), and deep vein thrombosis were seen in 3 cases (1/3 %).<br /><strong>Conclusion</strong>: Vascular injury following penetrating trauma occurs more commonly in young ages. However, the rate of vascular damage was higher in the arteries than in veins. The type of surgical treatment and side effects of treating vascular injuries vary depending on the type, site, severity, and other parameters (age, gender , etc.) associated with the trauma.https://www.traumamon.com/article_153619_dd068664c4220f3c5f963a6d08ac6cff.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746427320220601Predictive Value of Base Deficit in Outcomes of FAST Positive Patients with Multiple Trauma46446915362010.30491/tm.2022.307508.1378ENMohammad MohammadArbatiDepartment of General Surgery, Ayatollah Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, IranHossein ArabAhmadiDepartment of General Surgery, Ayatollah Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, IranMohammad Hadi MolseghiDepartment of General Surgery, Ayatollah Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, IranJournal Article20211001<strong>Background: </strong>Decreased tissue perfusion is a predictor of mortality in trauma patients, and measured by serum lactic acid, which isn’t possible at all centers. The reduction of Base Deficiency (BD) in trauma patients is mainly due to lactic acidosis. We sought to assess the predictive value of base deficit in outcomes of FAST positive patients with multiple trauma.<br /><strong>Methods: </strong> In this study, 88 trauma patients were referred to the emergency department with acute abdomen reqiuring surgery. Free intra-abdominal fluid on fast ultrasound, abdominal injury on CT scan, and candidates for either surgery or non-operative management, and their data were statistically analyzed.<br /><strong>Results</strong>: Out of 88 participants, eight patients (9.1%) died, and 24 of them (27.3%) required surgical intervention. Mortality rate and hospitalization days increased with increasing BD (P = 0.001), but the increase in mortality rate and BD increase did not show a significant relationship. The best BD cut-off point for predicting the need for surgery in patients was BD> 4.45 (sensitivity 79.2% and specificity 65.6%).<br /><strong>Conclusion</strong>: BD predicts the need for surgery and the length of hospital stay. Because a low number of deaths in our study, we suggeste that further studies be done with a larger statistical populations.https://www.traumamon.com/article_153620_699e3761019b1e9c49ee468dc3e98677.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746427320220601Procedural Pain Management of Trauma Patients in Intensive Care Units47047815363110.30491/tm.2022.310937.1387ENSorour MoslehMaster Science in Preoperative Care, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan university of Medical Sciences, Isfahan, Iran0000-0001-9269-3673Ghasem ZareiPhD student in physiology, Department of physiology, Isfahan University of Medical Sciences, Isfahan, Iran0000-0002-9828-267XMohammad Sadegh AboutalebiMaster Science in Critical Care Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran0000-0002-6301-4755Journal Article20211018<strong>Background: </strong>Pain management in diagnostic and therapeutic procedures and their complications is critical. The study aimed to assess the incidence and procedures type of pain control in patients admitted to Intensive Care Units (ICU).<br /><strong>Methods:</strong> This observational study was conducted on 400 trauma patients in ICU. The tool used in this study had three sections: In the first part, demographic variables, information related to trauma, and the type of painful procedures performed on the patient, were recorded. The second part was the measurement of the pain severity with the Critical-Care Pain Observation Tool (CPOT). The third part recorded the time of the pain assessment, methods of controlling pain in local anesthesia, and the pharmacological and non-pharmacological interventions.<br /><strong>Results:</strong> There were male (78.2%), with a mean age of 33.1 years. The most common procedure was tracheal suctioning (38.8%). The patients showed mild pain intensity according to CPOT before the processes. Also, according to the Friedman test results, they experienced a significant increase in pain intensity during the procedure for all procedures. A total of 160 patients received pain-relief interventions, of which 157 cases received pharmacy and three received non-pharmacological interventions. Patients who treated their pain with the interventions experienced additional pain according to the CPOT criteria immediately after the procedure.<br /><strong>Conclusion:</strong> Health services must be more active in pain management strategies for assessment of the pain intensity by proper tools to manage procedural pain appropriately.https://www.traumamon.com/article_153631_6d86c633c8540a4c6e6d4db1aa97a964.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746427320220601NT pro BNP: A Factor to Predict the Outcome of Head Trauma Patients47948415363310.30491/tm.2022.215817.1059ENSeyed Mohsen Hosseini ShiraziRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran.Zahra ParsianRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran.Haniyeh Ebrahimi BakhtavarRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran.Farzad RahmaniRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran.0000-0001-5582-9156Journal Article20200114<strong>Background:</strong> Surveying serum markers can be valuable in predicting the outcome of patients with head trauma. The current study examined the diagnostic value of the serum level of Brain Natriuretic Peptide (BNP) to determine the hospital outcome of patients with head trauma.<br /><strong>Methods: </strong> This descriptive-analytical study was conducted on 40 patients with pure head trauma who had indications for brain CT scans and required hospitalization from July 2017 to May 2019 at Trauma Medical-Educational Center. The variables were age, gender, initial consciousness level based on Glasgow Coma Score (GCS), trauma mechanism, the time-lapse between trauma and admission to hospital, mortality, Glasgow Outcome Scale (GOS) during discharge, GOS at one and six months after discharge, initial serum level of NT-pro BNP (N Terminal-pro BNP), and results of brain CT scan.<br /><strong>Results:</strong> Concerning the reports of brain CT scans, from 40 patients, 26 patients had normal brain CT scans, and 14 patients had abnormal brain CT scans. Mean ± SD value of NT-pro BNP for normal group was 407.7 ± 190.25 pg/ml and for abnormal group was 631.43 ± 219.25 pg/ml (p = 0.009). Only five patients with abnormal CT scans died during the study. In predicting mortality of patients, the initial serum level of NT-pro BNP was 693 pg/ml with 80%sensitivity and 74% specificity.<br /><strong>Conclusion:</strong> assessing of the serum values of NT-pro BNP can help predict the mortality rate of patients with head trauma. Higher values of NT-pro BNP during hospitalization is a good indicator of a low survival rate in patients.https://www.traumamon.com/article_153633_b1e9b130eebd5780caaf235014df9804.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746427320220601Penetrating Heart Injuries in Hospitals with Few Facilities: Not A Moment to Waste48549115363410.30491/tm.2022.313969.1398ENOktay AslanerAsistant Professor, Alanya Alaaddin Keykubat University, Antalya, Turkey.0000-0002-2952-6677Journal Article20211107<strong>Background: </strong>Penetrating heart injury is a genuine emergency that needs to be diagnosed and treated as soon as possible. Transport to a tertiary center with facilities such as a heart-lung pump and sternotomy can lead to loss of time. This study aimed to share the author's experiences in a private hospital with limited facilities.
<strong>Methods:</strong><strong> </strong> A retrospective study was conducted at a private hospital. Eleven penetrating cardiac injuries, which were treated surgically by the at two small hospitals from 2005 to 2015, were evaluated retrospectively. Patients' age and sex, type of injury, damage site at the heart, duration between injury and surgery, presence of additional damage, and patient survival were all recorded.
<strong>Results:</strong> The most common form of injury was sharp object injury, while the most common site was the right ventricle. The period from injury to surgery, the additional injuries were found to be statistically significant in terms of survival ratios. The probability of patients' survival at intervention times 30, 60, and 120 minutes was 90.9, 54.5, and 27.3%, respectively.
<strong>Conclusion:</strong> Mortality in cardiac injuries can be reduced with early intervention. The risks of being transported to an advanced hospital and the risk of emergency surgery performed in a small less equips facility should be well weighed. Successful surgeries may be performed even in a small, well-organized hospital.https://www.traumamon.com/article_153634_2e34b9d8a80916f72a8143f7a930c674.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746427320220601Comparison of Medical Students and Paramedics Using Simple Triage and Rapid Treatment and Sacco Triage Method in Mass Casualty Incident: A Simulated Cohort Study49249715364410.30491/tm.2022.320288.1415ENAbdorreza MohamadiM. D., Surgery and Trauma Research Center, AJA University of Medical Sciences, Tehran, IranSeyed Zia Hejripour RafsanjaniAssistant Professor of Emergency Medicine, Surgery and Trauma Research Center, AJA University of Medical Sciences, Tehran, IranSalman DehkhodaAssociate professor of General Surgery, Surgery and Trauma Research Center , AJA University of Medical Sciences, Tehran, IranReza MosaedAssistant Professor of clinical pharmacy, Faculty of medicine, AJA university of medical sciencesAmir Hosein PishgooieAssociate professor Nursing Faculty, AJA University of Medical Sciences, Tehran0000-0001-8042-2657Ali Omrani NavaAssistant Professor of Emergency Medicine, Surgery and Trauma Research Center, AJA University of Medical Sciences, Tehran, IranMohammad EftekhariSchool of Medicine, AJA University of Medical Sciences, Tehran, IranJournal Article20211217<strong>Background: </strong>In a Mass Casualty Incident (MCI), when medical resources are overwhelmed by the number and severity of casualties, victims’ triage plays a crucial role in disaster management. This study aimed to assess the difference between two triage methods, Simple Triage and Rapid Treatment (START) and the Sacco Triage Method (STM), in an MCI scenario and determine which way leads to a more accurate and quicker triage.
<strong>Methods:</strong><strong> </strong> This simulated cohort study was conducted in the Department of emergency medicine at AJA university of medical sciences, Tehran, Iran, from April 2021 until January 2022. In this simulated prospective cohort study, observers were selected among 2nd-year medical students and newly graduated paramedics and presented with an imaginary disaster scenario. Half of the medical students and paramedics used the START method, and the other half prioritized patients with STM. The triage accuracy, time to triage, and time to evacuation in the two methods were recorded and analyzed.
<strong>Results:</strong> One-hundred-fifty observers were divided into four groups. All of them were male, and their mean age was 20.37±1.22 years. The overall accuracy for STM was 89.52% which showed a better and statistically significant performance than the START method (p<0.001). The mean time to triage for each patient in START and STM was 14.29+-2.95 and 16.84+-3.33 seconds, respectively. The mean time to evacuation for each triage method was 4.76+-.98 minutes for START and 5.61+-1.11 minutes for STM. In both STM and START groups, medical students performed better in triage than paramedics (p<0.001 for START and p=0.025 for STM). Medical students were also significantly faster than paramedics in the time to triage and evacuation categories in the STM group (p<0.001).
<strong>Conclusion:</strong> In conclusion, 2nd-year medical students and newly graduated paramedics performed a more accurate and quicker triage with STM than the START method.https://www.traumamon.com/article_153644_81f5b0bc0ce41440956bb7ed81d6a5fb.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746427320220601Titanium Elastic Nailing System, An Effective Way of Pediatric Forearm Fracture Management49850315364710.30491/tm.2021.303355.1368ENShamim Ahmad BhatAssistant professor, Dept of Orthopedics, SHKM GMC Nalhar Nuh, Haryana, India.Surendra KumarSenior Resident, Dept of Orthopedics, SHKM GMC Nalhar Nuh, Haryana, India.0000-0002-2653-7370Lalit PathakJunior Consultant, Dept of Orthopedics, SHKM GMC Nalhar Nuh, Haryana, India.Ashish UpadhyayJunior Resident, Dept of Orthopedics, SHKM GMC Nalhar Nuh, Haryana, India.Siddharth Goelprofessor and Head, Dept of Orthopedics, SHKM GMC Nalhar Nuh, Haryana, India.Ritika GirdharSenior Resident, Dept of Psychiatry, SHKM GMC Nalhar Nuh, Haryana, India.Journal Article20210912<strong>Background: </strong>Pediatric forearm fractures are commonly encountered in an orthopedic emergency. Treatment varies widely from simple sling and cast to operative fixation with nailing and plating, with no definitive consensus on treatment modality. This study aimed to evaluate the functional outcome of pediatric forearm fractures managed by the titanium elastic nailing system and measure the difficulty.<br /><strong>Methods: </strong> The study was conducted at the department of orthopedics, SHKM Govt medical college Nuh, India, which included 30 patients, 18 males and 12 females from 6 to 15 years (with a mean age of ten years). Twenty patients had middle third fractures, six proximal 1/3rd, and three distal 1/3rd fractures. The transverse fractures were seen in 17, oblique fractures in six, communicated in four, and spiral fractures in three patients.<br /><strong>Results</strong>: Overall, 30 patients were included in this study, 18 were Male children, and 12 were females. The Right-sided Forearm was involved in 18 patients (60%), and the Left-sided in 12 patients (40%). Closed bone fractures were noted in 24 patients (80%), open Grade I in 4 patients, and Grade II in 2 patients. The Mean hospital stay was three days, ranging from 2-5 days. The Fracture site showed radiographic healing at six weeks in five patients, at nine weeks in 24 patients, and 12 weeks in all patients. The functional outcome was excellent in 28 patients and good in two patients. No patient showed poor function at the final follow-up (one year). The complications were eight patients with skin irritation at the nail insertion site, two cases who developed signs of infection like erythema and serous discharge, and two patients with ulnar nail back out.<br /><strong>Conclusion</strong>: TENS (Titanium Elastic Nailing System) allows micromotion at the fracture site due to the elasticity of the nails elastic deformation within the medullary canal creates a bending moment within the long bone that is not rigid but, that is stable enough to reduce and fix the fracture and favors callous formation and bone healing. The treatment of pediatric bone fractures with TENS continues to be the unparallel success and reliable treatment method with a predictable outcome and minimal complications. We recommend this type of treatment in angulated and unstable forearm fractures in children.https://www.traumamon.com/article_153647_35fd9d0d6a3fdfe8dc6e4649089f20a9.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746427320220601Dual Mobility Cups Hip Arthroplasty as A Treatment for Displaced Fracture of the Femoral Neck in the Elderly Patients: A Prospective Study50451213598410.30491/tm.2021.271571.1234ENDharmesh PatelAmandeep Hospital, Model Town, G.T. Road, Amritsar, Punjab, Indiadharmeshortho2019Avtar SinghAmandeep Hospital, Model Town, G.T. Road, Amritsar, Punjab, IndiaRajeev VohraAmandeep Hospital, Model Town, G.T. Road, Amritsar, Punjab, India00000000000000000000Sandeep ChauhanAmandeep Hospital, Model Town, G.T. Road, Amritsar, Punjab, IndiaJournal Article20210202<strong>Background: </strong>Arthroplasty is a treatment for displaced fractures of the femoral neck in the elderly. The type of arthroplasty remains controversial as total hip replacements potentially have a higher dislocation rate. The study aimed to evaluate dual mobility cups to manage fractures of the femoral neck with the posterior approach in the elderly.<br /><strong>Methods: </strong> This prospective study was conducted in Amritsar (Punjab), India. All patients with displaced fractures of the femoral neck treated via arthroplasty were operated on with the insertion of a dual mobility cup with the posterior approach. All patients were followed by clinical and radiological assessment at immediate post-op, 3 and 6 months, 1 and 3 years after surgery.<br /><strong>Results</strong>: Overall in the 240 patients, arthroplasty on the right hip of 121 (50.4%) and the left hip of 119 (49.6%) cases were performed. Majority of patients was male, and all patients were followed. The mean Harris hip score improved from 16.62 ± 6.34 preoperatively to 92.86 ± 2.28 at one-year follow-up and 95.20 ± 1.82 at three years’ follow-up. Three dislocations occurred, and Open Reduction was performed through a posterior approach under regional anesthesia for two patients. Closed Reduction was performed on one patient, and there was no recurrence of dislocation.<br /><strong>Conclusion</strong>: The low dislocation rate after acute total hip replacement using dual mobility design cups is comparable with hemi arthroplasties. The dual mobility cups may be considered a valuable option to prevent postoperative dislocation when treating displaced intra-capsular fractures of the proximal femur in elderly patients. A dual mobility cup reduces the incidence of postoperative instability even after using the posterior approach.https://www.traumamon.com/article_135984_3e739b03760966706fa911e32c928570.pdf