Official Publication of the National Center for Trauma ResearchTrauma Monthly2251-746430320250601The Association Between Hounsfield Bladder Urine in Non-Contrast CT Scan and Positive Urine Culture for Identification of Urinary Tract Infection1441144721684410.30491/tm.2025.501070.1805ENSeyyed HasanLangariDepartment of Radiology, School of medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranPoonehDehghanDepartment of Radiology, School of medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranFarzaneh SadatJafariDepartment of Radiology, School of medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran0009-0003-7088-2088AlirezaAbrishamiDepartment of Radiology, School of Medicine, Labbafinezhad Hospital, Shahid Beheshti University of Medical Science, Tehran, IranSaraBesharatDepartment of Radiology, School of Medicine, Labbafinezhad Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.Journal Article20250121<strong>Introduction: </strong>This study aims to examine Hounsfield bladder urine in a non-contrast CT scan with positive urinary culture to diagnose urinary tract infections in patients referred to Ayatollah Taleghani and Labbafinezhad Hospital in Tehran.
<strong>Method: </strong>The present research is a cross-sectional study to specify the correlation of urine bladder urine in non-contrast CT scans with positive urinary culture to diagnose urinary tract infection in patients referred to Ayatollah Taleghani and Labbafinezhad Hospital in Tehran in 2022. Patients who were hospitalized with complaints of urinary symptoms and acute abdominal pain, according to laboratory criteria, were diagnosed with a urinary tract infection and underwent a CT scan of the abdomen without injection, were included in the study. The required information in the field of Hounsfield number determination was obtained through radiological studies. Part of the necessary information was obtained from patients' files and from radiological studies.
<strong>Result: </strong>One hundred nine patients participated in this research; 52 (47.7%) were women. The mean age of the patients was 55.82 ± 17.60 years. Fifty-three people (48.6%) had positive urine culture. The average attenuation value in cases with positive culture was -7.37±5.66, and in cases with negative culture was 8.22±5.00 (P=0.0001). According to ROC curve analysis, the attenuation value's calculated cutoff point for predicting the urine culture's positivity was -3. Therefore, for predicting the positivity of urine culture, the sensitivity rate of the attenuation value was about 82.1%, and the specificity was 81.1% (AUC: 0.91, P-value<0.0001). Forty-three patients with an attenuation value less than negative 3 had positive Urine culture (P=0.0001). The neutrophil average was 73.50±16.38 in patients with attenuation value ≤− 3 and 68.25±12.58 in patients with attenuation value >−3 (P=0.010). Also, the relationship between the distribution of attenuation value with a negative cutoff value of 3 and the distribution of positive and negative cultures of patients was significant (P=0.0001). Also, the relationship between the distribution of attenuation value with a negative cutoff value of 3 and the distribution of leukocyte esterase in the patients was significant (P=0.002).
<strong>Conclusion: </strong>The measurement of attenuation in the specific bladder area can be a valuable tool in diagnosing urinary tract infections with high accuracy without incurring extra costs. Additional investigations are required to verify the outcomes.https://www.traumamon.com/article_216844_4bad2e5d97d98d0776f8c0812a355a1d.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746430320250601Comparison of Two Fluid Therapy Methods with and Without Lasix in Crash Injured Patients with Lung Contusion: A Randomized Clinical Trial1448145522569810.30491/tm.2025.430552.1670ENMehdiAhmadinejadAssociate Professor Associate Professor of Critical Care Medicine Department of Anesthesiology, School of Medicine Shahid Bahonar Hospital Kerman University of Medical0000-0002-3837-752XShahradTajoddiniAssistant Professor of Clinical Toxicology Department of Emergency Medicine, School of Medicine Afzalipour Hospital, Shahid Bahonar Hospital Kerman0000-0003-3932-9850MahdiehTaheriDepartment of Emergency Medicine, School of Medicine, Afzalipour Hospital, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran0000-0002-4762-1619YunesJahaniProfessor of Biostatistics, Department of Epidemiology and Biostatistics, School of Public Health, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran0000-0002-6808-7101EnayatollahNooriGeneral Practitioner, Qom University of Medical Sciences, Qom, Iran0000-0002-4457-129XJournal Article20231214<strong>Introduction: </strong>There are various approaches to fluid therapy for patients with lung contusions, and managing fluid levels can be crucial to the recovery of these patients. This study was conducted from January to June 2022 to determine the effectiveness of two methods of fluid therapy with and without Lasix in patients with crash injury accompanied by lung contusion.
<strong>Methods:</strong><strong> </strong>This clinical trial, conducted at Bahonar Hospital, Kerman, randomly divided patients with crush injury into two groups: recipients of normal saline and recipients of crystalloid plus Lasix. Clinical parameters, including blood pressure, respiratory function, and biochemical markers, were monitored at baseline and every 3 hours for a period of 96 hours.
<strong>Results:</strong><strong> </strong>The Lasix group showed a significantly reduced need for intubation (22.2% vs 43.8%, p = 0.02) and shorter NIV duration (p = 0.008) compared to the control group. Intra-abdominal pressure and PF ratio demonstrated favorable trends in the intervention group (p<0.01). Significant improvements in CPK, phosphorus, and potassium levels were observed with diuretic therapy (p<0.05).
<strong>Conclusion:</strong><strong> </strong>The addition of Lasix to standard fluid therapy improved respiratory outcomes and metabolic parameters in patients with crush injuries and pulmonary contusions. This combined approach warrants further investigation in larger clinical trials.https://www.traumamon.com/article_225698_ae6067467720537dbd13b42abb70f16a.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746430320250601Designing a Predictive Tool for Pressure Ulcer Occurrence in Bedridden Patients in Intensive Care Units: A Protocol for a Multi-Method Study1456146622571010.30491/tm.2025.448383.1707ENImanJafari-IraqiStudent Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran0000-0002-4108-8366AmirVahedian-AzimiNursing Care Research Center, Clinical Sciences institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran0000-0002-1678-7608SalmanBarastehNursing Care Research Center, Clinical Sciences institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran0000-0003-2042-599XMasoudSirati NirBehavioral Sciences research center, Nursing faculty, Baqiyatallah university of medical sciences, Tehran, Iran0000-0001-8319-3220Journal Article20240313<strong>Introduction: </strong>Early identification of pressure ulcers (PUs) is essential to provide timely therapeutic interventions and customized preventive measures for bedridden patients in the ICU. However, the current PU assessment tools lack transparency and objectivity, so developing a comprehensive and reliable tool suitable for ICU patients is necessary. The purpose of the protocol study is to demonstrate the design process of an assessment tool for predicting PUs in ICU bedridden patients using a multi-method approach<strong>.</strong><br /><strong>Methods:</strong><strong> </strong>This study will employ a sequential multi-method research design comprising three stages: a scoping review, Delphi methods, and a cross-sectional study. In the first stage, the scoping review examined ICU patients' risk factors for PUs. It will also identify potential predictors for PUs based on relevant published studies. Moving onto the second stage, a panel of experts in the field evaluated these predictors through three consecutive Delphi rounds. Their opinions will be considered, and any new factors suggested will be added to the list. The third Delphi round will aim to achieve over 75% agreement among the experts, resulting in the final version of the potential predictor list. Lastly, in the third stage, a cross-sectional study was conducted to assess the relative contribution of potential predictors to the development or worsening of PUs in ICU patients. The information and results from this study will be used to develop a pressure ulcer assessment tool for bedridden patients in ICUs.<br /><strong>Discussion:</strong><strong> </strong>This study employs a multi-method approach that combines various assessment tools, including comprehensive reviews, expert opinions, and objective clinical measurements. The resulting assessment tool will enable clinicians to predict the occurrence of PUs accurately, implement personalized preventive strategies and optimize resource allocation. Enhancing early detection and prevention of PUs can significantly improve patient well-being, reduce healthcare burdens, and achieve better long-term outcomes.https://www.traumamon.com/article_225710_02c65d9369d083917a0c1baf6fd2e307.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746430320250601Development and Implementation of a Self-Management Program Based on the Five-A Model and Its Impact on the Self-Efficacy of Caregivers for Trauma Patients with Head Injuries1467147522571510.30491/tm.2025.485853.1776ENShirinNasrolahnejhad TasoujPh.D. Candidate in Nursing, Department of Nursing, TeMS.C., Islamic Azad University, Tehran, Iran.0000-0001-9544-2239AsgharDalvandiDepartment of Nursing, TeMS.C., Islamic Azad University, Tehran, Iran.
Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran0000-0001-8762-7591JamilehMohtashamiDepartment of Nursing, TeMS.C., Islamic Azad University, Tehran, Iran
Department of Psychiatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0001-6604-9702Journal Article20241028<strong>Introduction: </strong>Patients with head injuries are considered the most challenging group of trauma victims. Head traumas are the most dangerous type of trauma and affect all economic, financial, social, and emotional aspects of the individual, family, and community. Providing continuous care creates chronic stress for the caregivers of these patients, jeopardizing their self-efficacy and quality of life. This study was conducted to develop and implement a self-management program based on the five-A model and examine its impact on the self-efficacy of caregivers for patients with head trauma.
<strong>Method:</strong> This clinical trial, of a quasi-experimental type, was conducted as a pre-test and post-test design at Shohada-ye Haftom-e Tir Hospital, affiliated with Iran University of Medical Sciences. In this research, 70 caregivers of patients with head trauma who met the inclusion criteria were selected using a convenience sampling method. Simultaneously with continuous sampling, the allocation of research units into two groups, test and control, was carried out using a four-block randomization method. The self-efficacy questionnaire was completed by both the test and control groups before the intervention and three months after the intervention. The caregivers in the test group participated in eight face-to-face 60-minute self-management training sessions. The data were analyzed using SPSS version 21, employing statistical tests including the chi-square test, Fisher's exact test, independent t-test, and paired t-test.
<strong>Results:</strong> Prior to the intervention, there was no statistically significant difference in mean self-efficacy between the test and control groups. However, after three months of self-management training based on the Five-A model, a statistically significant difference was observed between the two groups (p = 0.04). Additionally, in the test group, a statistically significant difference was observed in self-efficacy scores and their dimensions before the intervention and three months after it (p = 0.003).
<strong>Conclusion:</strong> The implementation of a self-management program based on the Five A's model can improve the self-efficacy of caregivers for patients with traumatic brain injuries. Interventions such as self-management educational programs can assist caregivers of patients, especially those with traumatic brain injuries, and enhance their self-efficacy, quality of care, and quality of life.https://www.traumamon.com/article_225715_921b88a9d5f8b3b8fb29923abde4d0e5.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746430320250601Epidemiology of Traumatic Spinal Fractures Due to Road Traffic Accidents Referred to Valiasr Hospital in Markazi Province1476148922573710.30491/tm.2025.480164.1768ENMaliheSafariAssistant Professor of Biostatistics, Department of Biostatistics, School of medicine, Arak University of Medical Sciences, Arak, IranClinical Research Development Unit of Amiralmomenin Hospital, Arak University of Medical Sciences, Arak, Iran0000-0002-8068-5921GhodratollahRoshanaeiProfessor of Biostatistics, Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran0000-0002-3547-9125AidinShakeriAssistant Professor of Neurosurgery, Department of Neurosurgery, School of Medicine, Arak University of Medical Sciences, Arak, IranAmirHamtaAssistant Professor of Biostatistics, Department of Biostatistics, School of medicine, Arak University of Medical Sciences, Arak, IranAlirezaMohammadiAssistant Professor of Neurosurgery, Department of Neurosurgery, School of Medicine, Arak University of Medical Sciences, Arak, IranAlirezaAmaniAssistant Professor of Orthopaedic surgeon, Department of Orthopedics, School of Medicine, Arak University of Medical Sciences, Arak, IranSaharBayatMs in Epidemiology, Department of Epidemiology, Faculty of Health, Arak University of Medical Sciences, Arak, IranYasamanPourandishInstructor of Medical Surgical Nursing, Department of Nursing, Arak School of Nursing, Arak University of Medical Sciences, Arak, Iran.
School of Medicine, Arak University of Medical Sciences, Arak, Iran.DorsaBeigiAssistant Professor of Neurosurgery, Department of Neurosurgery, School of Medicine Arak University of Medical Sciences, Arak, IranSaeidJafariAssistant Professor of Neurosurgery, Department of Neurosurgery, School of Medicine, Arak University of Medical Sciences, Arak, Iran0000-0002-7053-0539Journal Article20240924<strong>Introduction: </strong>Spinal fractures in some situations could be catastrophic, life-changing, and costly injuries for affected individuals, their families, and society. Road traffic accidents (RTA) are one of the leading causes of traumatic spinal Fractures. The first step in prevention is to know the epidemiological factors.<br /><strong>Objective and Methods:</strong><em> </em> The purpose of this study is to investigate the epidemiology of traumatic spine injuries due to RTA. A retrospective cohort study was conducted on 473 trauma patients hospitalized with spinal injuries due to RTA during 2022-2023 in Markazi Province. The patient's information included demographic and clinical characteristics. The effects of various factors were assessed on the level of injury, the type of vehicle involved in the accident, and the type of accident. Data analysis was done with SPSS 24 software.<br /><strong>Results:</strong> The mean (SD) Age of the patients was 40.5 (16.6) years. Of the 333 patients (70.4%), 333 were male. 290 (61.3%) patients were drivers. 74.4% of accidents were with cars. 52.9% were injured in a rollover accident. The level of injury was related to the length of hospital stay, admission to ICU, mortality, occupant position, type of accident, surgery, GCS, and AIS (p<0.05). Moreover, gender, marital status, and neck injury had a statistically significant relationship with the type of vehicle leading to the accident(p<0.05). In addition, Age, gender, marital status, education, occupational position, and back and neck injuries have a significant relationship with the type of accident.<br /><strong>Conclusion: </strong>Spine fractures due to RT are the most common cause in developing countries, which is the leading cause of people's disability. To implement adequate preventive measures, it is necessary to understand the causes and prevalence of these injuries and mitigate the factors that contribute to their occurrence.https://www.traumamon.com/article_225737_e4eb7a02b5fdd926eb60cdab1361b4fa.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746430320250601Comparison of Ketamine and Opioids during Anesthesia for Reducing Postoperative Pain in Recovery in Patients Candidate for Laparoscopic Sleeve Gastrectomy Surgery: A Double-Blind, Randomized Clinical Trial1490149822099310.30491/tm.2025.511251.1812ENAbasaliDelavariTrauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, IranYasamanRavariTrauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, IranMarziehLakTrauma Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, IranJournal Article20250308<strong>Introduction: </strong>Postoperative complications such as respiratory depression, nausea, and vomiting are particularly distressing for morbidly obese patients and pose significant challenges for anesthesiologists. This study aimed to evaluate the use of non-opioid analgesics to reduce opioid-related complications during recovery. We compared the analgesic effects of intravenous ketamine infusion and opioids in patients undergoing laparoscopic sleeve gastrectomy.
<strong>Methods:</strong><strong> </strong>In this double-blind, randomized clinical trial, 66 morbidly obese patients (BMI ≥ 40 kg/m²) without significant comorbidities, referred to Baqiyatallah Hospital for laparoscopic sleeve gastrectomy from April 2022 to April 2023, were included. Patients were randomized into two groups of 33: the ketamine group received 0.5 mg/kg intravenous ketamine before positioning, followed by 0.5 mg/kg/hour infusion, while the opioid group received 10 mg intravenous morphine sulfate before positioning, followed by remifentanil infusion (0.25 µg/kg/minute) until the end of surgery.
<strong>Results: </strong>The mean morphine consumption during recovery was 2.3 mg in the ketamine group and 2.4 mg in the opioid group (p = 0.88). The mean VAS score during recovery was 3.725 in the ketamine group and 3.984 in the opioid group (p = 0.320). Propofol consumption was significantly lower in the opioid group (603.943 mg vs. 808.333 mg, p = 0.03). All patients in the ketamine group required trinitroglycerin (TNG) infusion for hemodynamic stability, compared to none in the opioid group. Hallucinations were significantly more frequent in the ketamine group (16.7% vs. 0%, p = 0.00).
<strong>Conclusion: </strong>In laparoscopic sleeve gastrectomy, ketamine and opioids showed no significant differences in pain scores, opioid consumption, or PONV incidence during recovery. However, propofol consumption was significantly lower in the opioid group, and hallucinations were more frequent in the ketamine group. These findings suggest that while ketamine may be a viable alternative to opioids, its side effects and higher propofol requirements warrant further investigation.https://www.traumamon.com/article_220993_28740a5de75c8173db82a7f7a09aabed.pdfOfficial Publication of the National Center for Trauma ResearchTrauma Monthly2251-746430320250601Emergency Evacuation in Hospitals: A Neglected Necessity1499150121823910.30491/tm.2025.508440.1806ENAdelEftekhariAssistant Professor, Health in Emergencies and Disasters, Department of Nursing, Meybod School of Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.0000-0001-7961-2699FarzanMadadizadehAssociate Professor, Center for healthcare Data modeling, Departments of biostatistics and Epidemiology, School of public health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.0000-0002-5757-182XJournal Article20250223Crucially, emergency evacuations must occur as swiftly as possible, as the speed of transporting the injured can greatly reduce mortality rates (4). Unfortunately, despite many hospitals being built to world-class standards, compliance with safety regulations is often lacking, leaving them vulnerable to accidents. Experience shows a concerning low level of preparedness for the timely, effective, and safe evacuation of employees and patients (1, 5). In crises, while everyone aims for survival, hospital staff bear the additional responsibility of ensuring the safety of their patients. Therefore, preparing hospital personnel for disaster management—especially in patient evacuation and safety—should be a top priority for medical centers (3). The decision to evacuate a hospital stands as one of the most challenging choices for an incident commander. Once the need for evacuation is confirmed, it is essential that the incident command team activates the response phase, adhering to the risk management cycle approach. Evacuation occurs in five stages: decision, warning, movement, deployment to a safe assembly area, and return(6) (see Figure 1).https://www.traumamon.com/article_218239_9a75816b236e9a4767ae3445130923a3.pdf