While trauma registries provide the mechanisms to collect comprehensive, timely and accurate data related to the injuries and evaluate trauma care systems, they have not been established in most developing countries. On the other hand, in complex projects that have large aims, a logical framework approach (LFA) can help summarize and describe the multiple branches of the project systematically, and elucidate the main goals, extensive objectives, activities and expected outcomes. Therefore a LFA can be used to design and guide trauma registry project management, to integrate the cultural, clinical and capacity variations among countries; and to ensure early alignment of the project's design and evaluation.
Clinical Coding ; Humans ; Registries ; Wounds and Injuries

OBJECTIVEWe evaluated a new hypothesis of acetaminophen therapy to reduce the necessity of imaging in patients with probable traumatic cervical spine injury.

METHODSPatients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen (15 mg/kg) intravenously after cervical spine immobilization. Then, all the patients underwent plain radiography and computerized tomography of the cervical spine. The outcome measure was the presence of traumatic cervical spine injury. Sixty minutes after acetaminophen infusion, posterior midline cervical tenderness was reassessed.

RESULTSOf 1 309 patients, 41 had traumatic cervical spine injuries based on imaging. Sixty minutes after infusion, posterior midline cervical tenderness was eliminated in 1 041 patients, none of whom had abnormal imaging.

CONCLUSIONPatients with cervical spine trauma do not need imaging if posterior midline cervical tenderness is eliminated after acetaminophen infusion. This analgesia could be considered as a diagnostic and therapeutic intervention.

Acetaminophen ; administration & dosage ; Adolescent ; Adult ; Analgesics, Non-Narcotic ; administration & dosage ; Female ; Humans ; Iran ; Longitudinal Studies ; Male ; Middle Aged ; Neck Injuries ; diagnostic imaging ; drug therapy ; Prospective Studies ; Radiography ; Spinal Injuries ; diagnostic imaging ; drug therapy ; Unnecessary Procedures ; Wounds, Nonpenetrating ; diagnostic imaging ; drug therapy

OBJECTIVEInjuries are common and important problem in Tehran, capital of Iran. Although therapeutic centers are not essentially established following the constructional principles of developed countries, the present opportunities and equipments have to be used properly. We should recognize and reduce the deficits based on the global standards. This study deliberates the trauma resources and capacities in university hospitals of Tehran based on Arizona trauma center standards, which are suitable for the assessment of trauma centers.

METHODSForty-one university hospitals in Tehran were evaluated for their conformity with "Arizona trauma center standards" in 2008. A structured interview was arranged with the "Educational Supervisor" of all hospitals regarding their institutional organization, departments, clinical capabilities, clinical qualifications, facilities and resources, rehabilitation services, performance improvement, continuing education, prevention, research and additional requirements for pediatric trauma patients. Relative frequencies and percentages were calculated and Student's t test was used to compare the mean values.

RESULTSForty-one hospitals had the average of 77.7 (50.7%) standards from 153 Arizona trauma center standards and these standards were present in 97.5 out of 153 (63.7%) in 17 general hospitals. Based on the subgroups of the standards, 64.8% items of hospital resources and capabilities were considered as a subgroup with the maximum criteria, and 17.7% items of research section as another subgroup with the minimum standards.

CONCLUSIONSOn the basis of our findings, no hospital meet all the Arizona trauma center standards completely. The hospitals as trauma centers at different levels must be promoted to manage trauma patients desirably.

Arizona ; Hospitals, University ; standards ; Humans ; Iran ; Trauma Centers ; standards

OBJECTIVETo investigate the effects of mild head injury (HI) on the victims'intelligence by measuring their intelligence quotient (IQ).

METHODSThis cohort study was performed in Khatam-ol-Anbia Hospital, Zahedan, Iran and the IQs of 30 mild HI patients were measured right after the injury (IQ0) and six months later (IQ6). The IQs of 90 close relatives of the patients were also measured at the same period of time as the non-exposure group. The IQs were measured with Wechsler adult intelligence scale-revised (WAIS-R). The IQ0, IQ6 and their differences (IQ change) were compared in HI patients and their relatives using the Student's t test.

RESULTSThe mean IQ0 of the HI patients was similar to their relatives. The IQ6 of HI patients appeared to be less than those of their relatives. Moreover, the IQ6 of the HI patients appeared to be less than their initial scores. HI was associated with more decrease in IQ6 compared with IQ0 and the female subjects showed more decrease in IQ6 compared with their IQ0.

CONCLUSIONHI seems to be associated with decrease in IQ six months after the injury and it is more evident in female HI patients.

Adult ; Cohort Studies ; Craniocerebral Trauma ; psychology ; Female ; Humans ; Intelligence ; Iran ; Male

OBJECTIVETo examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA) cardiac arrest and predicting the resuscitation outcomes.

METHODSIn this prospective interventional study, patients presenting with PEA cardiac arrest were randomized into two groups. In Group A, ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity, right ventricle dilation, left ventricle function, pericardial effusion/tamponade and IVC size along with the advanced cardiac life support (ACLS) protocol. Patients in Group B solely underwent ACLS protocol without applying echocardiography. The presence or absence of mechanical ventricular activity (MVA) and evidences of PEA reversible causes were recorded. The return of spontaneous circulation (ROSC) and death were evaluated in both groups.

RESULTSOne hundred patients with the mean age of (58+/-6.1) years were enrolled in this study. Fifty patients (Group A) had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR). Among them, 7 patients (14%) had pericardial effusion, 11 (22%) had hypovolemia, and 39 (78%) were revealed the presence of MVA. In the pseudo PEA subgroup (presence of MVA), 43% had ROSC (positive predictive value) and in the true PEA subgroup with cardiac standstill (absence of MVA), there was no recorded ROSC (negative predictive value). Among patients in Group B, no reversible etiology was detected. There was no significant difference in resuscitation results between Groups A and B observed (P equal to 0.52).

CONCLUSIONBedside echocardiography can identify some reversible causes of PEA. However, there are no significant changes in survival outcome between the echo group and those with traditional CPR.

Cardiopulmonary Resuscitation ; Echocardiography ; Heart Arrest ; Humans ; Prospective Studies

OBJECTIVEInjury is a major cause of morbidity and mortality in the world. The assessment of patterns and severity of injury in high-risk groups is crucial for planning and service development. On a large scale national household survey, we estimated the annual incidence and the patterns of injury, the demographics of the injured people, as well as the service use for all injuries in Iran. The current study aims at assessing the reliability of the questionnaire before carrying out a national survey.

METHODSIn a pilot study using cluster random sampling approach, 73 people were interviewed. The interviewers asked the participants to report all injuries occurred in them and the care provided during the previous 12 months, based on "Short Form Injury Questionnaire 7" About two weeks later, the interview was repeated by another interviewer.

RESULTSIn our test-retest reliability, Kappa score was good for three and moderate for four questions. The question on the injured organ had the highest test-retest reliability with a Kappa score of 0.84.

CONCLUSIONSThe reliability of the questionnaire and the procedure of questioning are confirmed. The ques-tionnire is proper for utilization in large national surveies.

Humans ; Incidence ; Iran ; epidemiology ; Pilot Projects ; Reproducibility of Results ; Surveys and Questionnaires

PURPOSETraumatic brain injury (TBI) is a leading cause of death and disability. Intracranial hemorrhage (ICH) secondary to TBI is associated with a high risk of coagulopathy which leads to increasing risk of hemorrhage growth and higher mortality rate. Therefore, antifibrinolytic agents such as tranexamic acid (TA) might reduce traumatic ICH. The aim of the present study was to investigate the extent of ICH growth after TA administration in TBI patients.

METHODSThis single-blind randomized controlled trial was conducted on patients with traumatic ICH (with less than 30 ml) referring to the emergency department of Vali-Asr Hospital, Arak, Iran in 2014. Patients, based on the inclusion and exclusion criteria, were divided into intervention and control groups (40 patients each). All patients received a conservative treatment for ICH, as well as either intravenous TA or placebo. The extent of ICH growth as the primary outcome was measured by brain CT scan after 48 h.

RESULTSAlthough brain CT scan showed a significant increase in hemorrhage volume in both groups after 48 h, it was significantly less in the TA group than in the control group (p = 0.04). The mean total hemorrhage expansion was (1.7 ± 9.7) ml and (4.3 ± 12.9) ml in TA and placebo groups, respectively (p < 0.001).

CONCLUSIONIt has been established that TA, as an effective hospital-based treatment for acute TBI, could reduce ICH growth. Larger studies are needed to compare the effectiveness of different doses.

Adult ; Antifibrinolytic Agents ; therapeutic use ; Brain Injuries, Traumatic ; diagnostic imaging ; drug therapy ; Cerebral Hemorrhage, Traumatic ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Single-Blind Method ; Tomography, X-Ray Computed ; Tranexamic Acid ; therapeutic use

PURPOSE: Traumatic brain injury (TBI) is one of the major public health concerns worldwide. Developing a TBI registry could facilitate characterizing TBI, monitoring the quality of care, and quantifying the burden of TBI by collecting comparable and standardized epidemiological and clinical data. However, a national standard tool for data collection of the TBI registry has not been developed in Iran yet. This study aimed to develop a national minimum data set (MDS) for a hospital-based registry of patients suffering from TBI in Iran. METHODS: The MDS was designed in 2 phases, including a literature review and a Delphi study with content validation by an expert panel. After the literature review, a comprehensive list of administrative and clinical items was obtained. Through a two-round e-Delphi approach conducted by invited experts with clinical and research experience in the field of TBI, the final data elements were selected. RESULTS: A MDS of TBI was assigned to 2 parts: administrative part with 5 categories including 52 data elements, and clinical part with 9 categories including 130 data elements. CONCLUSION For the first time in Iran, we developed a MDS specified for TBI consisting of 182 data elements. The MDS would facilitate implementing a TBI's national level registry and providing essential, comparable and standardized information.
Brain Injuries, Traumatic/epidemiology* ; Data Collection ; Hospitals ; Humans ; Iran/epidemiology* ; Registries

PURPOSE: The median time from the event leading to the spinal cord injury (SCI) to the time of decompressive surgery is estimated to be 6.9 days in Iran, which is much longer than the proposed ideal time (less than 24 h) in published guidelines. The current qualitative study aimed to determine the reasons for the observed decompression surgery delay in Iran from the perspective of neurosurgeons. METHODS: This qualitative study is designed to perform content analysis on the gathered data from face-to-face semi-structured interviews with 12 Iranian neurosurgeons. RESULTS: The findings of the current study suggest that patient-related factors constitute more than half of the codes extracted from the interviews. Overall, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the main factors causing delayed spinal cord decompression in Iranian patients from the perspective of neurosurgeons. Other notable factors include delay in transferring patients to the trauma center, delay in availability of necessary equipment, and scarce medical personnel. CONCLUSION In the perspective of neurosurgeons, the type of injury, presence of polytrauma, and surgeons' wrong attitude are the leading reasons for delayed decompressive surgery of individuals with SCI in Iran.
Decompression ; Humans ; Iran ; Neurosurgeons ; Spinal Cord Injuries/surgery*

The National Spinal Cord Injury Registry of Iran (NSCIR-IR) is a not-for-profit, hospital-based, and prospective observational registry that appraises the quality of care, long-term outcomes and the personal and psychological burden of traumatic spinal cord injury in Iran. Benchmarking validity in every registry includes rigorous attention to data quality. Data quality assurance is essential for any registry to make sure that correct patients are being enrolled and that the data being collected are valid. We reviewed strengths and weaknesses of the NSCIR-IR while considering the methodological guidelines and recommendations for efficient and rational governance of patient registries. In summary, the steering committee, funded and maintained by the Ministry of Health and Medical Education of Iran, the international collaborations, continued staff training, suitable data quality, and the ethical approval are considered to be the strengths of the registry, while limited human and financial resources, poor interoperability with other health systems, and time-consuming processes are among its main weaknesses.