OBJECTIVETo illustrate mechanisms of spine fractures and the pattern of spinal injuries characterized by the major mechanisms in urban population of Iran.

METHODSData regarding spinal injuries including demographics, mechanism and level of spinal injury, abbreviated injury score, associated injuries and final fate of the patients were extracted from the Iranian national trauma registry database from 1999 to 2004.

RESULTSA total of 619 patients with traumatic spine fractures were identified, of whom 68.5% were males. The peak frequency of these injuries occurred in the 21-40 year age-group. Accidental falls and road traffic crashes (RTCs) were the most common mechanisms of spinal fractures (47.2% and 44.1%, respectively). RTCs tended to occur in younger patients compared with accidental falls. The most common spinal region for spinal fracture was the lumbar spine (53.63%). Cervical spine fractures were significantly more common in RTCs, while lumbar spine fractures were more common in accidental falls (P less than 0.001). A total of 171 (27.6%) patients had associated non-spinal injuries, of whom 127 had associated extremity injuries, and 55 had head injuries. Thirty-six (5.6%) patients had spinal cord injury (SCI).The injury severity score of the RTC group was significantly higher than that of accidental falls (P equal to 0.002). Fifteen (4%) patients died of traumatic injuries. The rate of death was significantly higher in RTCs compared with accidental falls (5.1% vs 2.1%, P equal to 0.039).

CONCLUSIONSThe patterns of spinal fractures are similar to those reported from developed countries. RTCs tend to affect the younger age population and are associated with a higher degree of associated injuries and mortality than accidental falls. Therefore preventive strategies should be based on reduction of the number and severity of RTCs.

Accidental Falls ; Accidents, Traffic ; Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Spinal Fractures ; etiology

PURPOSETrauma is an inevitable part of the health burden in every country. Both the preventive and rehabilitative aspects of traumatic injuries are expensive. Since most of the injuries happen in low- and middle-income developing countries, a judicious allocation of the limited resources to the most costefficient strategies is necessary. The present study was designed to report the causes of trauma, injured body regions, trauma severity scores and the one year survival rate of a randomly selected sample of trauma patients in a major referral hospital in Tehran, Iran.

METHODSWe chose and analyzed a random subgroup of traumatic patients admitted during the oneyear period of May 2012 to May 2013 to Shariati Hospital, a major University Teaching Hospital in Tehran, Iran. Patients who stayed at the hospital for less than 24 h were excluded. In total, 73 traumatic patients were registered. The mean age was (40.19 ± 20.34) years and 67.1% of them were male.

RESULTSIn general, the most common cause of injury was falls (47.9%), followed by road traffic crashes (RTCs, 40.8%). Assault and exposure to inanimate mechanical forces each were only associated with 5.6% of all injuries. The only cause of injury in ages of more than 65 years was fall. The most common cause of injury in ages between 15 and 45 years was RTCs. During the study, two deaths occurred: one was at ICU and the other was at home. The most commonly injured body region was the head (23.8%), followed by the elbow and forearm (19%), hip and thigh (15.9%), and multiple body regions (14.3%). The mean abbreviated injury score was 2.23 ± 1.02; injury severity index was 7.26 ± 7.06; and revised trauma score was 7.84, calculated for 38 patients.

CONCLUSIONPrevention strategy of traumatic injury should focus on falls and RTCs, which are respectively the most common cause of trauma in older aged people and young males.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Iran ; epidemiology ; Male ; Middle Aged ; Prospective Studies ; Time Factors ; Wounds and Injuries ; epidemiology ; mortality

OBJECTIVETo analyze the data of patients with spinal cord injury (SCI) induced by road traffic crashes in southeastern Iran for better understanding the pattern of these injuries and therefore for better designing health system planning.

METHODSIn this historical cohort study, the patients who had been transferred to Level I trauma center in southeastern Iran due to road traffic accidents with radiographic documented SCI were evaluated.

RESULTSAmong 64 patients with SCI, 38 patients (59.4%, 36 males and 2 females, aged 27.42 years+/-9.44 years on average) were injured by road traffic accidents. Car and motorcycle accidents were responsible for 26 cases (68.4%) and 12 cases (31.6%), respectively. And 31 patients (81.6%) had complete SCI. Conus medularis (T12-L2) was the most affected level.

CONCLUSIONSResults are discussed in terms of preventive measures, specifically those concerning the use of restraint and helmet and driving behavior. This study should be extended nationally to gain a larger case series so that the SCI risk of particular vehicle configurations, considering other crash factors, can be more precisely quantified and the characteristics for low occurrence of SCI can be more precisely identified.

Accidents, Traffic ; statistics & numerical data ; Adolescent ; Adult ; Equipment Design ; Head Protective Devices ; Humans ; Iran ; epidemiology ; Middle Aged ; Seat Belts ; Spinal Cord Injuries ; epidemiology ; prevention & control ; surgery

OBJECTIVETrauma is one of the leading causes of mortality and morbidity in adults and a major contributor to health care expenditures. Although spine-related injuries constitute a small proportion of trauma cases, they need special consideration due to poor functional outcomes and substantial burden. Despite relatively extensive previous studies on traumatic spinal injuries, there is still obscurity in some aspects of the issue. The purpose of this study is to establish a regional multicenter traumatic spine fracture/dislocation registry.

METHODSThis is a prospective case series study, including all patients with acute traumatic spine lesions admitted to a regional multicenter since 2014. Data is extracted based upon a form developed by Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. Novel electronic data entry software is initiated and data will be entered to the software. Information remains confidential and security considerations will be taken based on standards of data entry systems.

RESULTSThe results of this study will include age and gender distribution of the patients, causes of injury, location of pain and neurological deficit, the American Spinal Injury Association score and Frankel grade on admission, at discharge, after 6 and 12 months and at the latest annual follow-up, radiologic findings, details of operative procedures and methods of external fixation.

CONCLUSIONThis study will identify prognostic factors that influence the ultimate fate of spine fracture patients and determine short and long-term outcome of different treatment methods. It can lead to a considerable improvement in patient care and will have a great national and transnational impact.

Humans ; Iran ; epidemiology ; Joint Dislocations ; epidemiology ; Prospective Studies ; Registries ; Spinal Fractures ; epidemiology ; Spinal Injuries ; epidemiology

A 24-year-old male was transferred to the emergency department while being in the state of quadriplegia with a history of performing Parkour sport, which is also called double front flip. Neurological examination revealed that the patient's muscle power was 0/5 at all extremities. The patient did not show any sense of light touch or pain in his extremities. In radiological studies, cervical spine X-ray and CT scan images showed C4-C5 subluxation with bilateral locked facets and spinal cord injury. The results of this very rare case study revealed that exercising Parkour sport without taking into account safety standards could result in irreversible injuries to the cervical spinal cord with fatal outcome.
Cervical Vertebrae ; Humans ; Male ; Radiography ; Running ; injuries ; Spinal Cord Injuries ; diagnostic imaging ; etiology ; Young Adult

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

The spinal column is involved in less than 1% of all cases of tuberculosis (TB). Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications. In order to extract current trends in diagnosis and medical or surgical treatment of spinal TB we performed a narrative review with analysis of all the articles available for us which were published between 1990 and 2011. Althoug h the development of more accurate imaging modalities such as magnetic resonance imaging and advanced surgical techniques have made the early diagnosis and management of spinal TB much easier, these are still very challenging topics. In this review we aim to discuss the diagnosis and management of spinal TB based on studies with acceptable design, clearly explained results and justifiable conclusions.
Congenital Abnormalities ; Early Diagnosis ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Spine ; Tuberculosis ; Tuberculosis, Spinal

Multiple variables can influence triage decision in multiple trauma. Recognition of priorities and selection of the destination can be successfully achieved by field triage and individualized clinical judgment. This narrative review summarizes the new options and protocols for transport of injured subjects. There are four levels of emergency medical providers including first responders and three levels of emergency medical technicians. Two distinct accepted protocols for transport are known as scoop and run and treat and then transfer. The former provides minimum lifesaving treatment at the scene of accident followed by transferring the patient(s) as soon as possible, and the latter mainly emphasizes the need for complete stabilization as a prerequisite for safe transport. The destination and mode of transport are selected according to clinical capabilities of the receiving hospital, transfer time from the scene to the facility, patient's medical condition, accessibility of the scene, and weather. Two common methods of transfer are ground transport, including various type of ambulances, and air medical transport, i.e. helicopter and airplane.
Air Ambulances ; Decision Making ; Humans ; Mass Casualty Incidents ; Multiple Trauma ; therapy ; Transportation of Patients ; organization & administration ; Triage

OBJECTIVESince appropriate and time-table methods in trauma care have an important impact on patients'outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns' performance in simulated trauma patient management.

METHODSA descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant.

RESULTSOur findings showed that interns'ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P less than 0.001, P equal to 0.016 and P equal to 0.01 respectively).

CONCLUSIONATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

Advanced Trauma Life Support Care ; Clinical Competence ; Humans ; Inservice Training ; Patient Simulation ; Students, Medical ; Wounds and Injuries ; diagnosis ; therapy

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