OBJECTIVETo determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war.

METHODSData were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war.

RESULTSDuring 52 days, Tehran was stroked by 118 Al-Hussein missiles (a modified version of Scud missile). Eighty-six missiles landed in populated areas. During Iraqi missile attacks, 422 civilians died and 1 579 injured (4.9 deaths and 18.3 injuries per missile). During 52 days, 8.1 of the civilians died and 30.4 injured daily. Of the cases that died, 101 persons (24%) were excluded due to the lack of information. Among the remainders, 179 (55.8%) were male and 142 (44.2%) were female. The mean age of the victims was 25.3 years+/-19.9 years. Our results show that the high accuracy of modified Scud missiles landed in crowded areas is the major cause of high mortality in Tehran. The presence of suitable warning system and shelters could reduce civilian casualties.

CONCLUSIONThe awareness and readiness of civilian defense forces, rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile attacks are necessary.

Humans ; Iran ; Iraq

OBJECTIVEThe high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function.

METHODSThe current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.

RESULTSCurrently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources), it is not yet established in our system of trauma care.

CONCLUSIONSIt seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.

Accidents, Traffic ; prevention & control ; Emergency Medical Services ; Humans ; Iran ; Leadership ; Wounds and Injuries ; prevention & control ; therapy

OBJECTIVESeat belt use during pregnancy reduces injury to the mother and her fetus. During recent years, the use of seat belts has been mandated by law in Iran. The purpose of this study was to determine the attitudes and practices of pregnant women regarding seat belt use.

METHODSIn this cross-sectional study, we asked 335 pregnant women at a hospital-based prenatal care clinic on the use of safety belt before and during pregnancy. SPSS version 13.0 was used for data analysis.

RESULTSThe mean age of study subjects was 27.3 years ± 5.3 years with the median of 27 years. Compared with the seat belt use before pregnancy, no change was detected in 48.7% of the women; seat belt use had increased in 17.5 % of them and decreased in 33.8 %. Eighty-one percent of women knew the correct placing of both lap belt and shoulder belt. Only 4% of women had received education on proper restraint use during pregnancy.

CONCLUSIONSThe prevalence of seat belt use during pregnancy is lower than reports which are mostly from developed nations. The fact that about one-third of women have decreased their seat belt usage during pregnancy highlights the importance of education of mothers on this topic.

Accidents, Traffic ; Adult ; Cross-Sectional Studies ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Iran ; Pregnancy ; Seat Belts ; utilization

OBJECTIVEAlthough long bone fracture in children is not life-threatening, it may cause major disability, loss of working days and severe psychological distress. We conducted this study to determine the pattern of extremity fracture due to trauma in children.

METHODSDuring one year in six general hospitals in Tehran, trauma patients who were hospitalized for more than 24 hours and sustained injuries within seven days before admission were included in the study. The records of children (< or = 16 years old) hospitalized in six general hospitals in Tehran due to trauma were reviewed prospectively.

RESULTSDuring the study period, 1 274 children had sustained extremity fractures. Male to female ratio was 3.6/1, with the mean age of (10.3+/-4.2) years. Falls and traffic crashes were the main causes of injuries, with the percentages of 57.3% and 37.1%, respectively. Simple fall (falling on the ground) consisted 60% of patients that sustained fall-related injuries. Pedestrians and bicycle riders comprised most of the cases that were injured due to traffic crashes. Of our cases, 56.8% sustained fractures in the upper extremities and 43.2% in the lower extremities. Forearm was the most common fracture site (34.1%). Comparing our results in preschool and school-age children, falls were the main cause of injuries in both groups, but fractures of lower extremities were significantly more common in preschool children.

CONCLUSIONSImprovement of physical condition of sidewalks and crossings in roads will be necessary for prevention of injuries. More attention to safety of home environment should be paid for control of preschools'injury at home. Education of children and adults is necessary to reduce injuries resulting from road traffic crashes.

Adolescent ; Arm Bones ; injuries ; Child ; Child, Preschool ; Female ; Fractures, Bone ; etiology ; therapy ; Humans ; Infant ; Leg Bones ; injuries ; Male ; Multiple Trauma ; complications

OBJECTIVETo determine the nature and extent of Iranian casualties by ballistic missile attacks during the eight years of the Iraq-Iran war.

METHODSThe data collected about Iraqi missile strikes on Iranian cities included the following: date and time, number and type of missiles, cities targeted, and injuries and deaths resulting from impacts of missiles in civilian areas. The data were extracted from a database that was constructed by the army staff headquarters based on daily reports of Iranian army units during the war.

RESULTSOver a period of eight years (1980-1988), Iraqi army fired 533 ballistic missiles at Iranian territories. From those, 414 missiles (77.7%) landed on Iranian cities. The impacts of these missiles caused the deaths of 2,312 civilians and injured 11,625 others. Three types of ballistic missiles were used: FROG-7, Scud, and Al-Hussein (a modified version of the Scud missile). Twenty-seven cities in Iran were struck by Iraqi ballistic missiles. The highest mortalities from ballistic missiles were in Dezful and Tehran. Iraqi missile attacks continued for 90 months (2,748 days).

CONCLUSIONOur results point to the necessity of investigating the psychological consequences of Iraqi ballistic missile attacks among survivors in 27 Iranian cities during the eight years of the Iraq-Iran war.

Blast Injuries ; epidemiology ; Humans ; Iran ; Iraq ; epidemiology ; Time Factors ; Warfare ; Wounds and Injuries ; epidemiology ; Wounds, Gunshot ; epidemiology

OBJECTIVEToday, trauma is a major public health problem in some countries. Abdominal trauma is the source of significant mortality and morbidity with both blunt and penetrating injuries. We performed an epidemiological study of abdominal trauma (AT) in Tehran, Iran. We used all our sources to describe the epidemiology and outcome of patients with AT.

METHODSThis study was done in Tehran. The study population included trauma patients admitted to the emergency department of six general hospitals in Tehran during one year. The data were collected through a questionnaire that was completed by a trained physician at the trauma center. The statistical analysis was performed using the SPSS software (version 11.5 for Windows). The statistical analysis was conducted using the chi-square and P < 0.05 was accepted as being statistically significant.

RESULTSTwo hundred and twenty-eight (2.8%) out of 8,000 patients were referred to the above mentioned centers with abdominal trauma. One hundred and twenty-five (54.9%) of the patients were in their 2nd and 3rd decades of life and 189 (83%) of our patients were male. Road traffic accidents (RTA) were the leading cause of AT with 119 (52.2%) patients. Spleen was the commonly injured organ with 51 cases. Following the analysis of injury severity, 159 (69.7%) patients had mild injuries (ISS < 16) and 69 (30.3%) patients had severe injuries (ISS equal to 16). The overall mortality rate was 46 (20.2%).

CONCLUSIONSBlunt abdominal trauma is more common than penetrating abdominal trauma. Road traffic accidents and stab wound are the most common causes of blunt and penetrating trauma, respectively. Spleen is the most commonly injured organ in these patients. The mortality rate is higher in blunt trauma than penetrating one.

Abdominal Injuries ; epidemiology ; mortality ; therapy ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Hospitals ; Humans ; Iran ; epidemiology ; Male ; Middle Aged ; Trauma Severity Indices ; Wounds, Nonpenetrating ; epidemiology ; therapy

OBJECTIVETo determine the patterns of traumatic extremity injuries leading to amputation in Iran.

METHODSData of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation. This project was conducted in 8 major cities during 2000-2004.

RESULTSOf 17 753 traumatic patients, 164 (0.92%) had injuries to the extremities that resulted in the limb amputation. Of these, 143 (87.2%) were men. The patient's mean age was 29.0 years +/- 15.4 years and the highest incidence was seen in the age group of 21 to 30 years (34.1%). One hundred and four cases were occupational accidents (63.4%). Blunt trauma was in 54.9% of the cases. The most common reasons for amputation were respectively stabbings (37.8%) and crush injuries (31.7%). Amputation of hand fingers was the most frequent type of amputation (125 cases, 76.2 %). One patient died from severe associated injuries.

CONCLUSIONSThis study shows the patterns of traumatic limb amputation in Iran, a developing country. Results of this study may be used in preventive strategic planning.

Accidents, Traffic ; statistics & numerical data ; Adolescent ; Adult ; Aged ; Amputation ; statistics & numerical data ; Child, Preschool ; Cross-Sectional Studies ; Female ; Humans ; Iran ; epidemiology ; Lower Extremity ; injuries ; surgery ; Male ; Middle Aged ; Upper Extremity ; injuries ; surgery ; Wounds, Nonpenetrating ; epidemiology ; surgery ; Wounds, Penetrating ; epidemiology ; surgery ; Young Adult

OBJECTIVEThe extremity injury pattern after a major earthquake is not well understood because data on this type of injury and management are limited. The aim of this study was to analyze the data of trauma patients with extremity injury in the earthquake of Bam Iran, registering 6.6 on the Richter scale.

METHODSWe reviewed medical records of 486 patients admitted to hospitals of Tehran University of Medical Sciences. Among them, 274 patients sustained extremity injuries. This group was composed of 138 females (50.4%) and 136 males (49.6%) and 213 cases (77.7%) were under 40 years of age.

RESULTSFracture was the major type of injury (58.4% of extremity injuries). The most common sites of injury were lower extremities (185 patients, 67.5% of all victims). Pelvic and rib fractures and abdominal injuries were the most frequently associated injuries. The mean ISS was 6.2+/-4.0, and 61% of the patients had ISS less than 7. Amputation and death occurred in 2.9% and 2.5% of cases, respectively.

CONCLUSIONSSpecial attention should be given to dealing with orthopedic injuries in similar disasters in the future.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Disasters ; Earthquakes ; Extremities ; injuries ; Female ; Humans ; Infant ; Male ; Middle Aged

OBJECTIVEInjury is a major neglected health problem in developing countries. The first step in dealing with injury problem is to identify the injury patterns and characteristics. Therefore, we aimed to demonstrate the current status of trauma admissions to hospitals in Shiraz, as a major city of Iran.

METHODSA hospital-based study was conducted in 2002. All injured patients admitted during 6 months in emergency departments of two general hospitals of Shiraz, Nemazi and Chamran were included.

RESULTSA total of 1,765 injured patients were registered during the study period, with mean age of 33 years. Manual workers were the most vulnerable group among occupational categories. Inner-city roads were the most common place of injury and traffic accident was the major cause of injury. Overally, falling injury was the second common cause of injury in males and the first cause in females (especially at the age of over 60).

CONCLUSIONAs other studies conducted in our society, traffic accidents are the major cause of morbidity and mortality and this can emphasize on the obligation to take legislative action in the field of driving and road safety, directing resources and educating the public and raising the awareness of the community in prevention of this iceberg-like problem.

Accidents, Traffic ; statistics & numerical data ; Adolescent ; Adult ; Female ; Humans ; Iran ; epidemiology ; Male ; Middle Aged ; Wounds and Injuries ; epidemiology

OBJECTIVEChest injury, one of the most important aspects of trauma, directly accounts for 25% of all trauma-related deaths and plays a major contributing role in another 25% of trauma deaths. This paper aimed to explore the spectrum and outcome of thoracic injuries seen in a multi centric study of trauma patients.

METHODSA total of 276 consecutive trauma patients in 6 general hospitals were analyzed. The feature of injury, injury severity score (ISS), clinical treatment and mortality were recorded in a prospective manner and analyzed retrospectively. Multiple logistic regression analysis was used to determine the independent predictors of mortality following the chest trauma.

RESULTSThere were 246 males (89.1%) and 30 females (10.9%) ranging from 3 to 80 years with a mean age of (34+/-17) years. Road traffic accident was the main cause of injury, especially for pedestrians, followed by stab wound (89 cases, 32.1%) and falling injuries (32 cases, 11.6%), respectively. Haemothorax or pneumothorax (50.4%) and rib fracture (38.6%) were the most common types of chest injury. Extremity fracture was the most common associated injury with the rate of 37% ( 85/230), followed by head injury (25.2%) and abdominal trauma (19.6%). These injuries contributed significantly to the morbidity and mortality of trauma patients.

CONCLUSIONSAccording to the results, most patients with chest injury can be treated conservatively with close observation and tube thoracostomy. The presence of blunt trauma, head injury and abdominal injury independently adversely affect mortality after chest trauma. It is necessary to investigate the causes and patterns of injuries resulting from stab wound for effective prevention.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Thoracic Injuries ; etiology ; mortality ; therapy