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   Table of Contents - Current issue
Coverpage
October-December 2021
Volume 10 | Issue 4
Page Nos. 181-236

Online since Wednesday, December 29, 2021

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ORIGINAL ARTICLES  

A retrospective cross-sectional study of profile severity and outcome of pedestrian road traffic trauma patients presenting to the emergency department in South India − during 2019 p. 181
Akash Sethy, Darpanarayan Hazra, Ankita Chowdary Nekkanti, Rathijit Pal, Kundavaram Paul Prabhakar Abhilash
DOI:10.4103/atr.atr_25_21  
Background and Objectives: Pedestrian injuries are a common mode of trauma presenting to the emergency department (ED). This study analyzes the profile, severity, and hospital outcome of these victims. Methods: We conducted a retrospective cross-sectional analysis of pedestrian trauma victims who presented to our ED from January 2017 to December 2018. Results: During the 2-year study period, our ED received 463 patients with pedestrian trauma. The mean age was 39 (standard deviation: 22.72) years, with a male (309/463: 66.6%) predominance. Based on their hemodynamic stability, majority were triaged as Priority 2 (279/463: 60.2%). Injuries included fractures (49.5%; n = 229), lacerations (46.4%; n = 215), abrasions: (38.9%; n = 179) and brain contusions (23.1%; n = 107). Extremities were the most injured (66.6%), followed by the scalp/head (39.9%) and face/neck injuries (20.3%) patients. A New Injury Severity Score of more than or equal to 14 was noted in 64 (13.9%) patients. Most of the victims required surgical (major/minor) intervention as part of their treatment which accounted for 63.9% (n = 296) patients. The ED mortality rate was 0.4% (n = 2), whereas the in-hospital mortality rate was 2.2% (n = 8). Conclusions: Middle-aged males were the leading demographic affected by most events taking place in the evening. Extremities were the most injured body part with fractures being the principal type of injury. A significant number of victims had injuries that were grievous and required hospital admission.
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A comparison between modified early warning score, worthing physiological scoring system, national early warning score, and rapid emergency medicine score in predicting inhospital mortality in multiple trauma patients p. 188
Farhad Heydari, Saeed Majidinejad, Ahmad Ahmadi, Mohammad Nasr-Esfahani, Hossein Shayannejad, Neda Al-Sadat Fatemi
DOI:10.4103/atr.atr_31_21  
Background and Objectives: Physiological scoring systems could potentially aid emergency department (ED) trauma triage, and allowed clinicians to focus on treating the most severe patients first. This study aims to compare Modified Early Warning Score (MEWS), Worthing Physiological Scoring System (WPSS), National Early Warning Score (NEWS), and Rapid Emergency Medicine Score (REMS) in predicting inhospital mortality for multiple trauma patients. Methods: This prospective descriptive study was performed on adult multiple trauma patients referred to the ED of Al-Zahra and Kashani hospitals, Isfahan, Iran during 2019-2020. The primary outcome was inhospital mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate and compare the performances of four scores. Results: Of the 771 patients included in this study, 738 patients (95.7%) survived after 24 h of admission. The mean age of patients was 38.66 ± 18.67 years, and the majority of patients were male (79.1%). To predict inhospital mortality, the area under the ROC curve (AUC) of REMS, MEWS, NEWS, WPSS, and Injury Severity Score (ISS) were 0.944, 0.889, 0.768, 0.754, and 0.869, respectively. Results showed that REMS was more successful than other scores in predicting in-hospital mortality for multiple trauma patients. AUC of REMS was significantly better than NEWS, WPSS, and ISS in predicting inhospital mortality. Conclusions: The findings of this study reveal that REMS is an excellent predictor of in-hospital mortality and MEWS, NEWS, WPSS, and ISS are good predictors of in-hospital mortality.
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Identifying the factors affecting occupational accidents: An artificial neural network model p. 195
Soheil Hassanipour, Mojtaba Sepandi, Hadiseh Rabiei, Mahdi Malakoutikhah, Gholamhossein Pourtaghi
DOI:10.4103/atr.atr_49_21  
Background and Objectives: Occupational accidents impose high costs on organizations annually. This study aimed at investigating the factors affecting military work-related accidents using artificial neural network (ANN) and Bayesian models. Materials and Methods: This study was a cross-sectional survey in a military unit that examined all occupational accidents recorded during 2011–2018. First, we collected the data of the accidents using the accident database in the inspection sector of the Department of Health and the Medical Commission of the Armed Forces. ANN, Bayesian, and logistic regression models were used to analyze the data. Results: The results of the type of accidents showed that 219 cases of sport accidents (32.8%), 125 cases fall from height (18.7%), and 104 cases of driving accidents (15.6%) were the most common accidents. Based on the results of multivariate regression, accident variables due to fighting (odds ratio [OR] =17.21), injury to the body or back (OR = 122.55), and multiple injuries (OR = 25.72) were considered as influential and significant factors. The ANNs results showed that the highest importance factor was the injury to the body or back, multiple injuries, age, fighting, and finally, driving accident. Furthermore, the Bayesian model showed that the most important factors affecting the death consequence due to accidents were related to injuries to the body or back (OR = 276.23), multiple injuries (OR = 54.98), and accidents due to conflict (OR = 33.69). Conclusion: The findings show that the most important factors affecting the death consequence due to accidents in the military are the injury to the whole body, multiple injuries, age, fighting accident, and driving accident. The ANN and Bayesian models have provided more accurate information than logistic regression based on the obtained results.
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The influence of kinesiology tape on postoperative edema, pain, and trismus in zygomaticomaxillary fracture p. 203
Keerthana Krishnamurthy, Venkatesh Anehosur, Kiran Radder
DOI:10.4103/atr.atr_40_21  
Background and Objectives: Maxillofacial surgery induces alarming facial swelling while treating complex orbital and zygomatic bone fractures for which corticosteroids have been used aggressively causing side effects. This study is aimed to evaluate the efficacy of Kinesiology Tape (KT) in isolated zygomaticomaxillary complex (ZMC) fractures in the reduction of postoperative swelling, pain, and trismus. Methods: This was a prospective study involving thirty patients with isolated ZMC fractures divided into two groups: test and control. Surgery was performed in accordance with the standardized protocol customized for the study. KT was used on the test group. The objective assessment of swelling involving six specific reference points making five lines and pre- and postoperative mouth opening was recorded. The subjective assessment of pain and efficacy of KT was checked at the time of discharge. Results: There was a significant reduction in swelling in the postoperative period in the study group as compared to the control. The study group showed minimum swelling, and the rate of resolving was faster. Subjectively 86.6% of the patients were very satisfied in the study group and did not find any disturbance to the use of KT or difficulty in the neck movement. No significant difference was recorded in trismus and pain in both the groups. Conclusions: The postoperative swelling was significantly lower with application of KT in ZMC fractures. No significant influence was seen on pain and trismus. The subjective assessment of the patients revealed that the mouth opening increased after surgery in the study group which may be due to placebo effect. KT could be a simple, inexpensive, noninvasive approach in management of postoperative morbidity which promises to improve the quality of life.
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Gender-based trauma outcomes and predictors of postinjury in-hospital mortalities: A multicenter analysis from the national trauma registry of Iran p. 209
Lillian Saberian, Vali Baigi, Mohammadreza Zafarghandi, Khatereh Naghdi, Melika Ozlaty, Somayeh Bahrami, Nima Madadi, Vafa Rahimi-Movaghar, Homayoun Sadeghi-Bazargani, Esmaeil Fakharian, Hamid Pahlavanhosseini, Seyed Mohammad Piri, Moein Khormali, Sara Mirzamohamadi, Payman Salamati
DOI:10.4103/atr.atr_64_21  
Background and Objectives: Injuries in countries like Iran are one of the leading causes of death. This study aims to determine gender differences in trauma outcomes and predictors of in-hospital mortality after trauma. Methods: The data of four trauma centers were extracted from the National Trauma Registry of Iran databank between 2016 and 2020. The univariable and multiple logistic regression models analyzed gender differences in trauma outcomes and postinjury predictors of in-hospital mortalities. Results: Among 17,530 patients, the most common cause of injury in both genders was road traffic injury (40%). Regarding in-hospital mortality after trauma, although there was a significant gender-based difference between some centers, no overall gender difference was seen (0.9% vs. 1.0% P = 0.26). The odds of in-hospital mortality for patients over 65 years old was 10.45 times more than that for patients under 15 years old. Furthermore, the odds of in-hospital mortality for patients admitted to intensive care units (ICU) was 6.22 times as high as that for patients who were not admitted to ICUs. Intubation status had a significant association with in-hospital mortality after adjustment for covariates. The odds of in-hospital mortality for patients with an injury severity score (ISS) ≥16 was 2.57 times higher than that for patients with ISS 1–8. Conclusions: Although males had a survival privilege over females following trauma in some centers, there was no overall association between gender and in-hospital mortality. Moreover, older age, ISS, ICU admission, and intubation were predictors of in-hospital mortality for trauma.
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E-scooter crashes: Are they a risky underestimated new mode of transport? A medical and technical assessment p. 215
Friederike Weidemann, Bennet Mathis Schröder, Heiko Johannsen, Krettek Christian, Decker Sebastian
DOI:10.4103/atr.atr_48_21  
Background and Objectives: In 2019, electric scooters (e-scooters) were legalized for use on German roads. Their popularity is attributable to their relatively cheap and easy availability. E-scooters had already been established in other countries for some time. A rising number of crashes involving e-scooters have been reported from different countries, but data about crashes in Germany are still limited. Materials and Methods: Our local accident research unit documented prospectively a statistically randomized sample of e-scooter crashes between July 2019 and December 2020. Collected data include, but is not limited to, injury details as well as technical characteristics and circumstances of the crashes. Results: Twenty-three crashes are included in this study. Two drivers (8.70%) were uninjured and 60.87% (n = 14) suffered only minor injuries (Maximum Abbreviated Injury Scale [MAIS] 1). Four drivers (17.39%) sustained a MAIS 2 and three drivers (13.04%) a MAIS 3. 41 injuries in total were recorded among the 23 patients included in this study. The Injury Severity Score ranged from 0 to 22. In our cohort, the main person responsible for the crash was most often the e-scooter driver him/herself (n = 20, 86.96%). In n = 6 (26.09%), a positive alcohol test was carried out, and one driver (4.35%) was under the influence of cannabis. Conclusions: Crashes involving e-scooters have the potential to cause severe injuries and e-scooters should not be considered harmless gadgets. The prevalence of drug and alcohol use during e-scooter driving and the high percentage of e-scooter drivers being responsible for the crash may indicate potential recklessness on the part of the drivers.
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Factors affecting hospital length of stay in trauma patients before and during the COVID-19 pandemic: A regional trauma center in Iran p. 221
Ghodratollah Roshanaei, Sajjad Abdolmaleki, Mohammadreza Saatian, Mahnaz Farzian, Tayebeh Bathaei, Sahar Khoshravesh
DOI:10.4103/atr.atr_66_21  
Background and Objectives: Hospitals are often as an important goal focus on length of stay (LOS) for controlling the cost of trauma care. This study aimed to investigate the factors affecting hospital LOS in trauma patients before and during the COVID-19 pandemic in a regional trauma center in Iran. Methods: In this retrospective study, all trauma patients referred to Be'sat Hospital, the only regional trauma center in Hamadan, from 19 February to 20 November 2020 (during the COVID-19) were compared to the same date in 2019 (before the COVID-19). Data were collected using the recorded information in the Health Information Management Center of the Be'sat Hospital. Multivariate logistic regression was used to simultaneously evaluate the effect of covariates on LOS (≤3 days; >3 days) in two periods. All statistical analyses were performed using SPSS version 24.0. Results: The mean values for LOS in trauma patients before and during the COVID-19 were 3.9 and 3.2 days, respectively. Before the COVID-19, the age of <18 years old (odds ratio [OR] = 1.59; 95% confidence interval CI: 1.33–1.92, P < 0.01), winter season (OR = 1.33; 95% CI: 0.99–1.76, P = 0.04), and burn trauma (OR = 1.35; 95% CI = 1.02–1.79, P = 0.03) were significant. During the COVID-19, the age of <18 years old (OR = 1.39; 95% CI: 1.04–1.90, P = 0.04), males (OR = 1.48; 95% CI: 1.10–1.99, P = 0.01), burn trauma (OR = 1.77; 95% CI: 1.15–2.73, P = 0.01), and history of hospitalization (OR = 1.77; 95% CI: 1.15–2.73, P = 0.01) were significant. Conclusions: According to the results, before the COVID-19, the factors such as age, season, and mechanism of trauma were predictors of LOS. Furthermore, age, sex, mechanism of trauma, and history of hospitalization were factors that affected LOS in trauma patients during the COVID-19. Thus, this study may be helpful in improving the discharge planning in trauma patients.
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Road traffic accident fatality predictors: A case–control study in Isfahan p. 227
Masumeh Safaee, Reza Eshraghi Samani, Rezvan Abdolazimi
DOI:10.4103/atr.atr_51_21  
Background and Objectives: Traffic accidents are the most important cause of trauma and mortality in communities. Due to the limited information in this field about Isfahan, a metropolitan in the center of Iran, this study investigates and identifies the epidemiological characteristics of fatal traffic accidents in this city. Methods: This is a case–control study conducted on hospitalized patients due to traffic accidents in 2016-2017. Lethal accidents (n = 189) were considered cases, and a group of survivors (n=189) was the control. The demographic and clinical characteristics of the population were gathered, and compared between the cases and controls. Logistic regression assessment was applied to determine the factors associated with death. Results: Logistic regression assessments revealed that facial and head trauma, chest trauma, abdominal trauma, pelvic trauma, lower extremity trauma, surgical procedure requirement within 12 hours after the accident and intubation were the prognostic factors associated with fatality. Conclusions: According to the findings of this study, mortality due to accidents was independently associated with facial and head, chest, abdominal, pelvic and lower extremity traumas, intubation requirement, and surgery within the first 12 h after the accident. Besides, aging was inversely associated with the chance of survival following a road accident.
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CASE REPORT Top

An infant case of recurrent globe luxation p. 232
Songul Tomar-Guneysu, Okşan Derinoz-Guleryuz
DOI:10.4103/atr.atr_47_21  
Even though globe luxation is a quite rare eye problem observed in the pediatric emergency department, it is quite vital since it causes loss of vision. An 8-month-old male patient presented with the complaint of spontaneous eye protrusion. Eye manipulations that would increase intraocular pressure were avoided and the eye was quickly covered with a dressing to keep the eye wet. The eyeball was placed back performing lateral canthotomy. Unlike the other cases in the literature, the present case is a case of spontaneous and recurrent globe luxation in an infant with a syndromic facial appearance. Early diagnosis and management of the cases will prevent the development of complications.
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LETTER TO EDITOR Top

A case of COVID-19 with recent surgery for subdural hematoma – A therapeutic thromboprophylaxis dilemma p. 235
Shalendra Singh, CR Sarath Chandran, Shamik Kr Paul, Rabi Narayan Hota
DOI:10.4103/atr.atr_2_21  
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