Characteristics of Traumatic Patients Referring to the Emergency Department and their Association with Mortality and Incidence of Surgery Performance.

Objective: To identify the distinctive features of acutely injured patients who were presented to the emergency department (ED) and their association with mortality and surgical intervention outcomes. Methods: This cross-sectional study was conducted on all trauma patients resuscitated in the ED of Shahid Rajaee (Emtiaz) Trauma Hospital (Shiraz, Iran) from May 2018 to June 2019. Demographic information, the mechanism of trauma, trauma type, injured body regions, criteria of abbreviated injury scale (AIS) score, injury severity score (ISS), and surgical intervention were all taken into consideration. The items related to the mortality and surgical performance outcomes among the patients were analyzed. Results: Of all 1281 cases, 82.9% were men, and the mean age of the patients was 37.9±19.1 years. The most common mechanism of injury was a car accident, and the thorax was the most prevalent injured area of the body. The majority of the patients had moderate blunt trauma. The mechanism of trauma, ISS, and the severity of head trauma were all significantly correlated with operation interventions. Moreover, age, the mechanism and type of trauma, ISS, and the necessity for the surgery were significantly associated with death occurrence. Additionally, head, thorax, and abdomen trauma were significantly related to a high mortality rate. Conclusion: Age, trauma mechanism and type, ISS, and the necessity for surgery were significantly associated with the mortality rate of injured patients. The severity of the trauma, particularly head injuries and the mechanism of damage were important determinants in concern for surgery the necessity.

Epidemiology of Burns in Pediatric and Adolescent Patients of Fars Province between 2017 and 2018.

Objective: According to the reports of the World Health Organization approximately 300,000 deaths occur yearly worldwide due to burns or burn-associated injuries. This study aims to review the epidemiology of burns in pediatrics and adolescents in Fars province between 2017 and 2018. Methods: This is a cross-sectional study that investigated all people ≤18 years old who suffered from burn injuries in Fars province between 2017 and 2018. We use data from the file of burn patients which was provided by pre-hospital emergency services of Fars province. This data comprises demographic information (age and gender), burn-related information (type, degree, and severity of burns), mode of transfer (outpatient surgery or transfer to hospital) and the outcome of the disease (death before arrival to the hospital or alive). Results: The average age of the subjects of this study was 5.8±8.9. We also categorized the subjects into four age groups, 1-4, 5-8, 9-13 and 15-18 years. The number of boys who suffered from burn injuries is significantly more than the girls (p=0.011). Also, there is a remarkable correlation between burn with age (p<0.001) and burn with disease outcome (p=0.01). The Most common cause of burns in boys was nonchemical hot objects and liquids (28.5%). Likewise, the possibility of mortality in burn patients who faced an electric shock was 22.66%. ([95%CI=2.32-220.63], p<0.001 OR=22.66). Conclusion: This study shows that pediatrics and adolescents ≤ 4 have the most burn injuries, and boys have twice as many burn events as girls. More importantly, the most common cause of burns in both genders was burning with non-chemical hot objects and liquids, in particular, in the age group of 1-4 years, in which event happens at home.

What factors affect length of hospital stay among trauma patients? A single-center study, Southwestern Iran.

PURPOSE: Trauma is a major health concern. Length of hospital stay (LOS) has been targeted as an important metric to assess trauma care. This study aims to evaluate the risk factors that affect LOS among trauma patients in a trauma center in Southwestern Iran. METHODS: This cross-sectional study was conducted on patients admitted to Rajaee Trauma Center, Shiraz, Iran between January 1, 2018 and December 30, 2018. The inclusion criteria were age above 15 years and having traffic accident injuries, including car, motorcycle and pedestrian injury mechanisms. The exclusion criteria were existing diseases including cardiovascular, cerebral, renal, and pulmonary diseases prior to this study, dead upon arrival or within 48 h after admission, and stay at the hospital for less than 6 h. The risk variables analyzed for prolonged LOS were age, gender, mechanism of traffic accident injury, infection during hospital stay, type of injury, injury severity score, surgery during hospitalization, and survival. Poisson regression was performed to evaluate the partial effects of each covariate on trauma hospitalization (≥3 days as longer stay). RESULTS: This study was conducted on 14,054 patients with traffic accident injury and the mean age was (33.89 ± 15.78) years. Additionally, 74.35% of the patients were male, with male to female ratio of 2.90. The result of Poisson regression indicated that male patients, higher age, combination of thoracic injuries, onset of infected sites, and surgery patients were more susceptible to have a longer LOS. Considering the site of injury, patients with face injuries followed by those with thorax injuries had the highest means of LOS (3.74 days and 3.36 days, respectively). Simultaneous existence of surgical intervention and infection in a patient had the greatest impact on prolonged LOS. CONCLUSION: This study identified that age, gender, mechanism of injury, infection, type of injury, survival, and ISS could lead to prolongation of LOS, but the affect can be reduced by eliminating modifiable risk factors.

Pattern of Maxillofacial Injuries and Determinants of Outcome in a Large Series of Patients admitted to a Level-I Trauma Center.

OBJECTIVE: To investigate the severity of injuries and the pattern of jaw and facial injuries in trauma patients and also to determine the predictors of the outcome in these patients. METHODS: This cross-sectional study was conducted on 2697 patients with facial trauma who referred to trauma center in Shahid Rajaee (Emtiaz) Hospital, Shiraz, Iran during 2010-2015. Injury severity score was determined through the conversion of injury codes of the International Classification of Diseases, tenth revision (ICD-10). Binary logistic regression by backward method was used to determine the partial effects of independent risk factors on death odds ratio. RESULTS: The mean age of patients with maxillofacial injuries was 31.96 ± 15.80 years. The mean injury severity score (ISS) was 4.3 ± 4.4 and about 80% of the patients had an ISS between 1 and 8. Mandible fracture and ear injuries, respectively, were the most and the least prevalent types of maxillofacial injury. The odds ratio of death by motorcycle accident was 1.7 times higher than falling down in maxillofacial patients. CONCLUSION: Age, gender (male), ISS, and mechanism of injury were the significant predictors of mortality in the facial trauma patients. Mandible fracture and ear injury, respectively, were the most and the least prevalent types of maxillofacial injury. Our findings demonstrate the need for referral to the maxillofacial surgeon and maxillofacial surgery should be in connected with neurosurgical centers.

Renal capsule for augmentation cystoplasty in canine model: a favorable biomaterial?

PURPOSE: To evaluate effectiveness of canine renal capsule for augmentation cystoplasty. MATERIALS AND METHODS: Ten adult dogs participated in this study. After induction of anesthesia each animal underwent bed side urodynamic study, bladder capacity and bladder pressure was recorded. Then via mid line incision abdominal cavity was entered, right kidney was identified and its capsule was dissected. Bladder augmentation was done by anastomosing the renal capsule to the bladder. After 6 months bed side urodynamic study was performed again and changes in bladder volume and pressure were recorded. Then the animals were sacrificed and the augmented bladders were sent for histopathology evaluation. RESULTS: Mean maximum anatomic bladder capacity before cystoplasty was 334.00±11.40cc which increased to 488.00±14.83cc post-operatively (p=0.039). Mean anatomic bladder pressure before cystoplasty was 19.00±1.58cmH2O which decreased to 12.60±1.14cmH2O post-operatively (p=0.039). Histopathology evaluation revealed epithelialization of the renal capsule with urothelium without evidence of fibrosis, collagen deposits or contracture. CONCLUSIONS: Our data shows that renal capsule is a favorable biomaterial for bladder augmentation in a canine model.

Renal capsule for augmentation cystoplasty in canine model: a favorable biomaterial?

ABSTRACT Purpose: To evaluate effectiveness of canine renal capsule for augmentation cystoplasty. Materials and Methods: Ten adult dogs participated in this study. After induction of anesthesia each animal underwent bed side urodynamic study, bladder capacity and bladder pressure was recorded. Then via mid line incision abdominal cavity was entered, right kidney was identified and its capsule was dissected. Bladder augmentation was done by anastomosing the renal capsule to the bladder. After 6 months bed side urodynamic study was performed again and changes in bladder volume and pressure were recorded. Then the animals were sacrificed and the augmented bladders were sent for histopathology evaluation. Results: Mean maximum anatomic bladder capacity before cystoplasty was 334.00±11.40cc which increased to 488.00±14.83cc post-operatively (p=0.039). Mean anatomic bladder pressure before cystoplasty was 19.00±1.58cmH2O which decreased to 12.60±1.14cmH2O post-operatively (p=0.039). Histopathology evaluation revealed epithelialization of the renal capsule with urothelium without evidence of fibrosis, collagen deposits or contracture. Conclusions: Our data shows that renal capsule is a favorable biomaterial for bladder augmentation in a canine model.

Success rate and patients' satisfaction following intradetrusor dysport injection in patients with detrusor overactivity: a comparative study of idiopathic and neurogenic types of detrusor overactivity.

PURPOSE: To evaluate the efficacy of intradetrusor Dysport (a type of botulinum toxin type A) injection in patients with idiopathic or neurogenic detrusor overactivity, who were refractory to antimuscarinic drugs, and to compare the efficacy of Dysport injection in both groups. MATERIALS AND METHODS: Twelve patients with neurogenic detrusor overactivity (NDO) and 18 patients with idiopathic detrusor overactivity (IDO) participated in this study. All the patients received intravesical injection of 500 units of Dysport. They were followed up for 3 months after injection with maximum cystometric capacity, maximum detrusor filling pressure, and number of catheterization or pad usage. RESULTS: After 3 months, the mean maximum cystometric capacity increased from 109.36 ± 24.11 mL to 266.81 ± 97.18 mL (P = .000) in the NDO group and from 192.24 ± 36.21 mL to 272.61 ± 63.37 mL (P = .000) in the IDO group. The mean maximum detrusor filling pressure decreased from 48.14 ± 26.51 cmH2O to 28.91 ± 9.01 cmH2O (P = .005) in the NDO group and from 39.22 ± 9.92 cmH2O to 29.64 ± 10.14 cmH2O (P = .003) in the IDO group. CONCLUSION: Intradetrusor Dysport injection improved urodynamic parameters and quality of life (QoL) in both groups significantly. We did not find significant difference in QoL or urodynamic parameters between both groups.

Diagnostic Accuracy of Magnetic Resonance Angiography for Detection of Intracranial Aneurysms in Patients with Acute Subarachnoid Hemorrhage; A Comparison to Digital Subtraction Angiography.

OBJECTIVES: To determine the diagnostic accuracy of magnetic resonance angiography (MRA) compared to intra-arterial digital subtraction angiography (DSA) in detection of intracranial aneurysms in those suffering from acute subarachnoid hemorrhage (SAH). METHODS: This observational diagnostic study was performed at a tertiary teaching hospital and reference center in Shiraz, Iran. We included 55 patients who presented to our center with the diagnosis of acute SAH. All the patients underwent MRA and DSA during their hospital course in order to detect the intracranial aneurysms. The time-of-flight MRA protocol was used and the results were compared to the results of DSA as the gold standard test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for MRA. RESULTS: The mean age of the patients was 46.3 ± 7.9 including 26 (47.3%%) men and 29 (52.7%) women. In 46 patients, 51 intracranial aneurysms were diagnosed by DSA (5 patients had two aneurysms). No evidence of intracranial aneurysm was found in 9 patients with subarachnoid hemorrhage. MRA correctly identified 42 of the 51 aneurysms (sensitivity 82%) and missed 9 small aneurysms (less than 10 mm). MRA revealed one false- positive finding, resulting in a specificity of 88.8%. The PPC and NPV for MRA were 97% and 47%, respectively. The diagnostic accuracy per aneurysm was 0.83 for MRA. CONCLUSION: High sensitivity and specificity of MRA compared to DSA in diagnosis of intracranial aneurysms in those with acute SAH indicate that MRA could be reliably used as a diagnostic tool for this purpose. However we cannot recommend it as a routine substitute for DSA before surgery.