Comparison of nine trauma scoring systems in prediction of inhospital outcomes of pediatric trauma patients: a multicenter study.

Hereby, we aimed to comprehensively compare different scoring systems for pediatric trauma and their ability to predict in-hospital mortality and intensive care unit (ICU) admission. The current registry-based multicenter study encompassed a comprehensive dataset of 6709 pediatric trauma patients aged ≤ 18 years from July 2016 to September 2023. To ascertain the predictive efficacy of the scoring systems, the area under the receiver operating characteristic curve (AUC) was calculated. A total of 720 individuals (10.7%) required admission to the ICU. The mortality rate was 1.1% (n = 72). The most predictive scoring system for in-hospital mortality was the adjusted trauma and injury severity score (aTRISS) (AUC = 0.982), followed by trauma and injury severity score (TRISS) (AUC = 0.980), new trauma and injury severity score (NTRISS) (AUC = 0.972), Glasgow coma scale (GCS) (AUC = 0.9546), revised trauma score (RTS) (AUC = 0.944), pre-hospital index (PHI) (AUC = 0.936), injury severity score (ISS) (AUC = 0.901), new injury severity score (NISS) (AUC = 0.900), and abbreviated injury scale (AIS) (AUC = 0.734). Given the predictive performance of the scoring systems for ICU admission, NTRISS had the highest predictive performance (AUC = 0.837), followed by aTRISS (AUC = 0.836), TRISS (AUC = 0.823), ISS (AUC = 0.807), NISS (AUC = 0.805), GCS (AUC = 0.735), RTS (AUC = 0.698), PHI (AUC = 0.662), and AIS (AUC = 0.651). In the present study, we concluded the superiority of the TRISS and its two derived counterparts, aTRISS and NTRISS, compared to other scoring systems, to efficiently discerning individuals who possess a heightened susceptibility to unfavorable consequences. The significance of these findings underscores the necessity of incorporating these metrics into the realm of clinical practice.

Development and psychometric properties of appraisals of post traumatic spinal cord injury health scale in Iran.

STUDY DESIGN: Development and psychometrics study OBJECTIVE: To evaluate the reliability and validity of a new version of Appraisals of Post-Traumatic Spinal Cord Injury Health Scale (APTSCIHS) in the Persian language for persons with spinal cord injury (SCI). SETTING: The persons were selected from National Spinal Cord Injury Registry of Iran (NSCIR-IR) and Brain and Spinal Cord Injury Research center (BASIR). METHOD: This was a mixed sequential exploratory study that performed in two phases. In the qualitative phase, a systematic scoping review and 12 interviews with the participants were done. Finally, items were generated. In the quantitative phase, face, content, construct and convergent validity were assessed to evaluate validity. To evaluate construct validity, a cross-sectional study was conducted on 305 persons with TSCI along with internal consistency and stability assessments. All quantitative data analyses were conducted using SPSS 22 software. RESULTS: The content validity and reliability were indicated by Scale's Content Validity Ratio (S-CVR) = 0.73 and Scale's Content Validity Index (S-CVI) = 0.86, Cronbach's α = 0.9 and the Test re-test reliability using intra-class correlations were (ICC) = 0.97 to 0.98. Exploratory factor analysis determined eight factors which showed more than 52% of the variance. APTSCIHS had a significant and strong correlation with Appraisals of DisAbility Primary and Secondary Scale (ADAPSS) (r = 0.475, P < 0.001). CONCLUSION: Results showed the 36 items APTSCIHS tool had an acceptable validity and reliability in Iran, and it can help health care providers or even administrators improve the quality of the rehabilitation services and quality of life.

Predictors of Outcome After Surgical Decompression for mild degenerative Cervical Myelopathy -A Systematic Review.

STUDY DESIGN: Systematic Reviews. OBJECTIVES: To investigate predictors of surgical outcomes for mild Degenerative Cervical Myelopathy (DCM) by reviewing all related studies conducted at this point. METHODS: An electronic search was carried out in PubMed, EMBASE, Scopus, and Web of Science until June 23, 2021. Full-text articles reporting surgical outcome predictors of mild DCM cases were eligible. We included studies with mild DCM which was defined as a modified Japanese Orthopaedic Association score of 15 to 17 or a Japanese Orthopaedic Association score of 13 to 16. Independent reviewers screened all the records, and discrepancies between the reviewers were solved in a session with the senior author. For risk of bias assessment, RoB 2 tool was used for randomized clinical trials and ROBINS-I for non-randomized studies. RESULTS: After screening 6 087 manuscripts, only 8 studies met the inclusion criteria. Lower pre-operative mJOA scores and quality-of-life measurement scores were reported by multiple studies to predict better surgical outcomes compared to other groups. High-intensity pre-operative T2 magnetic resonance imaging (MRI) was also reported to predict poor outcomes. Neck pain before intervention resulted in improved patient-reported outcomes. Two studies also reported motor symptoms prior to surgery as outcome predictors. CONCLUSION: Lower quality of life before surgery, neck pain, lower pre-operative mJOA scores, motor symptoms before surgery, female gender, gastrointestinal comorbidities, surgical procedure and surgeon's experience with specific techniques, and high signal intensity of cord in T2 MRI were the surgical outcome predictors reported in the literature. Lower Quality of Life (QoL) score and neck prior to surgery were reported as predictors of the more improved outcome, but high cord signal intensity in T2 MRI was reported as an unfavorable outcome predictor.

The Prevalence of Asymptomatic Cervical Spinal Cord Compression in Individuals Presenting With Symptomatic Lumbar Spinal Stenosis: A Meta-Analysis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: The aim of this study was to determine the prevalence of asymptomatic cervical spinal cord compression (CSCC) in individuals with lumbar spinal stenosis (LSS). METHODS: A systematic electronic search was conducted in Medline, EMBASE, Scopus, and Web of Science without language restriction, with no starting date limit to June 8, 2023, to define the prevalence of asymptomatic CSCC in symptomatic LSS patients. Asymptomatic CSCC was defined based on radiographic studies. All types of studies were included in the review. Meta-analysis was performed on the reported prevalence of asymptomatic CSCC in LSS. RESULTS: The database search yielded 10,272 articles. After a full-text review, five studies were included in the final review, comprising a total of 1043 cases. Two studies had a low risk for bias, two moderate, and one estimated to be high risk. The range of prevalence of asymptomatic CSCC in LSS in the five included studies was between 24% and 61%. Meta-analysis on the reported prevalence of asymptomatic CSCC patients with symptomatic LSS demonstrated that the random pooled prevalence was 35% (95% CI: 23 to 48). CONCLUSIONS: Asymptomatic CSCC appears to occur in a high number of patients, with this study noting its presence in one-third of patients with LSS. Based on these findings, we strongly recommend that spine surgeons exercise particular caution during the positioning of patients who are undergoing surgery for lumbar stenosis. Furthermore, it is imperative to monitor individuals with symptomatic LSS closely for any potential signs of emerging myelopathy.

Quality of in-hospital care in traumatic spinal column and cord injuries (TSC/SCI) in I.R Iran.

PURPOSE: This study aimed to implement the Quality of Care (QoC) Assessment Tool from the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to map the current state of in-hospital QoC of individuals with Traumatic Spinal Column and Cord Injuries (TSCCI). METHODS: The QoC Assessment Tool, developed from a scoping review of the literature, was implemented in NSCIR-IR. We collected the required data from two primary sources. Questions regarding health system structures and care processes were completed by the registrar nurse reviewing the hospital records. Questions regarding patient outcomes were gathered through patient interviews. RESULTS: We registered 2812 patients with TSCCI over six years from eight referral hospitals in NSCIR-IR. The median length of stay in the general hospital and intensive care unit was four and five days, respectively. During hospitalization 4.2% of patients developed pressure ulcers, 83.5% of patients reported satisfactory pain control and none had symptomatic urinary tract infections. 100%, 80%, and 90% of SCI registration centers had 24/7 access to CT scans, MRI scans, and operating rooms, respectively. Only 18.8% of patients who needed surgery underwent a surgical operation in the first 24 h after admission. In-hospital mortality rate for patients with SCI was 19.3%. CONCLUSION: Our study showed that the current in-hospital care of our patients with TSCCI is acceptable in terms of pain control, structure and length of stay and poor regarding in-hospital mortality rate and timeliness. We must continue to work on lowering rates of pressure sores, as well as delays in decompression surgery and fatalities.

Mental health outcomes of hospital staff during the COVID-19 pandemic in Iran.

BACKGROUND: The COVID-19 pandemic, which had recorded 769 million cases and resulted in 6.95 million deaths by August 2023, has put pressure on healthcare systems. Frontline medical professionals face stress, potentially leading to health challenges. This research aimed to examine the mental health of staff during the COVID-19 pandemic. METHODS: This cross-sectional descriptive-analytical study was conducted in several hospitals in Tehran, Kerman, and Golpayegan between 2021 and 2022. The study encompassed a population of 1,231 nurses and physicians. Data collection was done using the General Health Questionnaire-28 (GHQ-28). We applied the K-means clustering algorithm to unveil hidden patterns within the data and extract valuable insights from participants' responses to the GHQ-28. This method was chosen because our dataset lacked explicit labels, making grouping individuals with similar characteristics necessary. The primary aim was to delineate how the COVID-19 pandemic affected the mental health of hospital staff and identify which factors played a more significant role in this process. RESULTS: We have observed that Cluster two exhibits the highest scores in response to the GHQ-28 questions, indicating a more significant degree of mental distress. Within this cluster, 83.0% of individuals identify as female, 71.0% hold bachelor's degrees and 42.8% are nurses who have experienced the most substantial impact. Among these individuals, 90.4% did not have a history of smoking. Additionally, 59.7% are married, suggesting that these mental health issues may also affect their families. CONCLUSION: Given that the most critical subscale is related to anxiety/insomnia within the second cluster, it is necessary to implement management plans aimed at appropriately redistributing night shifts to improve employee health.

Comparison of epidemiologic features between upper and lower limb injuries and risk factors for intensive care unit admission in a university hospital affiliated with the National Trauma Registry of Iran.

PURPOSE: Upper extremity injuries (UEIs) and lower extremity injuries (LEIs) constitute a considerable component of traumas. However, their epidemiologic differences and short-term in-hospital outcomes are not fully elucidated. This study aims to compare such discrepancies in a large-scale study. METHODS: In this retrospective study, all patients with UEIs and/or LEIs hospitalized from 24th July 2016 to 16th May 2020 in Sina Hospital, Tehran, Iran, and registered at the National Trauma Registry of Iran were enrolled in the study. Relevant demographic and clinical characteristics were extracted from the National Trauma Registry of Iran database. Patients were grouped into either UEI or LEI. For those with concomitant UEIs and LEIs, the more severe one based on the abbreviated injury scale was defined as the principal diagnosis. In addition, cases with the abbreviated injury scale > 3 for both UEI and LEI or concomitant injuries to body areas other than the limbs were excluded. Independent samples t-test, Mann-Whitney U test, Chi-square test, quintile regression models, and logistic regression models with "margins" command were used for statistical analyses, as indicated. RESULTS: In this research, 3170 eligible cases were identified. For the LEI group, there was a much higher proportion of male patients (86.7% vs. 82.0%) and higher mean age (years, 42.9 vs. 35.3) compared to the UEI group (both p < 0.001). Patients with an injury severity score (ISS) of 9 - 15 were outnumbered in the LEI group (22.9% vs. 1.6%, p < 0.001), while the proportion of those with an ISS < 9 was higher in the UEI group (98.1% vs. 76.8%, p < 0.001). The multiple logistic regression model showed a statistically significant association between intensive care unit (ICU) admission and ISS (odds ratio (OR) = 4.01 for ISS 9 - 15 vs. ISS <9, 95% confidence interval (CI)|: 3.01 - 5.35; OR = 17.65 for ISS ≥16 vs. ISS < 9, 95% CI: 4.03 - 77.27), age (OR = 1.02, 95% CI: 1.01 - 1.03), cause of injury (OR = 0.27 for blunt trauma vs. road traffic crash, 95% CI: 0.08 - 0.90; OR = 0.49 for cut/stab injuries vs. road traffic crash, 95% CI: 0.28 - 0.84) and body region (OR = 1.65 for lower extremity, 95% CI: 1.19 - 2.29). Having adjusted for other covariates, the odds of ICU admission in patients with LEIs was 1.65 times the odds in patients with UEIs. CONCLUSIONS: Patients with LEIs were older and suffered from more severe injuries. In addition, the age- and ISS-adjusted ICU admission and length of hospital stay were significantly higher in LEI patients. The chance of ICU admission was associated with age, cause of injury, ISS, and body region. The findings of this study can aid in the meticulous selection of ICU-candidate patients. In addition, the role of factors other than ISS and age in ICU admission and prolongation of hospitalization should be addressed by prospective studies.

Road traffic injuries and associated mortality in the Islamic Republic of Iran.

Background: Road traffic accidents are a major public health problem globally, causing millions of injuries, deaths and disabilities, and a huge loss of financial resources, especially in low- and middle-income countries. Aim: To determine the incidence of road traffic injuries and associated mortality from 1997 to 2020 in the Islamic Republic of Iran. Methods: This retrospective study used data from the Legal Medicine Organization of the Islamic Republic of Iran to estimate the annual rates of road traffic injuries and associated mortality from 21 March 1997 to 20 March 2020. The data were analysed using STATA version 14 and the annual rates are reported per 100 000 population. Results: During the study period, 5 760 835 road traffic injuries and 472 193 deaths were recorded in the Islamic Republic of Iran. The mortality rate increased from 22.4 per 100 000 in 1997 to 40 per 100 000 in 2005 and decreased to 18.4 per 100 000 in 2020. The injury rate increased from 111.1 per 100 000 in 1997 to 394.9 per 100 000 in 2005. It decreased in 2006 and 2007 and increased from then until 2010, finally reaching 331.8 per 100 000 in 2020. The male to female ratio for road traffic mortality was 3.9 in 1997 and 4.6 in 2020. The case fatality rate was highest (20.1%) in 1997 and decreased to 5.6% in 2020. Conclusion: Continuous interventions are needed to reduce the burden of road traffic injuries and associated mortality in the Islamic Republic of Iran.

Post-discharge follow-up of patients with spine trauma in the National Spinal Cord Injury Registry of Iran during the COVID-19 pandemic: Challenges and lessons learned.

PURPOSE: The purpose of the National Spinal Cord Injury Registry of Iran (NSCIR-IR) is to create an infrastructure to assess the quality of care for spine trauma and in this study, we aim to investigate whether the NSCIR-IR successfully provides necessary post-discharge follow-up data for these patients. METHODS: An observational prospective study was conducted from April 11, 2021 to April 22, 2022 in 8 centers enrolled in NSCIR-IR, respectively Arak, Rasht, Urmia, Shahroud, Yazd, Kashan, Tabriz, and Tehran. Patients were classified into three groups based on their need for care resources, respectively: (1) non-spinal cord injury (SCI) patients without surgery (group 1), (2) non-SCI patients with surgery (group 2), and (3) SCI patients (group 3). The assessment tool was a self-designed questionnaire to evaluate the care quality in 3 phases: pre-hospital, in-hospital, and post-hospital. The data from the first 2 phases were collected through the registry. The post-hospital data were collected by conducting follow-up assessments. Telephone follow-ups were conducted for groups 1 and 2 (non-SCI patients), while group 3 (SCI patients) had a face-to-face visit. This study took place during the COVID-19 pandemic. Data on age and time interval from injury to follow-up were expressed as mean ± standard deviation (SD) and response rate and follow-up loss as a percentage. RESULTS: Altogether 1538 telephone follow-up records related to 1292 patients were registered in the NSCIR-IR. Of the total calls, 918 (71.05%) were related to successful follow-ups, but 38 cases died and thus were excluded from data analysis. In the end, post-hospital data from 880 patients alive were gathered. The success rate of follow-ups by telephone for groups 1 and 2 was 73.38% and 67.05% respectively, compared to 66.67% by face-to-face visits for group 3, which was very hard during the COVID-19 pandemic. The data completion rate after discharge ranged from 48% to 100%, 22%-100% and 29%-100% for groups 1 - 3. CONCLUSIONS: To improve patient accessibility, NSCIR-IR should take measures during data gathering to increase the accuracy of registered contact information. Regarding the loss to follow-ups of SCI patients, NSCIR-IR should find strategies for remote assessment or motivate them to participate in follow-ups through, for example, providing transportation facilities or financial support.

Pre-Hospital and Post-Hospital Quality of Care in Traumatic Spinal Column and Cord Injuries in Iran.

STUDY DESIGN: A retrospective study. OBJECTIVES: The quality of care (QoC) for spinal column/cord injury patients is a major health care concern. This study aimed to implement the QoC assessment tool (QoCAT) in the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to define the current state of pre- and post-hospital QoC of individuals with Traumatic Spinal Column and Spinal Cord Injuries (TSC/SCIs). METHODS: The QoCAT, previously developed by our team to measure the QoC in patients with TSC/SCIs, was implemented in the NSCIR-IR. The pre-hospital QoC was evaluated through a retrospective analysis of NSCIR-IR registry data. Telephone interviews and follow-ups of patients with SCI evaluated the QoC in the post-hospital phase. RESULTS: In the pre-hospital phase, cervical collars and immobilization were implemented in 46.4% and 48.5% of the cases, respectively. Transport time from the scene to the hospital was documented as <1 hour and <8 hours in 33.4% and 93.9% of the patients, respectively. Post-hospital indicators in patients with SCI revealed a first-year mortality rate of 12.5% (20/160), a high incidence of secondary complications, reduced access to electrical wheelchairs (4.2%) and modified cars (7.7%), and low employment rate (21.4%). CONCLUSION: These findings revealed a significant delay in transport time to the first care facilities, low use of immobilization equipment indicating low pre-hospital QoC. Further, the high incidence of secondary complications, low employment rate, and low access to electrical wheelchairs and modified cars indicate lower post-hospital QoC in patients with SCI. These findings imply the need for further planning to improve the QoC for patients with TSC/SCIs.

Comparing Predictive Utility of Head Computed Tomography Scan-Based Scoring Systems for Traumatic Brain Injury: A Retrospective Study.

This study compared the predictive utility of Marshall, Rotterdam, Stockholm, Helsinki, and NeuroImaging Radiological Interpretation System (NIRIS) scorings based on early non-contrast brain computed tomography (CT) scans in patients with traumatic brain injury (TBI). The area under a receiver operating characteristic curve (AUROC) was used to determine the predictive utility of scoring systems. Subgroup analyses were performed among patients with head AIS scores > 1. A total of 996 patients were included, of whom 786 (78.9%) were males. In-hospital mortality, ICU admission, neurosurgical intervention, and prolonged total hospital length of stay (THLOS) were recorded for 27 (2.7%), 207 (20.8%), 82 (8.2%), and 205 (20.6%) patients, respectively. For predicting in-hospital mortality, all scoring systems had AUROC point estimates above 0.9 and 0.75 among all included patients and patients with head AIS > 1, respectively, without any significant differences. The Marshall and NIRIS scoring systems had higher AUROCs for predicting ICU admission and neurosurgery than the other scoring systems. For predicting THLOS ≥ seven days, although the NIRIS and Marshall scoring systems seemed to have higher AUROC point estimates when all patients were analyzed, five scoring systems performed roughly the same in the head AIS > 1 subgroup.

Development of a comprehensive assessment tool to measure the quality of care for individuals with traumatic spinal cord injuries.

OBJECTIVE: To develop a comprehensive assessment tool to evaluate the Quality of Care (QoC) in managing individuals with traumatic spinal cord injuries (TSCI). METHOD: At first, the concepts of QoC for TSCI were identified by conducting a qualitative interview along with re-evaluation of the results of a published scoping review (conceptualization). After operationalization of indicators, they were valued by using the expert panel method. Afterward, the content validity index (CVI) and content validity ratio (CVR) were calculated and served as cut-offs for indicator selection. Then specific questions were developed for each indicator and classified into three categories: pre-hospital, in-hospital, and post-hospital. Data availability of the National Spinal Cord Injury Registry of Iran (NSCIR-IR) was subsequently used to design questions that represent indicators in an assessment tool format. The comprehensiveness of the tool was evaluated using a 4-item Likert scale by the expert panel. RESULT: Twelve experts participated in conceptualization and 11 experts participated in operationalization phase. Overall, 94 concepts for QoC were identified from published scoping review (87 items) and qualitative interviews (7 items). The process of operationalization and indicator selection led to the development of 27 indicators with acceptable content validity. Finally, the assessment tool contained three pre-hospital, twelve in-hospital, nine post-hospital, and three mixed indicators. Ninety-one percent of experts evaluated the entire tool as comprehensive. CONCLUSION: Our study presents a health-related QoC tool that contains a comprehensive set of indicators to assess the QoC for individuals with TSCI. However, this tool should be used in various situations to establish construct validity further.

Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries: A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR) data.

PURPOSE: To identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs). METHODS: Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015 - 2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI). RESULTS: Altogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR = 3.06, 95% CI: 1.55 - 6.03, p = 0.001), and number of days in the ICU (OR = 1.06, 95% CI: 1.04 - 1.09, p < 0.001) maintained significance. CONCLUSIONS: These data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.

Insurance status and traumatized patients' outcomes: a report from the national trauma registry of Iran.

BACKGROUND: Trauma care is one of the most expensive medical procedures that is significantly affected by factors like insurance status. Providing medical care to injured patients has a significant impact on patients' prognosis. This study examined whether insurance status was associated with different outcomes, including hospital length of stay (HLOS), mortality, and Intensive Care Unit (ICU) admission. METHODS: This prospective study analyzed the data of traumatized patients who had been registered in the National Trauma Registry of Iran (NTRI), and hospitalized at Sina Hospital, Tehran, Iran, from March 22, 2016, to February 8, 2021. Given the type of insurance, the insured patients were classified as basic, road traffic, and foreign nationality. The outcomes of in-hospital death, ICU admission, and HLOS between insured and uninsured patients, and then different insurance statuses, were compared using regression models. RESULT: A total of 5014 patients were included in the study. 49% of patients (n = 2458) had road traffic insurance, 35.2% (n = 1766) basic insurance, 10.5% (n = 528) were uninsured, and 5.2% (n = 262) had foreign nationality insurance. The mean age of patients with basic, road traffic insurance, foreign nationality, and uninsured patients was 45.2 (SD = 22.3), 37.8 (SD = 15.8), 27.8 (SD = 13.3), and 32.4 (SD = 11.9) years, respectively. There was a statistically significant association between insurance status and mean age. Based on these results, the mean age of patients with basic insurance was higher than other groups (p < 0.001). Additionally, 85.6% of the patients were male, with male to female ratio of 9.64 in road traffic insurance, 2.99 in basic insurance, 14.4 in foreign nationality, and 16 in uninsured patients. There was no statistically significant difference between in-hospital mortality in insured and uninsured patients, 98 (2.3%) vs. 12 (2.3%), respectively. The odds of in-hospital mortality in uninsured patients were 1.04 times the odds of in-hospital death in insured patients [Crude OR: 1.04, 95%CI: 0.58 to 1.90]. Multiple logistic regression showed that after adjusting for age, sex, ISS, and Cause of trauma, the odds of in-hospital death in uninsured patients were 2.97 times the odds of in-hospital death in insured patients [adjusted OR: 2.97, 95%CI: 1.43 to 6.21]. CONCLUSION: This study shows that having insurance can change the ICU admission, death, and HLOS in traumatized patients. The results of this study can provide essential data for national health policy for minimizing the disparities among different insurance statuses and proper use of medical resources.

Prediction of In-Hospital Outcomes in Patients with Traumatic Brain Injury Using Computed Tomographic Scoring Systems: A Comparison Between Marshall, Rotterdam, and Neuroimaging Radiological Interpretation Systems.

OBJECTIVE: This study aimed to compare the prognostic value of Marshall, Rotterdam, and Neuroimaging Radiological Interpretation Systems (NIRIS) in predicting the in-hospital outcomes of patients with traumatic brain injury. METHODS: We identified 250 patients with traumatic brain injury in a retrospective single-center cohort from 2019 to 2020. Computed tomography (CT) scans were reviewed by two radiologists and scored according to three CT scoring systems. One-month outcomes were evaluated, including hospitalization, intensive care unit admission, neurosurgical procedure, and mortality. Logistic regression analysis was performed to identify scoring systems and outcome relationships. The best cutoff value was calculated using the receiver operating characteristic curve model. RESULTS: Eighteen patients (7.2%) died in the 1-month follow-up. The mean age and Glasgow Coma Scale of survivors differed significantly from nonsurvivors. Subarachnoid hemorrhage and compressed/absent cisterns were dead patients' most frequent CT findings. All three scoring systems had good discrimination power in mortality prediction (area under the receiver operating characteristic curve of the Marshall, Rotterdam, and NIRIS was 0.78, 0.86, and 0.84, respectively). Regarding outcome, three systems directly correlated with unfavorable outcome prediction. CONCLUSIONS: The Marshall, Rotterdam, and NIRIS are good predictive models for mortality and outcome prediction, with slight superiority of the Rotterdam in mortality prediction and the Marshall in intensive care unit admission and neurosurgical procedures.

Comparing epidemiologic features, outcomes, and diagnostic and therapeutic procedures of traumatic patients before and during COVID-19 pandemic: Data from the National Trauma Registry of Iran.

PURPOSE: To prepare for future possible communicable disease epidemics/pandemics, health care providers should know how the COVID-19 pandemic influenced injured patients. This study aimed to compare epidemiologic features, outcomes, and diagnostic and therapeutic procedures of trauma patients admitted to a university-affiliated hospital before and during the pandemic. METHODS: This retrospective study was performed on data from the National Trauma Registry of Iran. All injured patients admitted to the hospital from July 25, 2016 to March 10, 2021 were included in the study. The patients were excluded if they had hospital length of stay less than 24 h. The injury outcomes, trauma mechanisms, and therapeutic and diagnostic procedures of the 2 periods: before (from July 25, 2016 to February 18, 2020) and during (from February 19, 2020 to March 10, 2021) COVID-19 pandemic were compared. All analyses were performed using STATA version 14.0 software (Stata Corporation, College Station, TX). RESULTS: Totally, 5014 patients were included in the registry. Of them, 773 (15.4%) were registered after the beginning of the COVID-19 pandemic on February 19, 2020, while 4241 were registered before that. Gender, education level, and cause of injury were significantly different among the patients before and after the beginning of the pandemic (p < 0.001). In the ≤ 15 years and ≥ 65 years age groups, injuries decreased significantly during the COVID-19 pandemic (p < 0.001). The frequency of intensive care unit (ICU) admission decreased from 694 (16.4%) to 88 (11.4%) (p < 0.001). The mean length of stay at the hospital (days) and at the ICU (days) declined as follow: 8.3 (SD = 17.2) vs. 5.5 (SD = 6.1), p < 0.001 and 7.5 (SD = 11.5) vs. 4.5 (SD = 6.3), p < 0.022. The frequency of diagnostic and therapeutic procedures before and during the pandemic was as follows, respectively: ultrasonography 905 (21.3%) vs. 417 (53.9%) (p < 0.001), echocardiography 313 (7.4%) vs. 107 (13.8%) (p < 0.001), angiography 1597 (37.7%) vs. 534 (69.1%) (p < 0.001), MRI 166 (3.9%) vs. 51 (6.6%) (p < 0.001), surgery 3407 (80.3%) vs. 654 (84.6%) (p < 0.001), and internal/external fixation 1215 (28.6%) vs. 336 (43.5%) (p < 0.001). CONCLUSION: The pandemic affected the epidemiology of traumatic patients in terms of gender, age, educational level, and trauma mechanism. It changed the outcomes of injured patients: ICU admission, length of stay at the hospital and ICU decreased. The patients received more diagnostic and therapeutic procedures during the pandemic. To be more precise, more research is needed on the details.

Epidemiologic and Clinical Characteristics of Intentional Injuries among Cases Admitted to Sina Hospital: Affiliated with the National Trauma Registry of Iran.

BACKGROUND: Intentional injuries, including self-harm, suicide, conflict, and interpersonal violence are a significant public health concern in Iran, but they have not been adequately documented. This study aimed to investigate intentional injuries in cases admitted to Sina Hospital in Tehran, Iran, affiliated with the National Trauma Registry of Iran. Study Design: A retrospective cohort study. METHODS: A registry-based study on the characteristics of 852 intentional injury cases was conducted from 2016 to 2023. Information on various aspects, including baseline characteristics, injury characteristics, and injury outcomes was compared between groups of self-harm/suicide, conflict/interpersonal violence, and others (abuse and legal prosecution). RESULTS: Of 6,692 registered trauma cases, 852 (12.7%) had intentional injuries. Men accounted for 92 (77.3%) self-harm/suicide and 650 (96.4%) conflict/interpersonal violence cases (P<0.001). Self-harm/ suicide mostly occurred at home in 89 (74.8%) cases, while 73 (10.8%) conflict/interpersonal violence cases happened at home (P<0.001). Falls were the cause of trauma in 12 (10.1%) self-harm/suicide cases compared to 7 (1.0%) conflict/interpersonal violence cases (P<0.001). Furthermore, blunt trauma was the cause of trauma in one (0.8%) case of self-harm/suicide and 66 (9.8%) conflict/interpersonal violence cases (P<0.001). Moreover, 14 (11.8%) self-harm/suicide and 34 (5.0%) conflict/interpersonal violence cases required ventilation (P=0.010). Additionally, 74 (8.7%) intentional injury cases had multiple traumas, which were seen in nine (7.6%) self-harm/suicide and 58 (8.6%) conflict/interpersonal violence cases (P<0.001). CONCLUSION: Men were the majority of self-harm/suicide and conflict/interpersonal violence cases. Self-harm/suicide incidents mostly occurred at home and resulted in more injuries from falls, while conflict/ interpersonal violence resulted in increased blunt traumas and multiple traumas.

Long-Term Outcomes of Laminectomy in Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis.

Objective Lumbar spinal stenosis (LSS) patients suffer from significant pain and disability. To assess long-term safety and efficacy of laminectomy in LSS patients, a systematic review and meta-analysis study was conducted. Methods Literature review in MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library databases was performed using a predefined search strategy. Articles were included if they met the following characteristics: human studies, LSS, and at least 5 years of follow-up. Outcome measures included patient satisfaction, pain, disability, claudication, reoperation rates, and complications. Results Twelve articles met the eligibility criteria for our study. Overall, there was low-quality evidence that patients undergoing laminectomy, with at least 5 years of follow-up, have significantly more satisfaction, and less pain and disability, compared with the preoperative baseline. Assessment of neurogenic intermittent claudication showed significant improvement in walking abilities. We also reviewed the postoperative complication and adverse events in the included studies. After meta-analysis was performed, the reoperation rate was found to be 14% (95% confidence interval: 13-16%). Conclusion Our study provides low-quality evidence suggesting that patients undergoing laminectomy for LSS have less disability and pain and can be more physically active postoperatively.