Kashan University of Medical SciencesArchives of Trauma Research2251-953X9420201001Development of the Iranian National road safety plan: Study protocol149153156314ENHomayoun Sadeghi-BazarganiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranAlireza RazzaghiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranMohammad Hossein SomiProfessor in Liver and Gastrointestinal Disease, Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, IranShahriar Behzad BasiratStrategic Crisis Management, Research Institute for Law Enforcement and Social Studies, NAJA, Tehran, IranReza Deljavan AnvariRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranLeila DoshmangirDepartment of Health Policy and Management, Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IranAlireza EsmaeiliHRM and Traffic Safety Department, Tehran University of Police, Tehran, IranSedighe Etemad SaeidCEO of IRIB Radio Salamat, Member of Health Policy Counsel of IRIB, Tehran, IranMina GolestaniRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranJavad HedayatiGeneral Manager of Strategic Studies of Road Maintenance and Transportation (RMTO) Studies Department, Tehran, IranEinollah JahaniAmin Police University, Tehran, IranHamidreza KhankehHealth in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IranAlireza Khavandi KhiaviDepartment of Civil Engineering, Faculty of Engineering, University of Zanjan, Zanjan, IranReza Masoudi FarSocial Deputy of the Judiciary, Islamic Republic of Iran, Tehran, IranIraj MohebbiSocial Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, IranPooria MohammadianTransport Office of Ministry of Interior and Secretary of High Council for Urban Traffic Coordination of Iran, Tehran, IranSaeid Pour-DoulatiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranMahdi RezaeiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranMohammad SaadatiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran0000-0003-3047-5624Vahideh SadeghiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranMehdi ShafieianDepartment of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, IranHamid SooriSafety Promotion and Injury Prevention Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, IranEbrahim VahabzadehMinistry of Roads and Transportation, Road Safety Commission, Tehran, IranJabbar Ali ZakeriCenter of Excellence for Railway Transportation, School of Railway Engineering, Iran University of Science and Technology, Tehran, IranJournal Article20220908<strong>Introduction:</strong> A national road safety strategic plan (NRSSP) is considered as one of the main road safety management issues in different countries. Such a plan not only determines the vision and relevant strategies but also causes the implementation of appropriate interventions to be coordinated and strengthened to achieve the goals set by partner organizations. The present study mainly aims to report Iran's NRSSP 2021–2031 development protocol. <strong>Methods:</strong> According to a schedule, the study protocol consists of ten sections: (1) Determining a core planning center, (2) Establishment of a steering committee, (3) Stakeholder identification, (4) Identification and development of Goals and Strategies, (5) Vision development, (6) Establishment of committees, (7) Integration of Goals and Strategies, (8) Goals and Strategies assessment, (9) Action plans development, (10) Monitoring and evaluation. An appropriate study method is performed for each of the concerned steps. <strong>Conclusion:</strong> The road safety strategy plan is a critical component to promote the effectiveness of activities and achieve the goals determined for road safety purposes. The Decade of Action for Road Safety is just being closed to its end; hence, reviewing and drawing up a road safety document concerning authentic scientific models and evidence is of paramount importance in Iran. The present study takes over the mission to address this gap.https://archtrauma.kaums.ac.ir/article_156314_0a138de2d931f14a8c52b99a313b6409.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X9420201001Injury pattern and outcome of assault victims: An emergency department perspective154159156315ENDarpanarayan HazraDepartment of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, IndiaAnkita Chowdary NekkantiDepartment of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, IndiaKundavaram Paul Prabhakar AbhilashDepartment of Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, IndiaJournal Article20220908<strong>Background:</strong> Violence-related injuries top the list as a cause of mortality in the 15–40 years' age group in India. In contrast to the West, the spectrum of assault injuries in Southeast Asian countries is different. Our main aim was to profile intentional injuries due to interpersonal violence treated in the emergency department (ED) and to describe the severity, pattern, etiology, and outcome in such patients. <strong>Materials and Methods:</strong> We conducted a case-series analysis of assault victims who presented to the ED of Christian Medical College and Hospital, Vellore, India, from January 2017 to December 2018. Data were retrieved electronically from the clinical workstation. Categorized variables were summarized using counts and percentages. Quantitative variables were summarized using mean and standard deviation (SD). <strong>Results:</strong> During the study period, a total of 381 patients with a mean age of 36.16 (SD: 13.9) years presented to the ED. Male (81.9%) predominance was noted among these victims. A majority of them, i.e., 257 (67%) victims, were assaulted by people that were known to them, of which 66 (17.3%) victims were reported as domestic violence. Blunt objects were used in most, i.e., 234 (61.4%) cases. A spike in the incidence of assault, in general, was noted in the month of September during the South Indian festival season. Approximately one-fourth (21.3%) of the victims required hospital admission. Overall, 15.74% of the victims had to undergo major surgical procedures. There were no mortalities recorded among these study participants. <strong>Conclusions:</strong> Violence and its consequences lead to severe injuries and levy a heavy burden on health care. There is an urgent need to address the social and emotional needs of adolescents and young adults who are most at risk of being the victims of assault.https://archtrauma.kaums.ac.ir/article_156315_e24f52827fcd35ffeba97d5b86285e05.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X9420201001The Diagnostic Value of Chest and Abdominopelvic Computed Tomography in Detecting Thoracolumbar Fractures among Patients with Blunt Trauma160165156317ENHamid Reza TalariTrauma Research Center, Kashan University of Medical Sciences, Kashan, IranNooshin MousaviTrauma Research Center, Kashan University of Medical Sciences, Kashan, IranMasoumeh Abedzadeh-KalahroudiTrauma Research Center, Kashan University of Medical Sciences, Kashan, IranHossein AkbariTrauma Research Center, Kashan University of Medical Sciences, Kashan, IranAbolfazl KargarTrauma Research Center, Kashan University of Medical Sciences, Kashan, IranJournal Article20220908<strong>Background:</strong> Thoracolumbar fracture (TLF) is one of the common problems associated with trauma. This study evaluated the diagnostic value of chest and abdominopelvic computed tomography (CT) in detecting TLFs among patients with blunt trauma. <strong>Methods:</strong> This prospective diagnostic assessment study was conducted during 2016-2017. Participants were 256 patients above 18 years with blunt multiple trauma who had undergone chest and abdominopelvic CT at their admission to the emergency department and were subjected to thoracolumbar CT (TL CT) for the further assessment of TLFs. The sensitivity, specificity, and positive and negative predictive values of chest and abdominopelvic CT were calculated based on TL CT findings. <strong>Results:</strong> The total sensitivity, specificity, and positive and negative predictive values of chest and abdominopelvic CT in detecting TLFs were 89.55%, 100%, 100%, and 89.71%, respectively. These values were, respectively, 95.56%, 100%, 100%, and 98.39% in detecting transverse process fractures; 50%, 100%, 100%, and 91.04% in detecting vertebral body fractures; and 80%, 100%, 100%, and 65.24% in detecting vertebral body and posterior element fractures. Chest and abdominopelvic CT sensitivity and specificity were, respectively, 97.5% and 100% among patients younger than 40 years and 77.4% and 100% among patients older than 40 years. There was a significant agreement between chest and abdominopelvic CT and TL CT findings (kappa coefficient = 0.896; <em>P</em> < 0.001). <strong>Conclusion:</strong> Chest and abdominopelvic CT has acceptable sensitivity and specificity in detecting TLFs. However, due to low sensitivity and specificity in detecting vertebral body fractures without posterior element involvement and clinical importance of these fractures, image reformatting is suggested. Of course, TL CT can be used in case of suspicious fractures or older patients.https://archtrauma.kaums.ac.ir/article_156317_5759f7906eb717a622ff9bacfc04be95.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X9420201001Translation, validity, and reliability of disability rating scale in Iranian patients with traumatic brain injury166172156319ENKamran EzzatiGuilan Road Trauma Research Center, PourSina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IranShahrokh Yousefzadeh-ChabokGuilan Road Trauma Research Center, PourSina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, IranSajjad RezaeiDepartment of Psychology, University of Guilan, Rasht, IranZoheir ReihanianGuilan Road Trauma Research Center, PourSina Hospital; Department of Neurosurgery, School of Medicine, Guilan University of Medical Sciences, Rasht, IranJournal Article20220908<strong>Background:</strong> The Disability Rating Scale (DRS) is a short, efficient, and rapid instrument for assessing levels of functional disability, but little information is available on the translation and psychometric properties of its Persian version, especially for traumatic brain injury (TBI) patients. The aim of this study was to translate and adapt the Persian version of DRS and to determine the psychometric properties of the Persian version of this scale in patients with TBI. <strong>Materials and Methods:</strong> In this analytical cross-sectional study, 191 TBI patients (age range, 16–86 years) referred to the physiotherapy Center of PourSina Hospital in Rasht, Iran, were selected through census sampling. First, the DRS was translated into Persian, and then, the validity, reliability, and repeatability of DRS scores were evaluated. All patients were evaluated on admission and at discharge through the Glasgow Coma Scale (GCS) and Functional Independence Measure (FIM). <strong>Results:</strong> According to the reports of the translators, translation of the DRS into Persian language was easy. The quality of translation (including translation clarity, common language usage, conceptual equivalence, and overall quality of translation) was generally favorable. Inter-raters' reliability on admission and at discharge stages was excellent (intraclass correlation coefficient = 0.93–0.94). Cronbach's alpha values for the internal consistency of DRS on admission and at discharge stages were 0.96 and 0.97, respectively. The results showed a strong inverse relationship of DRS scores on admission and at discharge with GCS and FIM scores (in all cases more than 0.70, <em>P</em> < 0.0001). <strong>Conclusion:</strong> The validity, reliability, and repeatability of the DRS scores for the Persian version were confirmed. These results reflect that DRS can be used to determine the effects of therapeutic/rehabilitation interventions on levels of functional disability in Iranian patients with TBI.https://archtrauma.kaums.ac.ir/article_156319_ef041846c2bbc4bd802e02dfafe17356.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X9420201001Investigating the possibility of using noninvasive basic monitoring in patients with acute burns undergoing general anesthesia173175156320ENAli Akbar JafarianDepartment of Anesthesiology and Pain, Iran University of Medical Sciences and Motahari Hospital, Tehran, IranAli FarhoodiDepartment of Plastic Surgery, Iran University of Medical Sciences and Motahari Hospital, Tehran, IranZahra JafarianFaculty of Dentist, Qom Medical University, Qom, IranAzadeh EmamiDepartment of Anesthesiology and Pain, Iran University of Medical Sciences and Motahari Hospital, Tehran, IranMohaddeseh JafarianFaculty of Biological Science, Tarbyat Modarres University, Tehran, IranReza SalehiDepartment of Anesthesiology and Pain, Iran University of Medical Sciences and Motahari Hospital, Tehran, IranJournal Article20220908<strong>Background:</strong> Basic noninvasive monitoring is considered as the standard procedure in patients with acute burns under general anesthesia. In such cases, noninvasive monitoring probes may often be ineffective on damaged skin due to the nature of burns pathology. Hence, the noninvasive monitoring is very challenging. Because of such limitations, we conducted this study to examine the practical difficulties or possibility of noninvasive monitoring utilization. <strong>Methods:</strong> Over the period of 2016–2017, 100 patients who were injured by acute burns with 20%–90% of TBS and undergoing general anesthesia at Motahari Burn Hospital were enrolled in this descriptive study. Basic monitoring techniques including noninvasive blood pressure (NIBP), cardiac monitoring, and pulse oximetry were applied throughout all surgeries as much as possible. <strong>Results:</strong> Evidence demonstrated that the application of NIBP monitoring in 23% of cases, cardiac monitoring in 63% of patients, and also even pulse oximetry in 7% of them were impossible. <strong>Conclusion:</strong> Limited usage of invasive monitoring due to vulnerability to sepsis leads to the noninvasive approach. Hence, technical innovations in noninvasive monitoring may help clinicians to monitor physiological indices, more safely.https://archtrauma.kaums.ac.ir/article_156320_ea3f0ec0bc803d2269b768e12041fec8.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X9420201001Delay in anesthesia assessment time – A cause of postponement in orthopedic trauma surgery176180157049ENMohammad ZareiJoint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, IranAlireza MoharramiJoint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, IranBabak HaghpanahDepartment of Orthopedic Surgery, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, IranJournal Article20220915<strong>Background:</strong> Postponement of surgery increases the length of hospitalization and medical expenses, the mortality rate, and the prevalence of major medical complications. There is a limited study about the role of anesthesia assessment in developing these complications. Thus, the aim of the present study was to examine the anesthesia assessment time for traumatic patients aged over 50 years and also to investigate the role of anesthesia service in surgery postponement. <strong>Materials and Methods:</strong> This descriptive retrospective study was performed on 110 patients with traumatic injuries referred to Imam Khomeini Hospital Complex (Tehran, Iran) from March to September 2017. The information was extracted retrospectively from the hospital information system. The standard definitions in the International Classification of Diseases 10 code S00-T88 were used to identify traumatic injuries and fractures. <strong>Results:</strong> The results of the present study showed that the mean of anesthesia assessment time was significantly different in terms of the type of trauma, and femoral fractures had a higher anesthesia assessment time (<em>P</em> = 0.009). Furthermore, the anesthesia assessment time in patients who underwent echocardiography was significantly higher than those with no echocardiography (<em>P</em> < 0.05). The current study explored that the mean anesthesia assessment time was substantially higher in patients who underwent myocardial perfusion imaging (MPI) (7.1 vs. 1.84 days). Furthermore, the results revealed that there was no significant difference in anesthesia assessment time regarding gender of the patients (3 vs. 2.7 days). Finally, patients aged between 61 and 70 years had a higher anesthesia assessment time with a mean of 4.41 days (<em>P</em> < 0.05). <strong>Conclusions:</strong> The study concluded that the mean of anesthesia assessment time was significantly higher (3.6 days) in patients with a femoral fracture. Furthermore, this study has shown that diagnostic assessments, including echocardiography, MPI, and angiography, which were performed in some patients, did not change the surgery plan.https://archtrauma.kaums.ac.ir/article_157049_ac78b94d7a799bd59a6b32873edf8701.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X9420201001Preparation, characterization, and antibacterial studies of N, O-carboxymethyl chitosan as a wound dressing for bedsore application181188157050ENAtiyeh RaisiDepartment of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, IranAzadeh AsefnejadDepartment of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, IranMaryam ShahaliDepartment of Quality Control, Research and Production Complex, Pasteur Institute of Iran, Tehran, IranZeinab Alsadat Sadat KazerouniDepartment of Mechanical Engineering, Khomeinishahr Branch, Islamic Azad University, Isfahan, Tehran, IranAmin KolooshaniDepartment of Mechanical Engineering, Khomeinishahr Branch, Islamic Azad University, Isfahan, Tehran, IranSaeed Saber-SamandariNew Technologies Research Center, Amirkabir University of Technology, Tehran, IranBahareh Kamyab MoghadasDepartment of Chemical Engineering, Shiraz Branch, Islamic Azad University, Shiraz, IranAmirsalar KhandanNew Technologies Research Center, Amirkabir University of Technology, Tehran, Iran0000-0001-8878-5233Journal Article20220915<strong>Background:</strong> A study conducted on wound treatment by antibacterial wound dressings can reduce the need for using antibiotics to a minimum amount. These wound dressings can create a moist environment at the wound surface to speed the healing process up. In recent years, researchers have paid much attention to polymeric wound dressings. Chitosan can help heal the wounds because of its similar structure to glycosaminoglycans in the skin. In this regard, the aim of the present study was to fabricate and characterize a novel biolayer wound dressing based on the carboxymethyl chitosan polymer with ceramic nanoparticles as a reinforcement and antibacterial agent using the freeze-drying method. <strong>Methods:</strong> In this study, to make a flexible wound dressing from a biocompatible and biodegradable polymer, N-O-carboxymethyl chitosan, diopside was added to improve the mechanical and hydrophobic properties of the soft tissue and cell proliferation was fabricated. After making the samples, a variety of chemical and biological tests and analyses were performed on the samples, including scanning electron microscope and Fourier-transform infrared spectroscopy. <strong>Results:</strong> The results showed that the use of this wound dress significantly reduced the risk of infection at the wound site. <strong>Conclusions:</strong> An antibacterial product with the proper mechanical behavior as a soft tissue was produced and evaluated in this study. The chemical and biological investigation represented that the sample with 5 wt% magnetite nanoparticles has excellent characteristics and can be introduced as a wound dressing application.https://archtrauma.kaums.ac.ir/article_157050_8b83b44ce91e2176f446c79f8fb7b5e6.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X9420201001Explaining gender differences in transfer time to a trauma center in Northern Iran189196157051ENEnayatollah Homaie RadSocial Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, IranMohammad HajizadehSchool of Health Administration, Faculty of Health, Dalhousie University, Halifax, CanadaSatar RezaeiResearch Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, IranLeila Kouchakinejad-EramsadatiGuilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IranHamid HeydariGuilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, IranNaema Khodadadi-HassankiadehGuilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran0000-0002-2789-6770Journal Article20220915<strong>Background:</strong> The association between gender and time of receiving services (TRS) after traumatic injuries is rarely documented in developing countries. This study aimed to examine gender differences in time between occurring injuries and receiving services in hospital after trauma injuries in northern Iran. <strong>Materials and Methods:</strong> A total of 7085 injured patients were included in this study. Data on sociodemographic and clinical characteristics were extracted from the Guilan province trauma system registry (GTSR) from July 2017 to July 2018. The Oaxaca–Blinder (OB) method was used to explain the gender differences in the TRS after traumatic injuries. <strong>Results:</strong> There were significant differences between men and women in marital statues (<em>P</em> < 0.001), education level (<em>P</em> < 0.001), time of injury (<em>P</em> = 0.025), occupation (<em>P</em> < 0.001), type of trauma (<em>P</em> < 0.001), mode of transfer (<em>P</em> < 0.001), mean age (<em>P</em> < 0.001), average distance from hospital (<em>P</em> = 0.052), and average transfer time to the hospital (<em>P</em> < 0.001). We found gender differences in TRS after falling trauma (<em>P</em> = 0.006) when the transfer was performed by emergency medical services (EMSs) and in penetrating trauma (<em>P</em> < 0.001) when the transfer was performed by private vehicles. The difference in the observed characteristics of men and women explained 67% of gender differences in TRS (<em>P</em> = 0.06). <strong>Conclusion:</strong> The gender difference in the transfer of injured patients was in favor of men, depending on the socio-demographic and clinical factors. In OB analysis, the gender differences in falling trauma and transfer by EMS and the gender differences in penetrating trauma and private transmission to the hospital were also confirmed. Steps need to be taken to ensure that services are equally beneficial to both men and women.https://archtrauma.kaums.ac.ir/article_157051_04c27dcc82e292c73fb4af56d840d5fb.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X9420201001Otitic barotrauma causing facial baroparesis197199157052ENSantosh Kumar SwainDepartment of Otorhinolaryngology, IMS and SUM Hospital, Siksha “O” Anusandhan University (Deemed to be), Bhubaneswar, Odisha, India0000-0001-7933-4414Sampada MunjalDepartment of Otorhinolaryngology, IMS and SUM Hospital, Siksha “O” Anusandhan University (Deemed to be), Bhubaneswar, Odisha, IndiaJournal Article20220915Facial baroparesis is an extremely rare clinical entity which occurs due to otitic barotraumas. It is rarely reported in medical literature which can happen among persons those ascend to high altitude in flight or scuba diving. The overpressure in the middle ear cavity due to eustachian dysfunction may cause exertion of the excessive pressure over the facial nerve through a dehiscence of the horizontal segment of the fallopian canal leading to facial nerve paralysis. The clinical history and imaging help to diagnose this rare cause of facial nerve paralysis. Here, we report a case of a 38-year-old female who experiences unilateral facial nerve paralysis on ascent to high altitude on a flight, with relieve from symptoms shortly after descent.https://archtrauma.kaums.ac.ir/article_157052_c54b672b8ce77aa8bb6a8547a85be4b8.pdfKashan University of Medical SciencesArchives of Trauma Research2251-953X9420201001Dislocation of the first carpometacarpal joint200202157053ENGolnaz Latifian EsfahaniDepartment of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranTahere GhasemiDepartment of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranBehrang Rezvani KakhkiDepartment of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran0000-0003-3715-6618Sayyed Majid SadrzadehDepartment of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranElnaz Vafadar MoradiDepartment of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20220915First carpometacarpal (CMC1) joint dislocations are uncommon injuries. However, they can limit hand functions and lead to serious complications. Herein, we report the case of a multiple trauma man with dorsal dislocation of thumb CMC joint that was successfully treated with closed reduction and casting. The patient was a 47-year-old male with multiple traumas complaining of right wrist pain. Tenderness, deformity, and reduced range of motion of the right thumb CMC joint were observed. X-ray showed dorsal dislocation of the CMC1 joint. Closed reduction of the dislocated joint was performed under general anesthesia, and the joint was immobilized by a thumb-spica cast for 14 days. The patient was eventually discharged in good condition and had no complications or manual dysfunction after a 1-month follow-up. The optimal management of the CMC1 joint dislocations is controversial. The closed reduction seems adequate for these injuries. However, patients whose joints remain unstable after closed reduction, especially those with manual activities, should be considered for open reduction and surgical ligament repair.https://archtrauma.kaums.ac.ir/article_157053_5e324bb0bc56f47a4a844c84a37a01ee.pdf