Background: Injuries are the second greatest cause of mortality in Iran. Information about the epidemiological pattern of injuries is effective in decision-making. In this regard, the aim of the current study is to elaborate on the epidemiology of injuries in Iran through a systematic review. Methods: Required data were collected searching the following key words and their Persian equivalents; trauma, injury, accident, epidemiology, prevalence, Pattern, etiology, risk factors and Iran. The following databases were searched: Google Scholar, PubMed, Scopus, MagIran, Iranian scientific information database (SID) and Iran Medex. Some of the relevant journals and web sites were searched manually. The lists of references from the selected articles were also investigated. We have also searched the gray literature and consulted some experts. Results: Out of 2747 retrieved articles, 25 articles were finally included in the review. A total of 3234481 cases have been investigated. Mean (SD) age among these cases was 30 (17.4) years. Males comprised 75.7% of all the patients. Only 31.1% of patients were transferred to hospital by ambulance. The most common mechanism of injuries was road traffic accidents (50.1%), followed by falls (22.3%). In road traffic accidents, motorcyclists have accounted for the majority of victims (45%). Roads were the most common accident scene for the injuries (57.5%). The most common injuries were to the head and neck. (47.3%). The mean (SD) Injury Severity Score (ISS) was 8.1(8.6%). The overall case-fatality proportion was 3.8% and 75% of all the mortalities related to road traffic accidents. Conclusions: The main priorities in reducing the burden of injuries include: the young, male target group, improving pre-hospital and ambulance services, preventing road traffic accidents, improving road safety and the safety of motorcyclists (compulsory helmet use, safer vehicles, dedicated motorcycle lanes).

Injury epidemiology in Iran: a systematic review.

PURPOSE: Trauma is an inevitable part of the health burden in every country. Both the preventive and rehabilitative aspects of traumatic injuries are expensive. Since most of the injuries happen in low- and middle-income developing countries, a judicious allocation of the limited resources to the most costefficient strategies is necessary. The present study was designed to report the causes of trauma, injured body regions, trauma severity scores and the one year survival rate of a randomly selected sample of trauma patients in a major referral hospital in Tehran, Iran. METHODS: We chose and analyzed a random subgroup of traumatic patients admitted during the oneyear period of May 2012 to May 2013 to Shariati Hospital, a major University Teaching Hospital in Tehran, Iran. Patients who stayed at the hospital for less than 24 h were excluded. In total, 73 traumatic patients were registered. The mean age was (40.19 ±20.34) years and 67.1% of them were male. RESULTS: In general, the most common cause of injury was falls (47.9%), followed by road traffic crashes (RTCs, 40.8%). Assault and exposure to inanimate mechanical forces each were only associated with 5.6% of all injuries. The only cause of injury in ages of more than 65 years was fall. The most common cause of injury in ages between 15 and 45 years was RTCs. During the study, two deaths occurred: one was at ICU and the other was at home. The most commonly injured body region was the head (23.8%), followed by the elbow and forearm (19%), hip and thigh (15.9%), and multiple body regions (14.3%). The mean abbreviated injury score was 2.23±1.02; injury severity index was 7.26±7.06; and revised trauma score was 7.84, calculated for 38 patients. CONCLUSION: Prevention strategy of traumatic injury should focus on falls and RTCs, which are respectively the most common cause of trauma in older aged people and young males. Language: en

Epidemiology and short-term mortality in traumatic patients admitted to Shariati Hospital in Iran between 2012 and 2013

Greece currently has no national trauma registry. The primary aim of this study was to identify all the trauma registries that have been established in Greece and assess the methodology used in these registries. The secondary aim was investigation, through review of the registries, of the demographics, mechanisms of injury, severity of injuries, and mortality of Greek trauma patients. We performed a systematic review of published trauma registry literature from Greece, according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We assessed the methodology of the registries, based on the reported physical and human resources, administration strategies, processes of data collection, and analysis. SPSS was used for the synthesis of the quantitative data extracted from the registries (demographics, mechanisms of injury, injury severity score [ISS], mortality). The initial search retrieved 1,732 abstracts, after screening of which, 81 full-text articles were scrutinized for their suitability for inclusion. Finally, 14 papers from 6 registries, including a total 159,763 patients, were deemed eligible. Each registry used different inclusion criteria. Half of the publications (7/14) were derived from registries that received funding. Regarding the analysis included in the studies, epidemiological analysis was the most common (12/14), followed by comparisons (internal or external) (6/14). Quality improvement analysis was not presented in any publication. The mean age of the patients was 41±7.3 years, and 63.17% were males. Road traffic accidents (RTAs) were the most common mechanism of injury (38.19%), followed by falls (36.1%). The registries used a variety of different ISS thresholds for considering a trauma patient severely injured; the mean ISS threshold used was 12±5. The mean ISS of the entire population was 8.4±4.4 and the average mortality was 3.85%. RTAs and falls are responsible for a significant proportion of the Greek trauma burden. The small number of publications of the data from the registries and the complete absence of quality control studies indicate that trauma auditing in Greece is still in an embryonic state. There is a pressing need for national consensus on how to record and investigate trauma.

Measuring the Impact of Trauma in Greece: A Systematic Review of Greek Trauma Registries. Is Quality Improvement Achievable?

Background At present there is no organized trauma system in Greece and no national trauma database. The objective of this study was to record and evaluate trauma management at our university hospital and to measure the associated healthcare costs, while laying the foundations for a national database and the organization of regional trauma networks. Methods Retrospective study of trauma patients (n=2320) between 2014 and 2015, through our single-center registry. Demographic information, injury patterns, hospital transfer, investigations, interventions, duration of hospitalization, Injury Severity Score (ISS), outcomes, complications and cost were recorded. Results Road traffic collisions (RTC) accounted for 23.2% of traumas. The proportion of patients who were transferred to the hospital by the National Emergency Medical Services decreased throughout the study (n2015=76/1192 (6.38%), n2014=109/1128 (9.7%)) (p 15 and their mortality was 31.6%. The overall non-salary cost for trauma management was €623 140. 53% of these costs were attributed to RTCs. The cost resulting from the observed overtriage ranged from €121 000 to €315 000. Patients who did not meet the US trauma triage algorithm criteria accounted for 10.5% of total expenses. Discussion Our results suggest that RTCs pose a significant financial burden. The prehospital triage of trauma patients is ineffective. A reduction of costs could have been achieved if prehospital triage was more effective. Level of evidence Level IV.

https://tsaco.bmj.com/content/tsaco/5/1/e000401.full.pdf

Evaluating trauma care, outcomes and costs in a system in crisis: the necessity of a Greek National Trauma Database.

Background: Accidents are the second leading cause of death following cardiovascular disease in all age groups. Falls account for 40% of deaths worldwide. Objectives: This study aimed to investigate epidemiologically the victims of falls during a 6-year period by reviewing the medical records of the patients referring to Shahid Rajaee Hospital, Shiraz, Iran. Methods: This cross-sectional study was conducted by reviewing the medical records of 12,133 patients admitted to the accident department of Shahid Rajaee hospital from 2009 to 2014. Demographic and other important data, such as age, gender, marital status, the severity of injuries, and survival or death, were collected. Then, the data were analyzed using chi-square test and logistic regression analysis. Results: Medical records of 12133 fall victims were investigated. The mean age of the patients was 44.87 ± 20.91 years. The results of the multiple-regression model showed a significant relationship between death rate and age, injury severity, length of hospital stay, and injured body region in the fall victim (P < 0.05). The multiple-regression model also indicated a significant relationship between fall-related death and gender, injury severity, the injured body region, and the length of hospital stay (P < 0.05). Conclusions: The highest mortality rate was observed among fall patients aged over 55 years with a high Injury Severity Score (ISS). Therefore, appropriate strategies should be taken for these patients in order to reduce mortality

http://www.traumamon.com/article_100137_7cdf1a8a128cd7db2af6e05e1b7c132d.pdf

Accidents in Fall Victims

OBJECTIVE: The present study was designed to describe the patterns of trauma patients using a newly-introduced trauma registry, as well as retrospectively assess the management and outcome facts of these patients. MATERIALS AND METHODS: The study included 2346 patients (62.15% male) with a mean age of 34.06 +/- 23.77 years. Of these patients, 355 were multiple trauma patients. Privately owned vehicles were used as a mode of transportation for most of the trauma patients (96.65%). Data regarding patient demographics, arrival at the Emergency Department, mechanism of injury, injury severity, anatomical location and type of injury were collected and analyzed. RESULTS: Falls were the most prevalent mechanism of injury, accounting for 62.19% of the total admitted cases, with other causes (that also included occupational accidents and machinery trauma) being the second most prevalent, and MVAs--the third with a rate of 11.46%. The most commonly injured body regions were the extremities (50.26%), the head (42.50%), and the torso (19.39%). Fractures represented 11.46% of the injuries, while open wounds were much more frequent (29.41%). The mean abbreviated injury severity (AIS) score was 1.78 +/- 1.48 for all admitted patients and 3.56 +/- 1.02 for multiple trauma patients. A multi-disciplinary approach was required for 23% of the multiple trauma patients. The clinic admission rate for the whole patient sample was 13.55% and 48.96% for multiple trauma patients. The mean duration of stay for all clinic admissions was 2.7 days and 2.9 days for multiple trauma patients. CONCLUSIONS: With the epidemiology of trauma in Greece being rather poorly investigated, the present study manages to identify the major epidemiological patterns of trauma cases presenting to a tertiary regional hospital and addresses the need for development and implementation of injury prevention activities and policies. Language: en

Nicolaos D. Liratzopoulos

Papers

The Structure of Trauma Patients, its Management and Health Care in the University Hospital of Alexandroupolis