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Trauma care system in Iran

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Chinese Journal of Traumatology 2011年第3期14卷 131-136页

作者： Moussa Zargar Seyed mohammad reza Kalantar Motamedi Mojgan Karbakhsh Seyed mohammad Ghodsi vafa rahimi-movaghar Farzad Panahi soheil saadat Ali Khaji Seyed Mahdi Davachi Sarah Ganji Mahmoud Khodabandeh Shahab Abdollahi Far Morteza Abdollahi mohammad reza zarei Sina Trauma & Surgery research Center Tehran Uni-versity of Medical Sciences Tehran Iran Shahid Beheshti University of Medical Sciences Tehran Iran Community Medicine Department and Sina Trauma research Center Tehran University of Medical Sciences Tehran Iran Baghiatallah University of Medical Sciences TehranIran Emergency Medical Services Organization Iran

Objective： The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function. Methods： The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers. results： Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure （regarding staff, maintenance, financial resources）, it is not yet established in our system of trauma care. Conclusions： It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.

关键词： Emergency medical services Trauma centers Wounds and injuries

Establishment of a regional multicenter traumatic spine fracture/dislocation registry

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Chinese Journal of Traumatology 2014年第4期17卷 235-238页

作者： vafa rahimi-movaghar soheil saadat Saba Jafarpour Department of Neurosurgery Shariati Hospital Tehran University of Medical Sciences Tehran Iran Sina Trauma and Surgery research Center Tehran University of Medical Sciences Tehran Iran Sina Trauma and Surgery research Center Tehran University of Medical Sciences Tehran Iran

Objective：Trauma is one of the leading causes of mortality and morbidity in adults and a major contributor to health care *** spine-related injuries constitute a small proportion of trauma cases,they need special consideration due to poor functional outcomes and substantial *** relatively extensive previous studies on traumatic spinal injuries,there is still obscurity in some aspects of the *** purpose of this study is to establish a regional multicenter traumatic spine fracture/dislocation ***：This is a prospective case series study,including all patients with acute traumatic spine lesions admitted to a regional multicenter since *** is extracted based upon a form developed by Sina Trauma and Surgery research Center,Tehran University of Medical Sciences,Tehran,*** electronic data entry software is initiated and data will be entered to the *** remains confidential and security considerations will be taken based on standards of data entry ***：The results of this study will include age and gender distribution of the patients,causes of injury,location of pain and neurological deficit,the American Spinal Injury Association score and Frankel grade on admission,at discharge,after 6 and 12 months and at the latest annual follow-up,radiologic findings,details of operative procedures and methods of external ***：This study will identify prognostic factors that influence the ultimate fate of spine fracture patients and determine short and long-term outcome of different treatment *** can lead to a considerable improvement in patient care and will have a great national and transnational impact.

关键词： Spinal fractures registries Spinal injuries Prospective studies

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

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Chinese Journal of Traumatology 2015年第5期18卷 275-278页

作者： Sima Sheikhghomi vafa rahimi-movaghar Saba Jafarpour soheil saadat Iron University of Medical Sdences Tehran 11365-3876 Iran Sina Trauma and Surgery research Center Tehran University of Medical Sciences Tehran 11365-3876 lran Department of Neurology Boston Children's Hospital Harvard Medical School 1 Autumn St Boston MA 02115 United States

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 cost- efficient 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 one- year 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 6Z1% 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 respec- tively the most common cause of trauma in older aged people and young males.

关键词： Accidents Traffic Epidemiology Iran Body regions Complications

Effect of mild head injury on intelligence in Zahedan, Iran

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Chinese Journal of Traumatology 2010年第6期13卷 345-348页

作者： mohammad Hadi Shorooei Mahdi Sharif-Alhoseini soheil saadat Arya Sheikh-Mozaffari vafa rahimi-movaghar Khatam-ol-Anbia Hospital Zahedan University of Medical Sciences Zahedan Iran Sina Trauma and Surgery research Center Sina Hospital Tehran University of Medical Sciences Tehran11365-3876 Iran

Objective： To investigate the effects of mild head injury （HI） on the victims＇ intelligence by measuring their intelligence quotient （IQ）.Methods： This cohort study was performed in Khatamol-Anbia Hospital, Zahedan, Iran and the IQs of 30 mild HI patients were measured right after the injury （IQ0） and six months later （IQ6）. The IQs of 90 close relatives of the patients were also measured at the same period of time as the non-exposure group. The IQs were measured with Wechsler adult intelligence scale-revised （WAIS-r）. The IQ0, IQ6 and their differences （IQ change） were compared in HI patients and their relatives using the Student＇s t ***： The mean IQ0 of the HI patients was similar to their relatives. The IQ6 of HI patients appeared to be less than those of their relatives. Moreover, the IQ6 of the HI patients appeared to be less than their initial scores. HI was associated with more decrease in IQ6 compared with IQ0and the female subjects showed more decrease in IQ6 compared with their ***： HI seems to be associated with decrease in IQ six months after the injury and it is more evident in female HI patients.

关键词： Intelligence tests Head injuries, closed Wechsler scales Glasgow coma scale

Situation analysis of trauma based on Arizona trauma center standards in university hospitals of Tehran, Iran

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Chinese Journal of Traumatology 2009年第5期12卷 -页

作者： Mahdi Sharif-Alhoseini Aliashraf Eghbali vafa rahimi-movaghar soheil saadat Sina Trauma and Surgery research Center Sina Hospital Tehran University of Medical Sciences Tehran 11365-3876 Iran

Objective: Injuries are common and important problem in Tehran, capital of Iran. Although therapeutic centers are not essentially established following the constructional principles of developed countries, the present opportunities and equipments have to be used properly. We should recognize and reduce the deficits based on the global *** study deliberates the trauma resources and capacities in university hospitals of Tehran based on Arizona trauma center standards, which are suitable for the assessment of trauma ***: Forty-one university hospitals in Tehran were evaluated for their conformity with "Arizona trauma center standards" in 2008. A structured interview was arranged with the "Educational Supervisor" of all hospitals regarding their institutional organization, departments, clini-cal capabilities, clinical qualifications, facilities and resources, rehabilitation services, performance improvement, continuing education, prevention, research and additional requirements for pediatric trauma patients. relative frequencies and percentages were calculated and Student's t test was used to compare the mean ***: Forty-one hospitals had the average of 77.7 (50.7%) standards from 153 Arizona trauma center standards and these standards were present in 97.5 out of 153 (63.7%) in 17 general hospitals. Based on the subgroups of the standards, 64.8% items of hospital resources and capabilities were considered as a subgroup with the maximum criteria, and 17.7% items of research section as another subgroup with the minimum ***: On the basis of our findings, no hospital meet all the Arizona trauma center standards completely. The hospitals as trauma centers at different levels must be promoted to manage trauma patients desirably.

关键词： Trauma centers Hospitals Iran Arizona reference standards

Blunt Traumatic Cervical Spine Fractures in Iran

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Surgical Science 2011年第8期2卷 407-413页

作者： soheil saadat Aliashraf Eghbali Alexander r. Vaccaro Mahdi Sharif-Alhoseini vafa rahimi-movaghar 不详

Background: Blunt traumatic cervical spine fractures (TCSF) are serious injuries which may be associated with considerable mortality and morbidity. We describe the epidemiology of blunt traumatic cervical spine fracture in Iran over a definable time period. Methods: In a cross-sectional study, the data including the distribution of TCSF, demographics, mechanisms, abbreviated injury scale (AIS), spinal cord associated injuries and final outcome of patients, was extracted from the Iranian national trauma registry database in target hospitals in eight major cities of Iran from 1999 to 2004. The Chi square test was used to compare mortality and one-way ANOVA was used to compare ISS amongst the categories of TCSF. results: TCSF was identified in 120 cases, of these 70.8% were male. Their mean age was 36.6 ± 17.2 years. The overall incidence of TCSF among all trauma patients was 0.7% (95%CI: 0.61% - 0.88%). The TCSF incidence among all spine fractured patients was 19.38% (95%CI: 16.34% - 22.72%). The most common mechanism of TCSF was a motor vehicle collision (66.7%). The overall percentage of in-hospital death for TCSF was 12.6%. There were no statistically significant difference in death and injury severity scores (ISS) among TCSF categories (p > 0.05). Spinal cord and root injuries occurred in 34.9% and 2.4% of TCSF, respectively. Conclusions: Preventive strategies need to be developed in order to reduce the number and severity of TCSF in the general Iranian population.

关键词： Cervical Spine Fractures Iran Motor Vehicle Crash Trauma

Assessment of mechanism, type and severity of injury in multiple trauma patients： A cross sectional study of a trauma center in Iran

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Chinese Journal of Traumatology 2017年第2期20卷 75-80页

作者： Hamidreza reihani Hossein Pirazghandi Ehsan Bolvardi mohsen Ebrahimi Elham Pishbin Koorosh Ahmadi Mahdi Safdarian soheil saadat vafa rahimi-movaghar Emergency Medicine Department Imam Reza Hospital Mashhad University of Medical Sciences Mashhad Iran Emergency Medicine Department Shahid Beheshti Hospital Sabzevar University of Medical Sciences Sabzevar Iran Department of Emergency Medicine Alborz University of Medical Sciences Karaj Iran Sina Trauma and Surgery research Center Tehran University of Medical Sciences Tehran Iran

Purpose： To accurately assess the mechanism, type and severity of injury in Iranian multiple trauma patients of a trauma center. Methods： Patients with multiple traumas referring to the emergency department of Hasheminejad University Hospital in Mashhad, lran, entered this cross sectional study from March 2013 to December 2013. All the patients with injury severity score （ISS）〉 9 were included in this study. Data analysis was performed by SPSS software （Version 11.5） and P values less than 0.05 were considered as significant differences. results： Among the 6306 hospitalized trauma patients during this period, 148 had ISS〉9. The male fe- male ratio was 80%. The mean age of the patients was （33.5 m 19.3） years. And 71% of the patients were younger than 44 years old. There were 19 （13%） deaths from which 68.5% were older than 44 years old. The mean transfer time from the injury scene to hospital was （55 e 26） minutes. The most frequent mechanisms of injury were motorcycle crashes and falling from height, which together included 66.2% of all the injuries. A total of 84% of hospital deaths occurred after the first 24 h of hospitalization. Head and neck were the most common body injured areas with a prevalence of 111 cases （75%）. Conclusion： Motorcycle crashes have high frequency in lran. Since most victims are young males, injury prevention strategies should be considered to reduce the burden of injuries.

关键词： Accidents trafficInjury severity scoreWounds and injuriesIran

Strengthening Injury Surveillance System in Iran

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Chinese Journal of Traumatology 2011年第6期14卷 348-353页

作者： Seyed Abbas Motevalian Mashyaneh Haddadi Hesam Akbari reza Khorramirouz soheil saadat Arash Tehrani vafa rahimi-movaghar School of Public Health Tehran University of Medical Sciences Tehran 11365-3876 Iran （Motevalian SA and Tehrani A） Injury Prevention and Safety Promotion Department Disaster and Emergency management Center Ministry of Health and Medical Education Tehran 11365-3876 Iran Student Scientific research Center （SSrC） Tehran University of Medical Sciences Tehran 11365-3876 Iran Sina Trauma and Surgery research Center Sina Hospital Tehran University of Medical Sciences Tehran 11365-3876 Iran

Objective： To strengthen the current Injury Surveillance System （IS System） in order to better monitor injury conditions, improve protection ways and promote safety. Methods： At first we carried out a study to evaluate the frameworks of IS System in the developed countries. Then all the available documents from World Health Organization, Eastern Mediterranean regional Organization, as well as Minister of Health and Medical Education concerning Iran were reviewed. Later a national stakeholder＇s consultation was held to collect opinions and views. A national workshop was also intended for provincial representatives from 41 universities to identify the barriers and limitations of the existing program and further to strengthen injury surveillance. results： The evaluation of the current IS System revealed many problems, mainly presented as lack of accurate pre- and post-hospital death registry, need of precise injury data registry in outpatient medical centers, incomplete injury data registry in hospitals and lack of accuracy in definition of variables in injury registry. The five main characteristics of current IS System including flexibility, acceptability, simplicity, usefulness and timeliness were evaluated as moderate by experts.Conclusions： Major revisions must be considered in the current IS System in Iran. The following elements should be added to the questionnaire： identifier, manner of arrival to the hospital, situation of the injured patient, consumption of alcohol and opioids, other involved participants in the accident, intention, severity and site of injury, side effects of surgery and medication, as well as one month follow-up results. Data should be collected from 10% of all hospitals in Iran and analyzed every 3 months. Simultaneously data should be online to be retrieved by researches.

关键词： Wounds and injuries Population surveillance registries Iran

reliability of a patient survey assessing ＂Short Form Injury Questionnaire 7＂ in Iran

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Chinese Journal of Traumatology 2012年第3期15卷 145-147页

作者： Mahdi Sharif-Alhoseini soheil saadat Afarin rahimi-movaghar Abbas Motevalian Masoumeh Amin-Esmaeili Mitra Hefazi vafa rahimi-movaghar Sina Trauma and Surgery research Center Tehran University of Medical Sciences Tehran 11365-3876 Iran Iranian research Center for HIV/AIDS(IrCHA) Tehran University of Medical Sciences Tehran 11365-3876 Iran School of Public Health Tehran University of Medical Sciences Tehran 11365-3876 Iran

Objective： Injury is a major cause of morbidity and mortality in the world. The assessment of patterns and severity of injury in high-risk groups is crucial for planning and service development. On a large scale na- tional household survey, we estimated the annual incidence and the patterns of injury, the demographics of the injured people, as well as the service use for all injuries in Iran. The current study aims at assessing the reliability of the ques- tionnaire before carrying out a national survey. Methods： In a pilot study using cluster random sam- pling approach, 73 people were interviewed. The interview- ers asked the participants to report all injuries occurred in them and the care provided during the previous 12 months, based on ＂Short Form Injury Questionnaire 7＂. About two weeks later, the interview was repeated by another interviewer. results： In our test-retest reliability, Kappa score was good for three and moderate for four questions. The ques- tion on the injured organ had the highest test-retest reliabil- ity with a Kappa score of 0.84. Conclusions： The reliability of the questionnaire and the procedure of questioning are confirmed. The ques- tionnire is proper for utilization in large national surveies.

关键词： Injury severity score reproducibility of results Iran