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Background: Trauma is the sixth cause of death worldwide and the fifth main cause of significant disability and carries a great economic and social burden.Objective: This study was carried out to investigate the epidemiological and clinical characteristics of trauma and to assess the correlation between the cause of trauma and its severity in different body areas.Methods: Patients with all kinds of injuries referred to the Emergency Department (ED) of Al-Zahra University Hospital in Isfahan, Iran, who met the inclusion criteria, were recruited to this study from September 2019 to January 2023.Results: Among the 869 trauma patients admitted to the hospital during this period, 444 (51.1%) were married. There was a statistically significant difference in the pattern of trauma between males and females (P = 0.003). There was also a significant relationship between the average age of people and different causes of injury (P 3, according to our findings. These research endeavors will aid in devising improved methods to prevent occurrences and enhance healthcare approaches. To prevent and manage traumatic injuries, a multi-sectoral approach and collaboration between different stakeholders is needed.

Introduction: Head injuries (HI) pose a significant public health concern globally, impacting morbidity, mortality, and economic burden. This study aimed to evaluate the epidemiology and trends associated with head injuries in Iran from 1990 to 2019. Methods: Our study, based on data from the Global Burden of Diseases (GBD) Study 2019, undertook a comprehensive comparison of the burden of HI in Iran with the Middle East and North Africa (MENA) and global benchmarks. We assessed the incidence, prevalence, and years lived with disability (YLD) through various metrics, including absolute numbers, age-standardized rates (ASR), percentage changes, and estimated annual percentage changes (EAPC) from 1990 to 2019. Results: The incidence of HI in Iran decreased significantly from 1990 to 2019, with a notable reduction compared to MENA and global trends (EAPC: -1.44, 0.71, and -0.11, respectively). Prevalence showed a declining trend (EAPC: -1.00), with a slight increase in YLDs (EAPC: 0.12). Notable peaks in HI incidence coincided with natural disasters, notably the 1990 Manjil-Rudbar earthquake and the 2003 Bam earthquake. Conclusion: Our study reveals a decline in the overall burden of HI in Iran over the study period. To sustain this positive trend and minimize the impact of HI on public health and socioeconomic well-being, policy efforts should be directed toward ongoing prevention, early detection, and preparedness for natural disasters.

Abstract Background Injury is one of the leading causes of death worldwide, and the abdomen is the most common area of trauma after the head and extremities. Abdominal injury is often divided into two categories: blunt and penetrating injuries. This study aims to determine the epidemiological and clinical characteristics of these two types of abdominal injuries in patients registered with the National Trauma Registry of Iran (NTRI). Methods This multicenter cross-sectional study was conducted with data from the NTRI from July 24, 2016, to May 21, 2023. All abdominal trauma patients defined by the International Classification of Diseases; 10th Revision (ICD-10) codes were enrolled in this study. The inclusion criteria were one of the following: hospital length of stay (LOS) of more than 24 h, fatal injuries, and trauma patients transferred from the ICU of other hospitals. Results Among 532 patients with abdominal injuries, 420 (78.9%) had a blunt injury, and 435 (81.7%) of the victims were men. The most injured organs in blunt trauma were the spleen, with 200 (47.6%) and the liver, with 171 (40.7%) cases, respectively. Also, the colon and small intestine, with 42 (37.5%) cases, had the highest number of injuries in penetrating injuries. Blood was transfused in 103 (23.5%) of blunt injured victims and 17 (15.2%) of penetrating traumas (p = 0.03). ICU admission was significantly varied between the two groups, with 266 (63.6%) patients in the blunt group and 47 (42%) in penetrating (p

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 3 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% – 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.

Abstract 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.

Background: According to the reports, the road traffic injuries (RTI) mortality rate in Iran as a middle-income country in the Eastern Mediterranean Region (EMR) decreased in past decades but is higher than the global level and remained a health problem.Objectives: This study aimed to report the characteristics of registered patients injured by different trauma mechanisms in Yazd City, Iran.Methods: In this study, the patients were registered from September 28, 2016, to December 31, 2022, at Shahid Rahnamoon Hospital, affiliated with the National Trauma Registry of Iran (NTRI) for its first phase. Inclusion criteria were hospital length of stay (LOS) of more than 24 hours, death due to injury in the hospital, or transfer from other hospitals' intensive care units (ICU). Age, gender, Glasgow Coma Scale (GCS), systolic blood pressure (SBP), cause of injury, LOS, injury severity score (ISS), and in-hospital mortality were assessed.Results: Among 3960 participants, 2307 (58.2%) patients were injured due to RTI as the most common cause of injury. Also, 949 (23.9%) and 359 (9.1%) of the participants experienced fall and stab/cut injuries, respectively. Men were affected more than women in all injury causes (p

Summary: Background: Globally, fall-related injuries are a substantial problem, and 80% of fatal falls occur in low-income and middle-income countries. We aimed to measure time from injury to hip-fracture surgery in people aged 50 years or older living in low-income and middle-income regions, as well as to measure the proportion of patients with surgical stabilisation of their hip fracture within 72 h of admission to hospital and to identify risk factors associated with surgical delay. Methods: For this secondary analysis, we analysed data collected from Africa, Latin America, China, India, and Asia (excluding China and India) for the International Orthopaedic Multicentre Study in Fracture Care (INORMUS) between March 29, 2014, and June 15, 2022. Patients from INORMUS were included in this analysis if they were aged 50 years or older and had an isolated, primary hip fracture sustained from a ground-level fall. Staff at participating hospitals identified patients with musculoskeletal injury and referred them for assessment of eligibility. We report time from injury to surgery as three distinct time periods: time from injury to hospital admission, time from admission to surgery, and a total time from injury to surgery. Date and time of injury were self-reported by patients at the time of study recruitment. If time to hospital admission after injury exceeded 24 h, patients reported the primary reason for delayed admission. Reasons for surgery, no surgery, and surgical delay were reported by the treating team. For patients undergoing surgery, multivariable regression analyses were used to identify risk factors for surgical delay. Findings: 4486 adults aged 50 years or older with an isolated, primary hip fracture were enrolled in INORMUS from 55 hospitals in 24 countries. Countries were grouped into five regions: Africa (418 [9·3%] of 4486), Latin America (558 [12·4%]), China (1680 [37·4%]), India (1059 [23·6%]) and Asia (excluding China and India; 771 [17·2%]). Of 4486 patients, 3805 (84·8%) received surgery. The rate of surgery was similar in all regions except in Africa, where only 193 (46·3%) of 418 patients had surgery. Overall, 2791 (62·2%) of 4486 patients were admitted to hospital within 24 h of injury. However, 1019 (22·7%) of 4486 patients had delayed hospital admission of 72 h or more from injury. The two most common reasons for delayed admission of more than 24 h were transfer from another hospital (522 [36·2%] of 1441) and delayed care-seeking because patients thought the injury would heal on its own (480 [33·3%]). Once admitted to hospital, 1451 (38·1%) of 3805 patients who received surgery did so within 72 h (median 4·0 days [IQR 1·7–6·0]). Regional variation was seen in the proportion of patients receiving surgery within 72 h of hospital admission (92 [17·9%] of 514 in Latin America, 53 [27·5%] of 193 in Africa, 454 [30·9%] of 1471 in China, 318 [44·4%] of 716 in Asia [excluding China and India], and 534 [58·6%] of 911 in India). Of all 3805 patients who received operative treatment, 2353 (61·8%) waited 72 h or more from hospital admission. From time of injury, the proportion of patients who were surgically stabilised within 72 h was 889 (23·4%) of 3805 (50 [9·7%] of 517 in Latin America, 31 [16·1%] of 193 in Africa, 277 [18·8%] of 1471 in China, 189 [26·4%] of 716 in Asia [excluding China and India], and 342 [37·5%] of 911 in India). Interpretation: Access to surgery within 72 h of hospital admission was poor, with factors that affected time to surgery varying by region. Data are necessary to understand existing pathways of hip-fracture care to inform the local development of quality-improvement initiatives. Funding: The National Health and Medical Research Council of Australia, the Canadian Institutes of Health Research, McMaster Surgical Associates, Hamilton Health Sciences, and the US National Institutes of Health.

Abstract 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.

Background: Road traffic accidents (RTAs) are the leading cause of death for children and young adults aged 5 to 39 and the third-leading cause of death in Iran.Objectives: The aim of this study was to assess in-hospital costs of patients following RTAs and identify associated factors among the patients admitted to Sina Hospital, a collaborating hospital with the National Trauma Registry of Iran (NTRI).Methods: A hospital-based registry study was conducted between September 17, 2016, and April 30, 2022, involving 3245 patients affected by RTAs. Data collection utilized the NTRI minimum dataset. To assess the factors influencing in-hospital costs of RTAs, various statistical analyses were performed, including independent sample t-tests, one-way ANOVA, and multiple linear regression analysis.Results: The distribution of studied subjects based on sex, age, and road user group revealed that the majority were male (91%), within the working age range of 21-60 years (78.2%), and motorcyclists (55.2%). The mean in-hospital cost per patient following RTAs was 152.3 million Iranian Rial (IRR) ($609.35). In the multiple linear regression analysis, several factors were significantly associated with higher in-hospital costs (ps

Background: The registry systems are a tool to provide information which can be used for improvement of medical care and preventive policies over time. The efficacy of trauma registries in improving the quality of care depends on the quality of their data. Objectives: This study aimed to determine the completeness, reliability, validity, and patient coverage of the Sina Hospital Trauma Registry (SHTR). Methods: The data collected in the SHTR by May 28, 2021, were used to assess the data completeness. A random sample of 250 patients was re-registered to evaluate the reliability and validity. The intraclass correlation coefficient (ICC) and the kappa and weighted kappa statistics were used to assess the reliability of data and agreement. The coverage was determined by comparing the list of trauma patients obtained from the trauma registry and the one from the hospital information system. Results: The overall average completeness for all variables was 97.9%. The inter-rater agreement on important variables including Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), and final outcomes was, respectively, perfect (kappa= 0.90) optimal (ICC = 0.72), and substantial (kappa= 0.71). The patient coverage was 79.6%. Conclusion: The results confirm that the data quality and patient coverage were high. In addition, although the reliability of most variables was acceptable, the agreement between NTRI’s data and the medical record for AIS codes and ISS was moderate.

Background: There are many debates on socioeconomic indicators influencing trauma outcomes.Objectives: This study aimed to determine the association between education as a socioeconomic indicator and trauma outcomes.Methods: This descriptive-analytical study was conducted on 30,448 trauma patients during 2016-2021. The data were based on the minimum dataset of the National Trauma Registry of Iran (NTRI) from six different trauma centers in various cities of the country. The variables used in this study included age, education level, marital status, cause of injury, Glasgow Coma Scale (GCS), intensive care unit (ICU) admission, Injury Severity Score (ISS), and in-hospital mortality. Logistic regression was used to investigate the association between independent variables and trauma outcomes.Results: The study included 30,448 trauma patients with male predominance (75.8%). The mean age was 36.9 years. The most frequent education level was secondary education, with 14,228 (46.6%). Education levels had significant relationships with ISS, death, and ICU admission (P

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

Abstract 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

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

Surgeons played a vital role in the Iraq-Iran War by healing injured soldiers and reducing the rate of death. The purpose of this study was to describe their lived experiences and social impact during the war. This qualitative study was conducted from May 2018-June 2019 and surgeons who participated in the Iraq-Iran War were invited. Semi-structured in-depth interviews were used to collect the data from 28 participants. Four main themes emerged from the data: 1- Military role was important in providing essential facilities and safe zones for personnel and soldiers at the warfront. 2- It was critical to reinforce the infrastructure for immediate medical assistance. 3- Disaster training for medical personnel was vital for triage, treatment, education and research planning. 4- Spiritual and religious beliefs. Disaster planning and training for physicians by drills is essential to meet the challenges of unexpected events and operative readiness requires drill training on a quarterly or semi-annual basis.

Background and Objectives: Trauma is a prominent reason for morbidity and death in Iran. The objective of this study was to provide epidemiological and clinical features of the injured patients admitted to one of the collaborating centers of the national trauma registry of Iran (NTRI). Materials and Methods: The study was carried out at the one NTRI center from March 25, 2017, to November 20, 2020. Patients who had the NTRI criteria were included in the study. Data comprised demographics, injury information, prehospital and in-hospital information, procedures, International Classification of Diseases 10 codes, diagnoses, injury severity, and outcomes. Results: Overall, 4043 trauma patients were included in the trauma. Of whom, 3036 (75.0%) were men. There was a statistically significant association between the cause of trauma and the severity of the injury. The post hoc test results demonstrated that the percentage of the injury severity score (ISS) ≥9 in patients with falls was higher than in patients with road traffic injuries (RTI) (26.9% vs. 16.8%, P = 0.01). The univariable and multiple logistic regression analyses showed statistically significant associations between age ≥65, cause of trauma, years of school, and ISS ≥9 with intensive care units (ICU) admission. After adjusting for age and cause of trauma, the odds of ICU admission in patients with ISS ≥9 were 6.23 times more than in patients with ISS

Background and Objectives: Traumatic brain injury (TBI) is a catastrophic condition that exerts a high burden on individuals, families, and societies. The objective of this study was to systematically review the human studies on the efficacy and safety of citicoline for the management of TBIs. Materials and Methods: Relevant articles were identified by searching PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials on July 1, 2022. Results: Eighteen studies met the predefined eligibility criteria, including 12 randomized controlled trials (RCTs). Citicoline was administered via injectional (n = 11, 61.1%), enteral (n = 5, 27.8%), both injectional and enteral (n = 1, 5.5%), and unknown (n = 1, 5.5%) routes. Numerically, studies reporting the favorable impact of citicoline on patient outcome outnumbered (n = 13, 72.2%). However, the largest RCT could not demonstrate positive results. Only two studies reported complications, and the observed difference between citicoline and placebo groups was not statistically significant in either of them. Conclusion: Despite promising results in animal studies, human studies have shown inconsistent results regarding the role of citicoline in TBI management. Homogeneity of patients, subgroups of patients who might benefit more, the efficacy of citicoline as a part of combination therapies, and factors that could potentially influence the pharmacokinetics and brain uptake of citicoline should be considered when designing future studies.

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.

Purpose: Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries. Methods: The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset. Results: The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p

Background and Objectives: Injuries in countries like Iran are one of the leading causes of death. This study aims to determine gender differences in trauma outcomes and predictors of in-hospital mortality after trauma. Methods: The data of four trauma centers were extracted from the National Trauma Registry of Iran databank between 2016 and 2020. The univariable and multiple logistic regression models analyzed gender differences in trauma outcomes and postinjury predictors of in-hospital mortalities. Results: Among 17,530 patients, the most common cause of injury in both genders was road traffic injury (40%). Regarding in-hospital mortality after trauma, although there was a significant gender-based difference between some centers, no overall gender difference was seen (0.9% vs. 1.0% P = 0.26). The odds of in-hospital mortality for patients over 65 years old was 10.45 times more than that for patients under 15 years old. Furthermore, the odds of in-hospital mortality for patients admitted to intensive care units (ICU) was 6.22 times as high as that for patients who were not admitted to ICUs. Intubation status had a significant association with in-hospital mortality after adjustment for covariates. The odds of in-hospital mortality for patients with an injury severity score (ISS) ≥16 was 2.57 times higher than that for patients with ISS 1–8. Conclusions: Although males had a survival privilege over females following trauma in some centers, there was no overall association between gender and in-hospital mortality. Moreover, older age, ISS, ICU admission, and intubation were predictors of in-hospital mortality for trauma.

Abstract Background Determination of the prevalence and distribution pattern of intestinal parasites is a fundamental step to set up an effective control program to improve the health status. This study aimed to determine the prevalence of intestinal parasitic infections and associated risk factors among inhabitants of Rudbar-e Jonub county, southeast of Kerman province, southeastern Iran. Methods In this cross-sectional study, 861 stool specimens were collected from inhabitants of Rudbar-e Jonub county through a multistage cluster sampling method in 2018. The collected specimens were examined by parasitological methods including, direct wet-mounting (for the fresh specimens with a watery consistency), formalin-ethyl acetate sedimentation and agar plate culture. Results The prevalence of intestinal parasites was 34.2% (95% CI 30.1 to 38.2). The prevalence of protozoan parasites 32.3% (95% CI 28.4 to 36.5) was significantly higher than helminthic parasites 3.2% (95% CI 2.1 to 4.7). Blastocystis sp. (13.3%), Entamoeba coli (11.4%) and Giardia lamblia (10.6%) as protozoan parasite and Hymenolepis nana (2.4%) as helminthic parasite were the most common detected intestinal parasites in the study. Entamoeba histolytica/dispar (1.5%), Iodamoeba bütschlii (1.0%), Chilomastix mesnili (0.5%), Entamoeba hartmanni (0.4%), Enterobius vermicularis (0.3%) and Ascaris lambercoides (0.3%) were other detected parasites. Multiple logistic regression revealed a significant association of intestinal parasitic infections with source of drinking water and residency status (rural/urban). Multiple infections with 2 or 3 parasitic agents constituted 22.7% of 295 infected cases. Conclusions This study revealed a high prevalence of intestinal protozoan infections among inhabitants of Rudbar-e Jonub county. Intestinal parasites especially protozoans remain a challenging public health problem wherever sanitation and health measures are limited in Iran.

Objective: To investigate the epidemiological aspects of all-cause injuries in Hamadan province during a 6-year period.Methods: We conducted a cross-sectional study on injured subjects admitted to private or governmental hospitals in Hamadan province during March 2009 to March 2015. The epidemiological characteristics were retrieved from a registry-based system including gender, residency, injury mechanism and date of injury occurrence, outcome of hospitalization (full recovery/disability/death).Results: Totally, 135,925 hospitalized injured cases were recorded. The majority of cases were male (72.6%) and were occurred in urban areas (60%), about 40% of patients were in 20-34 years’ age group, and the highest proportion (30.13%) of injuries occurred in summer. Logistic regression showed that the odds of disability vs. recovery was significantly higher in rural areas [Adjusted odds ratio (AOR) =3.42] and the odds of death vs. recovery was higher among male gender (AOR=1.46). In addition, comparing to the 0-4-year age-group, odds of death were significantly higher in middle aged and elderly victims. Conclusion: Our findings showed that middle age groups, male gender and urban area increase the odds of death. Injured males and old age subjects had the highest odds of death and out of residential area injuries were common cause of leading death injuries.

Background: Tuberculosis (TB) treatment success rate remains a public health challenge in many developed and developing countries. The correlation between the incidence and pattern of TB and the Human Development Index (HDI) has not been globally determined. This study aimed to determine the correlation between incidence and pattern of TB treatment success rates and HDI around the world. Methods: In this global perspective, we used data on incidence and treatment success rates of TB and HDI from the World Health Organisation (WHO) and World Bank, respectively. Results: The highest estimated incidence and lower treatment success rates of TB were restricted to countries with low HDIs. Life expectancy, education level, gross national income, HDI, and urbanisation were significantly associated with both TB incidence and treatment success rates. Conclusion: Patterns in TB incidence and treatment success rates are correlated with Human Development Indices. In addition to following WHO strategies, policy makers need to focus on the social and environmental determinants in order to reduce the TB burden, particularly in low income countries.

Background: Health literacy is a major factor for health promotion and well-being. In spite of several researches on health literacy, information on the subject of the status of health literacy in Asian countries such as Iran is inadequate. Therefore, this study aimed to assess the inequality of health literacy in an Iranian population and its influencing factors. Methods: In this cross-sectional study, 736 families were selected by cluster random sampling. A validated questionnaire was used to measure the health literacy of participants. Socioeconomic status (SES) was calculated by asset-based approach, and principal component analysis (PCA) was performed to estimate the families' SES. Concentration index and curve were used to measure SES inequality in health literacy, and after that decomposed into its determinants. The data were analyzed by Stata software. Results: The mean age of the participants was 34.81 years (standard deviation = 5.98 years). The value of concentration index for health literacy equals 0.2292 (95% confidence interval = 0.168–0.283), and this value indicates that there is inequality in distribution of health literacy in Iran and the inequality disfavors the poor. Conclusions: The results of this study revealed that there is inequality in distribution of health literacy in Iran, and people of higher economic status in Iran enjoy from better health literacy levels.

[This corrects the article DOI: 10.1371/journal.pone.0158031.].

BACKGROUND:Asymptomatic bacteriuria (ASB) is defined as the presence of bacteria in urine without having signs and symptoms. The aim of this meta-analysis was to estimate the overall prevalence of asymptomatic bacteriuria among Iranian pregnant women. METHODS:Major national and international databases were searched up to November 2015, including Scientific Information Database, MagIran, Web of Science, Medline, Scopus, Science Direct and Ovid. The checklist of the STROBE statement was used for evaluating the quality of reporting. The extracted data were analyzed and the results were reported using a random-effects model with 95% confidence interval (CI). RESULTS:From 3709 obtained studies, 20 included in the meta-analysis, which involved 15108 pregnant women. The overall prevalence of ASB was 0.13 (95% CI: 0.09, 0.17). The prevalence of ASB in the northern and southern regions of Iran was 0.13 (95% CI: 0.09, 0.18) and 0.11 (95% CI: 0.05, 0.16), respectively. CONCLUSION:Prevalence of ASB among Iranian pregnant women is considerable. Due to the complications of ASB for pregnant women and their children, preventative planning and control of ASB among pregnant women in Iran is necessary.