Background and Objectives: Head injury is an increasing consequence of different kinds of trauma. It may result in release of substances such as glial fibrillary acidic protein (GFAP) within the cerebrospinal fluid or in serum, which can be used for the measurement of severity of damage. The aim of this study was to assess the predictive value of GFAP in prediction of trauma severity in head-injured patients. Methods: In this cross-sectional study, 98 patients with head injury admitted to Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS) enrolled in this study during 2020-2021. The GFAP serum level, the Extended Glasgow Coma Outcome Score (EGOS), Glasgow Coma Scale (GCS), and Rotterdam computed tomography score were assessed and then analyzed by SPSS V20. Results: The mean of GCS at the time of admission and discharge and EGOS and Rotterdam scores at a 3-month follow-up all were within a mild range. In addition, on the base of EGOS, all of the patients had recovered to a good state 3 months after their injury. Statistical analysis revealed a meaningful correlation between GFAP and GCS and EGOS (P < 0.05). GFAP with sensitivity of 80.8%, specificity of 65.3%, and area under the curve of 0.804 has appropriate strength for prediction of severity of head injury. Conclusions: The sensitivity and specificity of GFAP revealed acceptable strength for prediction of severity of head injury, even when confounding factors are considered. The mean of EGOS and GCS and Rotterdam score were all within the range of mild injury. However, further detailed and multicenter studies are recommended for better clarification of the role of GFAP as a biomarker of traumatic brain injury.

Background and Objectives: Workers of the steel industry are exposed to many hazardous risks of nonfatal injuries and diseases considering the structure of their working environment. The aim of this study was to evaluate and identify the risks associated with the furnace in one of the north of Isfahan (Iran) Steel Complexes. Methods: The data were gathered through meeting sessions, observation, and documents surveys and were documented in failure modes and effects analysis (FMEA) worksheets. In this way, the weight of each failure was considered of risk priority number. Data surveys were documented in FMEA worksheets. Results: The results showed that explosion hazards and gas leaks were among the most dangerous hazards with the highest number of risks, respectively. After identifying the control measures and applying them, the percentage of identified risks is 77% at the acceptable level, 22.2% at the acceptable level under the condition of control, and 0% at the unacceptable level. Hazards found in workplaces were greater in the steel industries and iron industries. Conclusions: It can be concluded that education and training regarding related risk factors, providing personal protective equipment, and development of programs that can ensure safety in industries may lessen and prevent hazards associated with working place.

Background: Studies have found that several individual and organizational factors influence the occurrence of accidents. Researchers have also highlighted the need for the development of new accident models. The main aim of this study was to assess the contributing causes of occupational accidents using a questionnaire. Methods: A total of 365 managers and employees participated in the current study from 9 manufacturing companies located in the northwest of Iran. A questionnaire comprising 100 accident causes was used to gather the required data for this study. Results: Exploratory factor analysis (EFA) yielded 14 factors contributing to accidents, and confirmatory factor analysis found satisfactory fit indices for the EFA model. The participants reported unsafe acts as the most important factor for the occurrence of accidents. A t-test revealed that participants who received safety training experienced fewer occupational accidents than other respondents. The one-way analysis of variance showed that the companies significantly differed in the perception of accident causes. Structural equation modeling indicated that organizational-managerial factors had a larger effect on individual factors than external factors. Conclusion: The results indicate that providing safety training is necessary to control the employees' unsafe acts. Managers of the companies should pay special attention to the organizational factors affecting the occurrence of accidents. The findings of this study might help the managers to develop more targeted countermeasures for reducing occupational accidents.

Background and Objectives: Given the importance and prevalence of trauma patients in the emergency department and the questioning of urinalysis value in predicting intra-abdominal injury, this study was conducted to examine the accuracy of various types of this test. Methods: This diagnostic accuracy study was conducted on adult patients with abdominal trauma. Data gathering were performed retrospectively until sample size completion using a preprepared checklist. Required data, including demographic characteristics, diseases confounding urinalysis, trauma mechanism, important associated injuries, vital signs, etc., were recorded. Accuracy of urinalysis (including macroscopic, microscopic and dipstick) results was compared with findings of patients' enhanced computed tomography (CT) scan findings that was considered as the gold standard, reported by a radiologist. Results: Totally, 152 multiple trauma patients with the mean age of 37.9 ± 17.7 years were enrolled (90.8% males), of whom 66 (43.42%) patients had hematuria and the CT scan was abnormal in 30 (19.73%) cases. There was a significant correlation between gross hematuria and abnormal CT scan (P 0.05). Based on the findings, the highest sensitivity was for dipstick and microscopic equally and highest specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios, NLR and accuracy were for the gross test. Conclusions: Microscopic hematuria and dipstick had no significant correlation with abnormal CT scan findings and cannot predict the intra-abdominal injuries in multiple trauma patients. But, macroscopic hematuria could be valuable in this regard.

Background and Objectives: Various treatment methods have been used to manage tibia fracture, including conservative and surgical treatment. Various studies investigated the effects of functional brace on fracture of tibia. This review was aimed to summarize the evidence on the effectiveness of functional brace on tibia fracture. Methods: An electronic search was carried out through internationally published scholarly articles in EBSCO, Medline, PubMed, Embase, and ISI Web of Knowledge (from 1950 to 2020) with the following keywords: tibia fracture, healing, conservative treatment, functional orthosis, brace, and patellar tendon-bearing orthosis. The quality of the papers was assessed using the Down and Black tool. Results: On the basis of the keywords, 50 articles were found, of which 11 articles were selected in accordance with the selection criteria. Most of studies support the use of orthosis for tibial fracture. The scores of reporting, external validity, internal validity (bias), and internal validity (confounding) varied between 2–7, 1–2, 1–5, and 2–4, respectively. Conclusions: One of the most important treatment methods for tibia fracture is use of functional brace. Based on the results of the available literature, use of functional brace is a good approach for stable tibia fracture. Some parameters, such as the condition of surrounding muscles, initial shortening, angulations of tibia, and intact of fibula, play significant roles in this regard.

Background and Objectives: The trauma is a major reason for various disabilities and even death around the world. Prompt actions and appropriate management are needed to minimize the level of injuries and mortality. An effective tool is needed to assess the prognosis of the patient in trauma. The objective of the study was to compare the evaluation of RTS and injury severity score (ISS) as a prognosis predictor among trauma patients. Methodology: A cross-sectional clinical observational study was conducted in the emergency department. A total of 88 samples were selected by random sampling technique. The data collection was done using demographic and clinical tools, Glasgow Coma Scale, Revised Trauma Score (RTS), and ISS. Data analysis was performed using SPSS 18. Results: In the present study, the majority of the participants (79.54%) were male. The most common mode of injury among the patients was road traffic accidents (54.54%) with blunt trauma. The findings revealed a negative correlation (‒0.368) between RTS and ISS scores with significant P = 0.0004. RTS (<10) and ISS (≥20) have significant association with mortality and hospital stay. The sensitivities of ISS and RTS with mortality were 84.2% and 89.4%, respectively. Conclusion: RTS is a comparatively better predictor of prognosis than ISS among trauma patients. Lower RTS and higher ISS are significantly associated with mortality and long hospital stay. Early evaluation of the injury level can be effective in patient management.

Background: 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. Methods: 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. Results: 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; P

Background: Warfare is an immense destruction of human life and infrastructure. Wide-scale trauma is a gigantic problem, and the latest war trends are toward targeting more civilians. Injuries in war are multifactorial depending mostly on arms engaged. The objective of this study was to examine the characteristics of extremity injuries in the Iran–Iraq war. The important principle is recognizing injury types, mechanism of trauma, and factors influencing complications in extremity injuries of war. Methods: In this retrospective study, we reviewed documents of 8437 patients who were transported and treated in Imam Khomeini Hospital, Tehran, during 8-year Iran–Iraq war from 1980 to 1988. 7352 patients with physical injuries were selected as a sample. Data collection form included type, mechanism, and location of the injury, associated lesions, and the treatment given. Data were analyzed by descriptive statistics (frequency and mean) using SPSS software. Results: Medical archive review identified 8437 patients, 7352 sustaining physical trauma and 4926 among them had 6601 extremity injuries. Mean age of the patients sustaining extremity injury was 23 years. 74% (4885) of the injuries were caused by shrapnel fragments, 12% (792) were caused by bullets and rest 14% were due to various other causes. There were 53.9% (3561/6601) fractures among the total injuries, most commonly involving femur (19.9%). Fracture fixation with 66.3% (1394/2103) was the most common type of orthopedic treatment provided. In addition, 20.6% (1359/6601) injuries were related to arterial lesions and 32% (2112/6601) were accompanied with nerve damage. Conclusion: Extremity injury is a major trauma in war zones and leads to high rate of morbidity; however, if appropriate care and timely assistance are provided, it has low risk of death. Understanding type, frequency, and mechanism of injury and factors influencing trauma is of extreme importance in appropriate management and avoiding unnecessary amputations.

Background: Injuries caused by home injuries in children under 5 years of age is one of the main causes of death in this group and also constitutes a significant public health burden. This review aimed at summarizing the literature on the effectiveness of interventions to prevent home injuries in children under 5 years of age. Methods: Magiran, Iran Medex, and SID in Persian Scientific databases and BioMed Central, PubMed, ScienceDirect, Web of Science, and Scopus were systematically searched for articles published up to June 2016. Then, two researchers reviewed the papers independently and finally, 14 studies fulfilled the inclusion criteria. Results: The results showed the effectiveness of intervention measures including training sessions at home, home visit, group discussions, and interviews as the educational tools. The educational approach was used as the intervention in 11 studies; legislative/incentive approach and engineering/technology approaches had not been used in papers; and three studies had used the educational intervention and engineering/technological approaches. Conclusions: Most of the effective inventions included studies that used the combination of effective methods to reduce the risk of injuries. Since the accidents are preventable, the appropriate intervention strategies, especially active intervention or a combination of interventional measures are effective to reduce the risk of home accidents and injuries in children.

Background: Due to the extensive use of subway transportation in high- and middle-income countries, the safety of passengers has become one of the important challenges in emergency management of subway station. Therefore, the present systematic review aimed to identify environmental and organizational management factors that affect the safe emergency evacuation in subway stations. Materials and Methods: In this systematic literature review, PubMed, Scopus, Web of Science, ProQuest, Google Scholar, Iran Medex, Magiran, and Scientific Information Database from 1990 to 2019 were searched to identify effective emergency management factors in safe emergency evacuation of the subways. A thematic content analysis was employed for data analysis. Results: Of 763 publications retrieved from the searches, 149 studies were included for data analysis. According to the findings, effective environmental and organizational management factors in safe emergency evacuation were discussed in eight subcategories, including infrastructure properties, evacuation-assisting resources, prevention of injuries and mitigation, preparedness for emergency evacuation, emergency response and reconstruction, and maintenance of evacuation facilities. Conclusion: The design of an optimal route for emergency evacuation is the main theme of most studies focusing on environmental factors. While a system approach for designer is needed for effective subway emergency evacuation, human-related factors focusing on injury prevention are also crucial.