https://fem.tums.ac.ir/index.php/fem <p><strong>Frontiers in Emergency Medicine</strong> is the official journal of emergency medicine department of Tehran University of Medical Sciences. It is an international, peer-reviewed open access academic emergency medicine journal. The journal covers both research and education as its main topics. Therefore, the journal publishes articles on various aspects of emergency medicine and anyone from medical students to professors can contribute to the journal. This journal adheres to the recommendations of International Committee of Medical Journal Editors (ICMJE).</p> Tehran University of Medical Sciences en-US Frontiers in Emergency Medicine 2717-3593 <p>This journal be published an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (<a href="https://creativecommons.org/licenses/by-nc/4.0/">https://creativecommons.org/licenses/by-nc/4.0/</a>)&nbsp;which permits anyone to copy, redistribute, remix, transmit and adapt the work provided the original work and source is appropriately cited.&nbsp;</p> https://fem.tums.ac.ir/index.php/fem/article/view/1471 <p><strong>Objective</strong>: Accurate assessment of acute pain in children is essential for effective emergency care but can be challenging due to varying pain expressions across ages. Our study aims to examine healthcare providers’ efforts to enhance assessment using age-appropriate tools.&nbsp;<strong>Methods</strong>: Patients were retrospectively selected from the King Abdulaziz University Hospital Emergency records which involved a cohort review of 157 children presented to the pediatric emergency department with acute pain from 2017 to 2018. Routine pain assessment tool grading acute pain as mild, moderate, severe by qualified pediatric emergency doctors, Canadian triage acuity scale (CTAS) and numerical rating scale (NRS) were used to describe pain intensity. Inter-statistical cohort analysis was used.&nbsp;<strong>Results</strong>: The mean age of patients were 8±3.3 years (range: 2.5-13.9 years) with 73 girls and 84 boys. About 80% (n=126) of the children presented to the emergency department with acute pain were scored as CTAS 2-3. All triaged patients passed to the emergency department were assessed as mild (n=66, 42%), moderate (n=27, 17%) and severe (n=35, 22%) pain. The NRS scoring was used in only 12 (7.6%) children as NRS only applies to older children. Paracetamol and nonsteroidal anti-inflammatory drug (NSAID) were the most frequent analgesia administered by the health care providers. There was a statistically insignificant relationship between the severity of the pain and the type of analgesia (P value&gt;0.05). Children with mild pain had a significantly higher level of NSAID administration than those with moderate or severe pain (P&lt;0.05). Children with mild pain had a significantly higher level of NSAID administration than those with moderate or severe pain (P&lt;0.05)&nbsp;<strong>Conclusion: </strong>Pain assessment with scoring methods like CTAS or NRS in the emergency room (ER) is crucial despite challenges. Inconsistent use affects outcomes, emphasizing the need for research to encourage consistent application in pediatric emergency care.</p> Shafiqa M AL Sharif ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2025-04-29 2025-04-29 https://fem.tums.ac.ir/index.php/fem/article/view/1448 <p><strong>Objective</strong>: Finding the associated factors of traumatic intra-abdominal injuries (IAIs) and designing a predictive model could minimize the unnecessary use of computed tomography (CT) scans. This study aimed to develop a risk stratification model in this regard.&nbsp;<strong>Methods:</strong> This&nbsp;prospective cross-sectional study was conducted at the emergency department (ED) of a level III trauma center. In this study, we thoroughly examined the association between demographic details, physical examinations, laboratory tests, and ultrasonography with abdominopelvic CT scan results regarding the presence of intra-abdominal injuries following blunt abdominal trauma, trying to develop a risk stratification model in this regard.&nbsp;<strong>Result: </strong>A total of 472 blunt trauma patients with a mean age of 39.06±18.49 (range: 15-96) were investigated (81.1% male). 47 intraabdominal damages in 45 (9.5%) patients were diagnosed. Based on logistic regression analysis, presence of abdominal pain (odds ratio [OR]: 39.60; 95% CI: 9.42,166.35), positive focused assessment sonography in trauma (FAST results (OR: 46.93; 95% CI: 14079,148.89), and injury severity index (ISS)≥25 (OR: 6.43; 95% CI: 2.07,19.90) were significantly correlated with the presence of intraabdominal injuries in blunt trauma patients. The area under the ROC curve of the model was 0,865 (95% Cl:&nbsp;0.805,0.926) with 86.67% sensitivity and 86.41% specificity.&nbsp;<strong>Conclusion: </strong>Being accurate and user-friendly alongside broader criteria compared to similar studies makes our risk stratification model a reliable decision-making tool to optimize CT scan usage in the emergency department.</p> Saeed Safari Seyed Hadi Aghili Hamed Maneshi Shahram Paydar Zahra Shayan Mehri Farhang Ranjbar ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2025-05-05 2025-05-05 https://fem.tums.ac.ir/index.php/fem/article/view/1447 <p><strong>Objective</strong>: One of the causes of severe injuries in urban accidents is the occurrence of accidents on urban highways and city outskirts. The present study will determine the severity of accidents in the complete urban ring of Tabriz, including Shahid Kasaei highway, Pasdaran, Dizel Abad, Sento road, and Airport road in Tabriz during the years 2016-2022.&nbsp;<strong>Methods</strong>: In a cross-sectional descriptive study, the injuries from traffic accidents that were registered in the pre-hospital emergency center of Tabriz city were included. The study variables included all the information recorded in the pre-hospital emergency file between 2016 and 2022 and included 44,712 injured patients. Timing of the missions, variables related to the injured (demographics, vital signs), the accident's location, the injury's severity, and the accident's outcome were evaluated at the scene. Data were analyzed by SPSS 24 software.&nbsp;<strong>Results</strong>: Among 44,712 patients, 32,299 (72.2%) were men and the rest were women. Regarding the location of the accident, 34321 (76.8%) of the injured were inside the city, and 10391 (23.2%) had an accident in the city traffic ring. The most common accident site was in the traffic ring on Pasdaran highway, with 3179 injured (30.6%). The rate of on-scene death was higher in traffic accidents inside the traffic ring (1.3% vs. 0.9%). The severity of trauma was higher inside the traffic ring (P-value ˂0.001). Reaction and response time were higher in missions outside the traffic ring, leading to death at the scene (P value˂0.001).&nbsp;<strong>Conclusion</strong>: Based on the study results and the role of arrival time on the outcome of missions, it seems necessary to establish new pre-hospital emergency stations inside the city.&nbsp; It is necessary to pay more attention to education through the media and improve the general culture of society to reduce the accidents and injuries caused by it.</p> Abazar Fathollahzadeh Ali Ahmadinia Reza Allahyari Homayoun Sadeghi Bazargani Haniyeh Ebrahimi Bakhtavar Abdollah Moharamzadeh Farzad Rahmani ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2025-05-06 2025-05-06 https://fem.tums.ac.ir/index.php/fem/article/view/1472 <p><strong>Objective:&nbsp;</strong>Effective pain management is crucial in emergency settings, and both penthrox (methoxyflurane) inhalation and intravenous morphine are commonly used analgesics. This study aimed to compare the analgesic efficacy, adverse effects, and patient satisfaction associated with penthrox spray and morphine for acute limb fracture pain management in the emergency department.&nbsp;<strong>Methods:&nbsp;</strong>This prospective, double-blinded, randomized controlled trial included 50 patients aged 20-55 years with acute limb fracture pain, randomly assigned to receive either penthrox spray or intravenous morphine. The primary outcome was pain intensity assessed using the visual analog scale (VAS) over 60 minutes. Secondary outcomes included adverse effects, vital signs, and patient satisfaction.&nbsp;<strong>Results:&nbsp;</strong>Both groups experienced significant pain relief over time, with a similar reduction in VAS scores (P&lt;0.001). However, the penthrox spray group showed a trend toward more rapid pain reduction, although not statistically significant. The frequency of vomiting and nausea tended to be lower in the penthrox spray group (24% vs. 40%, P=0.225). There were no significant differences in patient satisfaction scores between groups. While both groups experienced a decrease in blood pressure, the heart rate remained stable in the penthrox spray group but decreased significantly in the morphine group (P&lt;0.001).&nbsp;<strong>Conclusion:&nbsp;</strong>&nbsp;Penthrox spray and intravenous morphine demonstrated comparable analgesic efficacy for acute limb fracture pain in the emergency department. Penthrox sprays trended toward faster pain relief and potentially lower risk of vomiting and nausea. The stable heart rate observed with penthrox may be advantageous in certain clinical scenarios. Consideration of factors such as onset of action, adverse effects, and patient preferences may guide the choice between these analgesics.</p> Reza Azizikhani Babak Masoumi Farhad Heydari Mohammad Golban Mohammad Nasr-Esfahani ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2025-05-10 2025-05-10 https://fem.tums.ac.ir/index.php/fem/article/view/1524 <p>Transvaginal evisceration is a rare condition characterized by the externalization of abdominal viscera through the vagina. Menopause and hysterectomy are the primary risk factors. A postmenopausal woman presented to the emergency department with evisceration of the small intestine through the vagina three hours post-coitus. She had a history of laparoscopic hysterectomy performed three years prior. The patient underwent prompt laparotomic repair of the vaginal cuff. The diagnosis of transvaginal evisceration is primarily clinical, and immediate treatment aims to maintain intestinal viability and repair the vaginal cuff. The surgical approach is based on the surgeon’s experience, the patient's clinical condition, and resource availability.</p> Renan Lucas da Silva Marlon Alves Olivetti José Henrique Gomes Torres ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 2025-05-18 2025-05-18