Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2022 09 01 e3 e3 Melaku Getachew Department of Emergency & Critical Care Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia Habtamu Tadesse Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia Natanim Degefu Department of Pharmaceutics, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia 2022 08 07 2022 08 30 Objective: This study assesses the severity of mental health problems in healthcare professionals (HCPs) and its associated risk factors during COVID-19 pandemic at a tertiary hospital in Harar, Eastern Ethiopia. Methods: An institutional-based cross-sectional study was done from November 01 to 15, 2020. Data was collected by using a web-based self-administered questionnaire. Descriptive statistical analysis, cross tabs, and logistic regressions were utilized. Results: Out of 238 HCPs, 54.6% of them had a mental health problem. The prevalence of depression, anxiety, and stress was 44.1%, 48.3%, and 29.0%, respectively.  Cigarette smoking was the only factor associated with depression. Being female, a cigarette smoker, and previously diagnosed with COVID-19 were associated with anxiety, while cigarette smoking and previous COVID-19 suspect had a significant association with stress. Conclusion: The burden of mental health problems among HCPs is high. The Federal Ministry of Health should incorporate psychosocial support for healthcare professionals during pandemics. This study highlights the need for developing policies to decrease mental health problems among HCPs during the COVID-19 pandemic. https://fem.tums.ac.ir/index.php/fem/article/view/1061 https://fem.tums.ac.ir/index.php/fem/article/download/1061/422

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2022 12 31 e10 e10 Devendra Richhariya Department of Emergency Medicine Sarvodaya Hospital & Research Center, Delhi, India. Rakesh Gupta Department of Emergency Medicine Sarvodaya Hospital & Research Center, Delhi, India. 2022 11 10 The patient was a 61-year-old smoker male, who presented to emergency department (ED) with complaints of sudden onset of headache followed by painless blurring of vision of the right eye that was started 10 hours prior to the admission. Due to blood pressure of 190/104 mmHg at home, the patient had taken amlodipine 10mg orally. The patient reported some episodes of transient ischemic attacks in his past medical history, for which he did not take any advice from physicians. The patient was also found to be hypertensive with deranged cholesterol. On examination in ED, the patient was afebrile, and had pulse rate= 88/min, blood pressure (BP)= 130/90 mmHg, respiratory rate=22/min, and O2 Saturation=99% in room air. There was not any positive finding in systemic examination. Patient was admitted for further evaluation and management. Paraclinical lab tests were all reported in normal range. Echocardiography revealed left ventricular ejection fraction (LVEF) of 60%, with no regional wall motion abnormality (RWMA), mild concentric left ventricular hypertrophy (LVH) and normal cardiac chambers. In view of Headache, brain computed tomography (CT) scan was performed, in which, there was prominence of sulci, basal cistern, sylvian fissure and ventricular system suggestive of age-related diffuse cerebral atrophy. Ill-defined hypodensities were seen in bilateral periventricular white matter, suggestive of chronic ischemic changes. Later, brain magnetic resonance imaging (MRI) was also performed, which revealed multiple discrete and confluent areas of hyperintensity scattered in subcortical deep and periventricular white matter of both cerebral hemispheres, suggestive of nonspecific small vessel ischemic changes, likely a combination of ischemic demyelination chronic lacunar infarcts and prominent perivascular space. The ventricular system and subarachnoid space were prominent, suggestive of age-related cerebral atrophy. In the next step, cervical and brain MRI angiography was performed, which revealed 100% occlusion of right internal carotid artery at its origin, with no distal reformation of the artery in the neck and intracranial part. The right middle and anterior cerebral artery were filling via circle of Willis and were severely diffusely narrowed in calibre. There were mild atheromatous changes in the left common carotid artery and carotid bulb causing mild narrowing. Bilateral vertebral arteries were normal. There was evidence of diffuse severe narrowing and poor visualization of entire left anterior cerebral artery. Ophthalmology reference was taken and fundus examination was done. On examination, the patient was found to have finger counting close to face with no improvement with glasses. In the right eye, anterior segment examination showed relative afferent pupillary defect (RAPD), while fundus examination revealed retinal background pale white with cherry red spot in macula and absent venous pulsation in the right eye, suggestive of Central Artery Retinal Obstruction (CRAO), and thread like blood vessels and Grade II Hypertensive retinopathy. After starting the low molecular weight heparin, antiplatelet and steroid, vision improved from finger counting close to face to finger counting at 3 feet distance. Patient was later discharged under follow-up for further recovery. https://fem.tums.ac.ir/index.php/fem/article/view/1109 https://fem.tums.ac.ir/index.php/fem/article/download/1109/421

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2022 12 26 e8 e8 EN Charles Hwang Department of Emergency Medicine, University of Florida, Gainesville, FL, USA Travis Murphy Cardiothoracic Critical Care, Miami Transplant Institute, University of Miami, Miami, FL, USA Jesseca Antoine Department of Emergency Medicine, University of Florida, Gainesville, FL, USA K. Leslie Avery Division of Pediatric Critical Care, Department of Pediatrics, University of Florida, Gainesville, FL, USA Casey Carr Department of Emergency Medicine, University of Florida, Gainesville, FL, USA Francis Han Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA Garrett Snipes Department of Internal Medicine, University of Florida, Gainesville, FL, USA Sonya Zhou Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA Torben Becker Department of Emergency Medicine, University of Florida, Gainesville, FL, USA 2022 11 07 2022 12 08 The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct an annual search of peer-reviewed literature relevant to cardiac arrest. Now in its fourth year, the goals of this review are to highlight annual updates on clinically relevant and impactful clinical and population-level studies in the interdisciplinary world of cardiac arrest research from 2021.  To achieve these goals, a search of PubMed using keywords related to clinical research in cardiac arrest was conducted. Titles and abstracts were screened for relevance and sorted into seven categories: Epidemiology & Public Health; Prehospital Resuscitation; In-Hospital Resuscitation & Post-Arrest Care; Prognostication & Outcomes; Pediatrics; Interdisciplinary Guidelines; and Coronavirus disease 2019. Screened manuscripts underwent standardized scoring of methodological quality and impact by reviewer teams lead by a subject matter expert editor. Articles scoring higher than 99th percentile by category were selected for full critique.  Systematic differences between editors’ and reviewers’ scores were assessed using Wilcoxon signed-rank test. A total of 4,730 articles were identified on initial search; of these, 1,677 were scored after screening for relevance and deduplication.  Compared to the 2020 ICARE review, this represents a relative increase of 32% and 63%, respectively.  Ultimately, 44 articles underwent full critique. The leading category was In-Hospital Resuscitation, representing 41% of fully reviewed articles, followed by Prehospital Resuscitation (20%) and Interdisciplinary Guidelines (16%). In conclusion, several clinically relevant studies in 2021 have added to the evidence base for the management of cardiac arrest patients including implementation and incorporation of resuscitation systems, technology, and quality improvement programs to improve resuscitation. https://fem.tums.ac.ir/index.php/fem/article/view/1107 https://fem.tums.ac.ir/index.php/fem/article/download/1107/429

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2023 01 03 e2 e2 EN Payman Salamati Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohammad Reza Zafarghandi Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran 2022 12 03 2022 12 08 Dear editor We read with interest Abdolrazaghi and his colleague’s paper entitled ‘’ Brachial plexus injury following blunt trauma; an anatomical variation in electrodiagnostic findings’’ and enjoyed it a lot. They presented a brachial plexus injury (BPI) case, which was rare in clinical practice because blunt traumas did not commonly cause BPI. There is ample evidence that most cases are men and adolescents aged 15 to 25 years, and the main mechanism of injury (70%) is motor vehicle accidents. As BPI is increasing, we will provide some epidemiologic and clinical characteristics of our cases registered at Sina Hospital, affiliated with the National Trauma Registry of Iran (NTRI). The Sina Trauma and Surgery Research Center launched the NTRI in 2016 and first recorded the related data from Sina Hospital. As the registry expanded, the NTRI included some other Iranian hospitals from different cities in the next step. The inclusion criteria were discussed elsewhere. We have registered 10 cases of BPI since 2016 at Sina Hospital. All of them were men, ranging from 19 to 45 years. The cause of injury was cut/stab in nine and road traffic accidents in one patient; seven were intentional, and most were due to interpersonal violence. Five of the injuries happened outdoors, three cases in commercial and service departments, and two at homes. Furthermore, the median injury severity score (ISS) was 5.0 (IQR=1). All of the patients had surgical operations. No death or need for ventilators was reported. Only one patient needed intensive care unit (ICU) admission and stayed for three days in the ward. We hope this information can be helpful for the Frontiers in Emergency Medicine’s readers to know more about BPI and can compare similarities and differences between our cases and the others included in the literature. https://fem.tums.ac.ir/index.php/fem/article/view/1121 https://fem.tums.ac.ir/index.php/fem/article/download/1121/425

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2023 01 05 e9 e9 Adem Tunçekin Urology Department, Faculty of Medicine, Harran University, Şanlıurfa, Turkey Mehmet Demir Urology Department, Faculty of Medicine, Harran University, Şanlıurfa, Turkey İsmail Yağmur Urology Department, Faculty of Medicine, Harran University, Şanlıurfa, Turkey Eyyup Sabri Pelit Urology Department, Faculty of Medicine, Harran University, Şanlıurfa, Turkey Bülent Katı Urology Department, Faculty of Medicine, Harran University, Şanlıurfa, Turkey Halil Çiftçi Urology Department, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey 2022 10 30 2022 12 04 The diagnosis and treatment of foreign bodies in the urogenital system are difficult and it’s rare in children; It may also cause secondary injuries. In this article, we present a 14-year-old male patient who was admitted to the emergency outpatient clinic with complaints of difficulty in voiding and dysuria. He was diagnosed with a pin in the urethra and treated using an endoscopic method. He was hospitalised for foreign body removal after he admitted in his anamnesis about insertion a pin into his urethra the day before his complaints started. A pin was seen in the urethra on the urethrocystoscopy, and was successfully removed. Since foreign body in the urogenital system is rare in children, it is necessary to suspect, in order to make the diagnosis. In most cases, endoscopic intervention is sufficient. Psychiatric consultation should be requested for the patients, especially for pediatrics. https://fem.tums.ac.ir/index.php/fem/article/view/1102 https://fem.tums.ac.ir/index.php/fem/article/download/1102/424

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2023 01 06 e1 e1 Alireza Baratloo Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran 2023 01 06 In 2022, Frontiers in Emergency Medicine published 60 papers in four distinct issues with authors from various nationalities, including Mexico, Turkey, Egypt, India, Yemen, the USA, Palestine, Poland, Saudi Arabia, the Netherlands, the UAE, Algeria, Ethiopia, Jordan, Cameroon, the UK, and Iran. As we did last year, we decided to review and evaluate various aspects of our work in the previous year. In the year 2022, despite the not-yet-ended pandemic, COVID-19 apparently missed its priority as the hottest topic of research and it seems that researchers took time to focus on their main research lines. Therefore, we were able to publish articles in different fields and cover more topics; however, we still received so many papers on COVID-19 and published some of them, not only on treatment but also on other aspects of the disease, and also some case reports. We also published a letter in which the authors pointed to increased prevalence of bloodstream infection with Klebsiella species in patients with recent COVID-19 infection, which may be an interesting issue for further investigations. We had two other papers that were published as “Letter to the Editor”. One was related to blunt abdominal injuries in the National Trauma Registry of Iran, and the other was concerned with Eye emergencies during wars, which was published around the beginning of Russia's war against Ukraine. There were 25 published papers in 2022 that fulfilled the criteria of an original article. Of these, only 7 were focused on COVID-19, and the rest covered other topics including critical care, neurological emergencies, experimental studies, point of care ultrasound, cardiovascular emergencies, emergency department management topics, trauma, and prehospital emergency care. Interestingly, the most viewed article was the one in which a series of oleander poisoning cases were reported by a group of authors from India. In addition to original articles, there were also one umbrella review, one systematic review, and some other types of reviews that have their own value and specific audiences, in which some recommendations were reviewed by experts in the fields. Case presentation maybe the most popular part of the journals. We have various structures in this regard, so that we can respond to the passion of our addressees. We published 5 Case reports, and also 5 papers categorized as “case-based learning points”. However, there are some other structures available for those interested in sharing their experience with their patients, which we regularly suggest to the authors in the peer review process of their submissions. We are honored to have published a series of educational papers on “electrocardiogram interpretation”, all written by Jerry W. Jones as an invited author, and we are very grateful for his participation and companionship. We also intend to introduce historical aspects of emergency medicine in various countries; therefore, an editorial paper written by Ozgur Karcioglu was published, which points to the emergency medicine journey in Turkey. We are very eager to have this type of papers from other countries and we will certainlial worker considering the clinical features of the case. The social service experts and providing physicians were reassured there was no concerns for child abuse, sexual abuse, neglect, behavioral or psychiatric disorders. The patient was discharged with Bactrim and analgesics for one week after he was able to void independently. One month follow up at the urology clinic revealed that the patient had good skin preservation, wound healing, and micturition. The patient had no difficulties with anxiety, depression, or post-traumatic stress at his follow up appointments with a behavioral health therapist. https://fem.tums.ac.ir/index.php/fem/article/view/1157 https://fem.tums.ac.ir/index.php/fem/article/download/1157/436

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 2 2023 03 10 e20 e20 Wajeeha Musharraf Star Hospitals, Banjara Hills, Hyderabad, Telangana, India Sudhir Mane SVS Medical College and Hospital, Mahabubnagar, Telangana, India Habeeba Musharraf Shadan Institute of Medical Sciences, Peeramcheru, Hyderabad, Telangana, India 2023 02 08 2023 03 09 Workplace violence in hospitals, specifically in emergency departments (ED), has become a growing concern in recent years. This violence can come from patients, their families, or visitors and can take the form of verbal or physical attacks. Preventing violence in EDs can be achieved through design modifications with minimal personnel and infrastructure requirements. Infrastructure design plays a crucial role in reducing the risk of violence. Private lockers should be available at the ED entrance to limit dangerous objects being brought into the department. Furnishings should be fixed to prevent them from being used as weapons, and evacuation should be facilitated through open rows of seating. Positive distractions, such as gardens or natural areas visible through windows, can reduce stress in patients and lower aggression. Ligature points should be eliminated and tamper-resistant items should be provided to reduce dangers in the built environment. The triage desk should be positioned in a secure area with access control and panic buttons available for staff. Hidden exits should be provided in case of violence and emergency exits should open outward and be lockable only from the outside. It seems that preventing violence in EDs requires a combination of management, technology, planning, and physical design. Proper infrastructure design can play a crucial role in reducing the risk of violence, and healthcare professionals, administrators, and architects should be aware of best practices in ED design. https://fem.tums.ac.ir/index.php/fem/article/view/1164 https://fem.tums.ac.ir/index.php/fem/article/download/1164/437

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 2 2023 12 31 e14 e14 Shirin Madadian School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mojgan Rahimi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Peyman Saberian Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Parisa Hasani-Sharamin Tehran Emergency Medical Service Center, Tehran, Iran Amirhossein Orandi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Alireza Jalali Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Seyed Khalil Pestechi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Sepideh Aarabi Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Mahshid Faghani Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 2023 04 19 Objective: There are several methods for teaching emergency medical technicians (EMTs) cardiopulmonary resuscitation (CPR); but choosing the most effective option depends on several factors. This study was designed to compare the effectiveness of three different CPR training methods, including traditional, peer, and virtual methods, for EMTs. Methods: This study was a pretest-posttest study, which was performed from March to September 2020 in Tehran, Iran. Participants were EMTs working in the operations department of the EMS center. In the first step, for the pretest evaluation, an Objective Structured Clinical Evaluation (OSCE) exam was held for all participants. Thereafter, the subjects were divided into 3 groups including master-centered traditional collective education, peer training, and virtual courses. Then the participants underwent educational intervention and after that, another OSCE exam was held about 1 week after the sessions to evaluate the effect of interventions. Results: At first, 156 volunteers entered the study and participated in the pretest OSCE exam, of which 125 volunteers participated in the posttest OSCE exam. Of these, 51 volunteers participated in the peer education group, 35 volunteers were in the virtual education group, and 39 volunteers in the classic education group. The mean score of the participants in all 4 assessed skills, including endotracheal intubation, laryngeal mask airway insertion, basic life support, and advanced life support, increased significantly after educational intervention in all 3 groups (p<0.05); and this increase was higher in the virtual group compared to the other two groups (p<0.05). Conclusion: We found that virtual training was more effective than classic and peer training for CPR training of EMTs. https://fem.tums.ac.ir/index.php/fem/article/view/1201 https://fem.tums.ac.ir/index.php/fem/article/download/1201/441

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 2 2023 04 22 e15 e15 Khalid Almulhim Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia Ali Mobarki College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia Abdulelah Aljasir College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia. Abdullah Almulhim College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia. Ibrahim Almulhim College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia. 2022 12 25 2023 04 20 Objective: This study aims to understand students' skills based on their self-assessment and their perceptions regarding emergency medicine (EM) physicians, EM patients, and choosing EM as a future career. Methods: This study employed prospective observational design. It was conducted from 2 October to 2 November 2022 in Saudi Arabia. The study participants were senior medical students at King Faisal University. Senior students who finished a four-week EM rotation were involved as post-cases, and senior students who had not finished their EM rotation were involved as pre-cases. An online survey was administrated to all students who met out criteria. Results: A total of 161 students were included in the study; 65.2% had not yet done their EM clerkship, while 34.8% had completed their EM clerkship. Among them, 48.4% were male, and 51.6% were female. On average, post-EM clerkship students showed greater confidence in their skills of conducting an initial assessment of a patient (p=0.027), developing a management plan (p=0.007), explaining the principles of EM to others (p<0.001), presenting patient cases formally (p=0.049), interpreting electrocardiogram (p=0.006), and applying medical resuscitation (p=0.041). No significant differences were found between the average confidence in the skills and abilities of male and female students. Post-EM clerkship and male students were more likely to choose EM as a career when compared with pre-EM clerkship (p<0.001) and female students (p=0.006). Conclusion: It seems that, after completing a four-week rotation, students exhibited significant advances in knowledge, illness management, and procedural skills. It is likely that the EM clerkship significantly improved students' perceptions of the EM specialty. https://fem.tums.ac.ir/index.php/fem/article/view/1142 https://fem.tums.ac.ir/index.php/fem/article/download/1142/443

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 2 2023 04 26 e16 e16 Kiumarth Amini Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Mojtaba Mojtahedzadeh Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Atabak Najafi Department of Anaesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Hamidreza Sharifnia Department of Anaesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Aliasghar Tabatabaei Mohammadi Urmia University of Medical Sciences, Urmia, Iran 2022 12 13 2023 01 16 Objective: Sepsis is one of the leading causes of mortality in intensive care unit. Despite advances in its management, its mortality rate remains high. Recently, high dose of vitamin C in sepsis treatment has attracted the attention of researchers. In the current study, the impacts of 25 mg/kg of vitamin C every 6 hours as a bolus for 3 days were assessed in septic patients in intensive care unit (ICU). Methods: This was a prospective cohort study that was performed on adult patients with diagnosis of sepsis. Patients were assigned to control group (administration of placebo) or intervention group, i.e., those receiving a 25 mg/kg dose of vitamin C every 6 hours as a bolus for 3 days. Clinical data were recorded before and after the experiment. Also, plasma levels of antithrombin III, syndecan-1, fibrin degradation product (FDP), D-dimer, and C-reactive protein (CRP) were measured at 0, 24, 48, and 72 hours. Results: In septic patients receiving vitamin C, a significant upregulation of antithrombin III and significant decreases in the levels of syndecan-1 (at 48 hours; P-value=0.046 and at 72 hours; P-value=0.007), D-dimer and CRP were observed compared to the control. Reductions in sequential organ failure assessment (SOFA) score, in-hospital mortality, and ICU length of stay were seen in septic patients receiving vitamin C. Conclusion: Prescribing high dose of intravenous vitamin C can reduce the mortality of sepsis patients and reduce the length of stay in the ICU. https://fem.tums.ac.ir/index.php/fem/article/view/1131 https://fem.tums.ac.ir/index.php/fem/article/download/1131/442

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 2 2023 04 27 e17 e17 Alireza Zemestani Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran. Iran Amir Kavousi Department of Epidemiology, School of Public Health and Safety, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Homayoun Sadeghi-Bazargani Road Traffic Injury Prevention Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Hamid Soori Department of Epidemiology, School of Public Health and Safety, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2023 01 03 2023 01 22 Objective: Vehicle safety plays a key role in reducing the number of road traffic deaths and serious injuries. This study aims to investigate the effect of vehicle safety on the severity of traffic crashes in Iran using structural equation modeling (SEM). Methods: This was a comparative cross-sectional study of all imported vehicles with Aras free trade zone license plate as well as all domestic vehicles (cars produced in Iran) commuting on Tabriz-Jolfa road. The study population included drivers who had accidents on Tabriz-Jolfa road over a period of one year from September 22, 2020 to September 21, 2021 and were injured or  their vehicles had been damaged (n=652). Data was collected using set of questionnaires with 10 sections. The effect of independent variables, as exogenous latent variables (human, vehicle, and environmental factors), on a dependent variable, as an endogenous latent variable (crash severity) was measured using SEM. All data were analyzed using Mplus 8.0 software. Results: In the structure part of the model with foreign vehicles group, the effect sizes of three exogenous variables, i.e., human, environmental, and vehicle factors, on the dependent variables were found to be 0.412, 0.396 and 0.358, respectively. The effect sizes in the model with domestic vehicles were found to be 0.312, 0.702 and 0.820, respectively. Conclusion: Vehicle factors (variables related to car safety) had a high impact on crash severity in the national license plate and domestically manufactured vehicle group, indicating the necessity of improving vehicle safety. https://fem.tums.ac.ir/index.php/fem/article/view/1150