Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 01 31 e1 e1 Hamideh Akbari Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Jalili Emergency Medicine Department, Tehran University of Medical Sciences, editor-in-chief of Frontiers in Emergency Medicine (FEM), Tehran, Iran. 2024 01 28 2024 01 28 The year 2023 terminated and we need to prepare ourselves for a fresh start and a bright future in the coming year. To accomplish this task, the editorial team of Frontiers in Emergency Medicine (FEM) looks back on the past and reflects on the successes and failures of the journal. https://fem.tums.ac.ir/index.php/fem/article/view/1344 https://fem.tums.ac.ir/index.php/fem/article/download/1344/472

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 01 29 e2 e2 Abdolghader Pakniyat Emergency Medicine Department, Kurdistan University of Medical Sciences, Sanandaj, Iran. Farzane Jafari Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran. Seyedeh Hoda Ahmadi Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran. Mohammad Ghasemi-Rad Department of Interventional Radiology, Baylor College of Medicine, Houston, Texas, USA. Mahan Ghasemi Department of Bioengineering, Texas A & M University, Texas, USA. Korush Akhbari Emergency Medicine Department, Kurdistan University of Medical Sciences, Sanandaj, Iran. 2023 06 25 2023 11 03 Objective: Chest computed tomography (CT) scans are the gold standard for identifying pulmonary involvement in pneumonia-like COVID-19 cases, albeit with certain drawbacks such as radiation exposure and high costs. This research aims to evaluate the diagnostic precision of a 12-point lung ultrasound (LUS) against a low-dose chest CT scan in identifying lung lesions associated with COVID-19. Methods: The study incorporated 100 consecutive patients, aged over 18 years, exhibiting suspected clinical symptoms of COVID-19 or inpatients requiring a low-dose chest CT scan for diagnosing asymptomatic COVID-19 lung lesions. All participants underwent a 12-point LUS, followed by a low-dose chest CT scan. Data analysis was conducted using STATA-16, with descriptive results presented as mean and standard deviation. Results: The study comprised 60 males and 40 females, with an average age of 43.0±16.9 years. The mean distribution of the patients' clinical features was calculated. The LUS demonstrated a sensitivity, specificity, and positive and negative predictive values of 97.5%, 86.4%, 83.3%, and 98%, respectively. Conclusion: The 12-point LUS exhibited high sensitivity and specificity in assessing pulmonary involvement in COVID-19 patients. Therefore, lung ultrasound results, combined with medical history and clinical examination, can serve as an effective triage tool for COVID-19 patients. The LUS, a swift, safe, and effective ionization tool, can potentially replace chest CT scans in scenarios such as CT scan unavailability, intensive care management, and patient follow-up. https://fem.tums.ac.ir/index.php/fem/article/view/1236 https://fem.tums.ac.ir/index.php/fem/article/download/1236/466

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 02 05 e3 e3 Mustafa Ekici Emergency Medicine Department, Bitlis Provience Health Manager, Bitlis, Turkey. Gülşah Çıkrıkçı Işık Emergency Medicine Department, University of Health Sciences, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey. Özge Dağcı Varhan Emergency Medicine Department, İzmir Bornova Türkan Özilhan State Hospital, İzmir, Turkey. Şeref Çorbacıoğlu Emergency Medicine Department, University of Health Sciences, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey. Yunsur Çevik Emergency Medicine Department, University of Health Sciences, Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey. 2023 08 22 2024 01 27 Objective: Reactive oxygen radicals are generated in the early stages of acute pancreatitis (AP) and are responsible for its progression. Thiol/disulfide homeostasis (TDH) is an important antioxidative mechanism. This study aimed to evaluate the role of TDH in the differential diagnosis of AP and predict its clinical severity.  Methods: Patients admitted to the emergency department due to upper abdominal pain were evaluated. The study consisted of two groups: the AP group and the non-AP group (patients with diagnoses other than AP). The AP group was divided into mild and severe according to Acute physiology and chronic health evaluation II (APACHE-II) scores. TDH was measured with an automated assay from Erel et al. Statistical analyses were done with SPSS 16.0. Results: The results from 128 cases—58 in the AP group and 70 in the non-AP group—were evaluated. There was no difference in TDH parameters between the AP and non-AP groups. Among the AP subgroups, native thiol (sh) and total thiol (tt) were significantly lower in the severe AP group (sh: 313.9 μmol/L, 239.1 μmol/L; tt: 351.5 μmol/L, 303 μmo/L, respectively, in the mild and severe AP groups, P-value=0.006, P-value=0.013). Conclusion: TDH parameters change because of inflammatory processes in AP. Since this change does not occur for any specific reason, using TDH parameters for differential diagnosis of AP in patients with upper abdominal pain is not appropriate. However, in patients already diagnosed with AP, native and total thiol levels might be helpful in the prediction of clinical severity with a limited role. https://fem.tums.ac.ir/index.php/fem/article/view/1269 https://fem.tums.ac.ir/index.php/fem/article/download/1269/474

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 02 05 e4 e4 Karamatollah Rahmanian Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran. Vahid Rajabpour School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran. Vahid Rahmanian Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran. Mohammad Jokar Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran. Hossein Kargar Jahromi Research Center for Non-Communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran. 2023 06 14 2023 12 04 Objective: Road traffic crashes are a significant health problem worldwide, causing injury, disability, and death. This study aims to identify associated factors with intensive care unit (ICU) admission and mortality among road traffic accident victims using data from a trauma registry. Methods: This descriptive study examined 368 road traffic accident patients in the national trauma registry system fromMarch 2021 toMarch 2023. Following the objectives of the study, a checklist was created that included information on age, gender, marital status, level of education, injury severity score (ISS), Glasgow coma scale (GCS), and abbreviated injury scale (AIS). The factors associated with ICU admission and mortality among road traffic accident victims were found significant according to univariate andmultivariable logistic regression analyses results. Results: 87.8% of the 368 patients included in this study were men, with a mean age of 33.54±18.95 years. Ten patients (2.71%) of total died, and 46 (12.5%) needed to be admitted to the ICU. In-hospital mortality and gender were not significantly associated (P=0.081). However, univariate logistic regression revealed several factors significantly associated with in-hospital mortality, including GCS<8 (OR: 60.05, 95% CI: 11.67,309), ISS>16 (OR: 11.39, 95% CI: 2.67,48.55), ICU admission (OR: 5,01, 95% CI: 1.36,18.50), underwent surgery (OR: 0.055, 95% CI: 0.014,0.223), respiratory rate (OR: 0.726, 95% CI: 0.630,0.836), O2 saturation (OR: 0.906, 95% CI: 00.852,0.963), systolic blood pressure (OR: 0.910, 95% CI:0.865,0.957) and temperature (OR: 0.932, 95% CI: 00.891,0.975). Furthermore, the odds of ICU admission was found to be increased with an ISS>16 (OR: 2072.12, 95% CI: 17.29,50644.09), being a pedestrian (OR: 366.53, 95% CI: 31.44,389.85), GCS<8 on admission (OR: 87.64, 95% CI: 29.04,264.43), smoking (OR: 11.92, 95% CI: 1.45,97.64), drug usage before the accident (OR: 11.47, 95% CI: 7.09,18.56), being amotorcyclist (OR: 5.72, 95% CI: 1.06,29.22), age (OR: 1.19, 95% CI: 1.05,1.34) and the time duration between the event and admission (OR: 1.01, 95% CI: 1.003,1.02). Conclusion: This study underscores the critical role of timely and effective medical interventions, including surgical procedures, in improving the outcomes of road accident victims. It also highlights the need for targeted preventivemeasures and interventions for high-risk groups pedestrians and motorcyclists. Hospital Mortality https://fem.tums.ac.ir/index.php/fem/article/view/1232 https://fem.tums.ac.ir/index.php/fem/article/download/1232/469

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 01 29 e5 e5 EN Mahgol Sadat Hassan Zadeh Tabatabaei Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Vali Baigi Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammadreza Zafarghandi Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Vafa Rahimi-Movaghar Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Amin Valizade Hasanloei Department of Anesthesiology, Urmia University of Medical Sciences, Urmia, Iran. Seyed Mohammad Piri Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Armin Khavandegar Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Khatereh Naghdi Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Payman Salamati Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran. 2023 07 29 2023 10 03 Objective: Trauma is one of the major causes of mortality and morbidity globally. The current study aimed to improve the understanding of characteristics, severity of injuries and outcomes of trauma patients admitted to Imam Khomeini Hospital, Urmia, Iran. Methods: Data were obtained from the trauma registry of Imam Khomeini Hospital, a level 1 trauma referral center, for all patients admitted to the center from 17 september 2016 to 21 January 2023. Patients’ demographics, injury mechanisms, and patients' outcomes were analyzed. Results: The emergency department attended to 5555 trauma patients. The gender distribution was with 3998 (71.9%) males and 1557 (29.1%) females. Patients' age ranged from 1 to 101 years, with a mean±standard deviation (SD) of 33.1 (±20.7) years. Road traffic accidents followed by falls were the most common causes of traumas reported in 2138 (38.5%) and 1298 (23.4%) trauma patients, respectively. The in-hospital mortality rate was 0.9% (53 patients). The mean (±SD) age of death was 43.5 (±22.4) years. 569 (10.2%) patients were admitted to the intensive care unit (ICU). The univariable logistic regression models showed that there were significant associations between age (P<0.001), Glasgow coma scale (GCS) (P<0.001), injury severity score (ISS) (P<0.001), and mechanical ventilation (P<0.001) as independent variables and death outcome. The univariable and multiple logistic regression analyses showed statistically significant associations between age, cause of trauma, ISS, GCS and body site injury with ICU admission. The odds of ICU admission in patients after being adjusted for age, ISS, GCS, cause of trauma and type of transportation was 1.73 times higher in head, face, and neck injuries compared to limb injuries.  (adjusted OR: 1.73, [95% CI: 1.23,2.42]; P<0.01). Conclusion: Older age, low GCS, higher ISS and mechanical ventilation were associated with higher mortality. Older age, higher ISS, lower GCS, body site injury, type of transportation, and cause of trauma were all significant independent predictors of ICU admission. https://fem.tums.ac.ir/index.php/fem/article/view/1246 https://fem.tums.ac.ir/index.php/fem/article/download/1246/467

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 1 2024 01 29 e6 e6 Melika Hajiaghaei Shahir Tabriz Student Research committee, Tabriz university of medical sciences, Tabriz, Iran. Parham Maroufi Department of Orthopedy, school of medicine, Tabriz university of medical sciences, Tabriz, Iran. Seyed Pouya Paknezhad Emergency and Trauma Research Center, Tabriz university of medical sciences, Tabriz, Iran. Seyed Ehsan Mousavi Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Gholamreza Faridaalaee Emergency and Trauma Research Center, Tabriz university of medical sciences, Tabriz, Iran. 2023 05 27 2023 09 16 Objective: Wrist trauma is a common chief complaint in emergency departments and radiography is used to make the diagnosis. Excessive usage of radiographs would utilize resources, exert risk of radiation exposure, and overcrowding. Amsterdam wrist rules (AWR) have been proposed as a tool for clinical decision-making regarding the need for wrist fracture diagnosis. This study assessed the diagnostic test performance of this rule in wrist trauma for wrist fracture. Methods: All patients over 18 years old with the chief complaint of acute wrist trauma were included. They were excluded if Glascow coma scale (GCS) was below 15, needed emergency surgery without an X-ray, and had a history of wrist fracture in the past 3 months. Anteroposterior and lateral radiographs were obtained and the AWR predictors were assessed before going to the radiology unit. The presence of a fracture of the distal radius was confirmed by treating emergency physician or radiologist. Results: 205 participants were recruited in this study, of which 6 patients (2.9%) were excluded due to missing data. The median age was 40 (IQR: 30-50) and 74 (37.2%) patients were female. There were 66 (LastName>Barghi Shirazi Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran Shandiz Moslehi Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran Mohammad Reza Rasouli School of Industrial Engineering, Iran University of Science and Technology, Tehran, Iran Gholamreza Masoumi Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran 2022 03 06 2022 04 10 Objective: The simulation strategy is so important for appropriate responses and preparedness of hospital emergency department staff in emergencies to strengthen team building and care focused on the interdisciplinary community. Therefore, this study aimed to identify the factors affecting the hospital emergency department's simulators during emergencies and disasters. Methods: This conventional content analysis study was conducted in 2021. Participants were selected from Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis. Results: Analysis of the data results through semi-structured interviews showed 4 main categories and 11 subcategories including management and leadership (the structure, casualty management, command, interactions and coordination, communications and information, as well as human resources), and increasing the capacity (resources (physical resources, and financial resources)), modern technology approaches (information technology), laws and policies (policies, guidelines, and rules). Conclusion: The simulation technology use can be effective in preparing the hospital emergency department in the event of disasters, strengthening management and leadership, proper planning, appropriate organizational culture, organizational learning, interactions and coordination, casualty management, as well as providing resources, equipment, items, processes, and instructions. So, the use of these new technological training is recommended to improve responses in times of emergencies and disasters. https://fem.tums.ac.ir/index.php/fem/article/view/976 https://fem.tums.ac.ir/index.php/fem/article/download/976/400

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 3 2022 03 01 e37 e37 Mohammad Haji Aghajani Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mehrdad Haghighi Department of Infectious Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Sistanizad Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran Ziba Asadpoordezaki Department of Psychology, Maynooth University, Kildare, Ireland Amirmohammad Toloui Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran Arian Madani Neishaboori Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran Asma Pourhoseingholi Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Fatemeh Nasiri-Afrapoli Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Amir Heydari Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Reza Miri Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran Mahmoud Yousefifard Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran 2022 01 17 2022 01 21 Objective: In this study, we have evaluated the occurrence and risk factors of cardiac dysrhythmia on admission and during hospitalization in COVID-19 patients. Methods: This study was conducted as a retrospective cohort in which 893 electrocardiograms (ECGs) taken at the time of admission and 328 ECGs taken during hospitalization were evaluated. These ECGs were assessed for cardiac dysrhythmias by a cardiologist. Finally, relationships between clinical characteristics and the occurrence of cardiac dysrhythmias in patients were assessed. Results: Most common cardiac dysrhythmias on admission were sinus tachycardia (64.8%), atrial fibrillation (13.5%), and sinus bradycardia (11.3%). Multivariate regression analysis showed that a history of metformin use (RR=0.83; p=0.042) was independently associated with reduced risk of cardiac dysrhythmias on admission, while male sex (RR=1.16; p=0.018), history of cardiovascular diseases (RR=1.16; p=0.017), history of cancer (RR=1.40; p=0.004) and QT prolongation on ECG (RR=1.18; p=0.017) were associated with a higher risk of cardiac dysrhythmias on admission. Also, from the 328 patients that had a second ECG, 185 (56.4%) experienced cardiac dysrhythmias during their hospitalization. Multivariate analysis showed that presence of cardiac dysrhythmias on admission (RR=1.85; 95% CI; 1.49-2.35; p<0.001) was the only independent prognostic factor for the occurrence of cardiac dysrhythmias during hospitalization. no significant relationships were observed between treatment regimens and the incidence of cardiac dysrhythmias. Conclusion: The present study showed that more than half of COVID-19 patients have cardiac dysrhythmias on admission. Our analyses illustrated that a history of metformin use was associated with a lower risk of cardiac dysrhythmias on admission, while male sex, history of cardiovascular diseases, history of cancer, and QT prolongation were associated with a higher rate of cardiac dysrhythmias. Hydroxychloroquine use along with azithromycin and Kaletra (Lopinavir-Ritonavir) had no association with the development cardiac dysrhythmias during hospitalization. https://fem.tums.ac.ir/index.php/fem/article/view/935 https://fem.tums.ac.ir/index.php/fem/article/download/935/403

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 3 2022 05 03 e38 e38 Alireza Baratloo Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran Mobin Mohamadi Student Research Committee, Iran University of Medical Sciences, Tehran, Iran Mohammad Mohammadi Student Research Committee, Iran University of Medical Sciences, Tehran, Iran Amirmohammad Toloui Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran Arian Madani Neishaboori Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran Seyedeh Niloufar Rafiei Alavi Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran