Injury epidemiology in Iran: a systematic review

Analyzing the trend of mortality due to traffic and nontraffic accidents: a study in the north of Iran

Background

Examining the raw and standardized mortality rates is the primary strategy for improving life expectancy and human health in society through identifying risk factors and dealing with the factors that cause them.

Objectives

This study examined the trend of mortalities due to traffic and nontraffic accidents.

Methods

This cross-sectional study examines the registered mortalities during the years 2016-2022 in the form of a census in the health department's death registration and classification system. Mortality was analyzed as raw and standardized mortality in each 100 000 population.

Results

Out of 18 265 deaths during 2016-2022, 1305 (7.15%) were related to accidents and incidents. The age-standardized total mortality rate in the first year was 32.9, and in the final year of the study, it was 33.3 per 100 000 people; although there are fluctuations, this trend is upward (P.trend=0.021). Also, the age-standardized traffic death rate in the first year is 19, and in the final year is 12 per 100 000 people; this decreasing trend was not statistically significant (P.trend=0.061). The incidence of age-standardized intentional nontraffic deaths was 1.7 in the first year of the study interval and 9.8 in the last year in 100 000 people, which showed an upward trend (P.trend<0.001).

Conclusion

In light of the generally increasing trend of accidents, especially nontraffic accidents, universal and well-rounded measures are necessary for safety matters and reducing mortality.

Comparing the Emergency Care of Iranian and Afghan Patients During the COVID-19 Pandemic

BACKGROUND

This study investigated the quality of inpatient care provided to Afghan immigrants in Iran during the COVID-19 pandemic (February 2019 to March 2021). For this purpose, the services received by Afghan immigrants were compared with those received by Iranian citizens.

METHODS

Two emergency services (traumas with 8080 victims and 8,686 patients hospitalized with severe COVID-19 infection) were taken into consideration. The records of all patients, including the Afghan immigrants, in two referral hospitals in Kerman were reviewed, and the main variables were the length of hospitalization (LoH), intensive care unit (ICU) admission rate, and death rate. Quantile regression, multiple logistic regression, and Cox regression were used to analyze the data.

RESULTS

The median and interquartile range of LoH for Afghan and Iranian nationals admitted due to traumas were 3.0±4.0 and 2.0±4.0, respectively (P<0.01). Moreover, the chance of Afghan nationals being admitted to the ICU (38%, odds ratio=1.38; 95% confidence interval [CI]=1.12; 1.69) and the hazard of death (60%, hazard rate=1.60; 95% CI=1.03; 2.49) were higher compared to Iranian nationals, which is statistically significant. However, no significant differences were observed between the COVID-19 patients from the two nationalities in terms of the median LoH, the odds of being admitted to the ICU, and the hazard of death due to COVID-19.

CONCLUSION

Afghan nationals admitted to the hospital due to traumas were more likely to be admitted to ICUs or die compared to Iranian citizens. It seems that Afghan patients who had traumas went to the hospitals with more serious injuries. There was no difference between Afghan and Iranian patients in terms of COVID-19 consequences. Following the findings of this study, it seems that justice in treatment has been fully established for Afghan patients in Iran.

A population study on factors associated with unintentional falls among Iranian older adults

INTRODUCTION

Falls among older adults are a significant cause of disability, injury, and death worldwide. The high incidence of falls in older adults, combined with the increased susceptibility to injury of the older adult population, leads to severe global health issues. Further studies are needed to comprehensively evaluate the typical personal and environmental risk factors of falls in the Iranian elderly population. Future preventive strategies and intervention programs will be based on these findings. The study determined the risk factors associated with unintentional falls among a representative sample of older adults living in Tehran, the capital city of Iran.

METHODS

The study design was cross-sectional. The target population was men/women aged 65 years and over from the general population living in 22 different districts of Tehran who were selected by stratified random sampling. The researchers gathered the data using validated questionnaires and observations. The informed consent was obtained from all participants before starting the interview. Multivariate logistic regression analysis examined the association between falls occurring during the past 12 months with demographics/ socioeconomics and fall-related predictor factors.

RESULTS

The risk of falls was higher in women (47.0%) and those aged ≥ 75 years (44.1%). Older adults who were married had their fall risk reduced by 36.4% compared with other types of marital status. Older adults who were illiterate (48.1%), housewives (47.0%), and always had concerns about living expenses (53.9%) tended significantly to have a higher risk of falls. Moreover, participants who live with their family were less likely to fall than those who live alone (36.5% vs. 40.4%). Persons with safe homes were less likely to experience falls than persons with unsafe homes (30.9% vs. 41.4%). The logistic regression analysis showed that the female gender, being worried about living expenses, home safety, functional behavior, and function factors, were independently associated with the risk of falls during the past 12 months.

CONCLUSIONS

Our findings revealed that a wide range of intrinsic and extrinsic risk factors contributed to injurious falls; based on the literature, some are preventable. The present data may be helpful as a starting point and guide future efforts for health providers and policymakers to allocate additional resources and develop proper falls prevention or intervention programs at the community level.

"Current incidence of injuries in Iran; findings of STEPS survey 2021"

Background

The updated epidemiology of injuries at the national and sub-national levels are required for policymakers to effectively handle the burden of injuries. This paper aimed to assess the incidence and risk factors of different injuries in Iran based on a recent national survey.

Methods

We used data from Iran Stepwise approach to surveillance (STEPS) Survey 2021, a population-based study in urban and rural areas of Iran's 31 provinces. A multistage clustered probability design and weighting adjustments were used to select eligible individuals and generate estimations. We estimated the incidence of injuries, assessed sociodemographic variables, and identified potential behavioral risk factors associated with injuries, and results were reported for sociodemographic and geographic stratifications.

Result

Data from 27,874 participants of the STEPS survey were assessed, of which 1538 (5.5 %, 95 % CI: [5.2-5.8]) reported having an injury in the past 12 months. Falls (44.4 %) were the most common cause of injury, followed by road traffic injury (21.7 %) and exposure to mechanical forces (16.5 %). Except for falls and burns, males had a higher proportion of all types of injuries. Logistic regression analysis showed that being male (OR: 1.7, [1.5, 2.0]) and being an occasional or heavy alcohol drinker (OR: 2.0, [1.3, 3.0] and OR: 2.7, [1.7, 4.1] respectively) were significant risk factors associated with road traffic injuries. Seatbelt use was 90.0 % among both drivers and front-seat passengers, while the use of safety car seats for children was as low as 9.4 %. Injury incidence varied significantly among provinces, with the highest incidence among males observed in Razavi Khorasan (11.2 %) and among females observed in Tehran (12.0 %).

Conclusion

This study investigated the updated epidemiology of injuries in Iran and revealed socioeconomic and geographic disparities across country. This epidemiological information can be used to modify injury prevention programs.

A Retrospective Cohort Study: Predicting 90-Day Mortality for ICU Trauma Patients with a Machine Learning Algorithm Using XGBoost Using MIMIC-III Database

Objective

The aim of this study was to develop and validate a machine learning-based predictive model that predicts 90-day mortality in ICU trauma patients.

Methods

Data of patients with severe trauma were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The performances of mortality prediction models generated using nine machine learning extreme gradient boosting (XGBoost), logistic regression, random forest, AdaBoost, multilayer perceptron (MLP) neural networks, support vector machine (SVM), light gradient boosting machine (GBM), k nearest neighbors (KNN) and gaussian naive bayes (GNB). The performance of the model was evaluated in terms of discrimination, calibration and clinical application.

Results

We found that the accuracy, sensitivity, specificity, PPV, NPV and F1 score of our proposed XGBoost model were 82.8%, 79.7%, 77.6%, 51.2%, 91.5% and 0.624, respectively. Among the nine models, the XGBoost model performed best. Compared with traditional logistic regression, the calibration curves of the XGBoost model and decision curve analysis (DCA) performed well.

Conclusion

Our study shows that the XGBoost model outperforms other machine learning models in predicting 90-day mortality in trauma patients. It can be used to assist clinicians in the early identification of mortality risk factors and early intervention to reduce mortality.

Contributions of avoidable mortality to the sex gap in life expectancy and life disparity in Iran

BACKGROUND

Public health policies and healthcare quality play a pivotal role on the health outcome level and disparities across sociodemographic groups. However, there is little evidence on their role on disparities in life expectancy (LE) and life disparity (LD) in low and middle income countries. The present study aimed to assess the contributions of avoidable mortality, as a measure of inter-sectoral public health policies and healthcare quality, into the sex gap in LE (SGLE) and LD (SGLD) in Iran.

METHODS

Latest available data of death causes, according to the ICD codes, for Iran was obtained from the WHO mortality database for the period 2015-2016. An upper age limit of 75 years was applied to define avoidable causes of death. LD was measured as the average years of life lost at birth. The SGLE and SGLD (both females minus males) were decomposed by age and cause of death using a continuous-change model.

RESULTS

Females, on average, outlived males for 3.8 years (80.0 vs. 76.2 years) with 1.9 lower life years lost (12.6 vs. 14.4 years). Avoidable causes accounted for 2.5 (67%) and 1.5 (79%) years of the SGLE and SGLD, respectively. Among avoidable causes, injury-related deaths followed by ischaemic heart disease had the greatest contributions to both SGLE and SGLD. Across age groups, the age groups 55-59 and 60-64 accounted for the greatest contributions of avoidable causes to SGLE (0.3 years each), while age groups 20-24 and 55-59 had the greatest contributions to SGLD (0.15 years each). Lower mortality rates for females than males in age groups 50-74 years accounted for about half of the SGLE, while age groups 20-29 and 50-64 years accounted for around half of SGLD.

CONCLUSION

More than two third of the SGLE and SGLD in Iran were attributed to the avoidable mortality, particularly preventable causes. Our results suggest the need for public health policies targeting injuries in young males as well as lifestyle risk factors including smoking in middle aged males in Iran.

Temporal Trend and Research Focus of Injury Burden from 1998 to 2022: A Bibliometric Analysis

Background

Injury is one of the leading causes of mortality and disability worldwide. It is a major contributor to the overall burden of disease. This study aimed to analyze the temporal trend, research focus and future direction of research related to injury burden.

Methods

Publications on injury burden published between January 1998 and September 2022 were extracted from the Web of Science Core Collection (WoSCC) through topic advanced search strategy. Microsoft Excel, RStudio, VOSviewer, and CiteSpace were used to extract, integrate, and visualize bibliometric information.

Results

A total of 2916 articles and 783 reviews were identified. The number of publications on injury burden showed a steady upward trend. The United States of America (USA) (n=1628) and the University of Washington (n=1036) were the most productive country and institution. High-income countries started research in this domain earlier, while research in low- and middle-income countries began in recent years. Lancet was the most influential journal. Public, environmental occupational health, general medicine and neurology were the predominant research domains. Based on keyword co-occurrence analysis, the research focus was divided into five clusters: injury epidemiology and prevention, studies related to the global burden of disease (GBD), risk factors for injury, clinical management of injury, and injury outcome assessment and economic burden.

Conclusion

The burden of injury has drawn increasing attention from various perspectives over the years. The research field on injury burden is also becoming more and more extensive. However, there are some gaps among different countries or regions, and more attention needs to be paid to low and middle-income countries.

Comparison the Ability of Quantitative Trauma Severity Assessment Methods Based On GAP, RTS, and ISS Criteria in Determining the Prognosis of Accidental Patients

Objective

To compare the ability of quantitative trauma severity assessment methods based on Glasgow coma scale, age, and arterial pressure (GAP), revised trauma score (RTS), and injury severity score (ISS) criteria in determining the prognosis of accidental patients.

Methods

This cross-sectional study was performed on random patients referred to Imam Khomeini Hospital in Urmia from March 20, 2020 to September 21, 2020. The data were obtained by using a checklist includes items such as age, sex, respiration rate, oxygen saturation level, pulse rate, primary blood pressure, initial Glascow coma scale (GCS), patient outcome and injury to different parts of body. After collecting the data, it was entered into SPSS 18 and analyzed with the descriptive and analytical statistics include an independent t-test and receiver operating characteristic curve (ROC) curves.

Results

Out of 1930 studied patients, 365 (18.9%) were women and 1565 (81.1%) were men. The mean age of patients was 37.05±17.11 years and women were significantly older than men. The mortality rate was 4.8% and was significantly more in men compared to women. The mean blood pressure, GCS and oxygen saturation level were lower in deceased patients. The mean GAP, ISS and RTS values were 23.13±2.69, 4.07±3.82, 7.72±0.52, respectively. The mean values of GAP and RTS were significantly low in deceased patients whereas the mean ISS value was significantly high in the deceased patients. The Area under the curve (AUS) for ISS was greater than the other two scoring systems.

Conclusion

The findings of the current study showed that all three systems were adequately efficient to prognoses the final outcome in multi-trauma patients but the ISS measure was better than the other two criteria.

Evaluating mechanism and severity of injuries among trauma patients admitted to Sina Hospital, the National Trauma Registry of Iran

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 < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003).

CONCLUSION

Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.

Development of quality indicators to measure pre-hospital emergency medical services for road traffic injury

Background

Pre-Hospital Emergency Care (PEC) is a fundamental property of prevention of Road Traffic Injuries (RTIs). Thus, this sector requires a system for evaluation and performance improvement. This study aimed to develop quality indicators to measure PEC for RTIs.

Methods

Following the related literature review, 14 experts were interviewed through semi-structured interviews to identify Quality Measurement Indicators (QMIs). The extracted indicators were then categorized into three domains: structure, performance, and management. Finally, the identified QMIs were confirmed through two rounds of the Delphi technique.

Results

Using literature review 11 structural, 13 performance, and four managerial indicators (A total of 28 indicators) were identified. Also, four structural, four performance, and three managerial indicators (A total of 11indicators) were extracted from interviews with experts. Two indicators were excluded after two rounds of Delphi’s technics. Finally, 14 structural, 16 performance and, seven managerial indicators (A total of 37indicators) were finalized.

Conclusion

Due to the importance and high proportion of RTIs compared to other types of injuries, this study set out to design and evaluate the QMIs of PEC delivered for RTIs. The findings of this research contribute to measuring and planning aimed at improving the performance of PEC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06238-1.

Fall-related hospitalization of patients in Iran

PURPOSE

Trauma has been called the neglected disease of modern society. According to WHO, fall is the second major cause of trauma or deaths resulting from unintentional accidents. The aim of this study was to investigate the different types of fall according to International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) in hospitalized patients visiting specialized accident and trauma hospitals of Mashhad, Iran.

METHODS

This was a cross sectional retrospective study performed between March 20, 2013 and March 20, 2014. The research population consisted of all medical records of patients for fall injuries in three specialized accident and trauma hospitals. ICD-10 was adopted to categorize all types of falls (w00-w19). The results obtained were analyzed by SPSS 16.

RESULTS

Altogether 7,448 cases were included. The codes w18 (fall on same level) and w09 (fall involving playground equipment) with the frequencies of 1,856 and 1,303, respectively in both genders had the maximum number of falls. The maximum percentage of mortality has been related to "fall on and from ladder"," fall from cliff "and "fall on same level involving ice and snow".

CONCLUSION

As falls can cause irrecoverable injuries including mortality of people, thus health authorities and policymakers should take preventive measures given the causes of falls and the root of this type of injuries, so that the costs resulting from this cause and its injuries can be reduced.

Meta-synthesis of qualitative evidence in road traffic injury prevention: a scoping review of qualitative studies (2000 to 2019)

BACKGROUND

A considerable number of qualitative studies have been published in recent years on the issues that the quantitative studies have limitations on. This study aimed at performing a meta-synthesis on qualitative studies on Road Traffic Injuries (RTIs) with a scoping review approach.

METHODS

This meta-synthesis study was conducted as a scoping review in 2019. The Arkesy and O'Malley framework was applied which has six steps of identifying the research question, identifying the relevant studies, selecting the studies, charting the data, data analysis and reporting the results, and consultation exercise. The required data were gathered by searching the relevant keywords in databases of PubMed, web of knowledge, Scopus, Cochrane Library, Science Direct, Google scholar, Sid, IranMedex. Extracted data were analyzed by the Content-Analysis method.

RESULTS

Finally, 30 studies were included. Extracted data summarized in five main themes and 17 sub-themes. The main themes were: consequences (individual, family, social, financial), the needs of survivors (social support and healthcare), risk factors (general risk factors, risk factors for motorcyclists, risk factors for children and adolescents), barriers of prevention (general barriers, pre-hospital barriers, emergency, and hospital barriers), and prevention solutions (increasing safety, rules and regulations, education, increasing equipment, scientific solutions) of RTIs.

CONCLUSION

This study combined the methods of the scoping review and the meta-synthesis to mapping all qualitative studies on the RTIs, with this approach, this study provides extensive and practical information for policy-makers, managers, practitioners, and researchers in the field of RTIs. Also, by applying this approach, the gaps in the existing knowledge and areas in need of further research are identified.

An evaluation of posterior cruciate ligament reconstruction surgery

Background

The nature of posterior cruciate ligament (PCL) injuries and the scarcity of data on this issue have made reports on clinical and epidemiological features of PCL injuries valuable. We aimed to report our experiences with PCL injuries in our region.

Methods

Any patient who referred with a diagnosis of PCL rupture from 2004 to 2018 to our center, was included in this report. We evaluated pre- and postoperative outcomes and compared patients with isolated and combined (multi-ligament) PCL injuries.

Results

Overall, 55 patients were included in our study. Majority of patients were men (87.2%). Mean age of patients was 28.12 ± 8.53 years old.

Average follow-up period was 28.83 ± 20.62 months and mean duration between trauma and surgery was 27.8 ± 38.0 months. Most common cause of PCL injury was traffic accidents (70.9%) followed by sports injuries (5.5%). Majority of patients (69.1%) had combined PCL injuries.

Majority of patients underwent single tibial-double femoral tunnel reconstruction (56.4%), followed by single tibial-single femoral tunnel (34.5%) reconstruction. Allografts were used in 60% of patient. Average Cincinnati knee rating scale (CKRC) was 35.87 ± 11.4, which improved significantly after PCL reconstruction (79.45 ± 11.90, p <  0.001). Full range of motion only existed in 29.1% of patient prior to surgery, which improved after surgery (92.7%, p <  0.001).

Three patients had postoperative arthrofibrosis and motion stiffness, 1 had deep vein thrombosis and 3 patients had infections.

Those with isolated PCL injuries had higher pre-operative CKRS (42.05 ± 8.96 vs. 33.10 ± 11.45, p = 0.006) and lower pre-operative posterior drawer test (2.76 ± 0.43 vs. 3.1 ± 0.6, p = 0.042) compared to those with combined injuries.

Conclusion

Today with advances in surgical techniques, considering treatment of collateral ligament injuries, use of stronger allografts and more secure fixation methods, better rehabilitation programs and early range of motion, results of reconstruction of the PCL has become very promising. Accordingly we recommend surgical treatment even for isolated PCL tears, with the goal to prevent functional deficit and to prevent degenerative arthritis.

Epidemiologic study of traffic crash mortality among motorcycle users in Iran (2011-2017)

PURPOSE

Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are considered as vulnerable road users. The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran.

METHODS

In this cross-sectional study, a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017. The examined variables included demographic characteristics, helmet use, crash mechanisms, crash location, position state, type of counterpart vehicle, cause of death and place of death. In the study, road traffic mortalities involving drivers and/or passenger of motorcycles were included. Cases or events registered without these conditions were excluded from the study. To analyse the data, SPSS statistics 25 and GraphPad Prism 8 softwares were used.

RESULTS

Of the 122,682 fatal traffic injury cases, 28,356 (23.1%) were motorcycle users, of whom 95.3% were male and 4.7% were female. Most of the motorcycle fatalities belonged to the age group of 18-24 years (29.1%). Head trauma was the major cause of death (59.0%). Also, the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%. Most of the road traffic crash cases (46.8%) happened out of city and half of people (49.9%) died in hospital. About 77.4% of the victims were motorcycle riders and 21.1% were pillion passengers. The highest rate of mortality belonged to the self-employed (38.4%) and then workers (21.8%) and students (10.2%). In addition, most fatalities occurred in people with low education (77.5%) and the least occurred in university graduates (5.5%). Among 31 provinces of Iran, Fars had the highest (9.3%) occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest (0.5%). Most of the crash mechanisms were due to motorcycle-vehicle crashes (80.2%), followed by rollover (9.8%).

CONCLUSION

Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.

Development and Implementation of Integrated Road Traffic Injuries Surveillance - India (IRIS-India): A Protocol

Road traffic accidents stand as one of the leading causes of mortality and morbidity across the globe. The reasons for the high burden of road traffic injuries (RTIs) in developing countries are increasing in the number of motor vehicles, poor enforcement of traffic safety regulations, inadequacy of health infrastructure and poor transport facility. However, the systematic collection of road traffic data is not well developed in many developing countries including India and under-reporting of RTIs and deaths are common. Hence, surveillance of RTIs is recommended to assess the burden, to identify high-risk groups, to establish an association with probable risk factors and to plan interventions to control the RTIs. The broad objective of this study is to establish an electronic-based comprehensive and integrated RTI surveillance system, to assess the burden of RTIs, its risk factors and outcomes across rural and urban settings in India. This study with the support of the Indian Council of Medical Research (ICMR) is progressing in three cities (Chennai, Delhi and Jaipur) and two rural areas (Chittoor and Tehri-Garhwal). At each centre, major sources of data can be categorized under two categories including health facilities and community. In urban areas, one trauma centre, one private hospital and a community of 10000-population are included in the study. In rural areas, a district hospital, a private nursing home and two sub-centres areas of different primary health centres at each site are included for the surveillance. Passive surveillance is done at the trauma centres/district hospitals, while active surveillance is done in private hospitals/nursing homes, sub-centres and communities. Before establishing the surveillance system, situational analysis has been undertaken. Surveillance-related software was developed during the preparatory stage. This electronic surveillance platform allowed to gather data electronically across multiple sites. This internet-enabled surveillance platform has several modules to capture and analyse the data. The present study provides a model of surveillance including both passive and active surveillance to cover maximum number of RTIs. This study further provides the first comprehensive epidemiology of RTIs. The results of these studies will contribute to the setting of research and investment priorities to tackle the burden of RTIs.

Barriers to and Facilitators of Road Traffic Injuries Prevention in Iran; A Qualitative Study

Objective:

To identify the barriers to and facilitators of the prevention of road traffic accidents (RTIs) in Iran.

Methods:

In this qualitative study 42 key stakeholders and experts in the field of traffic injuries in Iran were selected based on purpose and theoretical sampling to reach informational saturation. Their views concerning barriers to and facilitators of the prevention of traffic injuries in Iran were studied using semi-structured interviews. Data were analyzed using Content Analysis method.

Results:

Five themes were identified: structural barriers, organizational barriers and planning, socio-cultural barriers, scientific barriers, and inter-sector barriers and 22 sub-themes were extracted. The lack of lead agency, which was among structural barriers, was selected as the main barrier. The five general facilitators included: sensitization of society and authorities, improving the resources and infrastructure (software and hardware), increasing the attention to safety of vehicles and roads, increasing the information and awareness, and use of expert manpower. The sensitization of society and authorities was selected as the most important facilitator.

Conclusion:

According to the key experts, the barriers of policy changes to prevent the RTIs are more numerous than its facilitators. Therefore, planning and paying more attention to removing these barriers and promoting the facilitators seems necessary to reduce RTIs. Having a lead agency in this regard should be the highest priority.

Social Differences in the Prevalence of Road Traffic Injuries among Pedestrians, and Vehicle and Motorcycle Users in Iran: Results of a National Multiple Indicator Demographic and Health Survey (IrMIDHS, 2010)

Background

Traffic injuries are considered as the most important health issues for different countries in the world, especially developing countries that are experiencing rapid social changes. The purpose of this study was to investigate the prevalence of road traffic injuries (RTIs) and its socioeconomic differences among road users in Iran as it is one of the countries with high rates of accidents in the world. The study population included all people in Iran. The target sample was 3,096 clusters consisting of 2,187 urban and 909 rural households.

Methods

Source of the raw data was the Iran's Multiple Indicator Demographic and Health Survey (IrMIDHS) 2010, which is a multi-stage stratified cluster-random cross-sectional study. The logistic regression has been performed for investigating the socioeconomic determinants which influence the RTIs among pedestrian, vehicle, and motorcycle users.

Results

The prevalence of RTIs is 13.8 (95% CI: 13.1, 14.5) per 1,000 people in the year leading up to the study. The injured groups included pedestrians (14.37%), vehicles (38.36%), motorcyclists (43.37%), and 3.9% of users injured with other vehicles. A total of 78.3% of the injured people underwent outpatient treatment or were hospitalized. The mean age in these three groups was significantly increased (27.9, 32.5, 33.4, respectively), and the proportion of men decreased (89.2, 75.2, and 60.6).

Conclusions

RTIs in Iran are higher than previous estimates due to consideration of non-hospitalized cases. Considering the high contribution of human factors in developing countries, these measures should prioritize vulnerable groups.

Challenges of establishing a road traffic injury surveillance system: a qualitative study in a middle-income country

BACKGROUND

Establishing effective road traffic injury surveillance is an important priority for low- and middle-income countries since a large proportion of fatal road traffic injuries occur in these countries. A surveillance system can coordinate the activities and compile the data gathered by all road safety organizations. This study aims to explore the challenges of establishing road traffic injury surveillance based on the stakeholders' experiences.

METHODS

This is a qualitative content analysis study that was performed in 2018 in Iran. The study was conducted through interviews with 13 participants and employed purposeful sampling. Data generation was continued until concept saturation.

RESULTS

Five main categories and 17 sub-categories were identified including: policy-making (legal authority, stakeholders, content policy and plan); process (collection and recording, analysis and interpretation, dissemination and feedback); resources and infrastructure (technology, staff, structure, finance); coherence and coordination (communication, dispersion, cooperation, consensus); and context (socio-cultural, political).

CONCLUSIONS

By creating a clear structure for a road traffic injury surveillance system, identifying data collection systems and stakeholders in the field of road safety and injury prevention, determining a clear goal for improving road safety, and formulating policies for the dissemination of road traffic crash data among stakeholders, it will be possible to overcome the obstacles to establishing a surveillance system for road traffic injury.

Epidemiology of Road Traffic Injuries among Elderly People; A Systematic Review and Meta-Analysis

Objective:

To systematically review the epidemiological patterns and interventions for prevention of road traffic injuries (RTIs) among elderly.

Methods:

Searching keywords including: accident, trauma, road injury, road traffic injuries, aging, old, elder, strategy, intervention, road traffic crash prevention and traffic accident in databases including, Google scholar, SID, IranMedex, PubMed and Scopus. English and non-Persian articles, articles presented in congresses, articles that considered elderly people to have age under than 60 years were excluded. The reporting quality of articles was assessed by two experts using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) check list.

Results:

RTIs compromised 23.6% of total injuries among elderly. The most frequent injuries were about car accidents (51.4%). Pedestrian injuries composed 48.1% of the RTIs. Head and neck (32.1%) were most injured body parts. There was a significant difference between elderly and non-elderly people in terms of RTIs associated mortality (Odd=2.57 [1.2-5.4 CI 95%]). Overall 25 main domains of intervention and 73 subordinate domains were extracted in five categories (human, road and environment, tools and cars, medical, legal and political issues).

Conclusion:

According to the notable prevalence and fatality of RTIs, lack of sufficient studies and valid evidence of the present study can provide an appropriate evidence for better interventions for RTIs prevention among elderly.

Effectiveness of Interventions for Prevention of Road Traffic Injuries in Iran and Some Methodological Issues: A Systematic Review

Objective

To review the effectiveness of Road Traffic Injuries (RTIs) interventions implemented for prevention of RTIs in Iran and to introduce some methodological issues.

Methods

Required data in this systematic review study were collected through searching the following key words: "Road Traffic Injuries", "Road Traffic accidents", "Road Traffic crashes", "prevention", and Iran in PubMed, Cochrane Library electronic databases, Google Scholar, Scopus, MagIran, SID and IranMedex. Some of the relevant journals and web sites searched manually. Reference lists of the selected articles were also checked. Gray literature search and expert contact was also conducted.

Results

Out of 569 retrieved articles, finally 8 articles included. Among the included studies the effectiveness of 10 interventions were assessed containing: seat belt, enforcements of laws and legislations, educational program, wearing helmet, Antilock Braking System (ABS), motorcyclists' penalty enforcement, pupil liaisons' education, provisional driver licensing, Road bumps and traffic improvement's plans. In 7 studies (9 interventions) reduction of RTIs rate were reported. Decreased rate of mortality from RTIs were reported in three studies. Only one study had mentioned financial issue (Anti-lock Brake System intervention). Inadequate data sources, inappropriate selection of statistical index and not mention about the control of Confounding Variables (CV), the most common methodological issues were.

Conclusion

The results of most interventional studies conducted in Iran supported the effect of the interventions on reduction of RTIs. However due to some methodological or reporting shortcoming the results of these studies should be interpreted cautiously.

The Effect of Implementation of the Standard Clinical Practice Guideline (CPG) for Management of Multiple Trauma Patients Admitted to an Emergency Department

INTRODUCTION

The purpose of triage in the standard Clinical Practice Guide (CPG) for multiple trauma patients is to perform the primary and secondary evaluations in the quickest and shortest possible time with minimal errors and the best quality in the emergency department (ED).

OBJECTIVE

In this study, a practical program for a coordinated management of multiple trauma patients in the ED has been provided by using the CPG guide. The impact of its implementation on the multiple trauma patients' management was evaluated.

METHODS

This is a cross-sectional study conducted in 2014 and 2015 in Isfahan's Al-Zahra hospital ED. Administration and management of multiple trauma patients had been prepared before the implementation of the plan based on standard clinical methods of implementation in a way that used a 12-step protocol for the practical guide. This protocol was designed as a flowchart and the results before and after its implementation were evaluated.

RESULTS

In this study, 100 multiple trauma patients before and after the implementation of the protocol were studied. The mean age of the patients and other baseline characteristics of studied patients in the two periods before and after implantation of the CPG were not significantly different (p > 0.05). The frequency of intubation (p = 0.016) and sent to the operating room (p < 0.001) were different in the two study periods. However, hospitalization in the ICU (p = 0.35) and death (p = 0.73) before and after implementation of the protocol were not statistically different. The time before examination by the EM physicians was significantly lower in all triage levels after CPG implementation. Meanwhile, no change in time elapsed occurred for the surgeons except for the patients in level 2 of triage.

CONCLUSION

Implementation of the strategic plan of CPG lead to a significant reduction in waiting time for visits by emergency medicine services and other specialized services, increased the deployment of patients needing surgery, and reducing the time spent in the ED.

Policy Analysis of Road Traffic Injury Prevention in Iran

Introduction

Due to the large number of Road Traffic Injuries (RTIs) in Iran, authorities have implemented a number of policies for the prevention of RTIs. However, a scientific analysis of these policies has thus far been neglected. Therefore, this study was conducted for policy analysis of RTIs prevention in Iran.

Methods

This qualitative study with a case study approach was conducted in Iran during 2016 in two phases: First, by reviewing literature and documents of the past ten years, policies that have been executed to prevent RTIs in Iran were identified. In the second phase of the study, the identified policies were ranked by prioritization matrices. The two policies with the highest scores were selected. ‘Policy triangle framework’ was used for Policy analyzing. Stakeholders of these policies (42 people) were interviewed. Data were analyzed manually by implementing Content-Analysis methods.

Results

The policies of “pupil liaisons” and “safety belt” were selected for analysis from thirteen potential identified polices. The results of some studies revealed that safety belts had not been properly used in Iran (less than 80%). There was an eight-year hiatus between the approval of the safety belts policy and implementation of this policy. Eight actors were identified for safety belts policy. Lack of diligence in implementation of the policy, failing to pay adequate attention to education and the culture of driving, and failing to select an organization for the implementation of the policy, were identified as the main weaknesses of this policy. For ‘pupil liaisons’ policy, five actors were identified. Following the implementation of this policy, the number of penalties was reduced (17.9%). Neglecting scientific findings and individual-based nature of the policy were identified as the primary weaknesses of this policy.

Conclusions

Taking serious measures to properly execute the policy, educating people, selecting an efficient organization that is responsible for the implementation of the policies, and using international experience are the measures that can be taken to reduce the number of RTIs in the country.