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Background: Knowing the direction of traumatic injury is important as the information can help avoid death after trauma. A trauma registry usually entails detailed information about the demographics, cause, intensity of the injury, and the final diagnosis and outcome of the trauma-affected patient. Researchers should be able to evaluate all aspects of trauma injury and the patient's status., Objectives: The purpose of this study was to develop a trauma data collection form., Materials and Methods: The development of the trauma registry form began in February 2013. The variables were finalized by a team consisting of general and trauma surgeons, specialists in emergency medicine, orthopedists, neurosurgeons, and public health professionals who have special interest in trauma research. The scale was sent to 10 specialists for validation., Results: After assessing the scale validity twice, it was accepted with an integrator agreement of 0.89. The test-retest reliability was assessed in a convenience sample of 20 physicians (Kendall t = 0.97; P < 0.001). Such a high reliability may reflect redundancy of some items., Conclusions: It is essential to establish a secure multicenter trauma registry in Iran for data collection, storage, and assessment of traumatic injury and these registries must be easy to install and use.

Background: Hospital readmission places a high burden on both health care systems and patients. Most readmissions are thought to be related to the quality of the health care system., Objectives: The aim of this study was to examine the causes and rates of early readmission in emergency department in a Tehran hospital., Patients and Methods: A cross-sectional investigation was performed to study readmission of inpatients at a large academic hospital in Tehran, Iran. Patients admitted to hospital from July 1, 2014 to December 30, 2014 via the emergency department were enrolled. Descriptive statistics were used to summarize the distribution demographics in the sample. Data was analyzed by chi2 test using SPSS 20 software., Results: The main cause of readmission was complications related to surgical procedures (31.0%). Discharge from hospital based on patient request at the patient's own risk was a risk factor for emergency readmission in 8.5%, a very small number were readmitted after complete treatment (0.6%). The only direct complication of treatment was infection (17%)., Conclusions: Postoperative complications increase the probability of patients returning to hospital. Physicians, nurses, etc., should focus on these specific patient populations to minimize the risk of postoperative complications. Future studies should assess the relative connections of various types of patient information (e.g., social and psychosocial factors) to readmission risk prediction by comparing the performance of models with and without this information in a specific population.

Background: Sometimes patients with a scaphoid fracture, especially in an acute phase of injury, can have normal radiographs and, therefore, initial diagnosis of the scaphoid fracture may be neglected. In this study, we determined the value in of clinical examination and a radiograph in the diagnosis of scaphoid fracture based on the results of a two-week follow-up magnetic resonance imaging (MRI)., Objectives: In this study, sought to assess the value of using both a clinical examination (tenderness of scaphoid tubercle, tenderness of anatomical snuffbox, and compression test) and radiographic imaging in the diagnosis of scaphoid fractures based on the results after a two-week follow-up MRI., Patients and Methods: From December 2012 to February 2013, we enrolled 48 patients with suspected scaphoid fractures who had been referred to the emergency department of Baqiyatallah hospital, Tehran, Iran. Patients with negative results for clinical and radiographic examinations were excluded from the study. Cast immobilization was done for patients who had at least one positive finding during a physical examination test and who had normal radiographs. Patients who had a normal physical examination, but abnormal radiographs were referred to the orthopedic clinic after cast or split treatment. These patients also had a follow-up MRI two weeks after wrist trauma; the MRI was used to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the clinical and radiographic examinations., Results: Scaphoid tubercle tenderness had a sensitivity of 95.23% and a specificity of 74.07% in the diagnosis of scaphoid fracture. This test did not show a statistically difference with MRI results (P = 0.05). The results of the tenderness of the anatomical snuff box (sensitivity = 85.71%, specificity = 29.62%) was statistically different from the MRI results (P = 0.000). The results for the sensitivity (42.85%) and specificity (29.62%) for a compression test were not statistically different from the MRI results (P = 0.05). All of the radiographic tests that we applied in our project had 100% specificity for the diagnosis of a scaphoid fracture. However, the results were significantly different from the MRI results (P = 0.000)., Conclusions: A clinical examination combined with a plain radiograph should be considered to improve the diagnostic precision for patients presenting with scaphoid fractures in an emergency department. In this way, both overtreatment and undertreatment of patients can be avoided.

Background: Rapid ultrasound in shock (RUSH) is the most recent emergency ultrasound protocol, designed to help clinicians better recognize distinctive shock etiologies in a shorter time frame., Objectives: In this study, we evaluated the accuracy of the RUSH protocol, performed by an emergency physician or radiologist, in predicting the type of shock in critical patients., Patients and Methods: An emergency physician or radiologist performed the RUSH protocol for all patients with shock status at the emergency department. All patients were closely followed to determine their final clinical diagnosis. The agreement between the initial impression provided by RUSH and the final diagnosis was investigated by calculating the Kappa index. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RUSH for diagnosis of each case., Results: We performed RUSH on 77 patients. Kappa index was 0.71 (P Value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic, cardiogenic and obstructive shock, the protocol had an NPV above 97% yet it had a lower PPV. For shock with distributive or mixed etiology, RUSH showed a PPV of 100% but it had low sensitivity. Subgroup analysis showed a similar Kappa index for the emergency physician and radiologist (0.70 and 0.73, respectively) in performing rush., Conclusions: This study highlights the role of the RUSH exam performed by an emergency physician, to make a rapid and reliable diagnosis of shock etiology, especially in order to rule out obstructive, cardiogenic and hypovolemic shock types in initial exam of shock patients.

Background: Procedural sedation in children continues to be a problem in the emergency department (ED). Midazolam is the first water-soluble benzodiazepine and it has been widely used for procedural sedation in pediatric patients., Objectives: The aim of this study was evaluation of clinical safety and effectiveness of intramuscular Midazolam for pediatric sedation in the ED setting., Materials and Methods: We performed a self-controlled clinical trial on 30 children who referred to the Baqiyatallah Hospital ED between 2009 and 2010. They received intramuscular Midazolam 0.3 mg/kg for procedural sedation and then they were followed for sedative effectiveness and safety. Vital signs and O2 saturation were also observed. The findings were compared using SPSS ver. 16 software., Results: The mean age was 5.50 ± 2.70 years, the mean weight was 19.50 ± 6.63 kilograms and 16 patients (53.3%) were females. The most common adverse effect was euphoria (66.66%) and vertigo (6.7%); 27.7% did not show any side effects. There was an overall complication rate of 72.3%. The vital signs including heart rate, respiratory rate, systolic and diastolic blood pressure and O2 saturation decreased significantly during sedation (P value < 0.05)., Conclusions: Midazolam is an effective and relatively safe sedative for pediatric patients in the ED. The patient should be observed closely and monitored for psychological and hemodynamic side effects.

Background: The overcrowded hospital is an unsafe one. Overcrowding the emergency department (ED) results in increased patient suffering, prolonged waiting time, deteriorating level of service, and on occasion, a worsened medical condition or even death., Objectives: This study proposes a strategy to overcome ED overcrowding., Materials and Methods: The proportion of acute area admitted patients to screened patients (A/S), and the proportion of patients who were finally transferred to inpatient wards (W/A) to those admitted in ED acute area were investigated during 6 consecutive months. Emergency medicine residents were assigned to screen patients before ED admission and afterwards., Results: The average A/S changed from 82.4% to 44.2% (P = 0.028), and the average W/A changed from 28.3% to 51.48% (P = 0.028) before and after screening patients respectively. The initiative resulted in 97 less patients in the acute area per day., Conclusions: Decreased number of acute area admitted patients, and increase W/A proportion showed that the initiative was successful in obviating ED overcrowding while provision of care to those most in need was not altered.