Search

Objective This study was conducted to determine the effect of intramuscular ondansetron on ketamine-associated vomiting in children undergoing procedural sedation. Methods This randomized, double-blind, placebo-controlled, parallel-group clinical trial was conducted at the emergency departments of two university-affiliated tertiary care hospitals. Eligible participants included all 6-month to 16-year-old children who received IM ketamine for PSA in the ED. A convenience sampling approach was used and a block randomization method was applied (blocks of four) using a computer-generated random sequence. Patients received ketamine 4 mg/kg or ketamine 4 mg/kg plus ondansetron 0.1 mg/kg intramuscularly. All findings including the occurrence of vomiting and its frequency were then recorded in the data collection sheets. Results Of 56 patients who received ondansetron plus ketamin, 7 (12.5%) and 1 (1.8%) experienced vomiting during recovery and before discharge and Of 65 patients in the control group, 14 (21.5%) and 6 (9.2%) experienced vomiting during recovery and before discharge, respectively. The observed differences in the rates of vomiting during recovery and at discharge were statistically significant between the two groups (P-value of 0.03 and Conclusion Intramuscular ondansetron is effective in controlling ketamine-associated vomiting.

The utility of PCR-based testing in characterizing patients with COVID-19 and the severity of their disease remains unknown. We performed an observational study among patients presenting to hospitals in Iran who were tested for 2019-nCoV viral RNA by rRT-PCR between the fourth week of February 2020 to the fourth week of March 2020. Frequency of symptoms, comorbidities, intubation, and mortality rates were compared between COVID-19 positive vs. negative patients. 96103 patients were tested from 879 hospitals. 18754 (19.5%) tested positive for COVID-19. Positive testing was more frequent in those 50 years or older. The prevalence of cough (54.5% vs. 49.7%), fever (49.5% vs. 44.7%), and respiratory distress (43.0% vs. 39.0%) but not hypoxia (46.9% vs. 56.7%) was higher in COVID-19 positive vs. negative patients (p

Context: The current review article considered the latest published papers on reducing unnecessary head Computed Tomography (CT) scans in pediatric patients, to pave the way for further surveys. Evidence Acquisition: The papers were selected through Google Scholar and PubMed. We searched “reducing unnecessary head CT scan in pediatric patients” with related keywords compatible with MeSH system in accordance with the search strategy. Original articles and systematic reviews published after 2010 were included. Other types of manuscripts such as a letter to editor, editorial reviews, case series, etc. were excluded. The title and abstract of the eligible articles were assessed in terms of relevance to our topic. The full text of final selected papers were studied by the investigators. Furthermore, a critical appraisal was performed in an expert panel to summarize it and make it applicable. Results: The extracted manuscripts have addressed this issue by various strategies. The findings could be categorized as follows: observation period, focused history taking, protocol and guideline development, implementation of validated clinical prediction rules, and blood-based decision making by assessing neuro-biomarker levels. Conclusions: Most of the reviewed articles were focused on clinical findings to discover the minimum or low risk category of the pediatric patients with blunt head trauma. Other articles attempted on facilitating the use of available clinical prediction rules in this regard. Also, the measurement of serum biomarker levels has been considered; however, their widely application in practice is not well supported by evidence yet.

Introduction: In 2010, a national triage train-of-trainer (TOT) workshop was held in Tehran, Iran. Objective: The present study aimed to assess the validity of the triage performed by the nurses educated by those who participated in TOT workshop. Method: This cross-sectional study was carried out in 6 teaching hospitals from 4 universities in Iran. Inter-rater and intra-rater reliability of performed triage by participations was measured. Thirteen nurses were randomly selected. Thereafter, at the end of each working shift, patient data recorded in the daily data registry forms were collected. Then, duration of hospital stay, number of cases admitted to general wards or intensive care units, number of cases discharged from the ED within 12 hours and mortality rate were compared with the triage level determined by the nurse. Results: In total, 30 nurses with a mean age of 28.4 ± 3.7 years were enrolled. In this study, 1491 triage cases (61.6% male) were evaluated, of which 4.2% were triaged as level 1, 18.3% as level 2, 37.1% as level 3, 20.4% as level 4 and 20.0% as level 5. The following outcome was observed: 3.64% were discharged, 6.29% were hospitalized, 3% died and 2.3% were discharged against medical advice without completing treatment. The correlation of determined triage level and patients’ duration of hospitalization was significant based on one-way ANOVA test (p = 0.000). The outcome of the patients significantly correlated with the level of triage determined by the study nurses (p = 0.000). Conclusion: Based on the findings, it appears that triage performed by the study nurses educated by those who participated in TOT workshop through cascade training system had perfect validity.

Myocardial infarction (MI) (i.e., heart attack) is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia) which accounts for a large number of deaths in the hospital. Diagnosis of myocardial infarction is confirmed based on clinical manifestations and electrocardiographic changes along with increased cardiac enzymes. Electrocardiogram (ECG) is one of the safest and easiest methods in the first place. Therefore, this study aimed to investigate the diagnostic value of standard electrocardiogram in the diagnosis of acute right ventricular infarction following lower cardiac infarction. This research was carried out at a time interval of one and a half years to diagnose acute primary infarction. In this method, the diagnostic value of ST↓ in lead I, ST↓ in lead aVL and I ST↓ + aVL, compared with ST↑ in lead V4R was investigated for diagnosis of right ventricular infarction. ST↑ in the lead V4R is a gold standard for the detection of right ventricular MI. All the patients who had the inclusion criteria were allowed to participate in the study. A total of 66 patients participated in the study. Accordingly, 58 (87%) were male and 8 (13%) were female. The mean age of the population was 54.9 ± 11.41. According to the ST↑ standard in lead V4R, 26 patients (39%) had right ventricular myocardial infarction. There was no significant relationship between angina pectoris and premature infarction (P-Value = 0.869). In this study, the right ventricular was most commonly involved in right coronary artery (78%). There was no significant relationship between the occlusion of right coronary artery and right ventricular infarction in 60 patients (P-Value = 0.94). The results showed that electrocardiogram manifestations help determine the occlusion site and the area at risk (ST↓ in lead aVL and aVL + I, sensitivity = 96%). In myocardial infarction, symptoms such as the ST-Segment elevation in lead aVR and ST-Segment depression in the lower leads are possible. Accordingly, in the lower infarction, ST changes in the leads V1-V6 are helpful in detecting patients at risk. Thus, the use of electrocardiogram in acute myocardial infarction helps detect more invasive patients and prevents extensive myocardial damage and other complications.

Magnitudes of the air pollution depend on various variables. Preprocessing and optimisation processes are necessary to discover the complexity of the relationship of the data for more accurate and efficient predictions. These techniques help to clean the datasets and to find the best structure of the smooth data model. The Gamma test (GT) and Genetic Algorithm (GA) are practical tools which can be applied for preprocessing and optimising data models. Regarding building a smooth data model, the developed artificial neural networks are functional optimisation strategies which are suitable for ANN training. Moreover, local linear regression (LLR) and dynamic local linear regression (DLLR) models are effective due to the high density of our normalised dataset. In this regard, we developed a process to construct a smooth data model to support environmental decision making in air pollution emergency conditions. The main objective of this work was to set an appropriate algorithm by preprocessing and optimising a set of the data model for developing smooth data-driven models which could play a significant role in early warning systems in regard to the human health. The data sets included the meteorological and air pollutant variables as inputs/predictors and emergency medical service clients as outputs. The GT and GA were applied to analyse and optimise the input variables. Three types of ANNS (ANN1, ANN2, and ANN3), (LLR), and (DLLR) techniques were used to establish the models. Finally, a smooth data model was constructed and evaluated.

Background: Climate change and air pollution are linked. Both of them are expected to impact human health. Climate can increase health risks from poor air quality and lead to emergencies. Forecasting health consequences of air pollution episodes is a matter of great concern. Objectives: The current study mainly aimed at simulating the climate change impact on emergency medical services (EMS) clients caused by air pollution to estimate the future trend of EMS clients with cardiovascular and respiratory symptoms by 2050. Methods: Future climate pattern was projected using general circulation model outputs under the scenario of two representative concentration pathways (RCP2.6 and RCP8.5). Statistical downscaling was performed by LARS weather generator to produce high-resolution synthetic time series weather dataset. Simulation was performed using an artificial neural network (ANN). Observed climate and air pollutant variables were tagged as predictors in ANN, and EMS clients were considered as the target. Projected future (2020 - 2050) climate and air pollution were applied to estimate the future trend of EMS clients. Results: The climate pattern was predicted to become warmer and wetter in the study area (Tehran, Iran). Annual trend of EMS clients with cardiovascular and respiratory symptoms increases under both RCP scenarios. Further increase is under RCP8.5 for EMS clients with cardiovascular symptoms, and the least increase is under RCP2.6 for those with respiratory symptoms. Annual and monthly trends of EMS clients with cardiovascular and respiratory problems are more sensitive to different groups of climate and air pollution variables. Conclusions: ANN is an executive tool to simulate the impact of climate change and air pollution on public health to estimate the future trend of related morbidity and forecast short-term cases across the world.

Requesting non-enhanced brain CT scans for trauma and non-trauma patients in ER is very common. In this study, the impact of incorrect brain CT scan interpretations by emergency medicine team on patients’ primary and secondary outcome was evaluated in the setting where neuroradiologist reports are not always available. During a 3-month period, 450 patients were enrolled and followed for 28 days. All CT scans were interpreted by the emergency medicine team, and the patients were managed accordingly. Neuroradiologists’ reports were considered as gold standard, and the patients were then grouped into the agreement or disagreement group. A panel of experts further evaluated the disagreement group and placed them in clinically significant and insignificant. The agreement rate between emergency medicine team and neuroradiologists was 86.4 %. The inter-rater reliability between emergency team and neuroradiologists was substantial (kappa = 0.68) and statistically significant (p < 0.0001). Only five patients did not receive the necessary management, and among them, only one patient died, and 12 patients received unnecessary management including repeated CT scan, brain MRI, and lumbar puncture. Forty-one patients were managed clinically appropriate in spite of misinterpretation. A 28-day follow-up showed a mortality rate of 0.2 %; however, expert panel believed the death of this patient was not related to the CT scan misinterpretation. We conclude that although the disagreement rate in this study was 13.6 %, primary and secondary outcomes were not clinically jeopardized according to the expert panel idea and 28-day follow-up results.

Objective Intravenous morphine has been used as a common method of pain control in emergency care. Nebulized fentanyl is also an effective temporary substitute. This study was designed to compare the effectiveness of nebulized fentanyl with intravenous (IV) morphine on management of acute limb pain. Methods This was a placebo-controlled, double-blind randomized clinical trial. Ninety emergency department patients with moderate to severe pain aged 15 to 50 years were blocked randomized and enrolled in this study. Forty-seven patients in the experimental group received nebulized fentanyl (4 μ g/kg) and IV normal saline as placebo, and the remaining 43 patients in the control group received IV morphine (0.1 mg/kg) and nebulized normal saline as placebo. All participants' pain scores were assessed by Numerical Rating Scale before and after intervention at 5-, 10-, 15-, 30-, 45-, and 60-minute intervals. Patients' vital sign and possible adverse effects were recorded respectively. Finally, all participants were assessed for their satisfaction. Results The mean initial pain score in the experimental group was 8.7 and 8.4 in the control group ( P = .1). Pain relief in both groups after 5 and 10 minutes were similar ( P = .72). Although the pain relief was significantly greater with fentanyl at 15 minutes, this difference is not clinically significant. Pain management in both groups was successful and was more than 3 scores reduction in Numerical Rating Scale. Patient satisfaction in both groups was similar. No adverse effects were reported in the experimental group. Conclusion This study suggests that nebulized fentanyl is a rapid, safe, and effective method for temporary control of acute limb pain in emergency department patients.

There are considerable rates of pediatrics trauma referring emergency department following a traumatic event. The worried parents are requesting for the most sensitive diagnostic test, so emergency physicians ask them to underwent brain computed tomography (CT) scan. Lower threshold of decision making regarding use of brain CT scan results in huge number of normal imaging. On the other hand, radiation exposer of the child may accompanied with lots of side effects in future. It may highlight a question that “how to reduce the numbers of unnecessary brain CT scan of traumatic pediatric patients?”

Objective: Emergency departments (EDs) are characterized by simultaneous care of multiple patients with various medical conditions. Due to a large number of patients with complex diseases, speed and complexity of medication use, working in under-staffing and crowded environment, medication errors are commonly perpetrated by emergency care providers. This study was designed to evaluate the incidence of medication errors among patients attending to an ED in a teaching hospital in Iran. Methods: In this cross-sectional study, a total of 500 patients attending to ED were randomly assessed for incidence and types of medication errors. Some factors related to medication errors such as working shift, weekdays and schedule of the educational program of trainee were also evaluated. Findings: Nearly, 22% of patients experienced at least one medication error. The rate of medication errors were 0.41 errors per patient and 0.16 errors per ordered medication. The frequency of medication errors was higher in men, middle age patients, first weekdays, night-time work schedules and the first semester of educational year of new junior emergency medicine residents. More than 60% of errors were prescription errors by physicians and the remaining were transcription or administration errors by nurses. More than 35% of the prescribing errors happened during the selection of drug dose and frequency. The most common medication errors by nurses during the administration were omission error (16.2%) followed by unauthorized drug (6.4%). Most of the medication errors happened for anticoagulants and thrombolytics (41.2%) followed by antimicrobial agents (37.7%) and insulin (7.4%). Conclusion: In this study, at least one-fifth of the patients attending to ED experienced medication errors resulting from multiple factors. More common prescription errors happened during ordering drug dose and frequency. More common administration errors included dug omission or unauthorized drug.

Introduction: Pandemic H1N1 influenza A (pdmH1N1) was a major health threat worldwide. Methodology: A prospective cross-sectional study was conducted at Imam Khomeini Hospital in Iran. Cases of suspicious pdmH1N1 patients referred to the emergency ward of the hospital were enrolled in the study, regardless of whether the final location of treatment was the community, the hospital ward, or the intensive care unit. Oseltamivir was administered within three hours of the patient's admission. The median length of stay for hospitalized patients was 3 days. Results: Gastrointestinal symptoms (nausea [164/434; 37.8%] and vomiting [98/434; 22.6%]) were the most common adverse reactions to oseltamivir in the study population, followed by dizziness (74/434; 17.1%). Out of 434 patients, 209 (48.2%) were treated in the community, 201 (46.3%) were admitted to the general ward in the hospital, and 24 (5.5%) were admitted to an ICU. Conclusions: This study provided insight on the effectiveness of oseltamivir in treating pandemic influenza A, as well as possible adverse reactions to the drug. The study further drew attention to a variety of pdmH1N1 complications, in particular secondary bacterial pneumonia. We also determined that 2009 influenza A (H1N1) infection-related critical illness and mortality affected fewer elderly than younger patients. Additionally, it was shown that our approach to patients with suspected Influenza A/H1N1 virus in our hospital was compatible with World Health Organization pandemic flu guidelines in our country.

Background: Ketamine has been used widely in emergency departments for different procedures, prescribed only as a single dose or dose per weight. We compared single dose of ketamine with dose per weight ketamine for procedures done in cases with acute musculoskeletal pain. Methods: This randomized double blind clinical trial, was conducted in the emergency department of Imam Khomeini Hospital during March and June 2012. Patients with traumatic or non-traumatic musculoskeletal pain with numeric rating scale (NRS) ≥ 4 were enrolled. Patients were divided to Weight groups and for each group 4 syringes with the same shape were considered. BP, PR, RR, O2 sat, level of consciousness and all complications were checked for the patients in minutes 20 and 30. First group received 50 mg and second group received 0.75 mg/kg intranasal ketamine. Results: Out of 136 patients enrolled in this study, 27 cases were excluded. Patients were divided to two groups of 60 (dose per kg) and 59 (single dose) persons. The most type of injuries were fractures (37.8%) followed by lacerations (26%). O 2 sat, HR, systolic and diastolic BP and Mean NRSs before and after procedures were not significantly different in the two groups. Mean NRS reduction was not significant between two groups (comparing NRS at baseline with NRS at minutes 30, 40 and 60). Discussion: Our study showed that 50 mg single dose of ketamine is the same as the 0.75 mg/kg dose per weight for reducing pain in cases with traumatic and non-traumatic musculoskeletal injuries.

Background: In order to assessment of intravascular fluid measurement of central venous pressure (CVP) is used via central venous catheterization (CVC). This procedure is highly invasive and may cause serious complications such as pneumothorax, infection, hematoma and etc. It is so valuable procedure if we can uses a less invasive or noninvasive procedure to assess patients intravascular fluid in critical positions. Objectives: In this study, the ultrasound was used to measure the central venous pressure (CVP). Patients and Methods: In this study, patients with Central venous catheterization were selected using simple random sampling. The largest diameter of longitudinal, transverse views and the cross-section of inferior vena cava (IVC) and internal jugular vein (IJV) were measured using the ultrasound in the bedside of the patients. Central venous pressure was measured using routine methods. Correlations between variables were analyzed using SPSS and linear regression. Results: Twenty patients with the mean age of 60.3 were studied. The main reason for cardiac catheterization was shock. There are no relationship between anterior posterior diameter of inferior vena cava and CVP of patients (P = 0.257). The longest diameter of IVC in ultrasonographic transverse view had significant association with CVP of patients (P = 0.045) but in patients with BMI > 25 it was not significant. Cross section of internal jugular vein had significant association with CVP of patients (P = 0.003). Longitudinal diameter of internal jugular vein had no significant association with CVP of patients (P = 0.052), but transverse diameter of internal jugular generally had significant association with CVP of patients (P = 0.003). Cross section of internal jugular had significant association with CVP (P = 0.001). Conclusions: Noninvasive assessment of the patient hydration condition using the ultrasound is a simple and practicable measure in emergency. With regard to the considerations, it is possible to estimate CVP via diameter measurement and cross-section of the central veins.

Background: Neurological emergencies are common causes of emergency department visits. The need for emergency medicine (EM) physicians and/or specialists worldwide is growing to meet this requirement. Delivery of time-sensitive interventions and lifesaving care requires training. Objectives: The aim of this study was to evaluate the level of knowledge of EM residents in neurosurgical emergencies before and after holding an education course. Materials and Methods: In this cross-sectional study, 28 EM residents during their first and second years of training were evaluated. A multiple choice questionnaire containing 60 questions about neurosurgical emergencies (radiology, cranial, spinal and spinal cord, and pediatrics) was designed by 3 neurosurgeons. Without any prior notification, pre-training exam was taken. A short-term course of education via didactic lectures in 8 sessions was held after the first exam. At the end of the course, participants were tested again in the similar conditions as the pre-training test. Scores were analyzed using paired t-tests. Results: Performance of residents was significantly improved from pre-training test with mean scores from 35.7 to 42.03 on post-training test (P < 0.001). Scores between males and females in the two exams were not significantly different (P = 0.063). The second-year residents had a significantly better performance compared to the one-year residents (P < 0.001). Conclusions: At present, there is no standard education program that provides the optimum needs for EM residency training. To deal with the need of improving EM residency education in neurosurgical emergencies, teaching by neurosurgeons either through formal lectures and clinical rotations or other similar educational methods could be advantageous.

BACKGROUND AND OBJECTIVE: Iran's hospitals have been considerably affected by disasters during last decade. To address this, health system of I.R.Iran has taken an initiative to assess disaster safety of the hospitals using an adopted version of Hospital Safety Index (HSI). This article presents the results of disaster safety assessment in 224 Iran's hospitals. METHODS: A self-assessment approach was applied to assess the disaster safety in 145 items categorized in 3 components including structural, non-structural and functional capacity. For each item, safety level was categorized to 3 levels: not safe (0), average safe (1) and high safe (2). A raw score was tallied for each safety component and its elements by a simple sum of all the corresponding scores. All scores were normalized on a 100 point scale. Hospitals were classified to three safety classes according to their normalized total score: low (≤34.0), average (34.01-66.0) and high (>66.0). RESULTS: The average score of all safety components were 32.4 out of 100 (± 12.7 SD). 122 hospitals (54.5%) were classified as low safe and 102 hospitals (45.5%) were classified as average safe. No hospital was placed in the high safe category. Average safety scores out of 100 were 27.3 (±14.2 SD) for functional capacity, 36.0 (±13.9 SD) for non-structural component and 36.0 (±19.0 SD) for structural component. Neither the safety classes nor the scores of safety components were significantly associated with types of hospitals in terms of affiliation, function and size (P>0.05). CONCLUSIONS: To enhance the hospitals safety for disaster in Iran, we recommend: 1) establishment of a national committee for hospital safety in disasters; 2) supervision on implementation of the safety standards in construction of new hospitals; 3) enhancement of functional readiness and safety of non-structural components while structural retrofitting of the existing hospitals is being taken into consideration, whenever is cost-effective; 4) considering the disaster safety status as the criteria for licensing and accreditation of the hospitals. Key words: Hospital, safety, disaster, emergency, Iran Correspondence to: Ali Ardalan MD, PhD. Tehran University of Medical Sciences, Harvard Humanitarian Initiative, Email: aardalan@tums.ac.ir, ardalan@hsph.harvard.edu. Language: en

Background: Anterior shoulder dislocation is one of the most common complaints of patients referred to emergency departments. Intravenous opiates and benzodiazepines are traditionally prescribed in order to relieve the pain in this group of patients; however, complications always pose a problem. Objective: To compare the pain relief and complications following intra-articular lidocaine and intravenous meperidine/diazepam in patients with anterior shoulder dislocation. Methods: 48 patients with non-habitual traumatic anterior dislocation of the glenohumoral joint admitted to Imam Khomeini hospital emergency department were enrolled in this randomised clinical trial. They were divided into two groups: one group of patients received intraarticular lidocaine 1%, while the other received intravenous meperidine and diazepam. Closed reduction using the countertraction–traction method was performed by a single person in all the patients. Utilising a 100 mm visual analogue scale, each patient’s pain was recorded before injection, before reduction, and after reduction. Results: Mean pain (mm) recorded before injection, before reduction, and after reduction in the intra-articular lidocaine group was 84.3 (95% confidence interval (CI) 79.8 to 88.8), 52.6 (95% CI 45.2 to 60.1), and 27.3 (95% CI 19.9 to 34.7), respectively. The corresponding rates in the intravenous meperidine/diazepam group were 83.2 (95% CI 79.2 to 87.2), 57.9 (95% CI 53.8 to 62.0), and 23.9 (95% CI 18.9 to 28.8), respectively. Both groups demonstrated a similar significant decline in pain after injection (p,0.005). No severe complications were reported in either of the groups. Conclusion: Intra-articular injection of lidocaine before closed reduction of anterior shoulder dislocation produces the same pain relief as intravenous meperidine and diazepam.

As a major public health problem, road traffic injuries (RTIs) affect all social groups of the society.1 Every year, around 1.3 million people die and 20-50 million people get injured or disabled as a result of the RTIs worldwide.2 The figure of RTIs is more alarming in low and middle-income countries (LMICs).1-2 RTIs in Iran are very important public health problems in the whole country. 3-6 When World Health Organization launched its call to action, it invited members of the public to be a part of the solution.1 The initiative focused on five important courses of action for the general public of which included: no speeding; wearing a seat-belt; wearing a helmet; never drink and drive; and being visible on the road. Being seen on the road is a fundamental requirement for safety of all road users, particularly vulnerable road users.2 Inadequate visibility plays a key role in RTIs during both day and night for pedestrians, cyclists and motorcyclists as well as car drivers.1 Being visible on the road seems to be a neglected action and hence it is still a major challenge, particularly in low and middle- income countries like Iran. Accordingly, it was decided to explore barriers related to pedestrians’ visibility on the road and to find suggestions for improvement based on road users’ experiences in Iran. Seventeen face-to-face interviews were conducted with road users including: pedestrian, motorcyclist, cyclist and car drivers between February-June 2013. A qualitative approach by means of content analysis was used to analyze the data. Findings indicated that barriers related to pedestrians’ visibility included a lack of knowledge of the importance of being seen, negative attitude towards using reflectors, a sense of being unusual when using reflectors, the significance of dark clothes as well as cultural support on wearing dark clothes and a lack of production of reflectors in the country. Suggestions for improvement included a public education campaign, effective law legislation, more rigorous law enforcements in terms of being visible on the road, more facilities for production of reflective materials and a more importantly further availability of reflectors in the country. In sum, the major barriers in terms of being visible of pedestrians on the road were identified as a lack of knowledge of importance of visibility and negative attitude in using reflective materials in both public and stakeholders. Suggestion for improvement of being visible on the roads covered educational campaigns and stricter law enforcements as well as more availability of reflectors in the society.

Objective To evaluate the ability of the Modified Acute Physiology and Chronic Health Evaluation (M-APACHE II) scoring system for the prediction of mortality in patients admitted to a tertiary emergency department in Iran. Methods During the study period, all patients aged >12 years who had been admitted to the emergency department of a tertiary hospital in Tehran, Iran were enrolled in the study. Traumatic and poisoned patients and those who died immediately after arriving at the emergency room were excluded. Using the M-APACHE II, risk of mortality was calculated for each patient. Finally, expected and observed mortalities were compared and the accuracy of M-APACHE II for prediction of mortality was determined using receiver operating characteristics (ROC) analysis. Results During the study period, 389 cases including 236 males (60.7%) were enrolled into the study. The mean age of the patients was 60.6±19.4 years (range 14 to 98 years). 117 patients died (30%) while the M-APACHE II predicted 129 deaths. The greatest discrepancy between observed and expected deaths occurred at M-APACHE II scores ≥21. The constructed area under the ROC curve basng on predicted and observed death was 0.938 (95% confidence interval 0.915-0.961). Conclusion M-APACHE II is an accurate scoring system for predicting mortality in patients admitted to the emergency department. However, further studies are needed to confirm our findings.