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Objective: During the past few decades, many scoring systems have been developed to evaluate the severity of injury and predict the outcome in trauma patients. This study aimed to assess the capacity of three common trauma scoring systems: injury severity score (ISS), Glasgow coma scale (GCS), and revised trauma score (RTS) in predicting in-hospital mortality and ICU admission in patients with traumatic injury. Methods: This is a multicenter study of the hospital-based national trauma registry of Iran (NTRI), an ongoing registry-based trauma database. This study included trauma cases from 12 major trauma centers throughout the country admitted between July 2016 and November 2023. The inclusion criteria were all patients admitted to the emergency department due to trauma, hospitalized for at least 24 hours, deceased within the first 24 hours of admission, and patients transferred from the intensive care unit (ICU)s of other hospitals. Results: A total of 50,458 traumatic patients, with 38,740 (76.9%) being male, were included in this study. After adjustment for confounders, head, face, and neck injuries were associated with the highest odds of death (OR: 7.51, P-value<0.001), whereas abdominal injuries were associated with the highest odds of ICU admission (OR: 4.58, P-value<0.001). Each Unit increase in RTS score was accompanied by a 61% decrease in odds of death (OR: 0.39, P-value<0.001). The area under the ROC curve for predicting in-hospital mortality was 0.81 (0.79 to 0.82) in ISS, 0.78 (0.77 to 0.80) in GCS, and 0.75 (0.73 to 0.76) in RTS. There was a significant difference between RTS and GCS, aswell as RTS and ISS for in-hospital mortality prediction (P-values< 0.001). The area under the ROC curve for the prediction of ICU admission was 0.75 (0.74 to 0.75) in ISS, 0.63 (0.62 to 0.63) in GCS, and 0.62 (0.61 to 0.63) in RTS. There was a statistically significant difference between ISS and GCS, as well as ISS and RTS, for ICU admission prediction (P-value<0.001). Conclusion: ISS is the best predictor of in-hospital mortality and ICU admission, compared to GCS and RTS. [ABSTRACT FROM AUTHOR]

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 from17 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 traumawere all significant independent predictors of ICU admission. [ABSTRACT FROM AUTHOR]

Background: According to the reports, the road traffic injuries (RTI) mortality rate in Iran as a middle-income country in the Eastern Mediterranean Region (EMR) decreased in past decades but is higher than the global level and remained a health problem. Objectives: This study aimed to report the characteristics of registered patients injured by different trauma mechanisms in Yazd City, Iran. Methods: In this study, the patients were registered from September 28, 2016, to December 31, 2022, at Shahid Rahnamoon Hospital, affiliated with the National Trauma Registry of Iran (NTRI) for its first phase. Inclusion criteria were hospital length of stay (LOS) of more than 24 hours, death due to injury in the hospital, or transfer from other hospitals' intensive care units (ICU). Age, gender, Glasgow Coma Scale (GCS), systolic blood pressure (SBP), cause of injury, LOS, injury severity score (ISS), and in-hospital mortality were assessed. Results: Among 3960 participants, 2307 (58.2%) patients were injured due to RTI as the most common cause of injury. Also, 949 (23.9%) and 359 (9.1%) of the participants experienced fall and stab/cut injuries, respectively. Men were affected more than women in all injury causes (p<0.001). In those with RTI, multiple trauma (55.3%) was the most prevalent event, and then extremities (23.5%) were the most body regions injured (p<0.001). Also, in people who fell, trauma to the extremities (35.4%) was higher than in other regions (p<0.001). According to the adjusted logistic regression model, being ≥65 years old has a 1.9 times higher chance of ICU admission compared to being<18 years old. Also, having ISS≥9, having GCS≤12, and having trauma to the head/neck/face, abdomen, spine and multiple trauma had a statistically significant association with the chance of ICU admission with odds ratios (OR) and 95% confidence intervals (CI) of 3.89 (2.49-6.08), 22.26 (10.54-47.02), 2.55 (1.33-4.88), and 4.40 (3.00-6.47), respectively. Conclusion: Data from the first phase of the only trauma registry center in Yazd province showed that RTI was the most common cause of injury, which was more prevalent among men. People aged 18 to 64 were significantly more affected by all injury causes. After multiple trauma, RTIs and fall injuries were mainly involved in the head and extremities. People must be warned against the potential risks and complications of trauma, especially RTI, more than before. [ABSTRACT FROM AUTHOR]

Background: There are many debates on socioeconomic indicators influencing trauma outcomes. Objectives: This study aimed to determine the association between education as a socioeconomic indicator and trauma outcomes. Methods: This descriptive-analytical study was conducted on 30,448 trauma patients during 2016-2021. The data were based on the minimum dataset of the National Trauma Registry of Iran (NTRI) from six different trauma centers in various cities of the country. The variables used in this study included age, education level, marital status, cause of injury, Glasgow Coma Scale (GCS), intensive care unit (ICU) admission, Injury Severity Score (ISS), and in-hospital mortality. Logistic regression was used to investigate the association between independent variables and trauma outcomes. Results: The study included 30,448 trauma patients with male predominance (75.8%). The mean age was 36.9 years. The most frequent education level was secondary education, with 14,228 (46.6%). Education levels had significant relationships with ISS, death, and ICU admission (P<0.001). Moreover, after applying the multiple logistic regression, the odds of deaths for trauma patients with no formal, primary, and secondary education levels were 3.36, 5.03, and 3.65 times, respectively, more than the odds of deaths at the higher education level after controlling for other factors (all Ps<0.05). However, there were no such relationships between education levels and the odds of ICU admission. Conclusion: Findings of the present study showed a significant association between the education levels and trauma outcomes. Adjusted for other covariates, the chance of death for trauma patients with no formal, primary, or secondary education levels was higher than that at the higher education level. [ABSTRACT FROM AUTHOR]

Background and Objectives: Trauma is a prominent reason for morbidity and death in Iran. The objective of this study was to provide epidemiological and clinical features of the injured patients admitted to one of the collaborating centers of the national trauma registry of Iran (NTRI). Materials and Methods: The study was carried out at the one NTRI center from March 25, 2017, to November 20, 2020. Patients who had the NTRI criteria were included in the study. Data comprised demographics, injury information, prehospital and in-hospital information, procedures, International Classification of Diseases 10 codes, diagnoses, injury severity, and outcomes. Results: Overall, 4043 trauma patients were included in the trauma. Of whom, 3036 (75.0%) were men. There was a statistically significant association between the cause of trauma and the severity of the injury. The post hoc test results demonstrated that the percentage of the injury severity score (ISS) ≥9 in patients with falls was higher than in patients with road traffic injuries (RTI) (26.9% vs. 16.8%, P = 0.01). The univariable and multiple logistic regression analyses showed statistically significant associations between age ≥65, cause of trauma, years of school, and ISS ≥9 with intensive care units (ICU) admission. After adjusting for age and cause of trauma, the odds of ICU admission in patients with ISS ≥9 were 6.23 times more than in patients with ISS <9 (odds ratio = 6.23, 95% confidence interval [4.92--7.88]). Conclusion: The odds of ICU admission were higher in older patients (age ≥65), lower educated patients, patients with falling, and severe injuries. [ABSTRACT FROM AUTHOR]

T follicular helper (Tfh) cells are a subdivision of T helper cells involved in antigen-specific B cell immunity. Tfh cells play an essential role in the interaction of T cells/B cells in the germinal centers (GC), and dysregulation of Tfh actions can offer pathogenic autoantibody formation and lead to the development of autoimmune diseases. This study seeks to evaluate changes in Tfh frequency and its related cytokines in autoimmune disease, its association with disease phase, severity, prognosis, and the effect of immunosuppressive treatment on the Tfh population. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. Electronic databases, including PubMed, Scopus, Web of Science, and Embase, were systematically searched for potentially eligible studies up to January 1, 2024. We identified 4998 articles in the initial search, from which 1686 similar titles were removed. A total of 3312 articles were initially screened, and 3051 articles were excluded by title/abstract screening. A total of 261 studies were considered for full-text assessment, and 205 articles were excluded by reason. Finally, a total of 56 studies were included in our review. The population of Tfh cells is generally higher in autoimmune diseases versus Health control. Moreover, the number of Tfh cells is associated with the disease severity and can be considered for determining the prognosis of studies. Also, peripheral blood circulating Tfh (cTfh) cells are an available sample that can be used as an indicator for diagnosing diseases. [ABSTRACT FROM AUTHOR]

Background: International economic sanctions (IES) influence a country's economic development and the overall welfare of a nation's population. Methods: An electronic search of PubMed, Embase and Web of Science was conducted until July 31, 2019. Additionally, a list of references to related articles was reviewed. Key search terms were "Economics", "Health", "Sanction", and their equivalents with no language or time restriction. Results: Totally, 8624 records were identified of which 2869 duplicates were deleted. Finally, 24 papers met the inclusion criteria and were selected for drafting. The number of papers included for evaluating each factor included healthcare (n = 16) and pharmaceutical industry (n = 10). Nine and eight studies examined the effect of sanctions imposed on Iran and Iraq, respectively. France, Haiti, Serbia, Cuba, Syria, and other areas such as Africa were also evaluated. Sanctions lead to a decrease in immunization rates and government health care expenditures. Sanctions increase infant and under-five mortality rate, road traffic injuries and fatalities, severe malnutrition, infective diseases, neurologic and visual disorders, as well as shortage of medical or dental instruments and a variety of medicines. Sanctions have adverse impacts on female labor and are associated with disabling hospitals, dispersing medical workers, and facilities for radiation therapy. Conclusion: The health status of sanctioned nations in terms of healthcare, and pharmaceutical industry was adversely affected in targeted countries. [ABSTRACT FROM AUTHOR]

Objective: Road traffic injury (RTI) is the second leading cause of death and disability, and motorcycle crashes rank as the first cause of traffic fatality in Iran. We aimed to compare various characteristics between traumatized motorcycle riders and pillion passengers registered with the National Trauma Registry of Iran (NTRI)., Methods: This is a retrospective study of the NTRI, an ongoing multicenter trauma database built on a registry. This study included injured motorcyclists from six major trauma centers nationwide admitted between February 2017 and November 2023. Motorcyclists should have been hospitalized for RTIs and met the NTRI's inclusion criteria. We assessed patients regarding their demographics, clinical features, the pattern of injuries, and diverse in-hospital outcomes., Results: Of 54,342 registered patients in the NTRI, 7,594 motorcyclists were included. Of them, 6,636 (87.4%) were riders, and 958 (12.6%) were pillion passengers. Among all, 7165 (94.5%) were male, and 420 (5.5%) female ( p  < 0.001). Only 656 (9.9%) of riders and 24 (2.5%) of pillion passengers were wearing helmets ( p  < 0.001). Lone motorcyclist crashes led to injuries in 1,394 (21.2%) riders and 332 (35.5%) pillion passengers ( p  < 0.001). Glasgow Coma Scale (GCS) was 3 to 8 in 204 (3.1%) riders and 16 (1.7%) pillion passengers ( p  = 0.016). The most frequent pattern of poly-trauma was "head and thorax," with 43 (32.3%) riders and 5 (25.0%) pillion passengers ( p  = 0.362). Univariable logistic regression analysis showed that Intensive Care Unit (ICU) admission (OR = 0.78, CI 95% = 0.62 to 0.97, p  = 0.028) and mechanical ventilation (OR = 0.58, CI 95% = 0.39 to 0.84, p  = 0.004) were significantly lower in pillion passengers compared to motorcycle riders. After adjustment for age, gender, occupational status, and helmet use, being a rider or a pillion passenger didn't have a significant association with any of the in-hospital outcomes., Conclusions: Motorcycle riders and pillion passengers sustain the same injuries in terms of pattern, severity, and in-hospital outcomes. Therefore, healthcare providers can approach them similarly. Since there is a high number of underage riders and helmets are not used commonly, there should be more police enforcement in this case.

Objective: The main objective of this study was to determine various characteristics and outcomes of self-harm and suicide in men and women with data obtained from the National Trauma Registry of Iran (NTRI). Method : This retrospective multicenter study using data from the NTRI included all patients who went to the emergency department (ED) due to self-harm and suicide, considering the NTRI's specific inclusion criteria, from September 2016 to January 2023. We evaluated patients regarding demographics and clinical characteristics, various outcomes, and factors influencing in-hospital death. Statistical analyses were conducted using the STATA software version 15.0. The chi-square test was used to compare the distribution of variables between men and women. Also, the logistic regression models were applied to assess the predictors of in-hospital death. Results: Self-harm and suicide cases were gathered from eleven geographically diverse hospitals across the country, and our study included 511 men and 347 women out of 50,661 registered trauma cases. Among them, 443 men (86.7%) and 267 women (76.9%) were between 18 and 49 years old (P < 0.001). Single women constituted 130 (37.3%) of the female cases, while single men were 313 (61.6%) of the male cases (P < 0.001). The three most common methods among our patients were poisoning with 234 (45.8%) of men and 245 (70.6%) of women cases, stab/cut with 208 (40.7%) of men and 54 (15.6%) of women cases, and fall with 16 (3.1%) of men and 26 (7.5%) of women cases (P < 0.001). The risk of death in patients with a Glasgow Coma Scale (GCS) score of 3 to 8 was 46.22 (95% CI = 18.66 to 114.45) times more than patients with a GCS score of 13 to 15. Conclusion: Data on self-harm and suicide traumatology were gathered from eleven hospitals in Iran. Our findings indicated differences in the distribution of age and marital status between genders. Moreover, both genders used similar methods for self-harm and suicide, and gender did not affect the outcome., Competing Interests: None., (Copyright © 2024 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

Background: Lengthy hospitalization may lead to an increased hospital-acquired patient complication, including infections, as well as increased costs for both healthcare systems and patients. A few studies evaluated the impact of various clinical and demographic variables on patients' length of stay (LOS). Hence, in this study, we aimed to investigate the impact of various variables on traumatic patients' LOS., Methods: This is a retrospective single-center, registry-based study of traumatic patients admitted to Taleqani, a major trauma center in Kermanshah, Iran. A Minimal Dataset (MDS) was developed to retrieve traumatic data on demographic and clinical aspects. We used univariable and multiple quantile regression models to evaluate the association between independent variables, including ISS, GCS, and SBP, with LOS. LOS is practically defined as the time interval between hospital admission and discharge. The LOS durations have been presented as median (Q1 to Q3) hours. A p-value of <0.05 was considered statistically significant., Results: A total of 2708 cases were included in this study, with 1989 (73.4%) of them being male. The median LOS was 87.00 (48.00 to 144.00) hours. When adjusted for systolic blood pressure (SBP), Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and cause of injury, the two characteristics of spine/back and multiple trauma were significantly associated with the higher LOS, with 43 (20.5 to 65.48) and 24 (10.39 to 37.60) hours more than extremities ( P < 0.001 and P = 0.005). Besides, the patients admitted due to road traffic injuries (RTI) were discharged 16 and 41 hours later than falling and cutting/stabbing ( P = 0.008 and < 0.001, respectively). Moreover, the patients with ISS≥16 and 9≤ISS≤15 had a median of 51 (21 to 80) and 34 (22 to 45) LOS hours more, compared to 1≤ISS≤8, respectively ( P < 0.001). The trauma cases experiencing SBP ≤ 90 mmhg on admission had a median of 41 (20 to 62) hours more hospitalization period than those with SBP> 90 mmhg ( P < 0.001). At last, the patients with GCS of 9 to 12 and GCS of 3 to 8 were hospitalized for 39 and 266 hours more than GCS of 13 to 15 ( P < 0.001)., Conclusion: Determining independent determinants of prolonged LOS may lead to better identifying at-risk patients on admission. Trauma care providers should consider the following risk factors for increased LOS: higher ISS, Lower GCS, and SBP, multiple trauma or spine injury, and trauma resulting from falling or cutting/stabbing. As a result, the impact of extended LOS might be reduced by intervening in the related influencing factors., Competing Interests: The authors declare that they have no competing interests., (© 2024 Iran University of Medical Sciences.)