mahnaz yadollahi; Zahra Moradi; Kazem Jamali; Maryam Fadaie Dashti
Volume 26, Issue 1 , 2024
Abstract
Background: The current study aimed to successively assess the applicability of trauma scoring systems.Objectives: To evaluate the outcomes, prognosis, and mortality in trauma patients.Methods: The present study was conducted on all 221 injured patients referred to Shahid Rajaee Hospital from January ...
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Background: The current study aimed to successively assess the applicability of trauma scoring systems.Objectives: To evaluate the outcomes, prognosis, and mortality in trauma patients.Methods: The present study was conducted on all 221 injured patients referred to Shahid Rajaee Hospital from January 2014 toDecember 2020 with International Classification of Diseases-10th Revision (ICD-10) injury mechanism codes of W32.0-34.09, indicating afirearm injury. Univariate analysis and Chi-square test were employed to discover the individual relationship between each variable andthe injury outcome. Logistic regression analysis was performed to control the confounder. Finally, the area under the Receiver OperatingCharacteristic (ROC) curve was used to compare the predictive efficiency of the injury severity scales.Results: The mortality rate of the gunshot was 15 (6.78%). The cause of the gunshot was related to assaults in 73.68% of the survivingpatients. Meanwhile, suicide attempt was the second cause of death in gunshot patients (16.67%). Most of the injuries that occurredamong 20-24-year-old patients resulted from assaults. The odds of mortality in gunshot victims increased by 4.25 times (95% CI [1.99,9.10]) for each additional unit AIS. In the random forest model, the Trauma Injury Severity Score (TRISS) was the most importantmortality predictor. The TRISS was the highest area under the ROC curve for death prediction among firearms gunshot patients.Conclusion: Injury Severity Score (ISS) had the least, and TRISS had the most area under the curve. Therefore, TRISS was found to be thebest predictor in determining the death or survival of firearms gunshot patients.
Mahnaz Yadollahi; kazem Jamali; Forough Pazhuheian; Mahmood ali Nezam eftekhari
Volume 23, Issue 5 , 2021
Abstract
Background: Simulation studies present an important statistical tool to investigate the performance, properties, and adequacy of statistical models in pre-specified situations. The proportional hazards model of survival analysis is one of the most important statistical models in medical studies. This ...
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Background: Simulation studies present an important statistical tool to investigate the performance, properties, and adequacy of statistical models in pre-specified situations. The proportional hazards model of survival analysis is one of the most important statistical models in medical studies. This study aimed to investigate the underlying one-month survival of road traffic accident (RTA) victims in a Level 1 Trauma Center in Iran using parametric and semi-parametric survival analysis models from the viewpoint of post-crash care-provider in 2017.
Materials and Methods: This retrospective cohort study (restudy) was conducted at Level-I Trauma Center of Shiraz, Iran, from January to December 2017. Considering the fact that certain covariates acting on survival may take a non-homogenous risk pattern leading to the violation of proportional hazards assumption in Cox-PH, the parametric survival modeling was employed to inspect the multiplicative effect of all covariates on the hazard. Distributions of choice were Exponential, Weibull and Lognormal. Parameters were estimated using the Akaike
Results: Survival analysis was conducted on 8,621 individuals for whom the length of stay (observation period) was between 1 and 89 days. In total, 141 death occurred during this time. The log-rank test revealed inequality of survival functions across various categories of age, injury mechanism, injured body region, injury severity score, and nosocomial infections. Although the risk level in the Cox model is almost the same as that in the results of the parametric models, the Weibull model in the multivariate analysis yields better results, according to the Akaike criterion.
Conclusion: In multivariate analysis, parametric models were more efficient than other models. Some results were similar in both parametric and semi-parametric models. In general, parametric models and among them the Weibull model was more efficient than other models.
Mahnaz Yadollahi; Ali Kashkooe; Ehsan Habibpour; Kazem Jamali
Volume 20, s1 , December 2018, , Pages 1-7
Abstract
Background: Spinal trauma is a devastating event which could disturb a person’s life. Objectives: The purpose of this study was to examine the prevalence and risk factors of spinal trauma in Rajaee Trauma Center, Shiraz, Iran.Methods: Data for this cross-sectional study were gathered from October ...
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Background: Spinal trauma is a devastating event which could disturb a person’s life. Objectives: The purpose of this study was to examine the prevalence and risk factors of spinal trauma in Rajaee Trauma Center, Shiraz, Iran.Methods: Data for this cross-sectional study were gathered from October 2009 to August 2015. The study was conducted through data extraction from the classified data of trauma patients admitted to Rajaei hospital. After performing some inclusion and ex- clusion criteria, 4630 cases were analyzed. The variables analyzed as the risk factors of spinal trauma included sex, age, cord injury, mechanism of injury, and injury severity score. Results: The prevalence of spinal trauma among traumatic patients was 7%; also, 3.7% of those with spinal trauma suffered cord injury. The mean age of the spinal traumatic patients was 38.2 ± 17.8, and male-to-female ratio was 2.394. Car accident, motorbikeaccident, and fall were the main causes of spinal trauma in this study. The lumbar region was the most common injured site in our study. Old age, cord injury, suicide, and car accident were the main risk factors of mortality among spinal traumatic patients. Risk factors of spinal trauma among traumatic patients were female gender, old age, and fall. The risk factors of cord injury in spinal traumatic patients were male gender, old age, and suicide. Conclusions: It was found that spinal trauma, spinal cord injury (SCI), and mortality among spinal traumatic patients in Iran de- pended on some risk factors, which should be reduced through eliminating such risk factors. Fall was the most prominent factor ofthe occurrence of spinal trauma. The most important factors of mortality in spinal traumatic patients were suicide and cord injury. Finally, suicide played the most important role in occurrence of SCI.
Mahnaz Yadollahi; Asieh Mahmoudi; Mohammadhadi Niakan; Maryam Fadaei Dashti
Volume 20, Issue 5 , 2018, Pages 1-7
Abstract
Background: Trauma is the main cause of death in all age groups, as well as the 7th leading cause of fatality among the elderly. Compared to the youth, the risk of mortality and length of hospital stay are higher in elderly patients experiencing similar trauma and injury severity. Objectives: The present ...
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Background: Trauma is the main cause of death in all age groups, as well as the 7th leading cause of fatality among the elderly. Compared to the youth, the risk of mortality and length of hospital stay are higher in elderly patients experiencing similar trauma and injury severity. Objectives: The present study aimed to identify the risk factors for mortality in the elderly. Methods: This was a cross-sectional study conducted on 65304 trauma patients who were referred to Shahid Rajaee (Emtiaz) Hos- pital trauma referral center, Shiraz, Iran 2011 - 2016. Information such as age, gender, injured body region, length of hospital stay, injury severity score (ISS), injury mechanism, nosocomial infection, and mortality was recorded. Injury severity scores and injured body regions were determined based on a conversion of international classification of diseases, the 10th revision (ICD-10) injury codes to Abbreviated Injury Scale (AIS-98) severity codes using a domestically developed electronic algorithm. The binary logistic regression was used to determine the partial effects of independent risk factors. Results: Patients over 60 had a mean age of 70.79 ± 8.83. Mortality rates were 4.7% (330) and 1.05% (614) among patients over and under 60, respectively. The most important risk factors for geriatric mortality included age over 75 [OR = 1.91, 95% CI (1.28 - 2.85)], nosocomial infection [OR = 10.56, 95% CI (6.52 - 17.10)], ISS (16 - 24) [OR = 12.51, 95% CI (7.28 - 21.490)], head injury [OR = 13.17, 95% CI (5.83 - 29.77)], and pedestrian accidents [OR = 1.47, 95% CI (1.47 - 1.95)]. Aging led to increased mortality due to nosocomial infection. Among the elderly patients, males had a higher mean injury severity score compared to females. Conclusions: According to our results, mortality rates increased by age in geriatric trauma patients. With similar severity of in- juries, there was a greater risk of mortality for trauma patients with very old age compared to old patients. Aging, gender (males), nosocomial infection, ISS, and head injury were the most significant predictors of mortality in the elderly.
Mahnaz Yadollahi; Mehrdad Anvar; Haleh Ghaem; Shahram Bolandparvaz; Shahram Paydar; Fateme Izianloo
Volume 19, Issue 1 , January 2017, , Pages 1-9
Abstract
Background: Since injury-related mortality is preventable, identifying factors that inversely affect trauma outcome are important initial steps towards reducing injury burden.Objectives: This study aims to determine independent risk factors of early/late in-hospital mortality among adult trauma victims ...
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Background: Since injury-related mortality is preventable, identifying factors that inversely affect trauma outcome are important initial steps towards reducing injury burden.Objectives: This study aims to determine independent risk factors of early/late in-hospital mortality among adult trauma victims with equal injury characteristics and severity at Shahid Rajaee (Emtiaz) Hospital during 2013 and 2014.Patients and Methods: A cross-sectional study of adult trauma patients (age≥ 15 years) sustaining injury through traffic accidents, violence, and unintentional incidents was conducted. Information was retrieved from three hospital administrative databases. Data on demographics, injury mechanisms, injured body regions, injury descriptions, outcomes of hospitalization, and development of nosocomial infections were recorded. Injury severity score was calculated by cross walking from international classification of diseases (ICD-10) injury diagnosis codes to abbreviated injury scale (AIS-98) severity codes. Two multiple logistic regression models were employed to reflect the partial effect of each covariate on early (within 48 hours) and late (beyond 48 hours) deaths.Results: There were 47,295 hospitalized patients (male/female ratio: 2.7:1.0) with a median age of 30 years (interquartile range 23 - 44 years). A crude mortality rate of 1% (454 cases) was observed and 52% of deaths occurred within 48 hours of hospital arrival. One percent developed a nosocomial infection in the course of admission. After adjusting for covariates, sustaining a thoracic injury (OR 8.5, 95% CI [4.7 - 15.2]), ISS over 16 (OR 6.4, 95% CI [3.6 - 11.4]) and age over 65 years (OR 5.1, 95% CI [3.0 - 8.8]) were the most important independent risk factors of early trauma death. Presence of a hospital-acquired infection (OR 12.7, 95% CI [8.9 - 18.1]), age over 65 years (OR 7.4 95% CI [4.5 - 12.1]), and ISS of more than 16 (OR 14.6, 95% CI [6.2 - 34.3]) were independent predictors of late death.Conclusions: Age, injury severity, injured body region, and hospital-acquired infections are important determinants of trauma outcome in our center. Timely recognition of factors affecting trauma mortality is crucial for monitoring changes of trauma quality of care. Our findings suggest the need to allocate resources for trauma prevention along with a potential focus on reducing inhospital complications.
