---

Background: Sever injuries, disabilities and deaths from road traffic accidents have unpleasant results on individual, familial and social levels. According to lack of basic information about risk factor of seventy of road traffic injury, this study conducted to examine and quantify the association between potential risk factors and injury severity in injured drivers of road traffic accidents. Materials & Methods: Study was conducted on the 175 drivers with newly road traffic injuries (those need medical or surgical services) in Qazvin-loshan road from 28 Mar to 22 Jul 2005. Association between 16 risk factor and injury severity (NISS score) was assessed. Data obtained from interview with drivers, hospital records and police reports and was analyzed with two approaches: bivariate analysis (crude) and multiple linear regression. Results:In data processing (bivariant analysis)ejection from vehicle, severity of collision, trapped in vehicle, number of crash, fall down to valley, overturning, deviation from road, length of time to assist, left side versus rear-end accident and age of driver were associated to collision severity. In multivariate analysis one unite rise in collision severity index, trapped in vehich and ejection multiply NISS score by 4.14, 1.53 and 1.482 respectively. Trapped in automobile, ejection from vehicle, left side Vs. rear-end collision and an unit increasing in severity of collision index and age of driver increase NISS value multiplicatively by 1.531 (1.188 – 1.972), 1.482 (1.164 – 1.892), 1.585 (1.076-2.333) , 4.14 (2.589 – 6.637) and 1.009 (1-1.016) respectively in the multivariate analysis. Conclusion: To reduce severity of injuries in road traffic accidents, strategies must target severity of collision by speed controlling, helmet and seat belt using and improving assistance to injured drivers.

---

Background & Aim: Recently motorcycle not only produce massively but also used as a popular transportation in middle class of society. 42% of all transport injuries in Tehran are related to motorcycle accidents. This study evaluate motorcycle accidents in Uremia. Materials & Methods: A retrospective study was conducted on all patients injured in motorcycle accidents who were admitted to the Shahid Motahari during two-years period since 1382. Results: The 695 patients admitted due to motorcycle-induced trauma in Shahid Motahari Medical center with 16.6% increased rate of admission in 1383 compared to 1382. 96% were men, the 391 patients were in 15-24 age groups. 94% were not wearing a helmet. Motorcyclists who don’t wearing a helmet had an increased risk of brain concussion and facial bones fracture. Lower extremity fracture is the most common motorcycle indused injuries in transportation crash. In this study showed the rate of brain concussion, lower extremity fracture, facial bone fracture were 645, 41% and 77% respectively.The most common cause of death was brain concussion. Conclusion: With plan to encourage use of helmet we can reduce brain concussion and by modified motorcycle design and leather dressing, lower extremity fracture is prevented in motorcycle induced trauma.

---

Abstract Introduction: Electrical injuries is one of the major causes of death annually. Electrical injuries happens when the body is a part of electrical circuit and consequently broad symptoms are revealed. Discussion: Agents like voltage, amperage, type and pathway of current (direct or alternative), tissue resistance and passage time are important factors in severity of these injuries. The result of such injuries may be: paralysis, syncope, bone fractures, electrical burns, injuries due to falling down, renal failure, and at last death. The researches has shown that alternative current , humidity and anxiety increases the risk of electrical fatalities. At Autopsy there are no definite sign of death due to electrocution but some things such as presence of electrical mark, visceral petechia and congestion and some histological findings (epidermal cell elongation with nuclei oriented horizontally stretched) may help to find out the cause of death To prevent such injuries one must concerned about safety of electrical devices specially at high risk places like bathroom (because of the presence of vapor and water). If the victim’s life is saved checking vital signs, usage of broad spectrum antibiotics and other drugs to relieve pain and amendment of wounds, long time physical therapy may be useful in improvement the function of injured part of the body. Conclusion: If we know how dangerous Electrical injuries can be and know about agents that take part in the severity of injuries we can prevent it by making safe environment with proper preveventive programs and treatment plans in such cases we can reduce mortality a of electrical injuries.

---

Abstract: Background & Aim: Accidents and incidents are the most important reasons of fatalities and physical disabilities in the world. Accidents, disputes and working events are the most significant cases which result in trauma and injuries due to quarrels and disputes dedicated a large number to itself in a way that according to the statistics of the cases referred to clinical examination department of legal medicine organization in the whole country, 50% of the cases, referred to the center following by arguments and disputes in 2002. Through epidemiologic consideration of the quarrels and roles of different variables of this field, we are going to take a great step by means of this study to make the subject clear for public minds. Materials & Method: The populations considered in this study were the men referred to the central branch of LMO in Tehran who were seeking for the assessment of their damages resulted from quarrel and also to get the expert opinions of the specialists about their injuries during 3 months. 300 volunteer interested in cooperation were selected out of all. Their injuries and needed information were gathered within a special questionnaire and then analyzed through statistical methods. Findings: The gender of assailant in 95.3% of the cases was male and in 4.7% was female. The history of drug abuse existed in 7.9%, alcohol usage in 2.5% and history of drug usage existed in 1.8% of assaulted persons. From among all imposed injuries, the highest number relates to scratches and scrapes and the lowest number relates to Fractures. According to the given data, in most of the cases (75.2%) the assaulted person referred to the clinical examination department on the same day of injury occurrence. Educational level in most of the cases (34.3%) was intermediate. When considering job distribution, most of them were independent workers and simple workers were in the next level. According to the statistical analysis, in most of the cases (41.6%) punching, in 14.5% of them hard materials and in 10.5% cold weapons were the tools used for injuring. In addition, when studying on the injuries made by cold weapons or edged tools, knife was considered as the most usable crime tool (64%) and Dagger, carpet cutter, broken glass and other devices were in he next grades. Considering frequency distribution of the age, assailant and assaulted were mostly between 20-30 years old. Considering the frequency of the injured area, the cases have mostly wounded by face but rarely by low back or flunk, according to the reports. Discussion: The results show the importance of performing such a study on the defects due to physical quarrel. They also express that, presenting appropriate solutions like: • Promoting the knowledge of the people about the effects of drinking alcohol and drug usage on making the bases for quarrels and its aftereffects, • Promoting scientific knowledge of the public, • Preventing the people from carrying intrusive and offensive tools and determining expensive penalties for weapon carriers, • promoting the culture of reconciliation and having recourse to law instead of personal revenge, besides culturalization in all fields can definitely have significant influences on decreasing such traumas

---

Abstract: Background & Aims: The aim of this study was to assess the clinical manifestation and causes of chronic post-traumatic headache. Several publications have emphasized the relationship between head trauma and chronic post-traumatic headache. However, there is little known about the etiology (psychiatric or organic), treatment and particularly legal issues of chronic post-traumatic headache. In spite of the high number of accidents and head trauma this study was preformed in Iran. Materials & Methods: This was a retrospective study for 2.5 years in Neurology and Psychiatry outpatient clinic of Ghaem and Avicenna Hospitals. Patients included according to the diagnostic criteria of the primary headaches in The International Headache Classification 2nd Edition. Findings: The clinical presentation of chronic post-traumatic headache in 79 patients was analyzed. 56% of patients were women. The average age of our patients was 32. Headache had an inverse relation with the severity of trauma. 62 patients agreed to follow in this study. 55% had a bad response to treatment and finally did not continue it. 10 patients were referred form the forensic department and 4 fulfilled the criteria of chronic post-traumatic headache. Conclusion: The results of this study were similar to previous researches. Most of the time headache was not associated with a severe head trauma. It is possible that microscopic brain injury in the level of cellular relation is responsible for chronic post-traumatic headache. Further studies and clinical trials are necessary to clarify the scientific bases and also legal issues of chronic post-traumatic headache.

---

Background & Aim: Standard protection of patience suffering from head injuries are very important. Any failure in cure protection of this kind of patience is equal with deviation from the cure protocols. always many head injuries patience in to the emergency unit of hospital. Materials & Method: The study was conducted on 668 patients in emergency section of Valiasr hospital of Arak in 2005. Questions categorized in four groups for nursing and profession cadre including: general cure, respiratory system, homodynamic system and nervous system. Data were collected by seeing the performance of collectors and analyzed by the software SPSS. Findings: Physical examination and statements of the patient were not recorded by nursing and profession cadre of hospital in 98% and 86% of cases respectively. In 96.5% of cases the patients’ pulses hadn’t been controlled and recorded by nurses and in 99% of patients who had disorder in the urine system did not get any recommendation by profession cadre of hospital. The control of the arterial blood gases was not described in 98% of patients. Radiography of cervical vertebra was not conducted in 81% of cases. Conclosion: According to the result, taking cure of head injury patients was nearly acceptable, but in some cusses there are some failures. The most important failures related to negligence of the hospital cadre that has many reasons.

---

Background & Aim: Because of its ability to demonstrate the nature, extent, sites, and multiplicity of brain injury, computed tomography (CT) is now the primary diagnostic method for head trauma. Although there have been numerous reports on the CT findings of most types of intracranial injuries, the findings in brainstem injuries have not been well described. This study aimed at comparing the autopsy findings of brainstem in head trauma in comparison with CT scan results. Materials & Methods: Two hundred patients with head trauma, who expired after a period of time of hospitalization, were assessed in a diagnostic value study. Brain stem involvement was determined by autopsy as well as CT scanning of the brain during their hospitalization. The results of the two methods compared with each other, emphasizing the type and the location of probable lesions in the brain stem. Considering the autopsy as the method of the choice, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CT scan in brain stem lesions of patients with head trauma were calculated. The effect of primary cause of head trauma, survival time and Glasgow coma scale (GCS) were evaluated, as well. Findings: Brain stem lesions detected in 39 (19.5%) patients in autopsy. However, CT scan revealed brain stem lesions in 23(11.5%) cases. The sensitivity, specificity, PPV and NPV of CT scan was 59%, 100%, 100% and 91% respectively. The most common lesions of the brain stem region were as contusion of pons (8.5%), medulla (5%) and midbrain (4.5%). There were 6 (3%) cases of pontomedullary junction tear and 1 (0.5%) case of cervicomedullary junction tear. Admitting GCS and survival time were significantly lower in patients with brain stem lesion (p<0.001 for both of them) however, the initial mechanism of trauma did not significantly differed between the two groups (p=0.343). Conclusion: CT scan is a specific method of evaluating patients with probable brain stem injuries after head trauma, but low sensitivity limits its efficacy. Our results are in conformity with the reports in the literature.

---

Background: The goal of present study was to investigate the effectiveness of cognitive-behavioral group therapy on anger reduction in brain injured people. 

Method:The plan of study was quasi experimental through pretest, posttest and follow up with control group. The sample of this study consists of 16 brain injured patients in Mashhad city and selected by Convenience sampling method and voluntarily participate in this study. Participants randomly divided into two groups. The first groups receive cognitive behavioral therapy and the second group hasn’t any therapy. Two groups in three pretest, posttest and follow up time level were measured. Applied measures in this study consisted of State-Trait Anger Expression Inventory and collected data were analyzed through Spss software by repeated measure analysis of variance.

Findings: The results showed that the experimental group that receive CBT showed insignificant differences in anger reduction in compare with control group that don’t receive any therapy. Also the results of secondary hypotheses showed that there is significant differences in anger components that mean state anger, trait anger, anger controlling and introjection of anger in experimental group in compare with control group that don’t receive any therapy in some components there were no differences for example in anger externalization and internalization.

Conclusion: There is discussion about the results in theoretical approach and its importance in clinical intervention. On the whole we could apply the results of present study in valid and accurate assessment and diagnosis of the brain injury effects in legal medical centers and furthermore offer CBT services for this clinical population as non-medical treatment, efficient and inexpensive therapy.

---

Background: Peripheral nerve injuries due to trauma are one of the leading causes of disability in the society and could be devastating in occupational and activity daily living functions. Prognosis of these injuries is dependent on the sex, age, trauma location and severity, cause of trauma and its treatment. In order to prevent peripheral nerve injuries’ complications, accurate diagnosis of these injuries and their etiology is very important in society. 

Methods: This descriptive- cross sectional study was done from April 2011 up to April 2012 in the forensics organization of East Azerbaijan province and Tabriz medical sciences. In this period all the referring traumatic patients to forensics organization were examined by the physician and if there was any risk of peripheral nerve injury, they were referred to physical medicine and rehabilitation department. Electro diagnostic (EMG/NCV) examination was conducted by the specialist.

Findings: In this study, 174 traumatic patient (145 male (83.3%) and 29 female (16.7%)) were studied; in which electro diagnostic examination revealed that in 72 patient (41.4%) (68 male (46.9% of male patients) and 4 female (13.8% of female patients)) had peripheral nerve injuries. 57 patients (32.8%) had peripheral nerve injury in the upper limb and 15 patients (8.6%) had the injury in the lower limb. Cause of traumatic nerve injury was motor vehicle accidents in 83 (47.7%), quarrel in 47 (27%), work related in 41 (23.6%) and iatrogenic in 3 (1.7%) patients.

Conclusion:The results of this study showed that most of patients suspected to peripheral nerve injuries due to trauma, actually have nerve lesion. In the other hand some of referral patients didn’t had nerve injury and this could be distinguished by electro diagnostic study. Also most prevalent cause of nerve lesion is due to motor vehicle accidents.

---

Introduction: Considering the fact that there has been a significant increase in accidents, assessing the consequences of accidents in terms of age and sex of victims can be an effective tool for health policy making efforts.

Materials &Methods: This study is a cross-sectional one, where all patients referred to hospitals' emergency wards in Hamadan province during 2009 to 2014 were enrolled in it. The data came from injury register database and were analyzed using descriptive and analytic statistics with Stata software version 12 with a less than 5% error margin.

Results: A total of 925135 patients were registered during this period, that in 98.97% of them, the outcome of accidents were remission. In one percent of cases (1359 cases) the outcome of accident was death and only in 41 patients the accident resulted in impairment. The odds of death or impairment in affected women were significantly higher than men and the highest odds of death were in the age group of 35 years and higher.

Conclusion: There is small percentage of accidents leading to death and disability during the years under study. The severity of injuries was higher in women and the elderly which may also be due to their greater vulnerability. Therefore, in order to reduce the burden of accidents, it is necessary to design and implement comprehensive educational interventional programs.

---

---