Epidemiology of traffic crash mortality in west of Iran in a 9 year period

The Role of Pathological Examination of the Liver in Medicolegal Autopsy: A Tertiary Care Center Study From North India

BACKGROUND

The pathological examination of a medicolegal autopsy is a great learning opportunity for a pathologist as well as for a forensic expert, where the cause of death remains unknown. Liver disease epidemiology differs from one geographic area to another.

MATERIAL AND METHODS

This was a prospective observational study with 100 medicolegal autopsy cases over a one-year period conducted in the Department of Forensic Medicine and Toxicology (FMT) and Pathology. Representative tissue from the liver was collected in 10% neutral buffered formalin and sent for histopathological examination.

RESULTS

The mean age of the cases was 41.98 ± 15.39 years, and ages ranged from 20 to 90 years with male preponderance. The most common histopathology and gross findings noted were mild to moderate chronic hepatitis (CH) (54%) and fatty change (36%), respectively. There was a significant association (p ≤ 0.05) between histopathology and gross findings, cause, and manner of death.

CONCLUSION

Gross and histopathological examination of the liver in a medicolegal autopsy has a significant role in ascertaining the cause and manner of death.

Trend of mortality rate due to traffic accidents in Iran from 2006 to 2020: A cross-sectional study

Background

Traffic accidents are a common global cause of mortality and physical disability. This study aimed to investigate traffic accident-related mortality trends across provinces in Iran.

Methods

In this study, information on all deaths caused by traffic accidents in Iran from 2006 to 2020 was collected from the Iranian Legal Medicine Organization, which collects annual data from all 31 Iranian provinces. The national and provincial demographics were assessed, and the trends in mortality rates were assessed over a 15-year span using joinpoint regression based on the log-linear model, with results expressed in terms of annual percentage change (APC). The analysis for the trend was performed using the Joinpoint Regression Program 4.9.0.1.

Results

During the study period, 291,774 traffic accident-related deaths occurred in Iran, of which 78.6% were men and 21.4% were women. The mean age of the deceased was 37.75 ± 20.89 years. The mortality rate has dropped from 39/100,000 in 2006 to 18.3/100,000 in 2020. In total, the national mortality rate APC for 2006-2015 was -6.3% (P < 0.05) and for 2015-2020 was - 1.70% (P > 0.05).

Conclusions

Despite the overall decreasing national trend in Iran's traffic accident-related mortality over the study period, the provincial variability was noted. Therefore, it seems necessary to design and conduct epidemiological studies in different areas and provinces, for a better and more accurate understanding of the factors affecting the occurrence of traffic accident-related deaths, resulting in more focused and measurable interventions.

Investigation of Death Rate Due to Type 2 Traffic Accidents and Non-Traffic Accidents in Iran during 2013-2018

BACKGROUND

In the classification of road accidents, type 2 traffic accidents and non-traffic accidents are not considered and in Iran so far no special study has been done in the field of type 2 traffic accidents and non-traffic accidents, so we aimed to investigate the incidence of type 2 traffic accidents and non-traffic accidents in Iran.

METHODS

This cross-sectional was conducted on all individuals referred to Forensic Medicine Organization (FMO) from all over Iran who suffered from non-traffic accidents and type 2 traffic accidents during 2013-2018. Demographic information, accident information and other information including the location of the impact, the final cause of death and the date of the accident were examined. The information received from the FMO was first checked and then analyzed using Stata 11 statistical software.

RESULTS

During the 6-year study period, 10882 people lost their lives in type 2 traffic accidents (4779 people) and non-traffic accidents (5287 people). In terms of age, the highest incidence of type 2 traffic accidents and non-traffic accidents was observed in the age group over 65 years. The incidence of type 2 traffic accidents has not been increasing, while the trend of non-traffic accidents has been increasing.

CONCLUSION

With respect to the high rate of deaths due to traffic accidents, including type 2 traffic accidents and non-traffic accidents, it is necessary for the national media and relevant agencies to educate the people about first aid and also inform about free relief services, timely presence is important.

Burden of Disease Caused by Road Traffic Accidents in the City of Mashhad

Background: Mashhad is the second-largest Iranian megacity with a population of roughly 3 million and receiving around 25 million tourists a year, wherein road traffic accidents (RTAs) have become the leading cause of death and injuries. Objectives: The main purpose of this study was to calculate the burden of disease caused by RTAs in the city of Mashhad. Methods: In this applied research using a descriptive cross-sectional method, data associated with RTAs in the city of Mashhad in March 2016 - March 2017 were collected based on a complete enumeration of RTA-induced fatalities and disabilities from the Organization for Cemetery Management (Ferdows Organization) affiliated to Mashhad Municipality and the database of the Ministry of Health of Iran (MOH). Following verification, the years of life lost (YLL), the number of years lost due to disability (YLD), and the disability-adjusted life years (DALYs) were measured through the method proposed by the World Health Organization (WHO). Results: The total number of RTA deaths was 677 cases (men = 494 (73%) and women = 183 (27%)) and the number of DALYs was 29155 years (men = 21219.3 (72.8%) and women = 7935.1 (27.2%)). Of the total DALYs, 96% of them were associated with YLL, and 4% were related to YLD. Conclusions: Mortality data are recorded with relatively high accuracy in Iran. Given low YLD in DALYs in comparison with the findings of similar studies in developed countries, there are possible defects in data quality, in particular in terms of non-fatal accidents and injuries. These findings can be thus exploited for optimal allocation of resources in Razavi Khorasan Province and across Iran.

Analysis of Emergency Department Presentations due to Injuries From Motor Vehicle Crashes and Pedestrian Strikes

Objective The objective of this study was to analyze the causes and outcomes of presentations to the emergency department (ED) due to injuries from motor vehicle crashes and pedestrian strikes along several parameters. Methods Data from 798 patients who were injured due to motor vehicle crashes or pedestrian strikes that occurred in Canakkale Province were retrospectively analyzed. Patient demographic data such as age and gender, emergency service outcomes, and the consulted clinics were also recorded. Distributions of the crashes by weekdays or weekends, national and religious holidays, official holidays, and Ramadan month were comparatively analyzed. Results A total of 253 people injured in motor vehicle crashes and 395 people injured in pedestrian strikes were directly brought to the ED from the crash or strike scene. While 656 patients were discharged from the ED, 142 patients were referred to other clinics for surgery. A total of 538 crashes occurred on weekdays and 206 on weekends, and 54 crashes occurred during official and religious holidays. Most crashes occurred in summer, and the second most occurred in autumn. The rate of pedestrian strikes that occurred in summer and autumn was statistically significantly higher than the rate of injuries from motor vehicle crashes observed in the same seasons. The majority of the weekend crashes were caused by persons who had not consumed alcohol. Conclusion Traffic crashes occur more commonly among young men and in the summer season, while national, official, and religious holidays do not seem to play a role in the frequency of traffic crashes.

Still careless: findings from a cross-sectional study of young pedestrians' risky road crossing behaviors

Background

Pedestrian-vehicle collision is one of the most common traffic injuries worldwide. This study aimed to investigate the determinants of pedestrians’ road crossing beliefs and behaviors in potentially risky situations using the Theory of Planned Behavior among Iranian young adults.

Methods

This was a population-based study on a sample of 562 young adults aged 18 to 25 years living in Tehran, Iran. Data were collected by using a self-administered validated questionnaire including constructs of the theory of planned behavior and items of perceived risk and severity. The data were analyzed using independent t-test, analysis of covariance and multivariate analysis of variance.

Results

From all the respondents, 17.8% reported that they had previous experience of vehicle-collision. Among the participants, those who had previous experience of vehicle-collision reported less safety behaviors in crossing the road than those who had not experience an accident. It was found significant differences between participants with and without a history of vehicle-collision for perceived risk (mean difference, adjusted multivariate P-value: − 5.77, 0.027) and perceived severity (− 6.08, 0.003), attitude toward traffic regulations (− 6.34, 0.006), attitude toward behavior (− 7.56, 0.005), perceived behavioral control (− 5.20, 0.018), behavioral intention (− 5.35, 0.046) and road crossing behavior in potentially risky situations (− 5.37, 0.004).

Conclusions

Previous unpleasant experience of vehicle-collision is not the only determinant of self-protective behaviors in road- crossing which indicate the role of cognitive and motivational factors such as, subjective norms, attitudes towards risk, feelings of invulnerability in case of facing with vehicle collision.

The Application of Non-Parametric Count Models for the Modeling of Female's Accident Rates in Hamadan Province from 2009 to 2016

BACKGROUND

Accidents were just one of the general health problems. According to WHO forecasts (2013), deaths from road accidents will become the fifth-highest cause of death in the world by 2030. Therefore, we have attempted the application of non-parametric count models for modeling female's accident rates.

METHODS

All accidents in Hamadan Province, western Iran are referred to as one of the emergency centers located in the hospitals. Data regarding the accidents were obtained from 21 emergency centers across Hamadan for the period 2009-2016. To assess the trend and pattern of the accidents, the Generalized Additive Model for the accident rate has been utilized.

RESULTS

The Mean±SD age of the females in study was 31.23±12.88 yr old. For each of the three kinds of road accidents (car accidents, motor accidents and pedestrian crashes), the accident rates in the "residential urban" areas are lesser than in the "non-residential" area (P=<0.001) and in "public and sports grounds" and "great roads, avenues and streets" are more than in "others". For the three kinds of accidents, the functional effect in the monthly trend of the accidents was signification (P=<0.001).

CONCLUSION

The rates for all three kinds of accidents decreased. The increase in accident rates from the beginning of 2014 to Mar 2016 maybe due to the generalization of insurances in Iran and the increase in the number of accident victims being referred to the hospitals, which was the same with the results of other studies.

Patient and injury characteristics associated with road traffic mortality in general hospitals in southern Thailand

Background

Road traffic injuries are a major public health burden in developing countries. Thailand has the highest fatality rate from road traffic injuries in southeast Asia so that prevention of unintentional injuries is important.

Objective

To identify patient and injury characteristics associated with road traffic mortality in the southern provinces of Thailand.

Methods

Data on a total of 78,862 road traffic injuries recorded by the general hospitals in 5 southern provinces of Thailand, during 2008–2013, were obtained from the Office of Disease Prevention and Control. Chi-squared test was used to determine the association between patient/injury characteristics and road traffic mortality, and logistic regression was used to identify the strength of associations.

Results

In this study, road traffic mortality was found to be 1.8% of all injuries. Most of the deaths occurred in males (61.7%), who were aged 25–44 years (35.8%), being drivers (68.6%), using motorcycle (78.4%), and not wearing a helmet (61.0%). Road traffic mortality was higher among males, older age people, those who were not wearing a helmet or not fastening a seat belt, pedestrians and when people crashed with or by motor car, with wound being penetrating or blunt with penetrating, and when they were having head or neck, chest, or abdominal or pelvic cavity injuries.

Conclusion

Policies and measures for reducing road traffic mortality should focus on males and older aged persons, use of safety devices, and occurrence of multiple injuries.

Morbidity and mortality from technological disasters in Iran: A narrative review

Iran as a developing country is at risk of vulnerability to technological disasters. These types of disasters occur frequently in last years and affected thousands of lives. Technological disasters in Iran cause thousands of deaths, thousands of injuries, and millions of dollars' economic loss in recent years. We searched suitable keywords in national and international disaster databases for gathering epidemiological data in these disasters in Iran. In addition, we searched suitable keywords in scientific databases including Google Scholar, Scopus, PubMed, Web of Knowledge, Scientific Information Database, Magiran, and Irandoc. After screening, only 19 articles discussed challenges of technological disasters in the country. Road accidents, explosions and fires, mine accidents, and railway accidents are common events in the country. After 2015, these types of disaster cause 823 deaths and injuries. Experience of response to these disasters showed that technological disaster management in the country faces too many challenges including comprehensive and prospective programs, weakness of necessary infrastructure for urban management, weakness in group work and interorganizational coordination, lack of coherent involvement of people and nongovernmental organizations, lack of information coverage during the disaster, volunteers in police service presence at scene, and normalization of these events. Due to interorganizational nature of mitigation in technological disasters, it must be developed coordination between various organizations to mitigate these types of disasters.

Comparison of epidemiology and injury profile between vulnerable road users and motor vehicle occupants in road traffic fatalities

Objective: Road traffic injuries (RTIs) are a major global health issue causing a global burden of mortality and morbidity. Half of all fatalities on the world's roads are vulnerable road users (VRUs). The targeted intervention strategies based on fatality analysis focusing on VRUs can effectively contribute to reducing RTIs. This study aimed to compare VRUs and motor vehicle occupants (MVOs) in terms of epidemiology and injury profile. Methods: We utilized a nationwide, prospective database of RTI-related mortality cases for patients who visited 23 emergency departments between January 2011 and December 2015. All fatalities due to RTIs in the prehospital phase or in-hospital were eligible, excluding patients with unknown mode of transport and those admitted to general wards. The primary and secondary outcomes were fracture injuries and visceral injuries diagnosed using the International Classification of Diseases, Tenth Revision (ICD-10). We compared fracture injuries between VRUs and MVOs using Abbreviated Injury Scale (AIS) 2- and 2+ classification. Results: Among a total 3,694 road traffic fatalities (RTFs), 43.3% were pedestrians, followed by MVOs (27.0%), motorcyclists (18.9), bicyclists (6.6%), and agricultural vehicle users (4.2%). The elderly (>60 years old) accounted for 54.9% of VRU fatalities. RTFs occurred most frequently in the autumn and the VRU group and the MVO group showed significant differences in weekly and diurnal variation in RTFs. The injury severities (AIS 2+) of the head, neck, and thorax were significantly different between the 2 groups (P < 0.05). Head (32.1%) and intracranial (58.6%) injuries were the most common fracture and visceral injury sites for RTFs, followed by the thorax and intrathoracic organs (25.3 and 28.8%, respectively). Conclusions: Elderly pedestrians should be targeted for decreases in RTFs, and road traffic safety interventions for VRUs should be made based on the analysis of temporal epidemiology and injury profiles of RTFs.

Epidemiology of Vehicle Fire Fatalities of Road Traffic Injuries in Kerman Province, Iran: A Cross-Sectional Study

BACKGROUND

Vehicle fires are one of the most important causes of fatalities in road traffic injuries (RTIs), but there are no accurate statistics about vehicle fire fatalities (VFFs) due to RTIs in Iran.

AIM

This study aimed to investigate the Epidemiology of vehicle fire fatalities (VFFs) due to road traffic injuries (RTIs) in Iran.

METHODS

In this cross-sectional study, a researcher-made checklist was used to collect the required data from the files of RTI fatalities in the Kerman Legal Medicine Organization (KLMO), or coroner's office. All reported victims of vehicle fires in the ten years from 2007 to 2017 were included in the study. The data were analysed using SPSS ver. 18, with p = 0.05 considered as the level of significance.

RESULTS

The authors found 124 cases of vehicle fire fatalities in Kerman, with a mean age of 30.45 ± 12.41, of which 50% were in the 25-49 years age group. Most frequently, the victims were Iranian (91.9%), married (66.1%), self-employed (51.6%), and urban dwellers (79.8%), and had died because of burns (91.9%). In 46.8% of cases, the victims were the driver, and in the remaining 53.2%, they were the passenger of the crashed vehicle. Most frequently, vehicle fires occurred on extra-urban roads (90.3%), during spring (35.5 %) or summer (32.3%), due to a vehicle-to-vehicle collision (66.9%), between sedans (69.9%), and at night (63.7%). Most victims died at the scene of the incident (87.9%) and had been transferred to hospital by an ambulance (71%).

CONCLUSION

This study indicated that car fires caused the death of young and middle-aged people. The authors suggest the implementation of preventative measures promoting car safety; establishing speed management; establishing laws governing driving, manufacturing and importation of vehicles; construction of safe roads; identifying accident-prone points; installing road warning signs; establishing more roadside stations; ensuring stricter police monitoring; and improving vehicle safety standards and public awareness about the risks of speeding.

Among substance-abusing traffic offenders, poor sleep and poor general health predict lower driving skills but not slower reaction times

Background

Traffic accidents are a significant health issue in Iran. Explanations for such accidents have included single consideration of the role of poor sleep and negative psychological trait and state variables. In this study, we examined whether and to what extent sleep, general health, and aggression can concomitantly predict driving behavior.

Methods

A total of 360 male traffic offenders (driving under substance use; mean age: 31 years) participated in this study. They completed the questionnaires covering sociodemographic, sleep-related, and behavior-related variables. In addition, their visual and acoustic reaction times were objectively tested.

Results

Poor sleep, poor general health, and higher aggression scores were associated with self-rated poor driving behavior. Poor sleep was directly associated with poor driving behavior and indirectly via poor general health and aggression. In contrast, visual and acoustic reaction times were unrelated to sleep, general health, aggression, or self-rated driving behavior.

Conclusion

To our knowledge, this is the first study in Iran to assess concomitantly poor sleep, poor general health, and higher aggression scores as independent predictors of poor driving behavior among a larger sample of substance-abusing traffic offenders. Furthermore, visual and acoustic reaction times were unrelated to sleep, general health, aggression, and driving behavior. Finally, importantly, poor sleep predicted both directly and indirectly poor driving behavior.

Epidemiology and Outcome Determinants of Pedestrian Injuries in a Level I Trauma Center in Southern Iran; A Cross-Sectional Study

Objective

To epidemiologically assess the accidents and incidents in the injured pedestrians referred to Shahid Rajaee Hospital, Shiraz in order to provide basic preventive strategies and reduce injuries and fatalities caused by traffic accidents in pedestrians.

Methods

This cross-sectional study was conducted on 5840 injured pedestrians referred to Shahid Rajaee Hospital, Shiraz from 2009 to 2014. The baseline characteristic including the demographic and clinical information, the mechanism of injury, injury severity score (ISS) and outcome determinants. We also recorded the outcome measures and the mortality. Multivariate logistic regression analysis was performed to investigate the factors related to mortality rate and Length of Stay (LOS) in hospital.

Results

In our study, the history of 5840 injured pedestrians was analyzed. The mean age of the patients was 41.32 ± 19.21 years. Multivariate logistic regression indicated that mortality increased with age. Moreover, the odds of mortality was more in patients with Injury Severity Score (ISS) between 16 and 24 [OR: 12.94, 95% CI (3.78-32.66), p=0.001] and injuries in the head and neck [OR: 7.92, 95% CI (4.18-14.99), p=0.020]. LOS in hospital was also higher in patients with ISS > 25 [OR: 16.65, 95%CI (10.68-25.96), p=0.001].

Conclusion

Pedestrians have always been one of the most vulnerable road users. Our study indicated that the adverse consequences and mortalities in pedestrians increased with age. Hence, approaches are required to improve primary prevention programs and reduce deaths and injuries due to this major public health problem.

Using Growth Mixture Modeling for Clustering Asian and North African Countries on the Road Injury Death Trend (1990-2010)

OBJECTIVES

The physical injuries and financial implications as a result of road accidents have serious economic, cultural, and social effects. We conducted this study to determine any changes in the trend of road-accident-related deaths in Asian and North African countries from 1990 to 2010.

METHODS

The current study was carried out using data from the Global Burden of Disease database. First, the process was assessed using the growth curve divided into six regions. Moreover, the classification was done based on the death rate using growth mixed modeling.

RESULTS

The road injury death trend for men had more variations than women. Classification of these countries based on mortality using the latent growth mixture model resulted in more homogeneous classes according to trend in road fatalities. Disregarding gender and sex, there were four optimal classes. The first three classes had a decreasing trend with the third class having the greatest decreasing trend. South Korea and Taiwan were in this group. Afghanistan, Indonesia, Thailand, Iran, the UAE, Saudi Arabia, and Oman lay in group 4 and had an increasing trend in road injury deaths.

CONCLUSIONS

Successful interventions that developed countries have used to avoid casualties of road injuries could be used in developing countries. These include passing laws making the use of seatbelts and child seats compulsory and determining appropriate speed limits.

Epidemiological Study of Patients of Road Traffic Injuries Attending Emergency Department of a Trauma Center in New Delhi

BACKGROUND AND AIMS

There is paucity of data regarding some of the lesser known contextual and epidemiological factors with respect to road traffic injuries (RTIs). The objective was to study the epidemiological profile of RTI victims attending an emergency department of a tertiary care trauma center.

METHODS

The present study was a hospital-based cross-sectional study conducted in the emergency department of a tertiary care trauma center in New Delhi. All patients of RTI attending the emergency department during the designated data collection days were included in the study. Patients brought dead were excluded from the study. A semi-structured interview schedule was developed for collecting data on various domains such as sociodemographic characteristics, vehicle-related factors, accident site-related factors, personal protection measures, contextual factors, and prehospital care-related factors.

RESULTS

A total of 984 patients and informants were approached and finally data of 900 participants were analyzed after excluding those who refused participation and those for whom incomplete data were available. Out of 900 RTI victims, 756 were male (84.0%) and 144 (16.0%) were female. Mean age of the victims was 32.7 years. Most of the victims, i.e., 377 out of 900 (41.9%) were occupants rather than drivers. Majority of victim's vehicle meeting accidents were motorized two-wheelers (53.4%), and majority of the colliding vehicle was a four-wheeler (39.3*). Helmet use was found to be low (63.3%), but seat belt use was particularly low (32.4%). Most accidents (28%) happened between midnight and 6 A.M. More than half of the victims were in a hurry on the day of the accident. An ambulance was used to transport the victims in only 14.6% cases.

CONCLUSION

In road traffic accidents some lesser known epidemiological data were generated that may be useful in defining preventive measures.

Predictors of Post-Traumatic Stress Disorder among Victims of Serious Motor Vehicle Accidents

BACKGROUND

Compelling evidence has shown that motor vehicle accidents have an enormous impact on mental health. Post-traumatic Stress Disorder (PTSD) is one of the most common psychological consequences in adult survivors of accidents, so it is important to understand the prevalence and predictors of this issue since delay causes damage to crucial daily functioning. This study aimed at investigating the prevalence and predictors of PTSD after motor vehicle accident.

METHODS

This cross-sectional study was conducted on 528 injured patients six weeks to six months after motor vehicle accident in Imam Reza Clinic of Poursina hospital, Rasht in 2015. Data collection tools were three questionnaires including post-traumatic stress-self report (PSS), Beck Depression Inventory (BDI-II), and the Numeric Rating Scale (NRS) for pain. The data were analyzed in SPSS (Version 19) using Chi-square, Fischer's exact test and multivariate logistic regression. Significance level was considered P≤0.05.

RESULTS

The prevalence of PTSD and depression was 30.49% and 19.89% in participants, respectively. Chi-square test indicated a significant relationship among age (P=0.02), sex (P<0.001), education level (P<0.001), work status (P<0.001) and PTSD. Participants who reported pain (P<0.001) and depression (P<0.001) were more likely to have high score of PTSD than the others. Multivariate logistic regression showed this significance in sex, depression, age, educational status and pain, as constant risk factors in developing PTSD after accident.

CONCLUSION

This study suggests that primary care setting should be readily prompted for diagnosis of these disorders in non-treatment seeking individuals in the community.

Psycho-social and Mental Variables and Post-Traumatic Stress Disorder in Traffic Accident Survivors in Northern Iran

OBJECTIVE

To assess the psycho-social and mental variables associated with post-traumatic stress disorder (PTSD) in a series of Iranian patients.

METHODS

A total of 528 eligible accident survivors in pre-sampling of a randomized controlled trial targeting PTSD were included in this cross-sectional study. Psycho-social characteristics associated to PTSD were explored in these survivors in an outpatient clinic. They completed the questionnaires via interview between six weeks to six months after accident. Data collection tools were PSS (DSM-V version) for PTSD and BDI-II for depression and a researcher-made questionnaire for psycho-social variables.

RESULTS

There was a significant association between PTSD and the following variables; family communication, current depression, return to work, history of death of relatives, witnessed the death, length of amnesia, hospitalization, injured situation, and accident severity. Multivariate logistic regression indicated that some variables were associated with PTSD such as accident severity, (p<0.001), injured situation, (p<0.001), current depression, (p<0.001), RTW (p<0.001), and family communication (p=0.01).

CONCLUSION

Psychiatric nursing prevention efforts is best directed toward motorcycle depressed drivers with severe accident and poor family communication who do not return to work. Thus, routine assessment of PTSD, depression and psycho-social variables after traffic accidents must be taken into account.

Risk Factors of Road Traffic Accidents Associated Mortality in Northern Iran; A Single Center Experience Utilizing Oaxaca Blinder Decomposition

OBJECTIVES

To investigate the differences in death after receiving emergency services in traffic accidents between urban and rural regions, and decompose factors of the gap in Langerood, Northern Iran.

METHODS

This cross-sectional study was conducted in Langrood, Northern Iran during a 1-year period from 2013 to 2014. The hospital data of traffic crashes were used. Data contained those patients who survived at the scene of accident. Injury severity score, time to admission, age, gender, season of crash and type of collision were variables used in this study. Oaxaca decomposition technique was used to show the amount of inequity. In addition, three regression models were used to show the reason of inequity.

RESULTS

Overall 1520 patients with road traffic accidents were admitted to our center during the study period. The mean age of the patients was 35.45 ± 17.9 years, and there were 1158 (76.1 %) men among the victims. Motorbike accidents accounted for 869 (57.1%) injuries and 833 (54.8 %) accidents occurred in rural regions. The in-hospital mortality rate was 60 (3.9%). The results of this study showed that 95% of inequity came from factors used in this study and 2.04% disadvantages were for rural crashes. Severity of crash and time to admission had relationship with death, while the effects of time to admission was higher in rural region and severity of the accident had more effect on mortality in urban regions in comparison with rural ones.

CONCLUSION

The high rate of fatal accidents could be decreased by deleting the gap of access to health care services between urban and rural regions. This study suggested that more efforts of health system are needed to reduce the gap.

Effect of light pressure stroking massage with sesame (Sesamum indicum L.) oil on alleviating acute traumatic limbs pain: A triple-blind controlled trial in emergency department

OBJECTIVES

Due to adverse effects of common medications used for traumatic pain management, it is crucial to use complementary methods to alleviate this pain. Present study aimed to assess the effect of light pressure stroking massage with topical sesame oil on pain severity of patients with limbs trauma.

METHODS

This triple-blinded randomized trial was conducted on 40 patients with upper or lower extremities trauma in emergency department of Busheher Amir Al-Momenian Hospital, Busheher, Iran, in 2015-2016. Patients received a 5min massage with either liquid paraffin (placebo) or sesame oil on trauma site twice a day for 9days duration. Pain severity was assessed by visual analogue scale in first day (baseline), 3th, 6th and 9th days of intervention in the both groups.

RESULTS

Mean changes of pain severity between two groups was significant in the 6th (-0.20±1.36; P=0.036) and 9th (-0.36±1.12; P<0.001) days of intervention. Regarding to intake of diclofenac, no significant difference was seen between sesame oil and placebo groups during 9days of intervention (575.23±3.11 and 625.13±4.23 respectively, P=0.601). There were no adverse effects during the study in the both groups.

CONCLUSION

Massage with topical sesame oil was associated with significant reduction in pain severity of patients with limbs trauma. Therefore, it is suggested to use this oil on complementary medicine for pain relief due to low cost, easy usage and lack of adverse effects.