In this study, the exact location of the injury was recorded based on a detailed study of the physician's reports of repeated examinations and surgery reports, radiological photographs, and computed tomography (CT) scans of patients after the end of the treatment period in the hospital.
In this study, the most common sites of injuries were related to the chest and then the head and neck, which is different from other studies in which the limbs, head, and neck were among the most common sites of injury (13–14–15). In 2017, a similar study was performed at the same center on all patients with randomized selection. In this study, similar to previous studies in other countries, limbs, head, and neck were among the most common sites of injury in trauma patients (16). Therefore, the reason for the difference may be due to the conditions of patients entering the study, therefore, only patients with immediate lifesaving intervention were included in this study. Similar to the previous studies (17–20), traffic accidents were the most common cause of injuries in our study.
In the present study, the mean length of patients’ hospital stay was longer than the length of hospital stays in other studies (21). The length of hospital stay can be considered as a measure of the severity and morbidity of the disease and as a result, the burden of the society’s disease and the reason for the increase in the hospital stay length may be due to the severity of injury in patients and the surgery need, although this time was shorter than the time mentioned in the study conducted in Turkey (19).
Mortality in this study was 13.45%, which is much higher than the rate mentioned in some studies (21). Of course, there are also studies with a higher mortality rate (19). The highest distribution of injuries in hospitalized patients was related to abdominal, head, and neck injuries. However, head and neck involvement in this study was less than other studies (19–22). In this study, the highest chance of death was age over 65 years based on multivariate logistic regression analysis, men gender, head and neck injury, abdomen, limbs, nosocomial infection, and high injury severity. Other studies have found more or less similar results (19–23). These results are consistent with a previous study conducted in the same hospital with census sampling method on all patients (whether hospitalized with or without immediate lifesaving intervention) (18).
Most patients with multiple trauma also had chest injuries at the same time. Thoracic injury is one of the most common body regions of missed injuries (12), therefore, it is necessary to pay attention to paraclinical testing, contrast-enhanced CT scans in patients with the evidence of chest injury. This result is completely consistent with a study conducted in Taiwan with the highest late diagnosis in trauma patients with chest injuries (14, 24). In this study, abdominal injury was one of the least common injuries in multiple trauma patients (18%), which is similar to a previous study (25).
Similar to other studies, among abdominal injuries, liver injury followed by spleen and kidney injuries were the most common abdominal injuries (25–27). The most common chest injuries were lung contusion followed by pneumothorax rib fracture and hemothorax. The lung contusion percentage in this study was higher than the British report (20) but was similar to Turkey (19). Similar to other studies, the most common sites of facial injury were eye followed by maxilla and zygmatic (28–30). However, in the previous study, the most common sites of facial injury was somewhat different (31). The prevalence of skull fractures was one of the most traumatic sites of head injury, which is similar to another study (32). A high frequency of skull fractures was expected because traffic accidents are the most common type of injury in these patients and most of them have been injured in motorcycle accidents, therefore, it is because of using the low helmet prevalence among motorcyclists in Iran (16, 33).
The most common cause of chest injury was car accidents. This result is similar to the previous studies conducted in the same trauma center (34) and Turkey (19); however, in the British study, the majority of patients were pedestrians (20). The most common cause of limb damage was due to the pedestrian accidents, which is consistent with the previous study on pedestrian accidents (35).
Head and neck injuries were significantly more common in patients due to falls from heights. In a previous study (36) and in addition to the head and neck, injuries were highly prevalent in the limbs. In that study, most patients did not need resuscitation and showed low severity of injury. Considering the high prevalence of chest injuries in patients with injuries related to beatings, penetrating injuries and suicide attempts, the need for attention, accuracy in examination, and paraclinical examinations in these patients increases. Similarly, these considerations are equally important in traffic accidents and falls from heights.
Accuracy in data collection, investigation of injury distribution by re-reading radiographs and patient records, high number of patients and review of the study in an entire one-year period are some of the significant points of this study; however, there were some limitations. For example, in this study, patients who died at the accident scene and autopsies were not examined. A study with forensic and autopsy reports is recommended due to the lack of accurate assessment of patients who died of arriving to the hospital and lack of sufficient information about the exact injury location in these patients. In other research, it is necessary to investigate the extent of missing injuries and their causes.