Enayatollah Homaie Rad
1 
, Farideh Sadeghian
2,3, Zahra Ghodsi
2, Shahrokh Yousefzadeh-Chabok
1, Mohammad Hosein Ranjbar Hameghavandi
2, Shahriar Ghashghaee
2, Zahra Mohtasham-Amiri
4, Hamid Heidari
1, Gerard O’Reilly
5,6,7, Seyed Mohammad Ghodsi
8 , Vafa Rahimi-Movaghar
2,8,9,10,11,12* 1 Guilan Road Trauma Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran
2 Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
3 Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
4 Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
5 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
6 Emergency and Trauma Centre, The Alfred, Melbourne, Australia
7 National Trauma Research Institute, The Alfred, Melbourne, Australia
8 Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
9 Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
10 Universal Scientific Education and Research Network (USERN), Tehran, Iran
11 Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
12 Visiting Professor, Spine Program, University of Toronto, Toronto, Canada
Abstract
Background: Integrated trauma systems (ITS) have shown potential in reducing traffic crash-related injuries and mortality, although their structure and impact can vary. This study assessed the effectiveness of ITS in Guilan, Iran.
Study Design: A retrospective observational study.
Methods: Utilizing a cross-sectional analysis, this descriptive-analytical study was conducted in Northern Iran from 2015 to 2019 to compare road traffic crash (RTC) data in Guilan (with ITS) against Mazandaran (without ITS), considering weather as a confounder. The study involved pre- and post-ITS intervention analyses to evaluate changes in RTC, injury, and mortality rates.
Results: Before ITS implementation, Guilan’s daily RTC mean was 38.4 (SD=16.7), which significantly decreased to 30.8 (SD=13.7) after the intervention. Conversely, in the control province of Mazandaran, the daily average number of RTCs increased from 37.29 (SD=14.1) to 42.55 (SD=16.4) post-ITS implementation in Guilan. Furthermore, the mortality rate in Guilan showed a marginal decline from 27.74 (SD=12.6) pre-ITS to 26.60 (SD=11.9) post-ITS, indicating the positive impact of the ITS. In contrast, Mazandaran demonstrated a significant increase in mortality from 32.16 (SD=14.5) to 51.75 (SD=15.7). The statistical analysis confirmed a significant reduction in mortality and injury incidence in Guilan at the time of the intervention, with a marked decrease observed post-intervention (P<0.001).
Conclusion: The findings revealed that RTC prevention is feasible in Iran, with ITS in Guilan significantly reducing RTCs, injuries, and mortalities, underscoring the importance of ongoing efforts to expand ITS components nationally.