Clinical and organizational aspects of providing medical care to victims with combined closed thoraco-cranial trauma
Annotation. In the general structure of injuries, the frequency of combined injuries is 40-60%. There is an increase in the dynamics of combined injuries in terms of both the number and severity of injuries, with mortality reaching 35–80%. It is necessary to develop adequate and optimal tactics for providing medical care to victims, which would take into account the features of closed thoraco-cranial trauma as a separate clinical and nosological form of polysystemic injury that requires clinical and organizational protocol schemes and routes. The aim of the study was to improve the results of treatment of patients with combined thoraco-cranial trauma by implementing a risk-oriented protocol scheme of clinical organization of medical care for victims with combined closed thoraco-cranial trauma. Two randomized controlled groups were formed with guaranteed homogeneity according to clinical-epidemiological and clinical-nosological features from patients who were in the department of polytrauma of KMKL SHMD during 2012–2013. Using a correlation method of risk assessment with the standard of medical care for victims with polytrauma at an early hospital stage, we formed a risk-oriented routing scheme for victims with cancer and cranial trauma. This scheme was formed on the basis of risk analysis and definition of tasks for the provision of medical care to victims with closed thoraco-cranial trauma. Clinical routes of the patient with catastrophic, critical, essential and minimum risk of lethal outcome are developed and their high efficiency is revealed. The developed risk-based protocol scheme for providing medical care to victims with closed combined thoraco-cranial trauma in the early hospital stage using the concept of clinical routing of patients has proven its effectiveness based on the results of implementation and can be recommended for widespread implementation.
2. Huriev, S. O., & Khmel, V. V. (2018). Analiz obstavyn otrymannia zakrytoi poiednanoi torako-kranialnoi travmy [Analysis of the circumstances of obtaining a closed single thoraco-cranial injury]. Ukrainskyi zhurnal ekstremalnoi medytsyny im. H.O. Mozhaieva – Ukrainian Journal of Extreme Medicine named after G.O. Mozhayev, 1, 22–27.
3. Huriev, S. O., & Khmel, V. V. (2018). Epidemiolohichni aspekty alkoholnoi intoksykatsii pry zakrytii poiednanii torako-kranialnii travmi [Epidemiological aspects of alcohol intoxication in closed combined thoraco-cranial trauma]. Viiskova medytsyna Ukrainy – Military medicine of Ukraine, 4, 14–20.
4. Huriev, S. O., & Khmel, V. V. (2020). Klinichni rezultatyvni ryzyky, asotsiiovani z kliniko-epidemiolohichnymy ta kliniko-nozolohichnymy ryzyk-stvoriuiuchymy faktoramy pry torako-kranialnii travmi [Clinically effective risks associated with clinical-epidemiological and clinical-nosological risk-creating factors in thoraco-cranial trauma]. Zhurnal “Klinichna khirurhiia” – Journal of Clinical Surgery, 87 (3-4), 69–73. DOI: 10.26779/2522-1396.2020.3-4.69
5. Huriev, S. O., Satsyk, S. P., Yevdoshenko, V. P., & Natsevych, R. O. (2015). Analiz zastosuvannia medychnykh tekhnolohii diahnostyky v postrazhdalykh unaslidok dorozhno-transportnykh pryhod v umovakh miskoi likarni. [Analysis of the application of medical diagnostic technologies in victims of road accidents in a city hospital.] Travma - Injury, 16 (2), 52–56. Vziato z http://nbuv.gov.ua/UJRN/Travma_2015_16_2_7
6. Huriev, S. O., Matsiuk, S. V., & Shyshchuk, V. D. (2006). Standartyzatsiia ta unifikatsiia likuvannia postrazhdalykh z travmoiu na rannomu hospitalnomu etapi. [Standardization and unification of treatment of victims with trauma at the early hospital stage]. Sumy: Mriia.
7. Panasenko, S. I., Huriev, S. O., Sheiko, V. D., & Shkurupii, O. A. (2017). Kliniko-epidemiolohichni trendy suchasnoi torakoabdominalnoi politravmy [Clinical and epidemiological trends of modern thoracoabdominal polytrauma]. Klinichna khirurhiia – Clinical surgery, 9, 58–60. Vziato z http://nbuv.gov.ua/UJRN/KlKh_2017_9_18
8. Fil, A. Yu., & Fil, Yu. Ya. (2014). Suchasna taktyka nadannia dopomohy pry skeletnii travmi postrazhdalym iz politravmoiu (ohliad literatury) [Modern tactics of providing assistance in case of skeletal trauma to victims with polytrauma (literature review)] Travma – Injury, 15 (1), 125–128. Vziato z http://nbuv.gov.ua/UJRN/Travma_2014_15_1_26
9. Battle, C. E., Hutchings, H., James, K., & Evans, P. A. (2013). The risk factors for the development of complications during the recovery phase following blunt chest wall trauma: a retrospective study. Injury, 44 (9), 1171–6. doi: 10.1016/j.injury.2012.05.019
10. Daegling, D., Warren, M., Hotzman, J., & Self, C. (2008). Structural analysis of human rib fracture and implications for forensic interpretation. J. Forensic Sci., 53, 1301–1307. doi: 10.1111/j.1556-4029.2008.00876.x
11. Dutton, R. P., Cooper, C., Jones, A., Leone, S., Kramer, M. E., & Scalea, T. M. (2003). Daily multidisciplinary rounds shorten length of stay for trauma patients. J. Trauma-Inj Infect. Crit. Care, 55 (5), 913–9. doi: 10.1097/01.TA.0000093395.34097.56
12. Emircan, S., Ozguc, H., Akkose Aydin, S., Ozdemir, F., Koksal, O., & Bulut, M. (2011). Factors affecting mortality in patients with thorax trauma. Ulus Travma Acil Cerrahi Derg, 17 (4), 329–33. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21935831/
13. Kessel, B., Dagan, J., Swaid, F., Ashkenazi, I., Olsha, O., Peleg, K., … & Alfici, R. (2014). Rib fractures: comparison of associated injuries between pediatric and adult population. Am. J. Surg., 208 (5), 831–4. doi: 10.1016/j.amjsurg.2013.10.033
14. Lin, F., Li, R., Tung, Y., Jeng, K., & Tsai, S. (2016). Morbidity, mortality, associated injuries, and management of traumatic rib fractures. J. Chin. Med. Assoc., 79, 329–334. doi: 10.1016/j.jcma.2016.01.006
15. Mitchell, J. D. (2017). Blunt chest trauma: Is there a place for rib stabilization? Journal of Thoracic Disease, 3 (9), 211–217. doi: 10.21037/jtd.2017.04.05
16. Narayanan, R., Kumar, S., Gupta, A., Bansal, V., Sagar, S., Singhal, M., … & Misra, M. C. (2018). An Analysis of Presentation, Pattern and Outcome of Chest Trauma Patients at an Urban Level 1 Trauma Center. Indian J. Surg., 80, 36–41. doi: 10.1007/s12262-016-1554-2
17. Pfeifer, R., Heussen, N., Michalewicz, E., Hilgers, R-D., & Pape, H-C. (2017). Incidence of adult respiratory distress syndrome in trauma patients: A systematic review and meta-analysis over a period of three decades. J. Trauma Acute Care Surg., 83, 496–506. doi: 10.1097/TA.0000000000001571
18. Rabinovici, R., Gautschy, S., & Coimbra, R. (2014). Trends in trauma surgery: Analysis of the American Association for the Surgery of Trauma program 1939–2012. J. Trauma and Acute Care Surgery, 76, 672–681. doi: 10.1097/TA.0000000000000149
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