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.