AN EXPERIENCE IN PROVIDING SPECIALIZED MEDICAL CARE IN CLOSED COMBINED INJURIES AND INJURIES AT THE LEVEL I TRAUMA CENTER OF SAINT-PETERSBURG RESEARCH INSTITUTE OF EMERGENCY MEDICINE N.A. I.I. DZHANELIDZE

Relevance. Mortality and unsatisfactory results of treatment with polytrauma are high, which is explained by the lack of an effective system of organizing specialized medical care for this category of victims.

Intention. To study the effectiveness of organizing specialized medical care for polytrauma in the Level I Trauma Center of St. Petersburg Research Institute of Emergency Medicine n.a. I.I. Dzhanelidze.

Methods. The 5-year (2013–2017) experience in the provision of specialized medical care in closed co-traumatic injuries in the trauma center of the St. Petersburg Research Institute of Emergency Care n.a. I.I. Dzhanelidze was analyzed. Of 3852 patients, 2970 had closed combined injuries, 882 – various wounds. 44.7 % of the victims with closed and 33.1 % with other injuries had signs of traumatic shock on admission.

Results and Discussion. Owing to the up-to-date methods of examination and treatment of patients, treatment and tactical prognosis by “T”-criterion and Damage Control approach, mortality in severe closed co-trauma was reduced from 18.1 % in 2013 to 9.9 % in 2017, and in other injuries – from 7.4 to 2.3 %, respectively. An advanced effective system of specialized medical assistance to victims of polytrauma has been created at the present time in St. Petersburg.

Conclusion. Аn experience of the Level I Trauma Center of Saint Petersburg Research Institute of Emergency Medicine n.a. I.I. Dzhanelidze as the oldest in the city and the country convincingly confirms the correctness of the modern concept of medical care in case of severe closed combined injuries. Our Trauma Centers uses the whole arsenal of diagnostic and treatment facilities of multi-profile hospitals with the involvement of various specialists, which results in reducing mortality and complications in polytrauma.

1. Kejer A.N., Frolov G.M., Savel’ev M.S. [et al.]. Sravnitel’naja ocenka travmatichno-sti operativnyh vmeshatel’stv na oporno-dvigatel’nom apparate v svjazi s hirurgicheskoj taktikoj, osnovannoj na prognoze ishoda travmaticheskogo shoka pri politravme [Comparative evaluation of the traumatism of surgical interventions on the locomotor apparatus in connection with surgical tactics, based on the prognosis of the outcome of traumatic shock in polytrauma]. Travmaticheskij shok [Traumatic shock] : collection of scientific works. Leningrad. 1983. Pp. 18–29. (in Russ.)

2. Tulupov A.N. Tjazhelaja sochetannaja travma. [Severe concomitant injury]. Sankt-Peterburg. 2015. 316 p. (in Russ.)

3. Tulupov A.N., Besaev G.M., Sinenchenko G.I. [et al.]. Osobennosti diagnostiki i lecheniya kraine tyazheloi sochetannoi travmy [Features of diagnostics and treatment of extremely severe combined injury]. Vestnik hirurgii im. I.I. Grekova. [I.I. Grekov Bulletin of Surgeri]. 2015. Vol. 174, N 6. Pp. 29–34. (In Russ.)

4. Tsibin Y.N., Galtseva I.V., Rybakov I.R. [Forecasting the severity of traumatic shock in the clinic]. Travmaticheskij shok [Traumatic shock]. 1975. № 6. Pp. 29–34. (In Russ.)

5. Pape H.С., Peitzman A.B., Schwab C.W., Giannoudis P.V. Damage control management in the polytrauma patient. New York : Springer. 2008. 464 p.

6. Rotondo M., Schwab C., McGonigal M. [et al.]. Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury. J. Trauma. 1993. Vol. 35. Рp. 375–382.