Email this article Predictors of polytrauma outcomes in the early period in children
- Authors: Shabaldin N.A.1, Golovkin S.I.1, Shabaldin A.V.1
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Affiliations:
- Kemerovo State Medical University of the Ministry of Health of the Russian Federation
- Issue: Vol 9, No 3 (2021)
- Pages: 307-316
- Section: Original Study Article
- URL: https://journal-vniispk.ru/turner/article/view/64929
- DOI: https://doi.org/10.17816/PTORS64929
- ID: 64929
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Abstract
BACKGROUND: The problem of anti-shock measures and stabilization of the general condition of the affected children with polytrauma at the stage of intensive care is an extremely urgent issue in pediatric traumatology. Various aspects, such as determining the most sensitive prognostic scale for assessing the severity of polytrauma, clinical and laboratory predictors of changes in the vector of development of the course of traumatic disease in the direction of thanatogenic orientation, remain actively discussed among clinicians.
АIM: The aim of the study is to analyse the dynamics of changes in the indicators of internal homeostasis in children with polytrauma, indicating a favorable or thanatogenic direction of the course of the traumatic disease.
MATERIALS AND METHODS: A retrospective analysis of the medical records of 49 patients diagnosed with polytrauma was performed. All patients were divided into two groups: the survivors’ group comprised 41 patients, and the deceased group consisted of 8 patients.
All patients were examined for total blood count (Er, Tr, Ht, Hb, le, ESR), acid-base state (pH, SBC, BE), blood biochemical parameters (creatinine, urea, ALT, AST, K, Na, Ca), and C-reactive protein. The tests were performed daily during the first 10 days of the acute phase of the injury. The severity of the injury was determined by the NISS and pediatric trauma score scales, and in the case of a traumatic brain injury, the Glasgow coma scale was used.
A logistic step-by-step regression analysis was performed to identify predictors of polytrauma outcomes. The statical significance was considered at p < 0.05.
RESULTS: The step-by-step logistic regression revealed significant predictors that determined the unfavorable outcome of polytrauma (death), already on the second day. They were the NISS score, the level of CRP, Hb, Er, Na, and creatinine. At the same time, the statistical significance in the dynamics of changes in red blood parameters (Er, Hb), blood ionic composition (Na, K), humoral activity (Le, ESR, CRP) remained up to 10 days, i.e., during the period of possible complications of the traumatic disease. Our data offered the possibility to derive an equation for calculating the risk of failure of compensatory mechanisms in polytrauma.
CONCLUSIONS: The course of traumatic disease in children with polytrauma is characterized by morpho-functional changes in many organ systems. Predictors of failure of compensatory-adaptive mechanisms in response to polytrauma can be determined already in the early post-shock period.
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##article.viewOnOriginalSite##About the authors
Nikita A. Shabaldin
Kemerovo State Medical University of the Ministry of Health of the Russian Federation
Author for correspondence.
Email: shabaldin.nk@yandex.ru
ORCID iD: 0000-0001-8628-5649
SPIN-code: 6283-2581
MD, PhD
Russian Federation, 22a Voroshilova str., Kemerovo, 650056Sergei I. Golovkin
Kemerovo State Medical University of the Ministry of Health of the Russian Federation
Email: golovkins2@mail.ru
ORCID iD: 0000-0003-2954-7213
SPIN-code: 2348-5399
MD, PhD, D.Sc., Associate Professor
Russian Federation, 22a Voroshilova str., Kemerovo, 650056Andrei V. Shabaldin
Kemerovo State Medical University of the Ministry of Health of the Russian Federation
Email: weit2007@yandex.ru
ORCID iD: 0000-0002-8785-7896
SPIN-code: 5281-0065
MD, PhD, D.Sc., Associate Professor
Russian Federation, 22a Voroshilova str., Kemerovo, 650056References
- Baindurashvili AG, Vissarionov SV, Solov’eva KS, Zaletina AV. Detskij travmatizm i okazanie specializirovannoj pomoshchi detyam v megapolise (na primere Sankt-Peterburga). Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2018;8(2):16–23. (In Russ.)
- Shelamov IV, Zavrazhnov AA, Argunov AV. Hirurgicheskaya taktika pri vypolnenii srochnyh travmatologicheskih vmeshatel’stv v ostrom periode politravmy u detej. Detskaya hirurgiya. 2020;24(1):96. (In Russ.)
- Nazarova EO, Karpov SM, Apaguni AE, Vyshlova IA. Sovremennyj vzglyad na patogeneticheskie mekhanizmy travmaticheskoj bolezni pri politravme (obzor literatury). Vestnik novyh medicinskih tekhnologij. 2018;12(1):126–130. (In Russ.). doi: 10.24411/2075-4094-2018-15688
- Agadzhanyan VV, Kravcov SA, Zheleznyakova IA, et al. Integraciya kriteriev stepeni tyazhesti politravmy s mezhdunarodnoj klassifikaciej boleznej. Politravma. 2014;(1):6–14. (In Russ.)
- Grigorenko EA, Amcheslavskij VG, Arsen’ev SB, Mishulina OA. Integral’nyj pokazatel’ kislotno-shchelochnogo sostoyaniya krovi dlya ocenki sostoyaniya pacientov s cherepno-mozgovoj travmoj. Medicinskij alfavit. 2014; 5(1):37–40. (In Russ.)
- Ust’yanceva IM. Laboratornaya diagnostika pri politravme. Politravma. 2008;(4):51–59. (In Russ.)
- Seliverstov PA, Shapkin YuG. Ocenka tyazhesti i prognozirovanie iskhoda politravmy: sovremennoe sostoyanie problemy (obzor). Sovremennye tekhnologii v medicine. 2017;9(2):207–218. (In Russ.). doi: 10.24412/FgOST53l4Hs
- Agadzhanyan VV, Sinica NS, Dovgal’ DA, Obuhov SYu. Lechenie povrezhdenij oporno-dvigatel’noj sistemy u detej s politravmoj. Politravma. 2013;(1):5–11. (In Russ.)
- Sinica NS, Dovgal’ DA, Obuhov SYu. Sravnitel’naya ocenka hirurgicheskogo lecheniya perelomov dlinnyh trubchatyh kostej u detej pri politravme. Politravma. 2015;(4):33–36. (In Russ.)
- Amcheslavskij VG, Arsen’ev SB, Luk’yanov VI, et al. Integral’nyj pokazatel’ kislotno-shchelochnogo gomeostaza i prognoz sostoyaniya detej v ostrom periode tyazhyoloj mekhanicheskoj travmy. Detskaya hirurgiya. 2018;22(5):228–234. (In Russ.)
- Agadzhanyan VV, Ust’yanceva IM, Hohlova OI. Sindrom sistemnogo vospalitel’nogo otveta i poliorgannaya disfunkciya u detej s politravmoj. Politravma. 2012;(4):69–81. (In Russ.)
- Lakin GF. Uchebnoe posobie dlya biol. spec. vuzov. 4-e izd., pererab. i dop. Moscow: Vysshaya shkola; 1990. (In Russ.)
- Ust’yanceva IM, Hohlova OI, Petuhova OV. S-reaktivnyj belok kak marker tyazhesti sindroma sistemnogo vospalitel’nogo otveta u bol’nyh v kriticheskom sostoyanii. Politravma. 2008;(3):12–15. (In Russ.)
- Agadzhanyan VV, Kravcov SA, Zheleznyakova IA, et al. Integraciya kriteriev stepeni tyazhesti politravmy s mezhdunarodnoj klassifikaciej boleznej. Politravma. 2014;(1):6–14. (In Russ.)
- Novokshonov AV, Lastaev TV. Cherepno-mozgovye povrezhdeniya u detej pri politravme. Politravma. 2015;(1):23–28. (In Russ.)
- Ust’yanceva IM, Hohlova OI. Osobennosti laboratornoj diagnosti kriticheskih sostoyanij u pacientov s politravmoj. Politravma. 2013;(3):81–90. (In Russ.)
- Agadzhanyan VV, Kravcov SA. Politravma, puti razvitiya (terminologiya). Politravma. 2015;(2):6–13. (In Russ.)
- Jovenko IA, Kobelyackij YuYu, Carev AV, et al. Intensivnaya terapiya krovopoteri, koagulopatii i gipovolemicheskogo shoka pri politravme. Medicina neotlozhnyh sostoyanij. 2016;75(4):64–71. (In Russ.). doi: 10.22141/2224-0586.4.75.2016.75819
- Nazarov PG. Pentraksiny v reakciyah vrozhdyonnogo i priobretyonnogo immuniteta, organizacii matriksa, fertil’nosti. Medicinskij akademicheskij zhurnal. 2010;10(4):107–124. (In Russ.)
- Du Clos TW, Mold C. Pentraxins (CRP, SAP) in the process of complement activation and clearance of apoptotic bodies through Fcγ receptors. Current opinion in organ transplantation. 2011;16(1):15–20. doi: 10.1097/MOT.0b013e32834253c7
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