Multiple Trauma Structuring in Children With Estimation According to Iss System and Concentrations of S100b Protein Markers and Cystatin C

Abstract

Introduction: to analyze pathological processes in a patient with multiple trauma. Classification and structuring are not taken into account, as they require estimation of condition severity and dynamics of pathological process. It is frequently impossible to do so. In every specific case, it is necessary to structure multiple trauma. The Injury Severity Score (ISS) system is useful in this case, as it consists of a combination, certain quantitative and qualitative estimate which makes it possible to estimate a patient’s condition at early pre-hospital stage and adjust treatment. Purpose: to make a structural analysis of a multiple trauma in children in the state of shock using ISS and concentrations of S100B protein and cystatin C to change the examination tactics and improve treatment outcomes. Materials and methods. 44 patients in shock with multiple trauma were structured and examined. The patients came for treatment from cities of the northern region and the city of Kemerovo. Patients mainly had a predominant severe cranial cerebral injury (SCCI). There were 36 patients including two patients with diffuse axonal injuries and 8 patients with predominant skeletal trauma (ST) and damage of internal organs with the syndrome of intraperitoneal bleeding (SPB). Results: treatment protocols were taken into account alongside with objectively obtained data on multiple trauma structure based on the ISS severity scale. We obtained reliable data on the type of changes in S100B and cystatin C concentrations during the acute period of multiple trauma. Conclusions: multiple trauma structuring in children using the ISS system and S100B protein and cystatin C concentrations enables objective detection of signs characterizing the severity of an acute period among those injured and optimization of the examination scheme along with a treatment program.

Acute period of polytrauma in children in the light of discriminant analysis

“…Вполне очевидно, что это отражается и на качестве реализации неотложных мер. В работе [6], предваряющей данное исследование, нами показано, что с применением шкалы тяжести травмы (Injury Severity Score -ISS), которая и у детей является золотым стандартом [7], удается объективно и с достаточной надежностью выделить в группах травмированных пациентов признаки, характеризующие тяжесть острого периода, оптимизировать схему обследования и программу лечения. Но при этом еще бо-лее важным оказывается не только их выявить, но и выразить количественно приоритеты параметров, в совокупности в виде вектора отражающих реконвалесцентную или танатогенную направленность динамики ведущих патофизиологических проявлений на каждом этапе реализации программы выведения пациента из состояния тяжелого шока.…”