Acute period of polytrauma in children in the light of discriminant analysis
- Authors: Bakovsky V.B.1, Golovkin S.I.2, Kukharova T.V.3, Utkin V.A.4, Chalaya E.N.4, Shabaldin N.A.2
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Affiliations:
- Children’s Regional Clinical Hospital
- Kemerovo State Medical University
- Saint Petersburg State University of Aerospace Instrumentation
- Pyatigorsk State Research Institute of Balneology of the Federal medical and biological Agency
- Issue: Vol 10, No 2 (2020)
- Pages: 145-156
- Section: Original Study Articles
- URL: https://journals.rcsi.science/2219-4061/article/view/122903
- DOI: https://doi.org/10.17816/psaic614
- ID: 122903
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Abstract
Introduction. The treatment of polytrauma in children requires identifying the signs that characterize the severity of the acute period and quantifying the priorities of the parameters. Collectively, these reflect the direction of drift of the leading pathophysiological manifestations at each stage of the patient withdrawal program from a state of severe shock.
Purpose. This study uses discriminant analysis to clarify the tactics of children with polytrauma in the first days of overcoming its consequences. It is based on the pathogenetically sound idea that each of the observed parameter’s role, together in the form of a vector, reflects injury severity and the child’s prognosis.
Materials and methods. This analysis included 45 children (34 boys and 11 girls) with polytrauma aged from 2.5 to 17 years and hospitalized in Kemerovo’s intensive care unit. Two groups were analyzed: the survivors and those who were deceased. Both were dominated by severe traumatic brain injury (PMT). The injury severity score (ISS) scale was used for clinical assessment of injury severity.
Results. Combined with objectively obtained data on the structure of polytrauma in the direction of drift, a successful outcome is defined as a whole. It borders on the “day to day” priorities, potassium, PH, white blood count, and hematocrit. Also, the vector orientation pattern was observed to increase organ failure. This progressive decline occurred despite timely surgical intervention to stop internal bleeding, very active efforts to compensate for hypovolemia, acidosis, and the use of adequate means of detoxification. The deterioration in the child's condition manifests itself by increased potassium losses against the background of almost no reaction from leukocytes.
Conclusions. The application of discriminant analysis enables the better revelation of the peculiarities of a polytrauma’s multidimensional dynamics in children in the first few days of resuscitation. It also permits the numerical expression of the priorities of individual parameters that describe their state, and by the severity and individual patient response in real-time to optimize treatment.
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##article.viewOnOriginalSite##About the authors
Vladislav B. Bakovsky
Children’s Regional Clinical Hospital
Email: bakovskivb@rambler.ru
Cand. Sci. (Med.), doctor, Department of traumatology and orthopedics
Russian Federation, KemerovoSergey I. Golovkin
Kemerovo State Medical University
Email: golovkins2@mail.ru
Dr. Sci. (Med.), associate Professor, Professor of the Department of pediatric surgical diseases
Russian Federation, KemerovoTatyana V. Kukharova
Saint Petersburg State University of Aerospace Instrumentation
Email: unit-4@yandex.ru
Сand. Sci. (Tech.), associate Professor of the Department of medical Radioelectronics
Russian Federation, Saint PetersburgVladimir A. Utkin
Pyatigorsk State Research Institute of Balneology of the Federal medical and biological Agency
Email: orgotdel@gniik.ru
Dr. Sci. (Med.), leading researcher
Russian Federation, PyatigorskElena N. Chalaya
Pyatigorsk State Research Institute of Balneology of the Federal medical and biological Agency
Email: orgotdel@gniik.ru
Cand. Sci. (Med.), scientific Secretary
Russian Federation, PyatigorskNikita A. Shabaldin
Kemerovo State Medical University
Author for correspondence.
Email: Shabaldin.nk@yandex.ru
Cand. Sci. (Med.), associate Professor of the Department of pediatric surgical diseases
Russian Federation, KemerovoReferences
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