Khmel V. Вlunt combined thoraco-cranial trauma in peacetime: clinical and epidemiological analysis and justification of risk-oriented medical care in the early hospital stage

The study was conducted with the formation of a database in excess of the required and sufficient, which was calculated in accordance with the law of large numbers. Two study groups were formed – the main – 176 cases, which was formed on the basis of the presence of thoracic and cranial components of the injury, and the comparison group, on the basis of isolated thoracic injury – 83 victims. The exclusion criterion in both study groups was the presence of damage to other organs and systems. Thus, the total amount of the study was 359 victims. To study the effectiveness of the implementation of the protocol scheme of clinical routing of victims, a group of 100 victims was formed – 50 before implementation and 50 after implementation. Combined cranio-thoracic trauma has a specific clinical and epidemiological characteristics, which is that the most common patients are from 20 to 50 years, with a pronounced gender impact – men – 71,91 %, women – 28,09 %, the most often occurs as a result of road accidents and injuries in the home by the mechanism of direct impact (68 %). Combined closed thoraco-cranial trauma is a multicomponent pathology, which is characterized by a variety of nosological forms of combined injuries, the most severe of which is a combination of closed traumatic brain injury in the form of brain contusion with subarachnoid hemorrhage, intracerebral hematomas with the presence of a large hemothorax. Severe at risk of death from the traumatic process is a combination of closed traumatic brain injury in the form of brain contusion with the presence of subdural hematoma, and closed chest injury in the form of bilateral rib fractures with the presence of a costal valve and large hemopneumothorax. Severe at risk of death from the traumatic process is a combination of closed traumatic brain injury in the form of brain contusion with the presence of subdural hematoma, and closed chest injury in the form of bilateral rib fractures with the presence of a costal valve and large hemopneumothorax. The developed risk-oriented 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 proved its effectiveness based on the results of implementation (reduction of mortality by 12-15 %) and can be recommended for widespread implementation.