Prokopenko K.A. Optimization of comprehensive surgical management of mine-explosive injuries in the civilian population. - Qualification scientific work submitted as a manuscript.
The aim of the study was to improve medical care for patients with mine-explosive injuries through the use of modern diagnostic and treatment methods by optimizing an algorithm for the management of victims with mine-explosive trauma.
During the dissertation research, a set of principles was developed that made it possible to optimize a comprehensive approach to the diagnosis and treatment of mine-explosive injuries in the civilian population. For the first time, the author developed an algorithm for diagnosis, treatment, and patient routing for individuals with mine-blast injuries sustained as a result of military actions.
The algorithm is based on dividing patients into groups depending on the severity of injuries, anatomical localization, and extent of wounds (soft tissue injuries, penetrating chest wounds, penetrating abdominal and/or retroperitoneal wounds, and combined thoraco-abdominal injuries), assessing patients using trauma risk scales with subsequent prognosis, and determining the optimal diagnostic strategy and the required volume of surgical intervention separately for each patient group, taking into account the principles of Damage Control Surgery.
Considering that the aim of the study was to improve the provision of care to patients with mine-explosive injuries through the use of modern diagnostic and treatment methods by refining the algorithm for managing victims with mine-explosive injuries, the injured patients were divided into two groups.
Group I (control group) consisted of 40 wounded patients who received medical care during the period from February 2022 to May 24, 2022, in accordance with generally accepted standards of medical care. The results obtained prompted a revision of the existing management tactics and the development of an algorithm for diagnosis, treatment, and patient routing for civilians with mine-blast injuries sustained as a result of military actions.
The developed algorithm and patient routing system were applied in 127 wounded patients (main group) with mine-blast injuries sustained as a result of military actions during the period from May 25, 2022, to April 2024.
An analysis of the effectiveness of the developed diagnostic and treatment algorithm demonstrated that the time required for preoperative examination decreased by approximately 33.6% (prior to implementation, it was 43.6±8.54 minutes, whereas after implementation it was 28.97±1.15 minutes (p-value = 0,03)), indicating an increased efficiency in selecting the diagnostic strategy in accordance with the proposed algorithm.
Reducing the duration of diagnostic procedures is particularly important in situations involving the mass admission of wounded patients, when overload of the healthcare system necessitates rapid patient stratification, priority determination of the scope of medical care, and rational allocation of resources.
A reduction in the duration of primary surgical treatment performed in accordance with the principles of Damage Control Surgery was also observed, amounting to 40.1% (59.8±7.69 minutes in the control group versus 35.79±3.3 minutes in the main group (p-value = 0,008)), which contributes to a decreased risk of complications and long-term disability. Medical care included modern wound management techniques, application of dressings, use of VAC therapy, surgical treatment, and implementation of damage control principles, which allowed optimization of treatment for patients with mine-explosion injuries.
The proposed algorithm for diagnosis, treatment, and patient routing for individuals with mine-blast injuries sustained as a result of military actions has significant practical value in improving the quality and efficiency of medical care during wartime.
Implementation of this approach reduces the likelihood of diagnostic and therapeutic errors at the stage of primary assessment and hospitalization of injured patients. The use of the developed diagnostic and treatment algorithm helps avoid unjustified or unnecessary diagnostic procedures, thereby reducing the time required for clinical decision-making, accelerating the initiation of urgent surgical care, and optimizing the use of material and human resources of healthcare facilities.
The developed algorithm for diagnosis, treatment, and patient routing for patients with mine-blast injuries sustained as a result of military actions can be implemented in the practical activities of surgical departments of multidisciplinary clinical hospitals, as well as general surgical departments of central district hospitals equipped with spiral computed tomography, enabling detailed examination of injured patients within a short time frame.
