Predictors of polytrauma outcomes in the early period in children

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.