DIFFERENTIAL DIAGNOSIS OF SEVERE COMBINED CRANIOCEREBRAL INJURY AND FAT EMBOLISM SYNDROME

Abstract

Objective: To improve the differential diagnosis of severe combined craniocerebral injury (SCCI) and the fat embolism syndrome (FES) Methods: The analysis of data on 338 patients with SCCI was carried out. There were 236 men (69.8%), women – 102 (30.2%) at the age of 18 to 68 years. Eligible patients were the presence of a concomitant injury with symptoms of traumatic shock and a violation of consciousness. In the control group (42.6%) performed the traditional tactics of diagnostics. In the main group (57.4%), in preventive diagnostic algorithm mode consisted of the identification of the fat globulemia (FG) according to Kornilov, a purposeful diagnosis of SFE, and an assessment of the severity of the craniocerebral components of the considered injury using computed tomography Results: In the control group, FES was set only 12 (8.3%) cases, which have been fatal. Total deaths in the control group took place in 58 (40.3%) observations. In the main group among SCCI FES was established in 33 (17.0%) patients; CCI in 99 (51.0%) and FES + CCI in 62 (32.0%) patients. Various manifestations of FES were revealed in 95 (49.0%) patients, which were presented classical – 15 (7.7%), clinical – 29 (15.0%) and subclinical forms – 51 (26.3%). Based on the results of the work, a scale was proposed for the differential diagnosis of FES and CCI, the efficiency of which was 97.4%. Conclusion: Optimization of SCCI treatment, with regard to the identification of FG, diagnosis of various forms of FES and computer tomography data, allowed to reduce the lethality by 13.5% compared to traditional approaches (26.8% and 40.3%, respectively). With a differentiated analysis in the main group, the specific gravity of lethality among patients with FES was 12.1%, with CCI – 23.2% and with CCI + FES – 40.3%. Keywords: Сombined injury, craniocerebral injury, fat globulemia, fat embolism syndrome, differential diagnosis, lethality.