Algorithm of medical care for children with polytrauma

Abstract

Backgrоund. Polytrauma is the main reason for incapacitation and death in children of all ages. The appropriate timing of specialized medical care plays a crucial role for the outcomes of the polytrauma. Aim. The aim of the study is to analyze the results of the treatment of musculoskeletal injuries with the use of a decision-making algorithm in pediatric patients with polytrauma. Materials and methods. This is a prospective, observational, controlled, single-center study. The research included 130 children who were divided into two groups. In the main group, the children were provided with specialized medical care by a multidisciplinary team. After stabilization, the patients were transferred to a specialized center for final surgical treatment by minimally invasive fracture osteosynthesis. After the elimination of existing life-threatening conditions and the fitting of skeletal traction, the patients in the control group received surgical treatment only after transferal to a specialized center. Results. In the main group, pain regressed significantly earlier (1.7 0.6 vs 3.2 0.4, p 0.05), and the duration of the postoperative ICU stay was significantly reduced (1.5 0.9 vs 2.4 1.4 days, p 0.05). The optimization of the surgical treatment of injuries facilitated a reduction in the duration of the ICU stay of patients in the main group (5.6 0.3 vs 6.5 0.4 days), in the surgical department (21.5 0.7 vs 25 0.9 days), and the overall hospital stay (up to 27.5 days). Conclusions. This study developed a decision-making algorithm for administering medical care to children with polytrauma based on the principle of stabilization of the condition and early low-trauma surgery in the hours following injury.