Current Classification of Infectious Complications in the Patients with Multiple Trauma
Introduction. Joining the ever-present revised conceptual approaches to trauma. Previously multiple trauma was considered as a complex of traumatic injuries with mutual compounding after-effects. Recent years this problem is seen as a dynamic concept of traumatic disease. Diagnosis, care and prevention of any clinical condition are impossible without systematization.
Material and methods included bibliographic and scientific analysis of the sources and specific information using the laws of formal logic and the data obtained by extrapolation of the results on the data of own research. The proposals were developed using the criteria and requirements of evidence-based medicine to the evaluation of probability and effectiveness of classifications practical implementation.
Results and discussion. The existing classifications hardly consider the pathophysiological stages and peculiarities of the traumatic process in the patients with multiple trauma that keeps us from using them. The analysis of retrospective application of these classifications to the patients with multiple trauma (1200 persons) demonstrated the inadequacy and ineffectiveness of these classification systems. Based on the analysis of about 25,000 patients with multiple organ and polysystemic damages we have developed our own classification of infectious complications, based on the staging principle and pathophysiology of traumatic process:
I. Primary infectious complications arising from SIRS as a cause of multiple organ failure.
II. Infectious complications without direct infection during injury.
Current clinical and pathogenetic classification was first proposed at the Congress of Orthopaedists-Traumatologists of Ukraine in 2010, where it ws positively mentioned both by researchers and clinicians dealing with this problem. The retrospective and prospective analysis of this classification usage suggests that it enables to confirm infectious complications of traumatic process and predict the course and sequela of this pathology.
Conclusions 1. The current clinical classification of infectious complications of traumatic process in the patients with multiple trauma are not adequate and efficient for verification and systematization of diagnosis due to insufficient consideration of traumatic process pathogenesis, especially its stages.
2. The lack of adequate classification of infectious complications of traumatic process in the patients with multiple trauma complicates the determination of the likely prognosis of traumatic process and development of adequate and effective diagnostic and treatment strategy.
3. Our classification allows adequately verify and systematize the classifications criteria and infectious complications of traumatic process in the patients with multiple trauma due to accounting for the stages of its course.
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