N.N. Priorov Journal of Traumatology and OrthopedicsN.N. Priorov Journal of Traumatology and Orthopedics0869-86782658-6738Eco-Vector8905210.17816/vto89052Research ArticleThe significance of clinical and instrumental methods for the diagnosis of multiple injuries in road accidents at an early hospital stageYaryginNikolay V.<p>MD, PhD, Dr. Sci. (Med.), traumatologist-ortopedist</p>dom1971@yandex.ruParshikovMikhail V.<p>MD, PhD, Dr. Sci. (Med.), traumatologist-ortopedist</p>parshikovmikhail@gmail.comhttps://orcid.org/0000-0003-4201-4577GovorovaNatalya V.<p>MD, PhD, Dr. Sci. (Med.), anesthesiologist-resuscitator</p>nataly12@yandex.ruhttps://orcid.org/0000-0002-0495-902XPerekhodovSergey N.<p>MD, PhD, Dr. Sci. (Med.), surgeon</p>miss.sapog@mail.ruhttps://orcid.org/0000-0002-6276-2305GovorovMikhail V.<p>MD, assistant, traumatologist-ortopedist</p>svgovorova2011@yandex.ruhttps://orcid.org/0000-0003-4873-3230ChemyanovIvan G.<p>MD, PhD, Cand. Sci. (Med.), traumatologist-ortopedist</p>georgiic@mail.ruProsvirinAleksandr A.<p>MD, PhD, Cand. Sci. (Med.), traumatologist-ortopedist</p>prosvirin.alex@gmail.comhttps://orcid.org/0000-0002-7943-5845A.I. Yevdokimov Moscow State University of Medicine and DentistryOmsk State Medical UniversityV.P. Demikhov City Clinical Hospital1604202228413202611202129122021Copyright © 2021, Yarygin N.V., Parshikov M.V., Govorova N.V., Perekhodov S.N., Govorov M.V., Chemyanov I.G., Prosvirin A.A.2021<p><em>BACKGROUND: </em>By reason of the high urbanization of the population the mortality rate in combined injury cases remains stably high, despite the CT-scans have appeared in the arsenal of many hospitals. There are a lot of questions: how to reduce the time of diagnosis in favor of therapeutic measures, determine the sequence of actions in different situations?</p>
<p><em>AIM: </em>To determine the degree of informativeness of clinical and instrumental methods for diagnosing combined injuries in an accident.</p>
<p><em>MATERIALS AND METHODS: </em>Were done a retrospective analysis of the results of treatment of 517 patients with combined trauma delivered to the emergency department of the Omsk City Clinical Hospital and the V.P. Demikhovs City Clinical Hospital of the Moscow for 20172019. All patients were examined by a multidisciplinary team using modern diagnostic methods including laparoscopic examination, CT according to the whole body program.</p>
<p><em>RESULTS: </em>The results of the data analysis showed that clinical examination, radiography and ultrasound do not allow the diagnosis to be carried out in full, revealing up to 80% of all injuries.</p>
<p><em>CONCLUSION: </em>FAST protocol has a high degree of informativeness at the early hospital stage (efficiency 83%, reliability 81%). When using modern computed tomographs with subsequent digital analysis of reconstructions, the value of performing radiographs in an urgent situation decreases. MSCT is the gold standard in the diagnosis of combined trauma, has a high diagnostic efficiency compared to other methods of radiation diagnostics.</p>polytraumadiagnosis of hidden injuriesCT whole bodyсочетанная травмадиагностика скрытых поврежденийМСКТ whole body[Bondarenko AB, Peleganchuk VA, Gerasimova OA. Hospital lethality in concomitant injury and possibility of its reduction. N.N Priorov Journal of Traumatology and Orthopedics. 2004;(3):49. (In Russ).][Grin AA, Danilova AV, Sergeev KS. Experience in using the fast protocol in a patient with polytrauma accompanied by fractures of the pelvic and hip bones. Politravma. 2018;(1):60–64. (In Russ).][Denisov AS, Schekolova NB, Ladeischikov VM. Surgical tactics in combined trauma of the chest in the acute and subsequent periods of traumatic disease. Perm Medical Journal. 2019;36(3):11–17. (In Russ). doi: 10.17816/pmj36311-17][Dorovskikh GN. Luchevaya diagnostika politravmy [dissertation]. Moscow; 2015. Available from: http://www.dslib.net/luch-diagnostika/luchevaja-diagnostika-politravmy.html. (In Russ).][Egiazaryan KA, Rat’ev AP, Sirotin IV. Travmatologiya i ortopediya. Egiazaryan KA, Sirotin IV, editors. Moscow: GEOTAR-Media; 2019. 575 p. (In Russ).][Zatevakhin II. Abdominal’naya khirurgiya. National guideline. Zatevakhin II, Kirienko AI, Kubyshkin VA, editors. Moscow: GEOTAR-Media; 2016. 912 p. (In Russ).][Kubachev KG, Zaitsev DA, Kukushkin AV, et al. On the problem of draining pleural cavity combined with trauma during mechanical ventilation. Vestnik of Saint Petersburg University. Medicine. 2012;(2):82–87. (In Russ).][Kozachenko AV, Khomchenko MA. About the difficult diagnosis, standards in medicine in general and the ATLS standard in particular. Meditsina neotlozhnykh sostoyanii. 2017;(2):158–161. (In Russ). doi: 10.22141/2224-0586.2.81.2017.99709][Ivanov PA, Petrikov SS, Kalenskii VO, Zadneprovskii NN. Leche-nie patsientov s sochetannoi i mnozhestvennoi travmoi. Opinion Leader. 2017;(5):16–20. (In Russ).][Litvina EA. Sovremennoe khirurgicheskoe lechenie mnozhestvennykh i sochetannykh perelomov kostei konechnostei i taza [dissertation]. Moscow; 2010. Available from: https://medical-diss.com/medicina/sovremennoe-hirurgicheskoe-lechenie-mnozhestvennyh-i-sochetannyh-perelomov-kostey-konechnostey-i-taza. (In Russ).][Goncharov SF, Bystrov MV, Kudryavtsev BP, Savvin YuN. The problem of multiple and associated injury (polytrauma), the ways of solution and the role of disaster medicine service. Politravma. 2016;(2):6–10. (In Russ).][Ivanov PA, Shibajev EYu, Nevedrov AV, Kalensky VO. Modern approaches to treating opened fractures of extremity bones in patients with polytrauma. Kremlevskaya meditsina. Klinicheskii vestnik. 2013;(2):113–118. (In Russ).][Sokolov VA. Dorozhno-transportnye travmy. Moscow: GEOTAR-Media; 2009. 176 p. (In Russ).][Linchevsky OV, Myasnikov DV, Makarov AV, Getman VG. Concomitant injury: to live till a dawn (topical article). Travma. 2012;(2):98–102. (In Russ).][Bergen G, Chen LH, Warner M, Fingerhut LA. Injury in the United States: 2007 Chartbook. Hyattsville, MD: National Center for Health Statistics; 2008. 211 p.][Marini JJ, Wheeler AP. Critical care medicine: the essentials. Philadelphia: Lippincott Williams & Wilkins; 2010. 708 p.][Zhang GH, Chen KJ, Zhu HT, et al. Preventable deaths in patients with multiple injuries: the importance of audit and continuous quality improvement. World J Surg. 2020;44(6):1835–1843. doi: 10.1007/s00268-020-05423-3][Parks J, Vasileiou G, Parreco J, et al. Validation of the ATLS shock classification for predicting death, blood transfusion, or urgent intervention. J Surg Res. 2020;245:163–167. doi: 10.1016/j.jss.2019.07.041]