Road combined trauma of the urinary system organs: organization and clinical tactics in a multidisciplinary hospital


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Abstract

Introduction. Damage to the organs of the urinary system (UMS) in road trauma (DT) is 4%, of which multiple and combined - over 70%. The aim of the study is to determine the main organizational and clinical directions for improving the EMC in case of trauma OMS in a trauma center of the 1st level. Material and methods. For the period from 2017 to 2020. 508 injured with road polytrauma were admitted to the hospital. Of these, trauma and secondary injuries were diagnosed in 108 people (21.3%), which were divided into three groups: the first - 73 (67.6%) victims with the injury of the OMVS, the second - 25 (23.1%) with secondary damage kidney, the third - 10 (9.3%) patients with «neurogenic bladder» with spinal trauma. The assessment of the severity of damage was carried out using the ISS scales and tables of the IH P and IH C. Results. It has been shown that the introduction of an interdisciplinary approach to the organization of in-hospital routing and differentiated algorithms of medical and diagnostic tactics based on the concept oftraumatic disease, led to the establishment of a final diagnosis in every third victim in the early stages, as well as to a decrease in the overall mortality rate by 3.7%, the overall mortality rate was 12,2%. The key directions for improving the efficiency and quality of care in case of dominant and concomitant trauma of the urinary system have been identified, based on the tactics of programmed multistage surgical treatment (Damage Control Urological). Conclusion. In the FSBI «3CVKG A.A. Vishnevsky «developed, organized and implemented a system and algorithm for the provision of specialized medical care for trauma to the Ministry of Railways, including high-tech assistance to victims of road accidents, associated with the regional and federal services of disaster medicine.

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About the authors

A. V Esipov

Federal State Budgetary Institution «3 Central Military Clinical Hospital A. A. Vishnevsky «Ministry of Defense of the Russian Federation

Email: 3hospital@mil.ru
MD, Chief

A. G Kochetov

Federal State Budgetary Institution «3 Central Military Clinical Hospital A. A. Vishnevsky «Ministry of Defense of the Russian Federation; Branch of the Military Medical Academy S.M. Kirova Ministry of Defense of the Russian Federation

Email: dr.aleksandr68@yandex.ru
MD, Head of the Urological Center

A. V Alekhnovich

Federal State Budgetary Institution «3 Central Military Clinical Hospital A. A. Vishnevsky «Ministry of Defense of the Russian Federation

MD, Deputy Head for Research and Development

Yu. N Fokin

Federal State Budgetary Institution «3 Central Military Clinical Hospital A. A. Vishnevsky «Ministry of Defense of the Russian Federation

Email: fokinun@yandex.ru
MD, Professor, Surgeon ofthe Consultative and Diagnostic Center

B. R Gvasalia

Federal State Budgetary Educational Institution Higher Education «Moscow State University of Food Production»

Email: bgvasalia@gmail.com
MD, Head of the Department of Urology of Medical Institute of Continuing Education

A. A Grizkevich

Federal State Budgetary Institution «National Medical Research Center of Surgery A.V. Vishnevsky» Ministry of HealthCare of the Russian Federation

MD, Head of the Department of Education

A. S Esipov

Federal State Budgetary Institution «3 Central Military Clinical Hospital A. A. Vishnevsky «Ministry of Defense of the Russian Federation

Email: alexeyesipov@mail.ru
hD, Head of the Department of Oncourology

I. V Karabach

Federal State Budgetary Institution «3 Central Military Clinical Hospital A. A. Vishnevsky «Ministry of Defense of the Russian Federation

Email: karabach78@mail.ru
PhD, Head of the Department of Urology

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