Algorithm of medical care for children with polytrauma

Backgr о und. 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.