EVERE MULTISYSTEM CRANIOCEREBRAL INJURY: FEATURES OF THE CLINICAL COURSE AND OUTCOMES

Severe multisystem craniocerebral injury (smcci) is characterized by long-term disability and high lethal rates. Objective: analysis of smcci, features of its clinical course and lethality, including the main causes and terms of death. Materials and methods. An analysis of 170 case histories of the deceased with smcci was carried out: 130 men (76.5%) and 40 women (23.5%). The average age is 43.3±17.5 years. Victims were divided into groups, depending on the combination of head trauma with injuries to other anatomical areas of the body. The analysis of lethality, including the main causes and terms of lethal outcomes, was conducted. Depending on the main causes of death, all the deceased were divided into five groups: massive blood loss and shock, edema and dislocation of the brain, infectious pulmonary complications, purulent intoxication and others. Depending on the terms of death, the victims were divided into four subgroups: i — up to 24 hours, ii — from 1 to 3 days, iii — from 3 to 10 days, and iv — more than 10 days. The severity of the damage was assessed according to the injury severity score (iss), the level of consciousness was assessed according to the glasgow coma scale (gcs). The frequency of development of infectious complications and its relation to the terms of death was analyzed as well. Results. In the distribution of the victims, depending on the main causes of death, it was found that: in 41.2% (70) cases, the main cause of death was edema and dislocation of the brain; 25.3% (43) — massive blood loss and shock; 15.9% (27) had purulent intoxication, 12.9% (22) had infectious pulmonary complications and 4.7% (8) died due to other causes. The number of patients who died on the first day was 62 (36.5%), while 35 victims (56.5%) died within the first 3 hours after admission. On the third day, 24 patients (14.1%) died, 37 patients (21.8%) died 3-10 days after admission, and 47 patients (27.6%) died later than 10 days after admission. There was a significant correlation between the severity of the trauma and the terms of death: spearman’s rank correlation coefficient = -0.637 (-0.718; -0.538), p<0.0001. A significant connection between the iss and the timing of death was indicated by the chi-square=99.495, degrees of freedom=9, p<0.0001 for the contingency table 4x4. A significant correlation between the development of the ipc and the terms of death was indicated by the analysis of the contingency table (2x4): chi-square=143.136 with degrees of freedom=3 and p<0.0001. Conclusion. In the general structure of smcci, victims with a combination of head and musculoskeletal injuries prevailed, the combination with a chest trauma was second, the combination with a trauma to the abdomen was third and the combination with a spinal injury was fourth. The main causes of death were edema and dislocation of the brain, massive hemorrhage and shock, infectious pulmonary complications, septic complications and others. The statistically significant relation was found between the trauma severity, the development of infectious complications, “main causes” on the one hand, and the terms of death on the other.

1. Gumanenko E.K. Combined trauma from the position of an objective assessment of the severity of injuries: Dr. Med. Sci. Diss. Saint Petersburg, 1992. 565 p. (In Russian).

2. Kaske S., Lefering R., Trentzsch H., et al. Quality of life two years after severe trauma: A single centre evaluation. Injury. 2014; 45 (Suppl 3): 100–105. PMID: 25284226. DOI: 10.1016/j.injury.2014.08.028.

3. Pape H.-C., Sanders R., Borrelli Jr. J., eds. The Poly-Traumatized Patient with Fractures. A Multi-Disciplinary Approach. Berlin Heidelberg: Springer-Verlag; 2011. 365 р.

4. Bondarenko A.V., Peleganchuk V.A., Gerasimova O.A. Hospital Lethality in Concomitant Injury and Possibility of Its Reduction. Vestnik travmatologii i ortopedii im NN Priorova. 2004; (3): 49–52. (In Russian).

5. Ermolov A.S., Abakumov M.M., Sokolov V.A., et.al. The structure of hospital mortality in combination with trauma and ways to reduce it. Khirurgiya Zhurnal im. NI Pirogova. 2006; (9): 16–20. (In Russian).

6. Khubutiya M.Sh., Shabanov A.K. Main mortality reasons at patients with severe polytrauma in the intensive care unit. Skoraya meditsinskaya pomoshch’. 2010; 11(3): 64–69. (In Russian).

7. Pfeifer R., Tarkin I.S., Rocos B., Pape H.C. Patterns of mortality and causes of death in polytrauma patients — has anything changed? Injury. 2009; 40(9): 907–911. PMID: 19540488. DOI: 10.1016/j.injury.2009.05.006.

8. Trajano A.D., Pereira B.M., Fraga G.P. Epidemiology of in-hospital trauma deaths in a Brazilian university hospital. BMC Emerg Med. 2014; 14: 22. PMID: 25361609. DOI: 10.1186/1471-227X-14-22.

9. Sokolov V.A. Multiple and concomitant injuries. Moscow: GEOTAR-Media Publ.; 2006. 512 p. (In Russian).

10. Eryukhin I.A., Shlyapnikov S.A. Extreme condition of the body. Elements of the theory and practical issues on the clinical model of severe concomitant injury. Saint Peterburg: Eskulap Publ.; 1997. 296 p. (In Russian).

11. Sokolov V.A., Kartavenko V.I., Garaev D.A., Svirskaya L.M. Syndrome of mutual aggravation of injuries in patients with a combined trauma. Vestnik khirurgii im. II Grekova. 2006; 165 (6): 25–29. (In Russian).

12. Fraerman A.P., Syrkina N.V., Zhelezin O.V. Combined craniocerebral trauma. Report 1. Peculiarities of the acute period clinical flow. Sovremennye tekhnologii v meditsine. 2010; (3): 113–118. (In Russian).

13. Puras Yu.V., Talypov A.E., Krylov V.V. Lethality at patients with severe concomitant head injury. Neyrokhirurgiya. 2010; (1): 31–39. (In Russian)