OPTIMIZATION OF THE ORGANIZATION OF CARE FOR PATIENTS WITH COMBINED AND ISOLATED TRAUMATIC BRAIN INJURY IN THE EMERGENCY DEPARTMENT OF A MULTIDISCIPLINARY CITY HOSPITAL

Abstract

Relevance. In Russia, traumatic brain injury (TBI) accounts for 25-30% of all injuries and in 50–60% of cases is the cause of deaths in combined trauma [3]. According to the National Research Institute of Public Health named after N.A. Semashko, the annual damage from TBI is estimated at 500 billion rubles. Traumatic brain injury is a serious socio-economic and state problem that requires a comprehensive and multidisciplinary approach [1, 2]. In this regard, improving the organization of care for such patients is an urgent task. The aim is to show the possibilities of effective and high–quality care for patients with combined and isolated traumatic brain injury (TBI) by optimizing the organization of work in the emergency department of a multidisciplinary urban hospital. Material and methods. The analysis of a sequential sample of 2932 case histories  of patients delivered to St. Petersburg State Medical Institution “City Mariinsky Hospital” for urgent indications with injuries of various organs for 7 months was carried out. Of these, 2017 (69%) had signs of damage to the skin of the head, skull bones, brain of varying severity. After admission, patients were divided into several groups according to certain criteria, each of which had a specific examination algorithm. All patients necessarily underwent multispiral computed
tomography (CT) of the head. Additional examination methods were performed depending on which group the patients belonged to after sorting. 352 people from 2017 (17%) were hospitalized with a diagnosis of isolated or combined TBI. Results. The principles of routing patients to the OSMP are determined, based on the separation of the flow of patients with isolated and combined traumatic brain injury in a compensated or decompensated state, with and without alcohol intoxication. For each of these groups, the algorithms of examination with the participation of a multidisciplinary team of specialists in the shock ward, in the OSMP department, in the boxed part of the reception department for people with alcohol intoxication have been refined. The distribution of patients into streams and the execution of examination algorithms reduces the time spent in the OSMP and allows you to determine which department is better to hospitalize a patient with polytrauma, including TBI.