DYNAMIC PROGNOSTIC SCALE FOR VENOUS THROMBOSIS AND EMBOLISM RISK EVALUA-TION IN PATIENTS WITH ISOLATET AND SEVERE COMBINED ABDOMINAL TRAUMA

Aim. To improve the results of treatment of patients with isolated and severe combined abdominal trauma by differentiated prophylaxis of VTE by the use of the developed dynamic prognostic scale for determining the degree of their risk. Materials and methods. The work is based on the results of the examination and treatment of 140 patients of retrospective, 105 of prospective and 57 injured patients of prospective group with isolated and severe combined abdominal trauma, who underwent surgery in Lviv city center of thoraco-abdominal trauma (Surgical department 1), traumatology and neurosurgery departments of Lviv city emergency hospital in 2005-2017. Diagnostic procedures and surgical interventions in all injured were performed urgently in terms defined by existing standards and protocols. At the time of admis-sion, 86 (81.9%) of the injured were in a moderately severe condition, 19 (18.1%) – in severe one. In the pre-operative period, correction of vital functions was per-formed taking into account the recommendations of adjacent specialists. All patients were assessed for anesthesiological risk according to the ASA score, and 101 (96.2%) patients underwent surgical intervention using inhalation or non-inhalation anesthesia, in 4 (3.8%) diagnostic procedures lasted 30-220 min (average - 123.8±42.6). Results. During the analysis of 105 cases of pro-spective group of isolated and severe combined ab-dominal trauma, operated in 2012-2016, 27 (25.7%) cases had thrombosis of the lower vena cava, of which 10 (37,0%) manifested clinically – edema of the limb, pastosity and pain syndrome. One-factor regression analysis of 48 indicators had identified 18 predictors with a statistically significant (p<0.05) effect on the onset of DVT in the lower extremities both in pre- and post-operative periods in isolated and severe combined abdominal trauma patients. Predictors, isolated by monofactor analysis, were calculated by a regressive sequential multivariate analysis of Wald. The numerical range was from -5.5 to +7.5 in the preoperative and from -8.5 to +6.5 – in postoperative period. In order to establish clinical efficacy, an objective dynamic predictive scale for assessing the risk of VTE in patients with isolated and severe combined abdominal trauma was tested in a group of 57 patients admitted in 2016-2017 without age and gender constraints, severity of injury >16 points for the ISS and > 2 points on the AIS, absence of DVT of the lower extremities upon admission. Preoperatively, the sum of up to 10 points corresponded to the low grade of the VTE (probability of DVT – up to 2%), 11-20 points – moderate (DVT – up to 20%), more than 20 points – high (DVT – >60%). Respectively, the risk was calculated after the operation: low – up to 20 points (DVT – 2%), moderate – 20-30 points (DVT – 2-25%) and high - >30 points (probability of DVT – >65%). Conclusions. There are 4 independent factors of the occurrence of DVT in the preoperative period and 3 in the postoperative period. Using the independent pre-dictive factors, an objectified dynamic prognostic scale for predicting the risk of VTE in patients with isolated and severe combined abdominal trauma has been worked out with light, moderate and high degree of risk (sensiti-vity 83.3%, specificity 76.5%). The introduction of an objectified dynamic prognostic scale of the risk of VTE in the clinic and use of prophylaxis significantly reduced the incidence of these complications from 25.7% to 7.1% (p<0.05).