Оценка тяжести и прогнозирование исхода политравмы: современное состояние проблемы (обзор)

Рассмотрены современные методы оценки тяжести и прогнозирования исхода политравмы.

Для решения проблемы объективной оценки тяжести политравмы многочисленные исследования уделяют большое внимание поиску независимых прогностических факторов ее исхода, многие из которых включаются в разнообразные балльные шкалы и статистические модели, позволяющие количественно ранжировать тяжесть травмы в установленных интервалах и рассчитать вероятность выживания. Общепризнанным считается учитывать анатомические критерии, определяющие тяжесть повреждений, и физиологические параметры, характеризующие ответ функциональных систем организма на полученные повреждения. В качестве независимых факторов риска летального исхода политравмы рассматриваются возраст, пол, сопутствующая патология, различные клинические параметры, показатели ацидоза, коагулопатии, окислительного стресса, воспалительной реакции, своевременность диагностики и качество лечения, нуждаемость в оказании различных мероприятий неотложной помощи.

В современной литературе активно обсуждаются прогностическая значимость и сравнительная эффективность многочисленных применяемых при политравме шкал оценки тяжести повреждений (ISS, NISS, APS, ICISS, TMPM) и функциональных нарушений (GCS, RTS, APACHEII, MODSII, SOFA, SAPSII, MPMII), а также различных комбинированных клинико-анатомических систем оценки (TRISS, ASCOT, RISCII, PTS и др.). Создание универсальной шкалы затруднено многообразием повреждений и нарушений, происходящих в организме после получения политравмы, недостаточной изученностью предикторов исхода травмы. Предлагаемые коэффициенты выживаемости и прогностические факторы привязаны к конкретным базам данных по политравме, различающихся по уровню летальности и качеству медицинской помощи, что отражается на их прогностической ценности.

Четкое определение понятия политравмы и формирование единой системы оценки степени ее тяжести позволят стандартизировать лечебную тактику, объективно решать вопросы организации и финансового обеспечения медицинской помощи тяжело травмированным.

1. von Rüden C., Woltmann A., Röse M., Wurm S., Rüger M., Hierholzer C., Bühren V. Outcome after severe multiple trauma: a retrospective analysis. J Trauma Manag Outcomes 2013; 7(1): 4, https://doi.org/10.1186/1752-2897-7-4.
2. Paffrath T., Lefering R., Flohé S.; Trauma Register DGU. How to define severely injured patients? — An Injury Severity Score (ISS) based approach alone is not sufficient. Injury 2014; 45(Suppl 3): S64–S69, https://doi.org/10.1016/j.injury.2014.08.020.
3. Березка Н.И., Литовченко В.А., Гарячий Е.В., Лап­шин Д.В., Морозова Ю.В. Оптимизация хирургической тактики лечения пострадавших с политравмой с исполь­зованием шкал оценки тяжести состояния и повреждений. Научные ведомости БелГУ. Медицина. Фармация 2014; 25(4): 116–119.
4. Wutzler S., Maegele M., Wafaisade A., Wyen H., Marzi I., Lefering R.; TraumaRegister DGU. Risk stratification in trauma and haemorrhagic shock: scoring systems derived from the TraumaRegister DGU®. Injury 2014; 45(Suppl 3): S29–S34, https://doi.org/10.1016/j.injury.2014.08.014.
5. Дубров В.Э., Блаженко А.Н., Ханин М.Ю., Горбу­нов И.А., Блаженко А.А., Кобрицов Г.П., Хашагульгов Г.М. Реализация принципа динамического контроля повреж­дений (damage control) в остром периоде политравмы. Политравма 2012; 2: 68–73.
6. Бойко И.В., Зафт В.Б., Лазаренко Г.О. Организация экстренной медицинской помощи пострадавшим с поли­травмой на этапах медицинской эвакуации. Медицина неотложных состояний 2013; 2(49): 77–84.
7. Di Saverio S., Gambale G., Coccolini F., Catena F., Giorgini E., Ansaloni L., Amadori N., Coniglio C., Giugni A., Biscardi A., Magnone S., Filicori F., Cavallo P., Villani S., Cinquantini F., Annicchiarico M., Gordini G., Tugnoli G. Changes in the outcomes of severe trauma patients from 15-year experience in a Western European trauma ICU of Emilia Romagna region (1996–2010). A population cross-sectional survey study. Langenbecks Arch Surg 2014; 399(1): 109–126, https://doi.org/10.1007/s00423-013-1143-9.
8. Fröhlich M., Lefering R., Probst C., Paffrath T., Schneider M.M., Maegele M., Sakka S.G., Bouillon B., Wafaisade A; Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society Sektion NIS. Epidemiology and risk factors of multiple-organ failure after multiple trauma: an analysis of 31,154 patients from the TraumaRegister DGU. J Trauma Acute Care Surg 2014; 76(4): 921–928, https://doi.org/10.1097/ta.0000000000000199.
9. Butcher N., Balogh Z.J. AIS>2 in at least two body regions: a potential new anatomical definition of polytrauma. Injury 2012; 43(2): 196–169, https://doi.org/10.1016/j.injury.2011.06.029.
10. Pape H.C., Lefering R., Butcher N., Peitzman A., Leenen L., Marzi I., Lichte P., Josten C., Bouillon B., Schmucker U., Stahel P., Giannoudis P., Balogh Z. The definition of polytrauma revisited: an international consensus process and proposal of the new ‘Berlin definition’. J Trauma Acute Care Surg 2014; 77(5): 780–786, https://doi.org/10.1097/ta.0000000000000453.
11. Агаджанян В.В., Кравцов С.А., Железнякова И.А., Корнев А.Н., Пачгин И.В. Интеграция критериев степени тяжести политравмы с Международной классификацией болезней. Политравма 2014; 1: 6–14.
12. Brockamp T., Maegele M., Gaarder C., Goslings J.C., Cohen M.J., Lefering R., Joosse P., Naess P.A., Skaga N.O., Groat T., Eaglestone S., Borgman M.A., Spinella P.C., Schreiber M.A., Brohi K. Comparison of the predictive performance of the BIG, TRISS, and PS09 score in an adult trauma population derived from multiple international trauma registries. Crit Care 2013; 17(4): R134, https://doi.org/10.1186/cc12813.
13. Lefering R., Huber-Wagner S., Nienaber U., Maegele M., Bouillon B. Update of the trauma risk adjustment model of the TraumaRegister DGU™: the Revised Injury Severity Classification, version II. Crit Care 2014; 18(5): 476, https://doi.org/10.1186/s13054-014-0476-2.
14. Baker S.P., O’Neill B., Haddon W. Jr., Long W.B. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14(3): 187–196, https://doi.org/10.1097/00005373-197403000-00001.
15. Akhavan Akbari G., Mohammadian A. Comparison of the RTS and ISS scores on prediction of survival chances in multiple trauma patients. Acta Chir Orthop Traumatol Cech 2012; 79(6): 535–539.
16. Köseoğlu Z., Ozdoğan M., Kuvvetli A., Kösenli O., Oruç C., Onel S., Das K., Akova A. Increased nutritional risk in major trauma: correlation with complications and prolonged length of stay. Ulus Travma Acil Cerrahi Derg 2011; 17(6): 521–524, https://doi.org/10.5505/tjtes.2011.28582.
17. Bolorunduro O.B., Villegas C., Oyetunji T.A., Haut E.R., Stevens K.A., Chang D.C., Cornwell E.E. 3rd, Efron D.T., Haider A.H. Validating the Injury Severity Score (ISS) in different populations: ISS predicts mortality better among Hispanics and females. J Surg Res 2011; 166(1): 40–44, https://doi.org/10.1016/j.jss.2010.04.012.
18. Rozenfeld M., Radomislensky I., Freedman L., Givon A., Novikov I., Peleg K. ISS groups: are we speaking the same language? Inj Prev 2014; 20(5): 330–335, https://doi.org/10.1136/injuryprev-2013-041042.
19. Соколов В.А., Бялик Е.И., Файн А.М., Смоляр А.Н., Евстигнеев Д.В. Лечение нестабильных повреждений таза на реанимационном этапе у пострадавших с политравмой. Политравма 2011; 2: 30–35.
20. Vyhnánek F., Fric M., Pažout J., Waldauf P., Očadlík M., Džupa V. Present concept for management of severely injured patients in Trauma Centre Faculty Hospital Královské Vinohrady. Cas Lek Cesk 2012; 151(10): 468–471.
21. Osler T., Baker S.P., Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997; 43(6): 922–926, https://doi.org/10.1097/00005373-199712000-00009.
22. Cook A., Weddle J., Baker S., Hosmer D., Glance L., Friedman L., Osler T. A comparison of the Injury Severity Score and the Trauma Mortality Prediction Model. J Trauma Acute Care Surg 2014; 76(1): 47–53, https://doi.org/10.1097/ta.0b013e3182ab0d5d.
23. Tohira H., Jacobs I., Mountain D., Gibson N., Yeo A. Systematic review of predictive performance of injury severity scoring tools. Scand J Trauma Resusc Emerg Med 2012; 20: 63, https://doi.org/10.1186/1757-7241-20-63.
24. Belzunegui T., Gradín C., Fortún M., Cabodevilla A., Barbachano A., Sanz J.A. Major trauma registry of Navarre (Spain): the accuracy of different survival prediction models. Am J Emerg Med 2013; 31(9): 1382–1388, https://doi.org/10.1016/j.ajem.2013.06.026.
25. Haider A.H., Villegas C.V., Saleem T., Efron D.T., Stevens K.A., Oyetunji T.A., Cornwell E.E. 3rd, Bowman S., Haack S., Baker S.P., Schneider E.B. Should the IDC-9 Trauma Mortality Prediction Model become the new paradigm for benchmarking trauma outcomes? J Trauma Acute Care Surg 2012; 72(6): 1695–1701, https://doi.org/10.1097/ta.0b013e318256a010.
26. Сулима В.С., Кузь У.В. Оценка тяжести состояния больных разного возраста с сочетанной скелетной травмой и острым респираторным дистресс-синдромом. Травма 2013; 14(3): 90–93.
27. Copes W.S., Champion H.R., Sacco W.J., Lawnick M.M., Gann D.S., Gennarelli T., MacKenzie E., Schwaitzberg S. Progress in characterizing anatomic injury. J Trauma 1990; 30(10): 1200–1207, https://doi.org/10.1097/00005373-199010000-00003.
28. Osler T., Rutledge R., Deis J., Bedrick E. ICISS: an international classification of disease-9 based injury severity score. J Trauma 1996; 41(3): 380–388.
29. Osler T., Glance L., Buzas J.S., Mukamel D., Wagner J., Dick A. A trauma mortality prediction model based on the Anatomic Injury Scale. Ann Surg 2008; 247(6): 1041–1048, https://doi.org/10.1097/sla.0b013e31816ffb3f.
30. Cassidy L.D., Cook A., Ertl A., Gourlay D., Osler T. Is the Trauma Mortality Prediction Model (TMPM-ICD-9) a valid predictor of mortality in pediatric trauma patients? J Pediatr Surg 2014; 49(1): 189–192, https://doi.org/10.1016/j.jpedsurg.2013.09.055.
31. Cordts Filho Rde M., Parreira J.G., Perlingeiro J.A., Soldá S.C., Campos Td., Assef J.C. Pelvic fractures as a marker of injury severity in trauma patients. Rev Col Bras Cir 2011; 38(5): 310–316.
32. Пурас Ю.В., Талыпов А.Э., Крылов В.В. Исходы лечения у пострадавших с сочетанной черепно-мозговой травмой на госпитальном этапе оказания медицинской помощи. Журнал им. Н.В. Склифосовского. Неотложная медицинская помощь 2013; 1: 38–45.
33. Huber S., Biberthaler P., Delhey P., Trentzsch H., Winter H., van Griensven M., Lefering R., Huber-Wagner S.; TraumaRegister DGU. Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry
34. (Trauma Register DGU®). Scand J Trauma Resusc Emerg Med 2014; 22: 52, https://doi.org/10.1186/s13049-014-0052-4.
35. Haddad S.H., Yousef Z.M., Al-Azzam S.S., AlDawood A.S., Al-Zahrani A.A., AlZamel H.A., Tamim H.M., Deeb A.M., Arabi Y.M. Profile, outcome and predictors of mortality of abdomino-pelvic trauma patients in a tertiary intensive care unit in Saudi Arabia. Injury 2015; 46(1): 94–99, https://doi.org/10.1016/j.injury.2014.07.025.
36. Holstein J.H., Culemann U., Pohlemann T.; Working Group Mortality in Pelvic Fracture Patients. What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res 2012; 470(8): 2090–2097, https://doi.org/10.1007/s11999-012-2276-9.
37. Gabbe B.J., de Steiger R., Esser M., Bucknill A., Russ M.K., Cameron P.A. Predictors of mortality following severe pelvic ring fracture: results of a population-based study. Injury 2011; 42(10): 985–991, https://doi.org/10.1016/j.injury.2011.06.003.
38. Миронов П.И., Юнусов Д.И., Гумеров А.А. Совре­мен­ные подходы к прогнозированию исхода тяжелой сочетанной травмы у детей. Вестник анестезиологии и реаниматологии 2013; 10(3): 56–61.
39. Teasdale G., Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2(7872): 81–84, https://doi.org/10.1016/s0140-6736(74)91639-0.
40. Galkova K., Vrabelova M. Normalization of blood lactate as early end-point of polytrauma treatment. Bratisl Lek Listy 2013; 114(11): 637–641, https://doi.org/10.4149/bll_2013_136.
41. Агаларян А.Х. Хирургическое лечение и летальность у пациентов с абдоминальными повреждениями при политравме. Политравма 2014; (4): 24–31.
42. Emircan S., Ozgüç H., Akköse Aydın S., Ozdemir F., Köksal O., Bulut M. Factors affecting mortality in patients with thorax trauma. Ulus Travma Acil Cerrahi Derg 2011; 17(4): 329–333.
43. Liu Y., Du D.Y., Hu X., Xia D.K., Xiang X.Y., Zhou J.H., Liu C.B. Risk factors of mortality in severe chest trauma patients. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2013; 35(1): 74–79.
44. Alamshah S.M., Pipelzadeh M., Mousavi S.R., Baharanfar H., Rezapour E. Determination of predictors and risk factors in patients with multiple emergency surgical traumas. Ulus Travma Acil Cerrahi Derg 2010; 16(5): 421–426.
45. Kapan M., Onder A., Oguz A., Taskesen F., Aliosmanoglu I., Gul M., Tacyildiz I. The effective risk factors on mortality in patients undergoing damage control surgery. Eur Rev Med Pharmacol Sci 2013; 17(12): 1681–1687.
46. Pandit V., Rhee P., Hashmi A., Kulvatunyou N., Tang A., Khalil M., O’Keeffe T., Green D., Friese R.S., Joseph B. Shock index predicts mortality in geriatric trauma patients: an analysis of the National Trauma Data Bank. J Trauma Acute Care Surg 2014; 76(4): 1111–1115, https://doi.org/10.1097/ta.0000000000000160.
47. Paladino L., Subramanian R.A., Nabors S., Sinert R. The utility of shock index in differentiating major from minor injury. Eur J Emerg Med 2011; 18(2): 94–98, https://doi.org/10.1097/mej.0b013e32833f212b.
48. Sellmann T., Miersch D., Kienbaum P., Flohé S., Schneppendahl J., Lefering R.; DGU Trauma Registry. The impact of arterial hypertension on polytrauma and traumatic brain injury. Dtsch Arztebl Int 2012; 109(49): 849–856.
49. Champion H.R., Sacco W.J., Copes W.S., Gann D.S., Gennarelli T.A., Flanagan M.E. A revision of the Trauma Score. J Trauma 1989; 29(5): 623–629, https://doi.org/10.1097/00005373-198905000-00017.
50. Стуканов М.М., Юдакова Т.Н., Максимишин С.В., Гирш А.О., Степанов С.С. Показатели, ассоциированные с летальными исходами у больных с травматическим шоком. Политравма 2015; 2: 37–43.
51. Davenport R. Pathogenesis of acute traumatic coagulopathy. Transfusion 2013; 53(Suppl 1): 23S–27S, https://doi.org/10.1111/trf.12032.
52. González Balverde M., Ramírez Lizardo E.J., Cardona Muñoz E.G., Totsuka Sutto S.E., García Benavides L. Prognostic value of the lethal triad among patients with multiple trauma. Rev Med Chil 2013; 141(11): 1420–1426, https://doi.org/10.4067/s0034-98872013001100008.
53. Mitra B., Tullio F., Cameron P.A., Fitzgerald M. Trauma patients with the ‘triad of death’. Emerg Med J 2012; 29(8): 622–625, https://doi.org/10.1136/emj.2011.113167.
54. Mommsen P., Andruszkow H., Frömke C., Zeckey C., Wagner U., van Griensven M., Frink M., Krettek C., Hildebrand F. Effects of accidental hypothermia on posttraumatic complications and outcome in multiple trauma patients. Injury 2013; 44(1): 86–90, https://doi.org/10.1016/j.injury.2011.10.013.
55. Ireland S., Endacott R., Cameron P., Fitzgerald M., Paul E. The incidence and significance of accidental hypothermia in major trauma — a prospective observational study. Resuscitation 2011; 82(3): 300–306, https://doi.org/10.1016/j.resuscitation.2010.10.016.
56. Müller M.C., Balvers K., Binnekade J.M., Curry N., Stanworth S., Gaarder C., Kolstadbraaten K.M., Rourke C., Brohi K., Goslings J.C., Juffermans N.P. Thromboelastometry and organ failure in trauma patients: a prospective cohort study. Crit Care 2014; 18(6): 687, https://doi.org/10.1186/s13054-014-0687-6.
57. Theusinger O.M., Wanner G.A., Emmert M.Y., Billeter A., Eismon J., Seifert B., Simmen H.P., Spahn D.R., Baulig W. Hyperfibrinolysis diagnosed by rotational thromboelastometry (ROTEM) is associated with higher mortality in patients with severe trauma. Anesth Analg 2011; 113(5): 1003–1012, https://doi.org/10.1213/ane.0b013e31822e183f.
58. Schoeneberg C., Probst T., Schilling M., Wegner A., Hussmann B., Lendemans S. Mortality in severely injured elderly patients: a retrospective analysis of a German level 1 trauma center (2002–2011). Scand J Trauma Resusc Emerg Med 2014; 22: 45, https://doi.org/10.1186/s13049-014-0045-3.
59. Sakellaris G., Blevrakis E., Petrakis I., Dimopoulou A., Dede O., Partalis N., Alegakis A., Seremeti C., Spanaki A.M., Briassoulis G. Acute coagulopathy in children with multiple trauma: a retrospective study. J Emerg Med 2014; 47(5): 539–545, https://doi.org/10.1016/j.jemermed.2014.06.018.
60. Kutcher M.E., Howard B.M., Sperry J.L., Hubbard A.E., Decker A.L., Cuschieri J., Minei J.P., Moore E.E., Brownstein B.H., Maier R.V., Cohen M.J. Evolving beyond the vicious triad: differential mediation of traumatic coagulopathy by injury, shock, and resuscitation. J Trauma Acute Care Surg 2015; 78(3): 516–523, https://doi.org/10.1097/ta.0000000000000545.
61. Søreide K. Clinical and translational aspects of hypothermia in major trauma patients: from pathophysiology to prevention, prognosis and potential preservation. Injury 2014; 45(4): 647–654, https://doi.org/10.1016/j.in jury.2012.12.027.
62. Whittaker B., Christiaans S.C., Altice J.L., Chen M.K., Bartolucci A.A., Morgan C.J., Kerby J.D., Pittet J.F. Early coagulopathy is an independent predictor of mortality in children after severe trauma. Shock 2013; 39(5): 421–426, https://doi.org/10.1097/shk.0b013e31828e08cb.
63. Peltan I.D., Vande Vusse L.K., Maier R.V., Watkins T.R. An international normalized ratio-based definition of acute traumatic coagulopathy is associated with mortality, venous thromboembolism, and multiple organ failure after injury. Crit Care Med 2015; 43(7): 1429–1438, https://doi.org/10.1097/ccm.0000000000000981.
64. Brown J.B., Cohen M.J., Minei J.P., Maier R.V., West M.A., Billiar T.R., Peitzman A.B., Moore E.E., Cuschieri J., Sperry J.L.; Inflammation and the Host Response to Injury Investigators. Characterization of acute coagulopathy and sexual dimorphism after injury: females and coagulopathy just do not mix. J Trauma Acute Care Surg 2012; 73(6): 1395–1400, https://doi.org/10.1097/ta.0b013e31825b9f05.
65. Pape H.C., Giannoudis P.V., Krettek C., Trentz O. Timing of fixation of major fractures in blunt polytrauma: role of conventional indicators in clinical decision making. J Orthop Trauma 2005; 19(8): 551–562, https://doi.org/10.1097/01.bot.0000161712.87129.80.
66. Hagemo J.S., Stanworth S., Juffermans N.P., Brohi K., Cohen M., Johansson P.I., Røislien J., Eken T., Næss P.A., Gaarder C. Prevalence, predictors and outcome of hypofibrinogenaemia in trauma: a multicentre observational study. Crit Care 2014; 18(2): R52, https://doi.org/10.1186/cc13798.
67. Parsikia A., Bones K., Kaplan M., Strain J., Leung P.S., Ortiz J., Joshi A.R. The predictive value of initial serum lactate in trauma patients. Shock 2014; 42(3): 199–204, https://doi.org/10.1097/shk.0000000000000208.
68. Guyette F., Suffoletto B., Castillo J.L., Quintero J., Callaway C., Puyana J.C. Prehospital serum lactate as a predictor of outcomes in trauma patients: a retrospective observational study. J Trauma 2011; 70(4): 782–786, https://doi.org/10.1097/ta.0b013e318210f5c9.
69. Dunham C.M., Chirichella T.J. Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients. Lipids Health Dis 2011; 10: 42, https://doi.org/10.1186/1476-511x-10-42.
70. Yang Y., Liu L., Jiang D., Wang J., Ye Z., Ye J., Chao J., Zhao M., Ao D., Qiu H. Critical illness-related corticosteroid insufficiency after multiple traumas: a multicenter, prospective cohort study. J Trauma Acute Care Surg 2014; 76(6): 1390–1396, https://doi.org/10.1097/ta.0000000000000221.
71. Şentürk G.Ö., Ünlüer E.E., Vandenberk N., Yavaşi Ö., Eroglu O., Sürüm N., Üstüner F., Kayayurt K. The prognostic value of cystatin C compared with trauma scores in multiple blunt trauma: a prospective cohort study. J Emerg Med 2013; 44(6): 1070–1076, https://doi.org/10.1016/j.jemermed.2012.11.037.
72. Устьянцева И.М., Хохлова О.И., Петухова О.В., Крупко О.В., Жевлакова Ю.А., Агаджанян В.В. Разработка патогенетических методов диагностики, оценка тяжести состояния и повреждений при поли­травме. Политравма 2010; 1: 34–38.
73. Gokdemir M.T., Sogut O., Kaya H., Sayhan M.B., Cevik M., Dokuzoglu M.A., Boleken M.E. Role of oxidative stress in the clinical outcome of patients with multiple blunt trauma. J Int Med Res 2012; 40(1): 167–173, https://doi.org/10.1177/147323001204000117.
74. Majercik S., Fox J., Knight S., Horne B.D. Red cell distribution width is predictive of mortality in trauma patients. J Trauma Acute Care Surg 2013; 74(4): 1021–1026, https://doi.org/10.1097/ta.0b013e3182826f02.
75. Lam S.W., Leenen L.P., van Solinge W.W., Hietbrink F., Huisman A. Comparison between the prognostic value of the white blood cell differential count and morphological parameters of neutrophils and lymphocytes in severely injured patients for 7-day in-hospital mortality. Biomarkers 2012; 17(7): 642–647, https://doi.org/10.3109/1354750x.2012.712161.
76. Baek J.H., Kim M.S., Lee J.C., Lee J.H. Systemic inflammation response syndrome score predicts the mortality in multiple trauma patients. Korean J Thorac Cardiovasc Surg 2014; 47(6): 523–528, https://doi.org/10.5090/kjtcs.2014.47.6.523.
77. Kleber C., Becker C.A., Schmidt-Bleek K., Schaser K.D., Haas N.P. Are pentraxin 3 and transsignaling early markers for immunologic injury severity in polytrauma? A pilot study. Clin Orthop Relat Res 2013; 471(9): 2822–2830, https://doi.org/10.1007/s11999-013-2922-x.
78. Доржеев В.В. Содержание IL-1β, IL-2, IL-8, IL-10 и TNFα у пациентов с политравмой. Забайкальский меди­цинский вестник 2014; 4: 132–135.
79. Miller C.M., Shi J., Wheeler K.K., Yin H., Smith G.A., Groner J.I., Xiang H. Chronic conditions and outcomes of pediatric trauma patients. J Trauma Acute Care Surg 2013; 75(2): 250–257, https://doi.org/10.1097/ta.0b013e3182930fb7.
80. Tebby J., Lecky F., Edwards A., Jenks T., Bouamra O., Dimitriou R., Giannoudis P.V. Outcomes of polytrauma patients with diabetes mellitus. BMC Med 2014; 12: 111, https://doi.org/10.1186/1741-7015-12-111.
81. Liu T., Chen J.J., Bai X.J., Zheng G.S., Gao W. The effect of obesity on outcomes in trauma patients: a meta-analysis. Injury 2013; 44(9): 1145–1152, https://doi.org/10.1016/j.injury.2012.10.038.
82. Andruszkow H., Veh J., Mommsen P., Zeckey C., Hildebrand F., Frink M. Impact of the body mass on complications and outcome in multiple trauma patients: what does the weight weigh? Mediators Inflamm 2013; 2013: 345702, https://doi.org/10.1155/2013/345702.
83. Hoffmann M., Lefering R., Gruber-Rathmann M., Rueger J.M., Lehmann W.; Trauma Registry of the German Society for Trauma Surgery. The impact of BMI on polytrauma outcome. Injury 2012; 43(2): 184–188, https://doi.org/10.1016/j.injury.2011.05.029.
84. Sousa A.N., Paiva J.A., Fonseca S.A., Raposo F.J., Loureiro A.M., Valente L.F., Gonçalves A.M., Cabral A.T., Almeida L. Trauma scores in the management of politrauma patients: which one and what for? Acta Med Port 2011; 24(6): 943–950.
85. Левченко Т.В., Кравцов С.А., Корнев А.Н., Шата­лин А.В., Дзубан Г.Г. Анализ госпитальной летальности и качества клинической диагностики у пострадавших с политравмой. Политравма 2014; 3: 24–32.
86. Grzalja N., Saftić I., Marinović M., Stiglić D., Cicvarić T. Polytrauma in elderly. Coll Antropol 2011; 35(Suppl 2): 231–234.
87. Wu J., Sheng L., Wang S., Li Q., Zhang M., Xu S., Gan J. Analysis of clinical risk factors associated with the prognosis of severe multiple-trauma patients with acute lung injury. J Emerg Med 2012; 43(3): 407–412, https://doi.org/10.1016/j.jemermed.2009.05.024.
88. Werman H.A., Erskine T., Caterino J., Riebe J.F., Valasek T.; Members of the Trauma Committee of the State of Ohio EMS Board. Development of statewide geriatric patients trauma triage criteria. Prehosp Disaster Med 2011; 26(3): 170–179, https://doi.org/10.1017/s1049023x11006315.
89. O’Neill S., Brady R.R., Kerssens J.J., Parks R.W. Mortality associated with traumatic injuries in the elderly: a population based study. Arch Gerontol Geriatr 2012; 54(3): e426–e430, https://doi.org/10.1016/j.archger.2012.01.007.
90. Jin H., Tang L.Q., Pan Z.G., Peng N., Wen Q., Tang Y.Q., Su L. Ten-year retrospective analysis of multiple trauma complicated by pulmonary contusion. Mil Med Res 2014; 1(1): 7, https://doi.org/10.1186/2054-9369-1-7.
91. Trentzsch H., Lefering R., Nienaber U., Kraft R., Faist E., Piltz S. The role of biological sex in severely traumatized patients on outcomes: a matched-pair analysis. Ann Surg 2015; 261(4): 774–780, https://doi.org/10.1097/sla.0000000000000789.
92. Ханин М.Ю. Коррекция анемии при множественных и сочетанных повреждениях опорно-двигательного аппа­рата. Медицинский вестник Башкортостана 2012; 7(2): 78–80.
93. Dewar D.C., White A., Attia J., Tarrant S.M., King K.L., Balogh Z.J. Comparison of postinjury multiple-organ failure scoring systems: Denver versus Sequential Organ Failure Assessment. J Trauma Acute Care Surg 2014; 77(4): 624–629, https://doi.org/10.1097/ta.0000000000000406.
94. Fueglistaler P., Amsler F., Schüepp M., Fueglistaler-Montali I., Attenberger C., Pargger H., Jacob A.L., Gross T. Prognostic value of Sequential Organ Failure Assessment and Simplified Acute Physiology II Score compared with trauma scores in the outcome of multiple-trauma patients. Am J Surg 2010; 200(2): 204–214, https://doi.org/10.1016/j.amjsurg.2009.08.035.
95. Потанина О.К., Дорфман А.Г., Огурцова Е.В., Швы­рев С.Л., Зарубина Т.В. Сравнение эффективности про­гностических шкал оценки тяжести состояния в разных диагностических группах среди реанимационных больных хирургического профиля. Информационно-измерительные и управляющие системы 2011; 9(12): 75–81.
96. Santana-Cabrera L., Sánchez-Palacios M., Rodríguez A.U. Differences in the prognosis among severe trauma and medical patients requiring mechanical ventilation. Int J Burns Trauma 2013; 3(4): 220–224.
97. Mica L., Rufibach K., Keel M., Trentz O. The risk of early mortality of polytrauma patients associated to ISS, NISS, APACHE II values and prothrombin time. J Trauma Manag Outcomes 2013; 7: 6, https://doi.org/10.1186/1752-2897-7-6.
98. Zali A.R., Seddighi A.S., Seddighi A., Ashrafi F. Comparison of the acute physiology and chronic health evaluation score (APACHE) II with GCS in predicting hospital mortality of neurosurgical intensive care unit patients. Glob J Health Sci 2012; 4(3): 179–184, https://doi.org/10.5539/gjhs.v4n3p179.
99. Hwang S.Y., Lee J.H., Lee Y.H., Hong C.K., Sung A.J., Choi Y.C. Comparison of the Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II scoring system, and Trauma and Injury Severity Score method for predicting the outcomes of intensive care unit trauma patients. Am J Emerg Med 2012; 30(5): 749–753, https://doi.org/10.1016/j.ajem.2011.05.022.
100. Сорокин Э.П., Грицан А.И., Пономарев С.В., Ши­ля­­ева Е.В. Опыт применения прогностических шкал для оценки выживаемости у пациентов с сочетанными трав­мами груди и живота. Вестник анестезиологии и реанима­тологии 2013; 10(5): 47–50.
101. Говоров В.В., Говорова Н.В., Мангус А.Э. Про­гнос­тическая оценка показателей основных систем жизне­обеспечения и шкалы APACHE II у пациентов с тяжелой сочетанной травмой. Политравма 2011; 2: 42–47.
102. Sardinha D.S., de Sousa R.M., Nogueira Lde S., Damiani L.P. Risk factors for the mortality of trauma victims in the intensive care unit. Intensive Crit Care Nurs 2015; 31(2): 76–82, https://doi.org/10.1016/j.iccn.2014.10.008.
103. Oestern H.J., Tscherne H., Sturm J., Nerlich M. Classification of the severity of injury. Unfallchirurg 1985; 88(11): 465–472.
104. Boyd C.R., Tolson M.A., Copes W.S. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma 1987; 27(4): 370–378.
105. Thanapaisal C., Saksaen P. A comparison of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Trauma-Injury Severity Score (TRISS) for outcome assessment in Srinagarind Intensive Care Unit trauma patients. J Med Assoc Thai 2012; 95(Suppl 11): S25–S33.
106. Deshmukh V.U., Ketkar M.N., Bharucha E.K. Analysis of trauma outcome using the TRISS method at a Tertiary Care Centre in Pune. Indian J Surg 2012; 74(6): 440–444, https://doi.org/10.1007/s12262-011-0404-5.
107. Ahun E., Köksal Ö., Sığırlı D., Torun G., Dönmez S.S., Armağan E. Value of the Glasgow coma scale, age, and arterial blood pressure score for predicting the mortality of major trauma patients presenting to the emergency department. Ulus Travma Acil Cerrahi Derg 2014; 20(4): 241–247, https://doi.org/10.5505/tjtes.2014.76399.
108. Champion H.R., Copes W.S., Sacco W.J., Frey C.F., Holcroft J.W., Hoyt D.B., Weigelt J.A. Improved predictions from a severity characterization of trauma (ASCOT) over Trauma and Injury Severity Score (TRISS): results of an independent evaluation. J Trauma 1996; 40(1): 42–49, https://doi.org/10.1097/00043860-199604000-00008.
109. Török Á., Bancu Ş., Neagoe R., Mureşan M., Kántor T., Suciu A., Vas K.E., Nagy Ö. The utility of the predictive scores in polytrauma with abdomino-pelvic injuries: a series of 38 patients. Chirurgia (Bucur) 2014; 109(1): 44–47.
110. Гуманенко Е.К. Объективная оценка тяжести травмы. СПб; 1999; 109 с.
111. Апарцин К.А. Хирургия сочетанных повреждений. Сибирский медицинский журнал (Иркутск) 2014; 126(3): 129–133.
112. Raj R., Brinck T., Skrifvars M.B., Kivisaari R., Siironen J., Lefering R., Handolin L. Validation of the revised injury severity classification score in patients with moderate-to-severe traumatic brain injury. Injury 2015; 46(1): 86–93, https://doi.org/10.1016/j.injury.2014.08.026.

Seliverstov P.A., Shapkin Y.G. Assessment of Severity and Prognosis of Polytrauma Outcome: the Current State of the Problem (Review). Sovremennye tehnologii v medicine 2017; 9(2): 207, https://doi.org/10.17691/stm2017.9.2.25