Risk-based characterization of combat abdominal trauma

Objective. Formation of a risk-oriented characterization of modern combat abdominal trauma as a fundamental basis for the creation of effective clinical protocols and clinical routes in the process of providing medical care to victims Materials and Methods. We analyzed 376 observations of combat abdominal trauma in a mixed population of military and civilian victims. The clinical and nosological structure of injuries, clinical outcome risks of death of the victim were determined and analyzed using the concept of Clinical Risk Management. The actual research material was analyzed using parametric and non-parametric and fractal analysis methods. The conclusions and statements obtained in the study are within the field of probability. Results. It has been established that combat abdominal trauma has a complex clinical and nosological structure, in 18.8% of victims it is combined with damage to other anatomical areas, that is, it is polystructural, with a combination coefficient of 1.48. In 83.9% of victims, the injury is open. The largest proportion (44.4%) is accounted for by relatively minor clinical and nosological forms of injuries - non-penetrating abdominal wounds without damage to internal organs. Clinical and nosological forms of combat abdominal trauma are characterized by diversity with a dissipation rate of 17.1. All of them are risk factors that form the clinical outcome risk of death of the victim. The overall risk of death of victims with abdominal trauma is catastrophic (0.86), but it significantly depends on the clinical and nosological form of injury, and the risk indicators for different clinical and nosological forms of injury have a significant dissipation coefficient of 5.8. The highest clinical outcome risks of death of the victim, which can be qualified as catastrophic, are associated with clinical and nosological forms of injury that cause external or internal bleeding, as well as the development of infectious complications of the traumatic process. Conclusions. Abdominal trauma is a major component in the structure of combat trauma. It has signs of a rather complex, combined and polystructural injury in terms of its main clinical characteristics. The clinical and nosological structure of combat abdominal trauma is complex with a high coefficient of dissipation of the proportion of clinical and nosological forms of injury. Each clinical and nosological form of abdominal injuries has its own risk of a negative outcome of the traumatic process (death of the victim), which ranges from 0.17 (insignificant) to 0.92 (catastrophic).