EUROMEDICA  Hanover 3-4  Juni 2010	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Berliner Medizinischen Gesellschaft, Berlin

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The problem of polytrauma diagnostics and treatment stays one of the most topical in the surgery of injuries. The number and severity of polytraumas are both consistently increasing. The lethality in such patients reaches 35-47%. The objectification of trauma severity, that would be based both on severity of damage and condition, is necessary for building diagnostic and therapeutic algorithm in polytrauma. In USA and some European countries, AIS scale is used for isolated traumas and IIS index is used for concomitant injuries; in Germany Hanover’s code for polytraumas PTS is successfully used for evaluating the trauma severity; in Russia -Tzibin’s grade rating and BFS system: BFS(MT) for mechanical traumas and BS(BW) fro ballistic wounds.

Special place in the problem of polytrauma is held by objective severity rating of patients’ condition, both when diagnosing and intensive care performing, as well as diagnosing polyorganic disfunction and complications.

Currently APACHE II scale and SAPS II, SOFA, MODS are of great popularity in USA and european countries. They are also applied in our country for monitoring, and diagnosing polyorganic disfunction, as well as sepsis. It is important to say, that APACHE II scale is very cumbersome, claims to be universal and is rarely used to the fullest extent, SOFA and MODS indexes solve small problems on revealing polyorganic disfunction in separate systems. We think that scale BFS is most sufficient scale for defining trauma severity in today condition of Russian healthcare. These scales were developed in the Department of Battle-Field surgery Military-Medical Academy. The grading is performed by giving severity level to every concrete injury. As the result, every scale point is actually converted severity index, acquired from adding products of lethality, permanent invalidization, and long loss of earning capacity numbers. Quantitative grading of condition severity is performed with using 2 BFS scales – one of them is used to evaluate the patient’s condition at the moment of intake into medical unit, and the other one is used for evaluating the condition during the treatment process. These 2 scales include 12 and 16 symptoms respectively, and are graded with the universal method fro 1 to 9. These symptoms, while being highly informative, also very simple in analyzing, and are accessible to use in any medical institutions both of peacetime and war-time. When evaluating condition severity, the symptoms listed in scales are observed, each of them is measured in points, after that points are summed - acquired index is quantitative characteristic of the condition at the moment of observation. According to BFS scale condition severity is divided on 3 levels – compensated, subcompensated, decompensated. For each severity level different types of operations are applied. Compensated condition is best for all types of operations. However in polytraumas the compensation of patient’s condition comes only in the 4th period of traumatic disease, at the same time basic surgical problems should be resolved in the 1st and 2nd period. - otherwise patients with polytrauma will not survive up to 4th period. That’s why all urgent and intermediary operations are performed against the background of subcompensated condition. When in decompensated condition, only immediate operations are performed, in order to eliminate the reasons of decompensation.

Thus, we think, that using the scales that were developed in the Department of Battle-Field surgery Military-Medical Academy is most rational in urgent surgery.