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THE ISSUE OF DEVELOPMENT OF POLYTRAUMA REGISTRY IN THE RUSSIAN FEDERATION Agadzhanyan V.V.

Regional Clinical Center of Miners’ Health Protection, Leninsk-Kuznetsky, Russia,
Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan, Novosibirsk, Russia

THE ISSUE OF DEVELOPMENT OF POLYTRAUMA REGISTRY IN THE RUSSIAN FEDERATION

At various times, the medical society had been actively discussing the issues of development of polytrauma registry. Multiple publications testify this fact [1-5, 9-12].
As a rule, polytrauma registries are nationwide and are used for increasing availability and providing the high quality of medical care for patients with severe trauma [13-17]. Two main goals are to be solved: warranty of quality of medical care in certain medical facilities, and implementation of high tech, evidence-based methods for arrangement, diagnostics and treatment.
In the Russian Federation, the attempts of creation of polytrauma registries are realized in view of guidelines of different levels [6, 7, 8]. These recommendations define the main terms and notions used for characteristics of polytrauma, such as injury severity and condition severity, and present the most substantiated (from the perspective of evidence-based medicine and clinical use) methods for selection of subsequence of surgical treatment with consideration of dominating injuries. They are used by the physician for selecting the optimal management strategy for patients with polytrauma.
However the absence of the uniform definitions for discussion of polytrauma issues from one side, and making the unified solution for practical development of the polytrauma registry from other side have not resulted in transition from recommendatory pattern to development of the Russian national registry of polytrauma.
In our previous study [6], we offered to use the modified control list of the measures (CLM) for trauma management according to the WHO guidelines [17].
Having the minimal set of the tools for polytrauma, one can continue the detailed discussion of subsequent practical construction of polytrauma registries.

The main tasks:

1. The control of the whole chain of medical care to identify the weaknesses and advantages from the perspective of physicians and patients in certain medical facilities.
2. Development of the standards of medical care realization for patients with severe injuries at different stages.
3. Determination of criteria for estimating the efficiency and quality of treatment and rehabilitation.
4. Provision of clinical studies for the issues of epidemiology of severe injury, diagnosis, treatment, economics, life quality, prognosis, estimation, recommendations, assessment of resources in medical and preventive facilities and qualification of medical staff.
We have made another attempt to attract attention of the specialists in polytrauma problem and necessity of development of the polytrauma registry. Therefore, in this article, we have published the control list of the measures (CLM) for trauma management with the WHO guidelines [6, 17], which has been accepted as the alternative way for treating the difficult cases in the clinics of Canada [13] and European Union [11, 14-16] for improving the management quality and the patient’s safety (the table).

Table. Modified CLM (control list of measures) for trauma management according to WHO recommendations

Перед тем как покинуть Отделение неотложной помощи	Before leaving the emergency department
1. Если верхние дыхательные пути вне опасности, планируете ли вы проводить дальнейшее вмешательство на них?	1. If upper airways are in safe, do you plan to conduct further intervention for airways?
□ Да □ Нет, и планирую обсудить это с коллегами	□ Yes □ No, and I have plans for discussion with my colleagues
2. У пациента 8 или менее баллов по Шкале Комы Глазго?	2. Is Glasgow Coma Scale 8 points or less?
□ Нет □ Да, и пациент интубирован	□ No □ Yes, the patient is intubated
3. Была ли сделана рентгенография грудной клетки, и исключен ли гемо/пневмоторакс?	3. Did somebody perform chest X-ray and exclude hemo/pneumothorax?
□ Да	□ Да Yes
4. Проверена ли пульсовая оксиметрия и функционирование?	4. Whether pulse oximetry and functioning were performed?
□ Да	□ Yes
5. Была ли сделана рентгенография области таза, чтобы исключить патологию и рассмотреть вопрос о бандаже?	5. Did somebody realize pelvic X-ray examination for excluding pathology and considering the issue about bandage?
□ Да □ Нет (противопоказано при проникающей травме)	□ Yes □ No (contraindicated in case of penetrating injury)
6. Проведено  ли назначение соответствующей инфузионной / инфузионно-трансфузионной терапии? (кристаллоидов, коллоидов, затем крови)	6. Did somebody designate appropriate infusion/infusion-transfusion therapy (cristalloids, colloids, and blood afterwards)?
□ Да	□ Yes
7. Проводился ли анализ крови на газы и кислотность?	7. Whether blood analysis of gases and acidity was performed?
□ Да	□ Yes
8. Находится ли пациент в состоянии шока (ацидоз, дефицит оснований ≤ -6 или стойкая тахикардия или гипотензия)?	8. Is the patient in shock (acidosis, base deficit  ≤ -6, persistent tachycardia or hypotension)?
□ Нет □ Да	□ No □ Yes
Если да: доведено ли это до сведения хирурга? □ Нет □ Да	If yes, is the surgeon informed?- □ No □ Yes
Заказана ли кровь? И рассматривается ли возможность её переливания?	– Is the blood ordered? Is the possibility for transfusion considered?
□ No	□ No
□ Yes	□ Yes
9. Внутреннее кровотечение было обнаружено с помощью	9. Internal bleeding was identified with
□ клинического обследования (например, при огнестрельном ранении брюшной полости)	□ clinical examination (for example, in case of abdominal gun shot)
□ фокусированной абдоминальной сонограммы (при тупой травме живота)	□ focused abdominal sonography (in blunt abdominal injury)
□ лапороскопия и исследование лаважой жидкости из брюшной полости	□ laparoscopy and examination of abdominal lavage
□ КТ или этот вопрос ещё в процессе решения	□ CT or this question is under decision making
10. Проверили ли Вы открытые раны и контролируете ли вы внешние кровотечения, включая кожу черепа, спины и промежность?	10. Did you check open wounds? Are you controlling external bleeding, including skin in the region of skull, back and crotch?
□ Да	□ Yes
11. Проверили ли Вы нервно-сосудистый статус всех 4-х конечностей?	11. Did you check nervous vascular status in all four extremities?
□ Да	□ Yes
12. Измерена ли температура и исключена ли гипотермия (температура ниже 35 градусов)?	12. Did somebody measure temperature and exclude hypothermia (body temperature < 35 degrees)?
□ Да, и в случае необходимости предприняты действия	□ Yes, and appropriate measures were initiated if it was necessary
13. Приняты ли во внимание необходимость назначения анальгетиков, антибиотиков, других необходимых лекарственных препаратов?	13. Did you consider the necessity of designation of analgetics, antibiotics and other required medicamental drugs?
□ Да	□ Yes
14. Объявили ли доктора-консультанты свои планы?	14. Did the consulting physicians give out their plans?
□ Анестезиолог/реаниматолог	□ Anesthesiologist/intensivist
□ Общий хирург	□ General surgeon
□ Ортопед	□ Orthopedist
□ Нейрохирург	□ Neurosurgeon
(если они уведомлены)	(if they were informed)
15. Готовятся ли для транспортировки пациента  необходимые препараты?	15. Is somebody preparing appropriate drugs for transportation?
□ наркотики	□ narcotics
□ гипнотики/атарактики	□ hypnotics/ataractics
□ релаксанты	□ relaxants
16. Остались ли у кого-то из бригады докторов вопросы, нерешенные до выписки из отделения травматологии?	16. Does somebody among the physicians has the issues which have not been solved before discharge from traumatology department?

It is necessary to note that the international expert group has defined the main notion of polytrauma term. The criteria for objectifying have been determined. They are simple, available for all medical facilities dealing with severe injured patients, and can be recommended for the basis of implementation into the scientific and practical activity of the Russian medicine.
With these criteria, the work group (associations, academies or society) of polytrauma issues will able to develop, and to perform the practical implementation of the national registries of polytrauma. Certainly, the successful integration of the registry requires the procedures of coordination, accept and acknowledgement with adherence to obligatory availability/openness, and possibility for feedback of executors and developers etc.
For wide discussion and making the changes in the control list of the measures for polytrauma management, we invite the health care managers, the employees of trauma centers of all levels, the society of the traumatologist-orthopedists, the surgeons, the neurosurgeons, the intensivists, the anesthesiologists and other specialists.
Wide discussion of these issues should increase the efficiency of use of the modern medical technologies that will decrease such socially important values as working incapability, disability, mortality, and, as result, will increase the quality and span of life of the population in the country.
The cooperation of the professionals in different medical fields will give a strong stimulus for experience exchange and improving the medical care arrangement system for patients with polytrauma, since the development of the optimal approach to prevention, diagnostics and treatment of severe injuries is the general task in the medical society.
I invite all concerned specialists for productive cooperation and discussion in the pages of Polytrauma journal. It will allow defining the tactics of cooperative activity, especially when solving the complex interdisciplinary medical problems of polytrauma management.
We hope that after completion of discussion the agreed recommendations will be used for development of the Russian national registry of polytrauma that is possible only with participation of the Health Ministry of the Russian Federation. 

Information about financing and conflict of interests

The study was conducted without sponsorship. The author declares the absence of any clear and potential conflicts of interests relating to publication of this article.