DIFFICULTIES COMPREHENSIVE CLINICAL DIAGNOSIS OF PNEUMONIA IN THE HOSPITAL AGAINST TRAUMATIC BRAIN INJURY.
DOI:
https://doi.org/10.11603/2415-8798.2017.1.7111Keywords:
nosocomial pneumonia, hospital acquired pneumonia, traumatic brain injury, diagnosis.Abstract
Nosocomial pneumonia (NP) holds a leading position in the structure of in-hospital morbidity and mortality. NP is one of the most dangerous infectious complications of severe traumatic brain injury (TBI). Clinical diagnosis of pneumonia in severe head injury remains challenging and continues to be developed.
The aim of the study is research was to find out the features of the clinical and laboratory diagnosis of NP, developed on the background of TBI.
Materials and methods. The sample of 166 patients, including 58 patients with isolated severe head injury (group 1) and 108 patients with TBI, complicated by the development of NP (group 2). All patients in Group 2 NP was confirmed by the radiography presence of infiltrates. Diagnosis of NP was established in accordance with international recommendations and the current Ukrainian protocol of diagnosis and treatment of pulmonary diseases in adults (decree of Ministry of Health of Ukraine No. 128 from 19.03.2007). In both groups we considered the complaint, physical examination and laboratory investigations of patients with conventional diagnosis in NP.
Results and Discussion. The following figures are obtained. The average score on the Glasgow coma scale (GCS) in group 1 was 12.0±3.0 points, group 2 – 10.3±3.3 points. The mean duration of mechanical ventilation in group 1 was 4.2±2.7 days, and in group 2 – 9.7±6.8 days. The average heart rate was 77.9±10.3 in group 1 and 95.0±11.3 in group 2. The average body temperature figure was 37.1±0.5 in the first group and 38.7±0.8 in the second group. In group 1, the erythrocyte sedimentation rate (ESR) index was 8.8±4.9 mm/h, leucocytes 8.0х109±3.3. leukocyte index of intoxication (LII) 2.0±0.8. In group 2, ESR rate was 30.6±13.4 mm/h, leucocytes 20.4 х109±6.6, LІI 5.9±3.4.
Conclusions. Thus, conventional clinical and laboratory diagnostic techniques have different nosocomial pneumonia (often low) level of sensitivity and specificity, as a result, no single criterion can not be the gold standard for the diagnosis of SE. Considering the clinical relevance of the SE and a high risk of its development in patients with TBI, today is a topical issue of new research GP diagnostic methods based on the most sensitive indicators and their complex application.
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