Modern strategies and interdisciplinary aspects of surgical treatment and rehabilitation of children with severe combined injuries

Abstract

Severe polytrauma in children represents a complex challenge in modern pediatric surgery, traumatology, intensive care, and rehabilitation, as the outcome is determined not only by the severity of the primary injuries but also by the timeliness of prehospital care, correct routing to a specialized center, stabilization of vital functions, and early initiation of restorative treatment. This review analyzes current data on surgical treatment, intensive care, diagnosis, rehabilitation, and organizational aspects of managing children with severe polytrauma, as well as risk factors influencing mortality, complications, and long-term outcomes. A search of published data was performed in PubMed/Ovid MEDLINE, ScienceDirect, Springer Link, Google Scholar, eLIBRARY, and CyberLeninka for 2019–2026; 77 publications were included. The review addresses epidemiology, prognostic scales and laboratory markers of severity, current approaches to prehospital care, ABCDE stabilization, damage control resuscitation, coagulopathy diagnosis, rational use of computed tomography and extended focused assessment with sonography for trauma (e-FAST), abdominal injuries, organ-preserving management of liver and splenic trauma, transcatheter arterial embolization, severe traumatic brain and spinal injury, and identification of child abuse-related trauma. The most unfavorable outcomes are associated with high Injury Severity Score/New Injury Severity Score values (≥16), low Glasgow Coma Scale scores (≤8), hemorrhagic shock, coagulopathy, the need for mechanical ventilation, and severe neurological deficit. The current care model should include early assessment of rehabilitation potential, correction of motor, cognitive, speech, and behavioral impairments, family support, and long-term multidisciplinary follow-up.