BAIDA Clinical Decision Cycle: a conceptual cyclical model of clinical decision support in combat extremity injuries | Ukrainian Medical Journal

Combat extremity injuries are characterised by marked variability of clinical presentation, extensive tissue damage, frequent neurovascular involvement, a high risk of infectious complications and the need for multistage reconstructive treatment. The dynamic course of the wound process demands continuous revision of treatment strategy, whereas most existing scales and algorithms are oriented predominantly towards a single-point assessment of injury severity or towards addressing isolated clinical tasks. The aim of this work was to provide a scientific rationale for, and to present, the BAIDA Clinical Decision Cycle as a conceptual cyclical model of clinical decision support in combat extremity injuries. Object and methods of the research. The methodological basis of the study comprised an analysis of the current scientific literature, international clinical guidelines and the findings of a retrospective study of 387 servicemen with combat extremity injuries. In developing the model, the principles of Damage Control Orthopaedics, orthoplastic reconstruction, clinical decision support systems and standardised integral severity assessment by means of the Blast Trauma Severity Scale (BTSS) were integrated. Results. The BAIDA Clinical Decision Cycle was accordingly developed as a five-component conceptual model encompassing comprehensive assessment of the combat injury, stratification of severity and risk, control of ischaemia and infection, planning of reconstruction in accordance with the characteristics of the defect, and adaptive staged treatment. The defining feature of the proposed model is the shift from static severity assessment to a cyclical process of clinical decision-making, in which a repeat comprehensive assessment of the patient’s condition is performed after each stage of treatment and is followed by revision of the treatment strategy. Conclusion. The integral BTSS score serves as a standardised instrument for severity stratification but is not regarded as a stand-alone criterion for the choice between reconstruction and amputation. The proposed model establishes a methodological foundation for the standardisation of staged treatment, multidisciplinary interaction and subsequent digital support of clinical decision-making. Its practical application requires further clinical validation.

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