Skoring prognostik ensefalitis anak = Prognostic scoring pediatric encephalitis
| Main Author: | Hening Tirta Kusumawardani, author |
|---|---|
| Format: | Masters Doctoral |
| Terbitan: |
, 2014
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| Online Access: |
http://lib.ui.ac.id/file?file=digital/2016-8/20404154-T42895-Hening Tirta Kusumawardani.pdf |
Daftar Isi:
- [<b>ABSTRAK</b><br> Latar Belakang : Ensefalitis adalah suatu infeksi cairan otak atau proses peradangan yang melibatkan parenkim otak yang berasosiasi dengan bukti klinis disfungsi otak (Gilroy, 2000). Ensefalitis masih merupakan masalah kesehatan yang serius, sehingga memerlukan diagnosis awal, terapi yang efektif, dan kontrol terhadap penanganannya. Di Indonesia infeksi susunan saraf pusat menduduki urutan ke- 10 dari urutan prevalensi penyakit, dengan angka kematian anak ensefalitis berkisar antara 18-40% dengan angka kecacatan berkisar antara 30-50% (Saharso dan Hidayati, 2000). Keterlambatan dan penanganan yang tidak optimal dapat memperparah keadaan sehingga dapat menyebabkan kematian dan kecacatan pada pasien. Penelitian tentang skoring prognosis ensefalitis akut pada pasien anak belum pernah dilakukan. Sehingga penelitian ini akan membuat suatu model prognostik yang akan memprediksi luaran pasien anak dengan ensefalitis. Metode : Penelitian kohort retrospektif dengan data sekunder rekam medis. Data yang terdiri dari beberapa variabel yang dikumpulkan secara retrospektif dari catatan medis pasien. RS di Jawa Tengah, Indonesia. Pengambilan data dilakukan pada bulan Oktober- November 2014. Jumlah sampel yang diambil sebanyak 299 pasien. Analisis yang dilakukan meliputi analisis univariat, bivariat, dan analisis multivariate cox proportional hazard dengan model matematis yang selanjutnya akan dibuat model skoring. Analisis roctab digunakan untuk menentukan nilai cut-off setiap variabel numerik Hasil : Variabel kejang, tingkat kesadaran, dan status gizi merupakan faktor protektif outcome, sedangkan variabel peningkatan tekanan intrakranial, kadar elektrolit natrium dan klorida, serta terapi diuretik merupakan faktor resiko untuk terjadinya outcome kematian pada pasien ensefalitis anak.Berdasarkan hasil analisis multivariat skoring didapatkan urutan faktor prognostik yang dominan menyebabkan kematian, yaitu peningkatan tekanan intrakranial (HR = 9.6, skoring 16), hiperklorida (HR = 1.5, skoring 6), terapi diuretik (HR=0.2, skoring 4), status gizi (HR=0.7, skoring 1), frekuensi kejang (HR=0.3, skoring -3), hipernatremia (HR=0.7, skoring -4), dan tingkat kesadaran yang dinilai dengan pediatric coma scale (HR=0.8, skoring -6). Dari hasil multivariat yang telah dilakukan sebelumnya, apabila skor <-108 tidak ada resiko untuk mengalami kematian, skor -54 s/d -39.9 resiko rendah untuk mengalami kematian, skor -40 s/d -24.0 resiko sedang untuk mengalami kematian, dan skor >-25 adalah resiko tinggi untuk mengalami kematian. Kesimpulan : Model skoring prognosis yang telah terbentuk ini mampu memprediksi 81% faktor yang berhubungan dengan prognosis ensefalitis. Apabila dari 100 anak ensefalitis dengan adanya semua variabel pembentuk model skoring maka 73 anak akan di prediksi meninggal dan apabila dari 100 anak ensefalitis tanpa adanya semua variabel tersebut maka 27 anak akan meninggal. <hr> <b>ABSTRACT</b><br> Background Encephalitis is an infection of the cerebrospinal fluid or inflammatory processes involving the brain parenchyma associated with clinical evidence of brain dysfunction Gilroy 2000 Encephalitis is still a serious health problem requiring early diagnosis effective treatment and control of the handling In Indonesia the central nervous system infection ranks 10th on the order of prevalence of the disease the child mortality rate ranged between 18 40 with disabilities numbers ranging from 30 50 Saharso and Hidayati 2000 Delays handling and unadequate theraphy may cause of death and disability in patients Research on scoring prognosis of acute encephalitis in pediatric patients have not been conducted Therefore this research will make a prognostic models that will predict the outcome of pediatric patients with encephalitis Methods A retrospective cohort study with secondary data medical records The data consists of several variables collected retrospectively from patient hospital medical records in Central Java Indonesia Data were collected in October November 2014 The number of samples taken 299 patients Analysis was conducted on the univariate bivariate and multivariate Cox proportional hazards analysis with mathematical models which in turn will be made scoring model Roctab analysis is used to determine the cut off value of any numeric variableResults Variable seizures level of consciousness and the nutritional status of a protective factor for outcome whereas the variable increased intracranial pressure electrolyte levels of sodium and chloride as well as diuretic therapy is a risk factor for the occurrence of mortality outcomes in pediatric patients with encephalitis Based on the results of the multivariate analysis of prognostic factors scoring sequence obtained the dominant cause of death are increase in intracranial pressure HR 9 6 scoring 16 hiperklorida HR 1 5 scoring 6 diuretic therapy HR 0 2 scoring 4 nutritional status HR 0 7 scoring 1 the frequency of seizures HR 0 3 scoring 3 hypernatremia HR 0 7 scoring 4 and level of consciousness was assessed by a pediatric coma scale HR 0 8 scoring 6 From the results of the multivariate has been done before when a score of 25 is a high risk for death Conclusion Prognostic scoring model that has been formed is able to predict 81 of the factors related to prognosis encephalitis If the 100 children encephalitis with all the variables forming the scoring model in the prediction of 73 children will die and when of 100 children encephalitis without all these variables the 27 children will die , Background Encephalitis is an infection of the cerebrospinal fluid or inflammatory processes involving the brain parenchyma associated with clinical evidence of brain dysfunction Gilroy 2000 Encephalitis is still a serious health problem requiring early diagnosis effective treatment and control of the handling In Indonesia the central nervous system infection ranks 10th on the order of prevalence of the disease the child mortality rate ranged between 18 40 with disabilities numbers ranging from 30 50 Saharso and Hidayati 2000 Delays handling and unadequate theraphy may cause of death and disability in patients Research on scoring prognosis of acute encephalitis in pediatric patients have not been conducted Therefore this research will make a prognostic models that will predict the outcome of pediatric patients with encephalitis Methods A retrospective cohort study with secondary data medical records The data consists of several variables collected retrospectively from patient hospital medical records in Central Java Indonesia Data were collected in October November 2014 The number of samples taken 299 patients Analysis was conducted on the univariate bivariate and multivariate Cox proportional hazards analysis with mathematical models which in turn will be made scoring model Roctab analysis is used to determine the cut off value of any numeric variableResults Variable seizures level of consciousness and the nutritional status of a protective factor for outcome whereas the variable increased intracranial pressure electrolyte levels of sodium and chloride as well as diuretic therapy is a risk factor for the occurrence of mortality outcomes in pediatric patients with encephalitis Based on the results of the multivariate analysis of prognostic factors scoring sequence obtained the dominant cause of death are increase in intracranial pressure HR 9 6 scoring 16 hiperklorida HR 1 5 scoring 6 diuretic therapy HR 0 2 scoring 4 nutritional status HR 0 7 scoring 1 the frequency of seizures HR 0 3 scoring 3 hypernatremia HR 0 7 scoring 4 and level of consciousness was assessed by a pediatric coma scale HR 0 8 scoring 6 From the results of the multivariate has been done before when a score of 25 is a high risk for death Conclusion Prognostic scoring model that has been formed is able to predict 81 of the factors related to prognosis encephalitis If the 100 children encephalitis with all the variables forming the scoring model in the prediction of 73 children will die and when of 100 children encephalitis without all these variables the 27 children will die ]