scholarly journals Performa Rapid Emergency Medicine Score dalam Memprediksi Outcome Pasien Trauma Kepala di Instalasi Gawat Darurat

2019 ◽  
Vol 30 (4) ◽  
pp. 302
Author(s):  
Didik Mulyono ◽  
Nurdiana Nurdiana ◽  
Rinik Eko Kapti

<p><br />Rapid Emergency Medicine Score (REMS) merupakan suatu sistem skor yang telah digunakan secara luas di berbagai negara untuk memprediksi mortalitas pasien non bedah maupun trauma di Instalasi Gawat Darurat (IGD), tetapi belum diuji pada populasi yang spesifik pada trauma kepala. Tujuan penelitian ini untuk menilai performa REMS dalam memprediksi outcome pasien trauma kepala di IGD. Penelitian ini menggunakan desain observasi analitik dengan pendekatan retrospektif. Sampel menggunakan data rekam medis pasien dengan trauma kepala sedang-berat disesuaikan dengan kriteria inklusi dan eksklusi dan digunakan teknik purposive sampling yaitu sebanyak 181 responden. Analisis bivariat yang dilakukan pada penelitian ini menggunakan uji Somers'd, sedangkan analisis multivariat menggunakan regresi logistik ordinal. Selanjutnya, kemampuan untuk memprediksi outcome dinilai menggunakan analisis the area under the receiver operating characteristic (AUROC). Hasil uji bivariat menunjukkan bahwa nilai somers'd REMS sebesar 0,310 dengan p value &lt;0,001 dan arah hubungan positif dengan outcome pasien trauma kepala. Hasil regresi logistik ordinal menunjukkan parameter Glasgow Coma Scale (GCS) memperoleh Odds Ratio sebesar 0,7, artinya skor GCS yang rendah memiliki risiko memperoleh outcome death sebesar 0,7 kali lebih besar dibandingkan memperoleh outcome moderate disability, severe disability, persisten vegetatif state. Nilai Area Under Curve (AUC) REMS pada cut of point &gt;5 dengan sensitivitas 61,4 dan spesifisitas 77,8 adalah 0,753 (95% CI; 0,683-0,814. REMS menunjukkan performa yang baik dalam memprediksi outcome pasien trauma kepala.</p>

2020 ◽  
pp. 102490792090867
Author(s):  
Sultan Tuna Akgol Gur ◽  
Ilker Akbas ◽  
Muhammed Zubeyir Kose ◽  
Abdullah Osman Kocak ◽  
Alper Eren ◽  
...  

Background: Ischemic stroke is a leading cause of death and functional disability worldwide. Several clinical scores or stroke scales, biological test or markers, clinical signs, and radiological imaging have been performed to predict both worse neurologic outcome and mortality for ischemic stroke. Objectives: The aim of our study was to investigate the association between early Bispectral Index scores and in-hospital mortality in patients with ischemic stroke. Methods: This is a comparative prospective methodological study, in which we evaluated the predictive accuracies of Bispectral Index, Glasgow Coma Scale, and Charlson Comorbidity Index for in-hospital mortality of patients with ischemic stroke. Receiver operating characteristic analysis was used for comparing the accuracy of the scoring systems, areas under receiver operating characteristic curves were calculated, and Youden J index was used for estimating associated cut-off values. Results: Among the 80 ischemic stroke patients, in-hospital mortality rate was 38.8% (n = 31). The areas under receiver operating characteristic curves were 0.984, 0.960, and 0.863 for Bispectral Index, Glasgow Coma Scale, and Charlson Comorbidity Index, respectively. The difference between areas under receiver operating characteristic curves for Bispectral Index and Glasgow Coma Scale was statistically similar. Besides, the difference between areas under receiver operating characteristic curves for Bispectral Index and Charlson Comorbidity Index, and the difference between areas under receiver operating characteristic curves for Glasgow Coma Scale and Charlson Comorbidity Index were statistically significant. The associated cut-off values were ⩽74, ⩽12, and >4 for Bispectral Index, Glasgow Coma Scale, and Charlson Comorbidity Index, respectively. For these cut-off points, sensitivity and specificity of Bispectral Index were 93.6% and 95.9%, sensitivity and specificity of Glasgow Coma Scale were 100.0% and 83.7%, and sensitivity and specificity of Charlson Comorbidity Index were 83.9% and 69.4%, respectively. However, accuracy of Bispectral Index was 95.0%, accuracy of Glasgow Coma Scale was 90.0%, and accuracy of Charlson Comorbidity Index was 75.0. Conclusion: Knowledge of the risk factors for mortality in patients with ischemic stroke can help to identify which patients have a higher risk of fatal outcome. The Bispectral Index score improved discrimination and classified patients with higher mortality better than both Glasgow Coma Scale and Charlson Comorbidity Index.


2020 ◽  
Vol 5 (2) ◽  
pp. 83
Author(s):  
Siti Komariah ◽  
Hary Nugroho

Latar Belakang:Komplikasi kehamilan adalah kegawat daruratan obstetrik yang dapat menyebabkan kematian pada ibu dan bayi. Penyebab komplikasi kehamilan diantaranya kurangnya pengetahuan ibu tentang deteksi dini kehamilannya, usia pasien < 20 tahun dan > 35 tahun serta anak lebih dari 3.Tujuan :Penelitian ini bertujuan untuk mengetahui hubungan pengetahuan, usia dan paritas dengan kejadian komplikasi kehamilan pada ibu hamil trimester III.Metode Penelitian:Jenis penelitian observasional analitik dengan pendekatan cross sectional. Teknik pengambilan sampel menggunakan purposive sampling, sehingga sampel adalah ibu hamil trimester III yang berkunjung di Rumah Sakit Ibu dan Anak Aisyiyah Samarinda berjumlah 84 orang. Analisis yang digunakan uji chi square.Hasil : Hasil penelitian menunjukkan terdapat responden yang memiliki pengetahuan kurang baik, terdapat usia berisiko antara < 20 tahun dan > 35 tahun, terdapat paritas berisiko > 3 orang anak dan komplikasi kehamilan berupa hipertensi, anemia, preeklempsia dan plasenta previa. Ada hubungan pengetahuan dengan kejadian komplikasi kehamilan (p value : 0,001 < α : 0,05 dan odds ratio : 6,800 > 1). Ada hubungan usia dengan kejadian komplikasi kehamilan (p value : 0,003 < α : 0,05 dan odds ratio : 5,837 > 1). Ada hubungan paritas dengan kejadian komplikasi kehamilan (p value : 0,002 < α : 0,05 dan odds ratio : 6,250 > 1).Kesimpulan: Terdapat pengetahuan kurang baik berjumlah 27 responden (32,1%), usia berisiko (< 20 tahun dan ≥ 35 tahun) berjumlah 25 responden (29,8%), paritas berisiko (1 atau ≥ 3 orang anak) berjumlah 21 responden (25%) dan ada komplikasi kehamilan berjumlah 18 responden (21,4%), Ada hubungan pengetahuan, usia dan paritas dengan kejadian komplikasi kehamilan pada ibu hamil trimester III di Rumah Sakit Ibu dan Anak Aisyiyah Samarinda.


BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masakatsu Paku ◽  
Mamoru Uemura ◽  
Masatoshi Kitakaze ◽  
Shiki Fujino ◽  
Takayuki Ogino ◽  
...  

Abstract Background Local recurrence is common after curative resections for rectal cancer. Surgical intervention is among the best treatment choices. However, achieving a negative resection margin often requires extensive pelvic organ resections; thus, the postoperative complication rate is quite high. Recent studies have reported that the inflammatory index could predict postoperative complications. This study aimed to validate the correlation between clinical factors, including inflammatory markers, and severe complications after surgery for local recurrent rectal cancer. Methods This retrospective study included 99 patients that underwent radical resections for local recurrences of rectal cancer. Postoperative complications were graded according to the Clavien-Dindo classification. Grades ≥3 were defined as severe complications. Risk factors for severe complications were identified with univariate and multivariate logistic regression models and assessed with receiver-operating characteristic curves. Results Severe postoperative complications occurred in 38 patients (38.4%). Analyses of correlations between inflammatory markers and severe postoperative complications revealed that the strongest correlation was found between the prognostic nutrition index and severe postoperative complications. The receiver-operating characteristic analysis showed that the optimal prognostic nutrition index cut-off value was 42.2 (sensitivity: 0.790, specificity: 0.508). In univariate and multivariate analyses, a prognostic nutrition index ≤44.2 (Odds ratio: 3.007, 95%CI:1.171–8.255, p = 0.02) and a blood loss ≥2850 mL (Odds ratio: 2.545, 95%CI: 1.044–6.367, p = 0.04) were associated with a significantly higher incidence of severe postoperative complications. Conclusions We found that a low preoperative prognostic nutrition index and excessive intraoperative blood loss were risk factors for severe complications after surgery for local recurrent rectal cancer.


2018 ◽  
Vol 75 (1) ◽  
pp. 131-138 ◽  
Author(s):  
Giola Santoni ◽  
Amaia Calderón-Larrañaga ◽  
Davide L Vetrano ◽  
Anna-Karin Welmer ◽  
Nicola Orsini ◽  
...  

Abstract Background Geriatric health charts that are similar to pediatric growth charts could facilitate monitoring health changes and predicting care needs in older adults. We aimed to validate an existing composite score (Health Assessment Tool [HAT]) and provide provisional age-specific reference curves for the general older population. Methods Data came from the Swedish National study on Aging and Care in Kungsholmen (N = 3,363 participants aged 60 years and over examined clinically at baseline and 3 years later). HAT was validated by exploring its relationship with health indicators (logistic regression) and comparing its ability to predict care consumption with that of two of its components, morbidity and disability (receiver operating characteristic curve areas). A flowchart was developed to obtain individual-level HAT scores (nominal response method). Sex-specific health charts were derived by graphing seven percentile curves of age-related HAT change (logistic quantile regression). Results HAT scores above the age- and sex-specific median were related to good performance in chair-stand tests (odds ratio [OR] = 2.62, 95% confidence interval [CI]: 2.07–3.31), balance and grip tests (interaction balance grip test, OR = 1.15, 95% CI: 1.05–1.25), and good self-rated health (OR = 2.19, 95% CI: 1.77–2.71). Receiver operating characteristic curve areas (HAT vs number of chronic disorders) were formal care, 0.76 versus 0.58 (p value &lt; .001); informal care, 0.74 versus 0.59 (p value &lt; .001); hospital admission, 0.70 versus 0.66 (p value &lt; .001); primary care visits, 0.71 versus 0.69 (p value &gt; .05); and specialty care visits, 0.62 versus 0.65 (p value &lt; .001). HAT consistently predicted medical and social care service use better than disability. Conclusions HAT is a valid tool that predicts care consumption well and could be useful in developing geriatric health charts to better monitor health changes in older populations.


Sari Pediatri ◽  
2016 ◽  
Vol 13 (3) ◽  
pp. 215
Author(s):  
Rismala Dewi ◽  
Irawan Mangunatmadja ◽  
Irene Yuniar

Latar belakang. Penilaian kesadaran penting dilakukan pada pasien anak dengan sakit kritis untuk memperkirakanprognosis. Modifikasi Glasgow Coma Scale (GCS) banyak digunakan untuk menilai kesadaran tetapi memilikiketerbatasan terutama pada pasien yang diintubasi. Terdapat skor alternatif baru yaitu Full Outline ofUnResponsiveness score (FOUR score) yang dapat digunakan untuk menilai kesadaran pasien terintubasi.Tujuan. Membandingkan FOUR score dengan GCS dalam menentukan prognosis pasien kritis, sehinggapemeriksaan FOUR score dapat digunakan sebagai alternatif pengganti GCS.Metode. Penelitian prospektif observasional pada anak usia di bawah 18 tahun yang dirawat di Unit PerawatanIntensif Anak RSCM dengan penurunan kesadaran. Waktu penelitian antara 1 Januari – 31 Maret 2011.Masing-masing subjek dinilai oleh 3 orang supervisor berbeda yang bekerja di Unit Perawatan Intensif Anak.Ketiga penilai diuji reliabilitas dalam menilai FOUR score dan GCS. Dibandingkan sensitivitas, spesifisitas, danreceiver operating characteristic (ROC) kedua sistem skor terhadap luaran berupa kematian di rumah sakit.Hasil. Reliabilitas tiap pasangan untuk FOUR score (FOUR 0,963; 0,890; 0,845) lebih baik daripadamodifikasi GCS (GCS 0,851; 0,740; 0,700). Terdapat hubungan yang bermakna antara besar skor danluaran kematian di rumah sakit dengan (pFOUR score = pGCS = 0,001). Nilai sensitivitas, spesifisitas, nilai prediksipositif dan negatif serta rasio kemungkinan positif masing-masing adalah 93%; 86%; 88%; 92%; 6,6. Areaunder curve (AUC) FOUR score 0,854 dan GCS 0,808Kesimpulan. Prediksi prognostik pada pasien yang dirawat di Unit Perawatan Intensif Anak dengan FOURscore lebih baik dibandingkan GCS.


2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Jiajia Li ◽  
Xiaojing Zhao ◽  
Xueting Li ◽  
Meijiao Lu ◽  
Hongjie Zhang

The clinical course of ulcerative colitis (UC) is featured by remission and relapse, which remains unpredictable. Recent studies revealed that fecal calprotectin (FC) could predict clinical relapse for UC patients in remission, which has not yet been well accepted. To detect the predictive value of FC for clinical relapse in adult UC patients based on updated literature, we carried out a comprehensive electronic search of PubMed, Web of Science, Embase, and the Cochrane Library to identify all eligible studies. Diagnostic accuracy including pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and pooled area under the receiver operating characteristic (AUROC) was calculated using a random effects model. Heterogeneity across studies was assessed by the I2 metric. Sources of heterogeneity were detected using subgroup analysis. Metaregression was used to test potential factors correlated to DOR. Publication bias was assessed using Deek’s funnel plots. In our study, 14 articles enrolling a total of 1110 participants were finally included, and all articles underwent a quality assessment. Pooled sensitivity, specificity, PLR, and NLR with 95% confidence intervals (CIs) were 0.75 (95% CI: 0.70–0.79), 0.77 (95% CI: 0.74–0.80), 3.45 (95% CI: 2.31–5.14), and 0.37 (95% CI: 0.28–0.49) respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.82, and the diagnostic odds ratio was 10.54 (95% CI: 6.16–18.02). Our study suggested that FC is useful in predicting clinical relapse for adult UC patients in remission as a simple and noninvasive marker.


Author(s):  
Farhan Alenazi ◽  
Prachi Dilip Tambur ◽  
Noora Nabeel Mumenah ◽  
Haya Hendi Alqahtani ◽  
Rawan Abdulrazaq Alenazi ◽  
...  

Introduction: Tracheostomy is one of the most common procedures that done to critical patients such as head injury ones to improve their situation. It is done by creating an anterior stoma in the neck and inserting a short tube to maintain stoma open. Objective: The objective of this study was to determine if there were benefits of early tracheostomy and the following components: ICU stay, hospital stay, ventilation- associated-pneumonia, weaning from Mechanical Ventilator, Glasgow Coma Scale, and decannulation. Methods: This study was done retrospectively, and non-random sampling involved 56 head injury patients with a tracheostomy who were admitted to ICU in King Abdulaziz medical city (KAMC). Out of 56 head injury patients who underwent an early tracheostomy (≤12 days) were 25 patients and late tracheotomy (>12 days) were 31 patients. Using data collection form which contains demographic data, intubation duration, tracheostomy, decannulation, MV, Glasgow coma scale, VAP, ICU, and hospital stay. Results: Total of 56 head injury patients with tracheostomy; their age ranges from 18-80 years with the mean 41.77years, height 168.95cm, and weighs 69.07kg. Head injury patient in this paper was classified according to the day that was done the procedure on after the injury occurred. Which result in 25 patients had early tracheostomy ≤12 days with a mean of (9.8 days) and median (10), whereas 31 patients had late tracheostomy >12 with mean of (17.677 days) and median (16).Patients with early tracheostomy showed significant (P-value <0.05) less length stay in ICU (22.68 days), MV duration (15.16 days), decannulation (27.80 days) compared with late trach ICU stay (33.10 days), MV duration (28.10 days), decannulation (47.03 days). VAP incidence among patients with a late trach was 12.90% and there were no VAP with an early trach. The median in early tracheostomy patients did not show any improvement in GCS (6 before trach,7 after trach) while in the late trach (7 before thrach,8 after trach). The hospital stays showed an insignificant p-value which means there were no differences between the early and late tracheostomy.  Conclusion: Early tracheostomy for head injury patients associated with less MV time, less VAP, shorter ICU stay, and faster decannulation. However, there was no significant effect on hospital stays period and no improvements on GCS.


2015 ◽  
Vol 23 (3) ◽  
pp. 303-311
Author(s):  
Adriana Topan ◽  
Dumitru Carstina ◽  
Raluca Rancea ◽  
Adriana Slavcovici ◽  
Mirela Flonta ◽  
...  

Abstract Background: Soluble CD14 subtype (sCD14-ST), also named presepsin, has been proposed as a novel biomarker for the diagnosis of sepsis. We hypothesized that presepsin value might be helpful in the diagnosis of infective endocarditis (IE). Material and methods: In this prospective study a total of 29 patients with clinical suspicion of IE were enrolled. The plasma presepsin samples were collected at the admittance in the same time with blood cultures, CRP (C-reactive protein) and routine blood tests. Data about the antibiotic treatment prior to admittance were recorded. The diagnosis of IE was made using the Duke modified criteria. Receiver operating characteristic (ROC) curves analysis and binary logistic regression were performed using SPSS software, version 18. A p value less than 0.05 is considered statistically significant. Results: Patients were divided in two subgroups: 14 patients with definite IE and 8 with IE - rejected according to the modified Duke criteria. 7 patients with final diagnosis of sepsis were excluded. Presepsin levels in patient with definite IE were significantly higher than in those with rejected IE (p<0.03). The area under the receiver operating characteristic curve (AUC) was 0.781 (95 % confidence interval (CI) 0.590 - 0.973). The threshold value of presepsin in predicting IE was determined to be 345 pg/ml, of which the clinical sensitivity and specificity were 64% and respectively, 88%. The AUC for CRP was 0.656 (95% CI 0.37-0.88). Conclusion: Presepsin might be a useful additional diagnostic marker in patients with suspected IE. These preliminary results needs confirmation by future studies.


2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Cirilia Aripratiwi ◽  
Jon Hafan Sutawardana ◽  
Mulia Hakam

ABSTRAKStroke dapat menyebabkan penurunan kesadaran. Pada kasus stroke dengan penurunan kesadaran dapat mengakibatkan pasien mengalami kematian, defisit neurologi, semakin lamanya waktu perawatan, dan akan meningkatkan biyaya perawatan. Kasus stroke dengan penurunan kesadaran banyak dijumpai di RSD dr. Soebandi Jember. Namun upaya perawat dalam meningkatkan kesadaran pasien berfokus pada terapi farmakologi sehingga memerlukan terapi non farmakologi seperti terapi Familiar Auditory Sensory Training (FAST) untuk membantu proses pemulihan kesadaran. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh FAST pada tingkat kesadaran pasien stroke. Penelitian didesain dengan quasi experimental menggunakan rancangan Non equivalent control group melibatkan 29 pasien stroke yang mengalami penurunan kesadaran. 29 pasien dibagi menjadi 15 kelompok intervensi yang diberi terapi FAST selama tiga hari. FAST diberikan 3 kali sehari. 14 pasien berikutnya dalam kelompok kontrol hanya dilakukan pemeriksaan GCS. Tingkat kesadaran pasien diukur menggunakan instrumen Glasgow Coma Scale (GCS) yang terdiri dari 3 komponen yakni respon mata, verbal, dan motorik. Data dianalisis dalam SPSS menggunakan uji Mann-Whitney dan uji Wilcoxon. Hasil analisis uji baik pada kelompok intervensi maupun kontrol diperoleh nilai p 0,010 (nilai p α). Hasil uji yang signifikan membuktikan bahwa ada pengaruh FAST dalam meningkatkan kesadaran pasien stroke. FAST dapat dijadikan terapi nonfarmakologi untuk membantu proses pemulihan kesadaran pada pasien stroke.ABSTRACTStroke can cause a decrease in consciousness. In the case of stroke with decreased consciousness can result in the patient experiencing death, neurological deficits, the longer treatment time, and will increase the cost of treatment. Cases of stroke with decreased consciousness are often found in RSD dr. Soebandi Jember. However, nurses' efforts in increasing patient awareness focus on pharmacological therapy so that it requires non-pharmacological therapy such as Familiar Auditory Sensory Training (FAST) therapy to help the process of recovering consciousness. The purpose of this study was to determine the effect of FAST on the level of awareness of stroke patients. This study involved 29 stroke patients who experienced a decrease in consciousness. 29 patients were divided into 15 intervention groups who were given FAST therapy for three days. FAST is given 3 times a day. The next 14 patients in the control group only performed GCS examination. The level of patient awareness was measured using the Glasgow Coma Scale (GCS) instrument consisting of 3 components namely eye, verbal, and motor response. Data were analyzed in SPSS using the Mann-Whitney test and Wilcoxon test. The results of the test analysis in the intervention and control groups obtained p-value 0.010 (p-value α). Significant test results prove that there is an influence of FAST in increasing stroke patient awareness. This study shows that nurses should be able to increase the application of nonpharmacological therapies such as FAST to help the process of recovering consciousness in stroke patients.


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