Nafi’ah, Rizka Hayyu (2019) Perbedaan Keakuratan Modified Early Warning Score (MEWS) dan National Early Warning Score (NEWS) Terhadap Risiko Pemburukan Pasien Stroke di Instalasi Gawat Darurat. Magister thesis, Universitas Brawijaya.
Abstract
Stroke merupakan penyakit dengan prevalensi tertinggi kedua di dunia yang mengakibatkan peningkatan angka kematian, kecacatan, serta mengurangi waktu produktif seseorang sehingga berakibat pada peningkatan beban sosial ekonomi yang besar. Survei data tahun 2000-2016 didapatkan bahwa penyakit stroke mengalami peningkatan sebesar 4.56 juta orang dari total 569 juta penderita. Tingkat kematian pasien stroke tertinggi mencapai 222.6/100.000 orang dan angka kecacatan mencapai 4.409,8/100.000 orang pertahun. Tingginya mortalitas dan disabilitas penyakit stroke berkaitan dengan adanya pemburukan kondisi pasien selama perawatan di rumah sakit. Pemburukan klinis pasien stroke juga menyebabkan risiko terjadinya kerusakan fungsi organ ginjal, hingga gangguan fungsi mata. Pemburukan yang terjadi sangat berkaitan dengan waktu pemeriksaan CT-Scan, pemberian terapi trombolitik, antiplatelet serta terapi endovaskular. Untuk mencegah adanya pemburukan pasien diperlukan strategi pencegahan melalui pemeriksaan tanda- tanda vital dengan menggunakan early warning scoring system (EWSS) yaitu modified early warning score (MEWS) dan national early warning score (NEWS). Tujuan penelitian ini adalah untuk mengetahui perbedaan kekuatan prediksi MEWS dan NEWS terhadap risiko pemburukan pasien stroke di instalasi gawat darurat. Penelitian ini merupakan penelitian dengan metode observasional analitik menggunakan desain kohort melalui pendekatan cross sectional untuk mendeteksi secara dini adanya pemburukan kondisi dan lama rawat pasien stroke selama perawatan di IGD. Jumlah responden sebanyak 109 orang yang dipilih menggunakan teknik non probability sampling dengan purposive sampling. Pengumpulan data dilakukan menggunakan lembar observasi selama periode Maret hingga April 2019 di IGD RS Tk. II dr. Soepraoen dan RS Wava Husada Malang. Analisis data pada penelitian ini dilakukan menggunakan uji Reicivier viii Operator Charateristics (ROC) untuk mengetahui nilai Area under Curve (AUC), menentukan cut-off point, sensitivity, specitifity pada masing-masing MEWS dan NEWS. Hasil analisis univariat terhadap karakteristik responden didapatkan prevalensi stroke lebih banyak terjadi pada perempuan dengan rerata usia 61 tahun. Riwayat penyakit terbanyak yang dialami oleh responden adalah penyakit pada sistem kardiovaskular. Responden yang mengalami pemburukan berjumlah 39 orang, komponen yang mengalami pemburukan yaitu tekanan darah sistolik. Berdasarkan uji ROC didapatkan nilai AUC MEWS 0,884 (IK95% 0,811 – 0,957), cut-off > 4, sensitivitas 0,462 dan spesifisitas 0,957. Nilai AUC NEWS adalah 0,830 (IK95% 0,739 – 0,920) dengan cut-off > 4, sensitivitas 0,744 dan spesifisitas 0,871. NEWS lebih sensitif atau lebih baik digunakan untuk memprediksi risiko pemburukan karena sistem skoring memiliki komponen saturasi oksigen dan pemberian oksigen yang tidak dimiliki oleh MEWS. Pemberian oksigen dapat menjamin kebutuhan oksigenasi pada otak sehingga pasien tidak mengalami penurunan kondisi. Pemberian oksigen dapat mencegah terjadinya kerusakan jaringan otak yang irreversibel. Oksigen merupakan salah satu komponen gas dan unsur vital dalam proses metabolisme, untuk mempertahankan kelangsungan hidup seluruh sel tubuh. Secara normal elemen ini diperoleh dengan cara menghirup udara ruangan dalam setiap kali bernapas. Penyampaian oksigen ke jaringan tubuh ditentukan oleh interaksi sistem respirasi, kardiovaskuler, dan keadaan hematologis. Adanya kekurangan oksigen ditandai dengan keadaan hipoksia, yang dalam proses lanjut dapat menyebabkan kematian jaringan bahkan dapat mengancam kehidupan. Selain itu pemberian terapi oksigen berpengaruh terhadap tekanan parsial CO2 darah untuk mencegah terjadinya peningkatan tekanan intrakranial. Jika tekanan parsial CO2 bertambah maka tekanan parsial O2 akan menurun dan sebaliknya. Kesimpulan dari penelitian ini yaitu NEWS lebih akurat mendeteksi risiko pemburukan dibandingkan MEWS.
English Abstract
Stroke is a disease with the second highest prevalence in the world which resulting in increasing of mortality, disability, and reducing one’s productive time then resulting in increasing of large socio-economic burden. Data survey during 2000-2016 found that stroke had increased by 4.56 million people from a total of 569 million sufferers. The highest mortality rate for stroke patients reached 222.6/100,000 people and the disability rate reached 4,409.8 / 100,000 people per year. The high mortality and disability of stroke is related to the deterioration condition of patient during treatment in hospital. The clinical deterioration of patients with stroke also carries a risk of damage to kidney function to impaired eye function. The deterioration that occurs is strongly related to the time of CT- Scan, administration of thrombolytic therapy, antiplatelet and endovascular therapy. To prevent deterioration of patients, required prevention strategies through examining vital signs by using an early warning scoring system (EWSS), which is modified early warning score (MEWS) and national early warning score (NEWS). The purpose of this study was to understand the difference in predictive strength of MEWS and NEWS against the risk of deteriorating clinical conditions in patients with stroke in the emergency department. This study was an observational analytic method that used cohort design through a cross sectional approach to detect deterioration risk of patients with stroke during in emergency department treatment. The number of respondents were 109 people who were selected using non probability sampling techniques with purposive sampling. Data collection was carried out using an observation sheet during March to April 2019 at the Emergency Room of Army Hospital Lv. II of dr. Soepraoen and Hospital of Wava Husada Malang. In this study data was analized with Receiver Operator Charateristics (ROC) test to determine the value x of Area under Curve (AUC), determine the cut-off point, sensitivity, specificity on each MEWS and NEWS. The results of the univariate analysis on respondents characteristics found that the prevalence of stroke was more common in women with an average age of 61 years. The history of the most diseases experienced by respondents was cardiovascular system disease. Respondents who experienced deterioration were 39 people, the component that experienced deterioration was systolic blood pressure. Based on the ROC test, the AUC value of MEWS was 0.830 (CI 95% 0.811-0.957), with cut-off point of > 4, sensitivity of 0.462 and specificity of 0.957. The AUC value of NEWS was 0.884 (IK95% 0.739-0.920) with a cut-off of > 4, sensitivity of 0.744 and specificity of 0.871. NEWS is more sensitive or better used to predict deterioration because the scoring system has a component of oxygen saturation and oxygen administration that MEWS does not have. Giving oxygen can guarantee the oxygenation needs of the brain so that the patient does not experience a decrease in condition. Giving oxygen can prevent irreversible damage to brain tissue. Oxygen is one component of gas and a vital element in the metabolic process, to maintain the survival of all body cells. Normally this element is obtained by breathing in the air in each breath. Submission of oxygen to body tissues is determined by the interaction of the respiratory system, cardiovascular, and haematological conditions. The lack of oxygen is characterized by a state of hypoxia, which in the further process can cause tissue death can even be life threatening. In addition, oxygen therapy has an effect on CO2 partial blood pressure to prevent an increase in intracranial pressure. If the partial pressure of CO2 increases, the partial pressure of O2 will decrease and vice versa. The conclusion of this study is NEWS more accurately detects the risk of deterioration compared to MEWS
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/616.81/NAF/p/2019/041905147 |
| Uncontrolled Keywords: | Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), Stroke, Instalasi |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases > 616.8 Diseases of nervous system and mental disorders > 616.81 Cerebrovascular diseases |
| Divisions: | S2/S3 > Magister Keperawatan, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 19 Jul 2022 04:30 |
| Last Modified: | 19 Jul 2022 04:30 |
| URI: | http://repository.ub.ac.id/id/eprint/192291 |
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