Akurasi Kriteria Acep Dan Cchr Terhadap Hasil Patologis Ct Scan Kepala Pada Cedera Kepala Ringan

Seleska Aph, Anna (2017) Akurasi Kriteria Acep Dan Cchr Terhadap Hasil Patologis Ct Scan Kepala Pada Cedera Kepala Ringan. Magister thesis, Universitas Brawijaya.

Abstract

Latar Belakang:cedera kepala ringan merupakan proporsi terbesar dari seluruh cedera kepala dan berkontribusi terhadap peningkatan biaya kesehatan akibat pemeriksaan CT scan kepala yang berlebihan. Skoring klinis (ACEP dan CCHR) diharapkan memiliki performa tinggi dalam memprediksi kelompok risiko tinggi yang memiliki hasil CT scan kepala patologis, sehingga mengurangi penggunaan CT scan kepala. Tujuan:membandingkan akurasi kriteria ACEP dan CCHR dan evaluasi kesesuaian kriteria tersebut terhadap hasil CT scan kepala patologis pada cedera kepala ringan. Metode:penilaian skoring ACEP dan CCHR terhadap pasien cedera kepala ringan dewasa dilakukan di triage. Uji diagnostik dan kesesuaian kriteria dilakukan pada 100 pasien yang menjalani pemeriksaan CT scan kepala untuk mengetahui akurasi skoring dan prediktor klinis. Hasil:25 dari 100 pasien memiliki hasil CT scan kepala patologis (25%) , hanya 2% yang menjalani pembedahan kepala. ACEP dan CCHR memiliki sensitifitas 100%, dengan spesifisitas rendah 44.6% dan 30.8%.Akurasi ACEP (69%) dan CCHR (44%). Prediktor klinis mayor CCHR adalah muntah (OR 19.6 CI 95% 5.8 – 66.2) dan usia ≥ 65 tahun (OR 6.6 CI 95% 1.1 – 40.5). Kriteria ACEP menunjukkan kesesuaian (nyeri kepala, GCS<15, defisit neurologis fokal, anterograde amnesia, cedera di atas clavicula, muntah, usia ≥ 65 tahun, fraktur basis cranii) tanpa prediktor dominan, dengan odds ratio tertinggi pada nyeri kepala (276 CI 95% 43.4 – 1754.9) Kesimpulan:ACEP memiliki akurasi lebih baik dari CCHR, meskipun masih di bawah nilai standar uji diagnostik skrining. Nyeri kepala sedang – berat memiliki akurasi tinggi dalam prediksi lesi patologis pada cedera kepala ringan

English Abstract

Background: Mild traumatic brain injury has been accounted for the majority of head injury cases. It contributes in an increase of healthcare cost due to high numbers of head CT scan ordered. Clinical scoring (ACEP and CCHR ) are expected to perform well in predicting high risk group with pathologic lesion, thus decrease the number of unecessary examination. Objectives:to compare accuracy of ACEP and CCHR criteria and to evaluateconformity of each criteria with pathologic head CT scan results.Methods:ACEP and CCHR was performed in triage for adult mild traumatic brain injury patients, 100 patients with head CT examination included. A diagnostic test and conformity evaluation were performed to compare accuracy of both scoring and to find major clinical predictors. Results:25 among 100 patients had pathologic result (25%), only 2 patients underwent head surgery (2%). Both ACEP and CCHR had 100% sensitivity, with low specificity, 44.6%, 30.8%, respectively. ACEP accuracy was 69%, while CCHR, 44%. Major clinical predictors for CCHR were vomiting and age ≥ 65 year (OR 19.6 CI 95% 5.8 – 66.2; OR 6.6 CI 95% 1.1 – 40.5). ACEP criteria showed conformity (headache, GCS<15. Focal neurological deficit, anterograde amnesia, above clavicle injury, vomit, age ≥ 65 year, basal cranium fracture) without dominant predictor with highest OR and accuracy (276 CI 95% 43.4 – 1754.9; 95%) belonged to headache. Conclusion:ACEP has better accuracy than CCHR, although below diagnostic level. Moderate – severe headache has high accuracy in predicting patological lesion in mild traumatic brain injury.

Item Type:	Thesis (Magister)
Identification Number:	TES/616.025/SEL/a/2017/041705335
Uncontrolled Keywords:	AMERICAN COLLEGE OF EMERGENCY PHYSICIANS, EMERGENCY MEDICINE, MEDICAL RADIOLOGY - COMPUTER - ASSISTED INSTRUCTION, HEARD - WOUNDS AND INJURIES
Subjects:	600 Technology (Applied sciences) > 616 Diseases > 616.02 Special topics of disease > 616.025 Medical emergencies / Emergency medicine / Emergency nursing / Triage (Medicine)
Divisions:	S2/S3 > Magister Ilmu Biomedis, Fakultas Kedokteran
Depositing User:	Nur Cholis
Date Deposited:	26 Jul 2017 01:23
Last Modified:	29 Dec 2020 04:24
URI:	http://repository.ub.ac.id/id/eprint/616

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