Pengembangan Sistem Skoring Diagnosis Hemodynamically Significant Patent Ductus Arteriosus

MUSLIKHAH YUNI F, dr. Setya Wandita, MKes, SpA(K);dr Alifah anggraini, M.Sc,SpA(K)

2021 | Tesis-Subspesialis | SUBSPESIALIS ILMU KESEHATAN ANAK

Latar belakang : Hemodynamically Significant Patent Ductus Arteriosus (hs-PDA) merupakan masalah yang sering terjadi pada bayi kurang bulan. Keterlambatan diagnosis dan pemberian terapi akan meningkatkan morbiditas dan mortalitas. Terdapat keterbatasan penggunaan ekokardiografi sebagai baku emas diagnosis. Skor diagnostik hs-PDA dapat digunakan untuk membuat diagnosis dan terapi yang cepat dan tepat Tujuan : Mengembangkan sistem skoring diagnosis hs-PDA pada bayi kurang bulan Metode : Kami melakukan penelitian potong lintang pada bayi berat lahir <1500 gram atau umur kehamilan <34 minggu yang dirawat di Instalasi Maternal Perinatal RSUP dr Sardjito mulai bulan Maret sampai Juni 2019. Metode Spiegehalter Knill-Jones digunakan untuk mengembangkan skor diagnosis. Akurasi ditentukan dengan kurva ROC. Ekokardiografi digunakan sebagai baku emas diagnosis hs-PDA. Hasil : Dari 58 bayi yang memenuhi kriteria, 18 (31,04%) terdiagnosis hs-PDA. Dikembangkan empat sistem skor dengan menggunakan variabel yang memenuhi kriteria yaitu takikardia, bising sistolik, pulsasi prekordial, bounding pulse, perburukan respirasi dan indek perfusi. New hs-PDA Score (NHS) dengan titik potong nilai total 3,5 memiliki sensitivitas 61,2%, spesifisitas 58,0% dan nilai area ROC 0,61. Nilai area ROC untuk Simplified New hs-PDA Score (SNHS) pada titik potong nilai total 0 adalah 0,95 dengan sensitivitas 88,9% dan spesifisitas 87,5%. Nilai diagnostik sistem Extended hs-PDA Score (EHS) 5 dan sistem Simple Extended hs-PDA Score (SEHS) 1 secara berurutan yaitu, nilai area ROC 0,95 dan 0,94 dengan sensitivitas dan spesifisitas yang sama yaitu 94,4% dan 82,5% Simpulan : Sistem SNHS 0 dan SEHS 1 dapat digunakan untuk mendiagnosis hs-PDA pada bayi kurang bulan.

Background: Hemodynamically Significant Patent Ductus Arteriosus (hs-PDA) is a common problem in preterm infant. Delayed diagnosis and treatment could result in significantly increased morbidity and mortality. Echocardiography had several limitation to be performed. hs-PDA scoring system has been proposed to make diagnosis and treatment promptly. Objective: To develop a diagnostic score for hs-PDA in premature infant Method: A cross sectional study was conducted among < 34 weeks gestasional of age and VLBW babies admitted to NICU dr Sardjito Hospital during March until June 2019. Diagnosis hs-PDA was confirmed through echocardiography. Spiegelhalter Knill-Jones approach was used to develop four new hs-PDA diagnostic score. Accuracy of diagnostic score was performed using a ROC curve. Results: Of 58 subjects, 18 was hs-PDA (31,04%). Four scoring systems were proposed. Using the Spiegelhalter Knill-Jones approach, diagnostic criteria were tachycardia, sistolik murmur, precordial pulse, bounding pulse, respiratory deterioration and perfusion index. ROC curve from New hs-PDA Score (NHS) yielded an area under curve (AUC) 0,61. Using the cut off value -3,5 this score had sensitivity 61,2% and specificity 58%. The total score of Simplified New hs-PDA Score (SNHS) 0 had sensitivity 88,9%, specificity 87,5% and AUC 0,95 on ROC curve. Using cut off value 5 for Extended hs-PDA Score (EHS) and 1 for Simple Extended hs-PDA Score (SEHS), both of two systems had sensitivity 94,4% and specificity 82,5% with AUC 0,95 and 0,94 respectively. Conclusion: An diagnostic score for hs-PDA was established. A total SNHS 0 and SEHS 1 can diagnose hs-PDA in premature infant less than 34 weeks.

Kata Kunci : hs-PDA, scoring system, diagnostic value