EVALUASI PERFORMA PEDOMAN NASIONAL PELAYANAN KEDOKTERAN (PNPK) SEPSIS 2021 DALAM MENDIAGNOSIS SEPSIS BAKTERIAL PADA ANAK

Lilis Siti Asiyani, Dr. dr. Rr Ratni Indrawati, Sp.A(K)

2022 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Latar belakang: Sepsis masih merupakan salah satu penyebab utama kesakitan dan kematian pada anak di seluruh belahan dunia. Diagnosis pasti sepsis adalah dengan kultur darah, namun false negative kultur darah relatif tinggi dan membutuhkan waktu lima sampai dengan tujuh hari untuk menunggu biakan mikroorganisme pada kultur. Sehingga dibutuhkan triage tool tervalidasi untuk diagnosis cepat dan terapi segera pada sepsis, yang mampu menurunkan mortalitas sepsis. Di Indonesia pedoman diagnosis dan tata laksana sepsis anak berdasarkan PNPK sepsis 2021. Tujuan: Mengevaluasi performa PNPK sepsis 2021 dalam mendiagnosis sepsis bakterial pada anak. Metode: Penelitian cross-sectional dengan menggunakan data sekunder dari rekam medis pasien anak yang dirawat di PICU RSUP Dr. Sardjito periode Oktober 2019-Oktober 2021 dengan dugaan infeksi bakterial yang memenuhi kriteria inklusi dan ekslusi. Sebanyak 200 subjek dimasukkan dalam penelitian secara consecutive sampling. Selanjutnya dilakukan penilaian sepsis dengan PNPK sepsis 2021, dan dilakukan analisis performa PNPK sepsis 2021 dengan SPSS versi 25, dengan menilai sensitivitas, spesitifitas, akurasi, Nilai Prediktif Positif, Nilai Prediktif Negatif, dan Likelihood ratio. Hasil: Dari penelitian ini didapatkan sebagian besar subjek adalah laki-laki (52,5%) dengan distribusi usia terbanyak <1 tahun (40,5%), fokus infeksi terbanyak system respirasi (49%), 63,5% merupakan kasus rujukan, dengan lama perawatan >48 jam (69,7%). Sebanyak 77% subjek sudah mendapatkan antibiotik pada perawatan di rumah sakit sebelumnya. Untuk luaran, 63,5% subjek hidup dan 36,5% meninggal. Lama perawatan subjek di PICU 9,5 ± 9,4 hari. Sebanyak 31/200 (15,5%) subjek didiagnosis sepsis berdasarkan PNPK sepsis 2021. Positivity rate kultur darah dari penelitian ini sebesar 19%. Evaluasi performa PNPK sepsis 2021 terhadap referensi standar kultur darah didapatkan sensitivitas 28,95%, spesifisitas 87,65%, akurasi 76,5%, Nilai Prediksi Positif (PPV) 35,48%, Nilai Prediksi Negatif (NPV) 84,02%, Positive Likehood Ratio (LR +) 2.34 (95% IK, 56%-81%), dan Negative Likehood Ratio (LR -) 0.81 (95% IK, 41%-49%). Kesimpulan: PNPK sepsis 2021 mempunyai sensitivitas 28,95% dan spesifisitas 87,65% dalam mendiagnosis sepsis bakterial.

Background: Sepsis remains as one of the main causes of child morbidity and mortality in worldwide. The definitive diagnosis of sepsis is blood culture, but its false negative is relatively high. Therefore, a validated triage tool is needed for rapid diagnosis. In Indonesia, diagnosis and management of pediatric sepsis are based on National Guidelines for Medical Services (PNPK) sepsis 2021. Objective: To evaluate the performance of PNPK Sepsis 2021 in diagnosing pediatric bacterial sepsis in PICU. Methods: This cross-sectional study was conducted in pediatric patients treated in the PICU of Dr. Sardjito hospital between October 2019 and October 2021, who where suspected for bacterial infections. The secondary data were taken from the medical records. We used consecutive sampling technique for sample collection. The sepsis was assessed with PNPK sepsis 2021. Performance analysis of PNPK sepsis 2021 was conducted with SPSS version 25, by assessing sensitivity, specificity, accuracy, Positive Predictive Value, Negative Predictive Value, and Likelihood ratio Results: Two hundred thousand subjects were enrolled in this study, of whom 52.5% were males and 47,5% were females, most subject were under one year old (40.5%), the most common infection was respiratory system (49%). A total of 63.5% were referral cases, with the length of stay in the previous hospital more than 48 hours (69.7%). There were 77% of subjects had antibiotics treatment at the previous hospital. Regarding outcome, 63.5% survived and 36.5% died. The length of stay (LOS) in PICU was 9.5 ± 9.4 days. The positivity rate of blood culture in this study was 19%. Performance evaluation of PNPK sepsis 2021 revealed sensitivity 28.95%, specificity 87.65%, accuracy 76.5%, Positive Predictive Value (PPV) 35.48%, Negative Predictive Value (NPV) 84.02%, Positive Likelihood Ratio (LR +) 2.34 (95% CI, 56%-81%), and Negative Likelihood Ratio (LR -) 0.81 (95% CI, 41%-49%). Conclusion: National Guideline for Sepsis Management 2021 has low sensitivity and high specificity in diagnosing bacterial sepsis

Kata Kunci : sepsis, PNPK sepsis 2021, blood culture, PELOD-2