HUBUNGAN ANTARA FAST DENGAN HASIL LUARAN TERAPI NON-OPERATIF PADA TRAUMA TUMPUL ABDOMEN DI RSUP DR. SARDJITO YOGYAKARTA TAHUN 2018-2021

DEWI S WAHYUNINGTIAS, dr. Imam Sofii, Sp.B-KBD; dr. Eko Purnomo, PhD, Sp.BA

2021 | Tesis-Spesialis | ILMU BEDAH

Latar belakang: Hasil luaran terapi non-operatif trauma tumpul abdomen dipengaruhi oleh berbagai faktor. Hasil FAST merupakan salah satu dasar pertimbangan dari pemilihan terapi non-operatif, dimana hasil FAST dapat berubah dipengaruhi oleh onset trauma, tingkat keparahan trauma serta ada atau tidaknya cedera lain. Hasil luaran terapi non-operatif sendiri dipengaruhi oleh tatalaksana sistemik (misal pemberian transfusi darah), faktor internal (misal penurunan nilai hematocrit/ dHCT, peningkatan sel darah penanda inflamasi) dan faktor eksternal (misal pengawasan di ruangan intensif). Metode: Non-eksperimental dengan desain cohort retrospektif melibatkan 211 orang sejak April 2018 hingga April 2021 di RSUP dr. Sardjito yang mengalami trauma tumpul abdomen dengan hemodinamik stabil. Analisis data menggunakan SPSS versi 24 dengan uji one sample T-test, independent T-test, Chi square dan logistic regression. Hasil: Onset trauma (p=0.012; 95%CI 2.26-17.76), SBP (p=0.019; 95%CI -13.45- -1.2), ISS (p=0.004; 95%CI 0.87-5.37) dan nilai PLR (p=0.001; 95%CI -89.86- -23.75) berhubungan dengan FAST. Nilai ISS (p=0.014; RR=0.639; 95%CI 0.455-0.897), nilai PLR (p=0.033; RR=1.465; 95%CI 1.043-2.057), kebutuhan transfusi darah (p=0.045; RR=0.702; 95%CI 0.500-0.987) berhubungan dengan FAST. Analisis variabel independen (usia, onset trauma, SBP, ISS, TRISS, nilai NLR, nilai PLR, nilai dHCT, lama rawat intensif, dan total lama rawat inap) dengan hasil luaran terapi non-operatif tidak didapatkan perbedaan signifikan (p>0.05). Kebutuhan transfusi darah (p=0.047; RR=1.041; 95%CI 0.995-1.088) berhubungan dengan hasil luaran terapi non-operatif. Cedera pelvis (p=0.036; OR=0.065; 95%CI 0.005-0.833) dan cedera eksternal (p=0.000) berhubungan dengan hasil luaran terapi non-operatif. Hasil pemeriksaan FAST tidak berhubungan dengan keberhasilan terapi non-operatif (p=0.679; RR=0.816; 95%CI 0.073-9.152). Kesimpulan: Hasil pemeriksaan FAST tidak berhubungan dengan hasil luaran terapi non-operatif.

Background: outcome of non-operative therapy in blunt abdominal trauma is influenced by various factors. FAST results are one of the basic considerations in choosing non-operative therapy, where FAST results can change depends on the onset of trauma, severity of the trauma and presence of other injuries. Outcome of non-operative therapy itself is influenced by systemic management (eg blood transfusion), internal factors (eg decreased hematocrit/ dHCT, increased inflammatory marker blood cells) and external factors (eg monitoring in intensive care). Aim: to determine the relationship between FAST and outcome of non-operative therapy in blunt abdominal trauma patient and identify the associated factors. Method: Non-experimental with retrospective cohort design involving 211 patients from April 2018 to April 2021 at RSUP dr. Sardjito Yogyakarta who experienced blunt abdominal trauma with stable hemodynamics. Data analysis used SPSS version 24. Result: Univariate analysis of trauma onset (p=0.012; 95%CI 2.26 to 17.76), SBP (p=0.019; 95%CI -13.45 to -1.2), ISS (p=0.004; 95%CI 0.87 to 5.37) and PLR values (p=0.001; 95%CI -89.86 to -23.75) associated with FAST positive. Bivariate analysis of ISS (p=0.014; RR=0.639; 95%CI 0.455 to 0.897), PLR value (p=0.033; RR=1.465; 95%CI 1.043 to 2.057), need for blood transfusion (p=0.045; RR=0.702; 95%CI 0.500 to 0.987) corresponded to FAST positive. Univariate analysis of independent variables (age, trauma onset, SBP, ISS, TRISS, NLR value, PLR value, dHCT value, length of intensive care, and total length of stay) with non-operative therapy outcomes showed no significant difference (p>0.05). Bivariate analysis of the need for blood transfusion (p=0.047; RR=1.041; 95%CI 0.995 to 1.088) was associated with the outcome of non-operative therapy. Multivariate analysis of pelvic injuries (p=0.036; OR=0.065; 95%CI 0.005 to 0.833) and external injuries (p=0.000) were associated with non-operative outcomes. The results of the FAST examination were not associated with the success of non-operative therapy (p=0.679; RR=0.816; 95%CI 0.073 to 9.152). Conclusion: The results of the FAST examination were not associated with the outcome of non-operative therapy.

Kata Kunci : trauma tumpul abdomen, FAST, non-operatif, NLR, PLR, dHCT, ISS, TRISS