Tanda dan gejala klinis sebagai diagnostik untuk menilai hipoksemia pada anak sengan serangan asma

HANUM, Latifah, dr. Roni Naning, Sp.A(K), M.Kes

2010 | Tesis | S2 Ilmu Kedokteran Klinik

Serangan asma dapat menyebabkan hipoksemia dan salah satu cara mendeteksi hipoksemia dengan pulse oximeter. Namun pulse oximeter tidak selalu tersedia sehingga diperlukan alat diagnostik sederhana untuk mendeteksi adanya hipoksemia. Penelitian ini adalah suatu uji diagnostik yang dilakukan di Bagian IKA FK UGM/RSUP Dr. Sardjito Yogyakarta. Sampel penelitian adalah anak 0-18 tahun yang didiagnosis asma dan datang dengan serangan asma di Instalasi Gawat Darurat dan Poli Respirologi Anak sejak Februari 2010 sampai Mei 2010. Sebanyak 77 subyek dilakukan pemeriksaan tanda klinis dan saturasi oksigen sebagai baku emas. Hasil penelitian didapatkan hipoksemia pada serangan asma anak sebesar 18,2%. Tanda klinis tunggal terbaik untuk diagnostik hipoksemia yaitu takikardi mempunyai nilai sensitivitas 86% (IK 95% 67-100), spesifisitas 59% (IK 95% 49-71), dan napas cuping hidung mempunyai sensitivitas 79% (IK 95% 57-100), spesifisitas 69% (IK 95% 58-80). Penggabungan dua tanda klinis menunjukkan peningkatan sensitivitas dan spesifisitas, yaitu retraksi dinding dada-napas cuping hidung (sensitivitas 79%, spesifisitas 71%), retraksi dinding dada-takikardi (sensitivitas 86%, spesifisitas 76%), retraksi dinding dada-takipnea (sensitivitas 86%, spesifisitas 51%), takikardi- takipnea (sensitivitas 79%, spesifisitas 76%). Penggabungan retraksi dinding dada-takikardi-takipnea mempunyai sensitivitas sebesar 79% dan spesifisitas 79%. Tanda klinis retraksi dinding dada dan takikardi mempunyai nilai diagnostik yang lebih tinggi dibandingkan dengan tanda klinis yang lain untuk menilai hipoksemia pada anak dengan serangan asma.

Asthma attack may cause hypoxemia and oxygen saturation measurement are important tools to detect hypoxemia. However, these tools are not always available in health care centers. Therefore, a simple diagnostic tool is needed as an alternative method to detect hypoxemia. This study aims to find clinical signs that are the best diagnostic of hypoxemia in the case of acute asthma in children. The study is performed by conducting diagnostic test in the Pediatric Departement, Gadjah Mada University, Sardjito Hospital, Yogyakarta from February to May 2010. It involved children aged 0-18 years old who attended Emergency Department as well as Respiratory Outpatient Clinic. Seventy-seven subjects were chosen to whom the test is performed in an attempt to detect clinical sign and oxygen saturation as the gold standard. The study showed that hypoxemia is present in 18,2% of the children asthma case. The best single clinical sign of hypoxemia was tachycardia [sensitivity 86% (95% CI 67-100), specificity 59% (95% CI 49-71)] and nasal flare [sensitivity 79% (95% CI 57-100), specificity 69% (95% CI 58-80)]. Combination of the two clinical sign showed increase of sensitivity and specificity, i.e. chest retraction-nasal flare (sensitivity 79%, specificity 71%); chest retraction-tachycardia (sensitivity 86%, specificity 76%); chest retraction-tachypnea (sensitivity 86%, specificity 51%); tachycardia-tachypnea (sensitivity 79%, specificity 76%). Combination of chest retraction-tachycardia-tachypnea produced sensitivity value of 79% and specificity value of 79%. Chest retraction and tachycardia have higher diagnostic value than other clinical signs to detect hypoxemia in children with asthma attack.

Kata Kunci : Serangan asma,Hipoksemia,Tandan klinis,Anak