DIAGNOSIS KLINIS PASCA PERAWATAN CEDERA KEPALA SEBAGAI PREDIKTOR ACTIVITY of DAILY LIVING CEDERA KEPALA RINGAN DAN SEDANG

NELLA HARISA NOVIANI, Prof. Dr. dr. Sri Sutarni, SpS(K).; dr. Indarwati Setyaningsih, Sp.S(K)

2016 | Tesis-Spesialis | SP ILMU PENYAKIT SYARAF

Kesulitan dalam menentukan prognosis sering timbul akibat kurang akuratnya penilaian klinis dan tidak tersedianya fasilitas penunjang baik imaging dalam hal ini head-CT Scan maupun laboratorium terutama pada sarana kesehatan di daerah perifer sehingga sering sekali berdampak terhadap keluaran outcome penderitanya, padahal penilaian klinis dapat dilakukan secara cepat juga tanpa biaya yang mahal. Penelitian ini bertujuan untuk mengetahui apakah diagnosis klinis pasca perawatan cedera kepala dapat menjadi prediktor outcome fungsional dalam hal ini Activity of daily living (ADL) penderita pasca cedera kepala ringan dan sedang terutama bagi sarana kesehatan yang belum memiliki fasilitas imaging lengkap. Penelitian ini menggunakan rancangan kohort prospektif observasional, dengan subjek penelitian pasien cedera kepala yang dirawat di RSUD Wates. Sebanyak 96 orang dengan cedera kepala mengikuti penelitian dibagi menjadi dua kelompok berdasarkan diagnosis klinis pasca perawatan yaitu 48 orang cedera kepala ringan dan 48 orang cedera kepala sedang yang diikuti hingga tiga bulan berikutnya untuk menilai ADL dengan mengukur perubahan skor BI. Hasil analisis bivariat didapatkan 3 faktor yang bermakna secara signifikan dapat mempengaruhi perubahan BI pasien cedera kepala yaitu usia (p=0,025; RR 5,45; 95%CI 1,07-27,83), pupil (p=0,023; RR 24,57; 95%CI 1,97-305,71)dan diagnosis pasca perawatan (p=0,031; RR 9,41; 95%CI 1,12-78,42). Namun dari analisis multivariat menunjukkan bahwa ketiga faktor tersebut bukanlah faktor independen, sehingga disimpulkan bahwa selain diagnosis klinis pasca perawatan, perlu dipertimbangkan faktor lainnya dalam memprediksi ADL pasca cedera kepala.

The difficulty in determining the prognosis often arise due to the lack of accurate clinical assessment and the lack of supporting facilities both imaging in this case the head CT scans and laboratory primarily at health facilities in the peripheral areas so that often affect the output of the outcome of patients, whereas clinical assessment can be done quickly as well at an acceptable cost. This study aims to determine whether the clinical diagnosis after hospitalization in head injury can be a predictor of functional outcome in this case the Activity of daily living (ADL)in mild and moderate head injury and was primarily for health facilities that do not have a complete imaging facilities. This study used a prospective observational cohort design, with research subjects head injury patients were treated in hospitals Wates. A total of 96 people with head injuries following the study were divided into two groups based on the clinical diagnosis after hospitalization are 48 people with mild head injury and 48 people with moderate head injuries were followed up three months later to assess ADL by measuring changes in the Barthel Indeks (BI)score. The results of bivariate analyzes are three factors could significantly affect the change of BI scores, they are age (p=0.025; RR 5.45; 95%CI 1.07-27.83), the pupil condition (p=0.023; RR 24,57; 95%CI 1.97-305.71) and the clinical diagnosis after hospitalization (p=0.031; RR 9.41; 95%CI 1.12-78.42). However, multivariate analysis showed that three factors are not independent factors, so it is concluded that besides the clinical diagnosis after hospitalization, it is necessary to consider other factors to predict ADL after a head injury.

Kata Kunci : head injury, functional outcome, Activity of Daily living, Barthel Indeks.