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Aditarahma Imaningdyah
Protein S100 sebagai petanda kerusakan otak pada cedera otak ringan dan sedang = S100 Protein as a brain injury biomarker in mild and moderate traumatic brain injury / Aditarahma Imaningdyah
"ABSTRAK
Tujuan : Mengetahui hubungan kadar protein S100 pada pasien cedera otak ringan dan sedang yang diukur secara bertahap pada saat pasien tiba di rumah sakit, beberapa jam pasca trauma, dan sekian hari perawatan di rumah sakit, sehingga dapat digunakan sebagai petanda kerusakan otak.
Latar belakang : Cedera otak menjadi masalah kesehatan masyarakat di seluruh dunia karena dapat menyebabkan kecacatan dan kematian. Diagnosis cedera otak ditegakkan berdasarkan pemeriksaan klinis neurologi, dan CT scan atau MRI untuk melihat kerusakan anatomi. Pemeriksaan kadar protein S100 pada pasien cedera otak ringan dan sedang dengan menggunakan bahan serum diperlukan untuk mendeteksi dan dapat untuk mengevaluasi adanya kerusakan otak pasca traumatik.
Metode : Subyek penelitian adalah orang sehat dan pasien cedera otak ringan dan sedang berdasarkan nilai SKG, pemeriksaan klinis neurologi, dan CT scan, yang diambil darahnya untuk pemeriksaan kadar protein S100 pada saat tiba di rumah sakit, 6 jam pasca trauma, 24 jam pasca trauma, dan hari terakhir perawatan. Pemeriksaan kadar protein S100 dalam serum menggunakan Elecsys S100 dengan prinsip ECLIA.
Hasil : Terdapat perbedaan bermakna (p = 0,001) pada semua kadar protein S100 yang diukur saat tiba di rumah sakit, 6 jam pasca trauma, 24 jam pasca trauma, dan hari terakhir perawatan, baik pada pasien cedera ringan maupun sedang. Puncak kadar protein S100 tercapai pada 6 jam pasca trauma pada pasien cedera otak ringan dan sedang. Kadar protein S100 pada pasien cedera otak sedang saat tiba di rumah sakit lebih tinggi secara bermakna dibandingkan pasien cedera otak ringan (median 0,259 μg/L rentang 0,207 – 0,680 μg/L vs median 0,150 μg/L rentang 0,051 – 0,289 μg/L, p = 0,001) dan kadar protein S100 pasien cedera otak ringan saat tiba di rumah sakit lebih tinggi secara bermakna dibandingkan kadar protein S100 orang sehat (median 0,150 μg/L rentang 0,051 – 0,289 μg/L vs rerata 0,065 ± 0,017μg/L, p = 0,001).
Kesimpulan : Pada pasien cedera otak ringan dan sedang saat tiba di rumah sakit sudah terdapat peningkatan kadar protein S100 secara bermakna dibandingkan dengan orang sehat. Protein S100 dapat digunakan sebagai petanda untuk deteksi dan evaluasi kerusakan otak pasca traumatik.
ABSTRACT
Objective: To identify the relation of protein S100 level in mild and moderate brain injury patient, which is measured repeatedly at admission, few hours post trauma, and few days of hospitalization, thus it can be used as brain injury biomarker.
Background: Brain injury becomes worldwide public health issue since it may cause disability and mortality. The diagnosis of brain injury is made based on clinical neurology examination, and CT scan or MRI, to observe anatomical impairment. Serum S100 protein examination in mild and moderate brain injury patients is needed to detect and evaluate the presence of post traumatic brain injury.
Method: This research subject is healthy people and patients with mild and moderate brain injury, based on their GCS grade, clinical neurologic examination, and CT scan. On these patients, the blood for S100 protein examination is taken at admission, 6 hours post trauma, 24 hours post trauma, and last day of hospitalization. Examination of a serum S100 protein is conducted using Elecsys S100 with ECLIA method.
Result: There is significant difference (p = 0,001) in mild or moderate brain injury patients in all serum S100 protein which is measured at admission, 6 hours post trauma, 24 hours post trauma, and the last day of hospitalization. The peak level of serum S100 protein reached at 6 hours post trauma. Serum S100 protein in moderate brain injury patients at admission is significantly higher than the mild ones (median 0, 259 μg/L range 0,207 – 0,680 μg/L vs median 0,150 μg/L range 0,051 – 0,289 μg/L, p = 0,001), and serum S100 protein in mild brain injury patients is also significantly higher than healthy people (median 0,150 μg/L range 0,051 – 0,289 μg/L vs mean 0,065 ± 0,017μg/L, p = 0,001).
Conclusion: In mild and moderate brain injury patients, serum S100 protein is already significantly increased at admission, compared to healthy people. Serum S100 protein can be used as brain injury biomarker to detect and evaluate the presence of post traumatic brain injury."
Fakultas Kedokteran Universitas Indonesia, 2012
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UI - Tesis Membership  Universitas Indonesia Library
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Hendra Samanta
Protein S100B sebagai prediktor tingkat keparahan cedera kepala = Protein S100B as predictor severity traumatic brain injury
"Latar Belakang. Cedera kepala merupakan salah satu masalah kesehatan masyarakat yang serius yang dapat menyebabkan kematian, kecacatan fisik dan kecacatan mental. Cedera kepala dapat menyebabkan sel astrosit rusak sehingga mengeluarkan protein S 100B yang dapat dideteksi didalam darah perifer, sehingga dapat dipakai untuk memprediksi tingkat keparahan cedera kepala yang terjadi. Penelitian ini bertujuan untuk mencari hubungan antara kadar protein S 100B dengan tingkat keparahan cedera kepala.
Metode. Desain penelitian adalah potong lintang untuk mengetahui kadar protein S 100B pada pasien cedera kepala akut onset kurang dari 24 jam. Subyek penelitian sejumlah 85 pasien yang datang berobat ke Instalasi Gawat Darurat RSCM sejak bulan maret ? juni 2015. Dilakukan penilaian GCS, lamanya tidak sadarkan diri, lamanya amnesia pasca trauma dengan bantuan alat TOAG, pemeriksaan CT Scan dan pemeriksaan serum protein S 100B.
Hasil. Didapatkan kadar rerata protein S 100B serum 0,77 ÎĽg/L, rerata durasi amnesia 21,22 jam, rerata nilai GCS 13. Terdapat perbedaan kadar protein S 100B pada CKR (rerata 0,4175) dibandingkan dengan pada CKS dan CKB (1,0722) (p=0,020), nilai titik potong kadar protein S 100B pasien yang meninggal 0,765 ÎĽg/L (p= 0,002).
Simpulan. Kadar rerata protein S 100B pada cedera kepala ringan lebih rendah dibandingkan dengan kadar protein S 100B pada cedera kepala sedang dan berat, semakin tinggi kadar protein S 100B akan semakin tidak baik keluaran pasien cedera kepala.
Background. Traumatic brain injury is still a serious community health problem can cause death, physical and mental disability. Protein S 100B release from destructive astrocyte from brain injury and detected in the peripheral blood, so that protein S 100B can serve as predictor of severity traumatic brain injury. This research aimed to find association between protein S 100B with traumatic brain injury severity.
Method. This was a cross sectional study focusing to protein S 100B value from acute traumatic brain injury patients with onset < 24 hours. Eighty five patients were recruited from emergency room RSCM. GCS value, duration of post traumatic amnesia with TOAG tools, duration loss of consciousness, brain CT scan and concentration serum protein S 100B were record.
Results. The mean concentration serum Protein S 100B were 0.77, mean PTA duration were 21,22 hours, and the mean GCS were 13. There is a significant differentiation value of concentration protein S 100B from mild trumatic brain injury compare moderate and severe traumatic brain injury (p=0,020), cut off point for death patients was 0,765 ÎĽg/L.
Conclusion. The mean serum Protein S 100 B from mild trumatic brain injury lower than moderate and severe traumatic brain injury higher consentration of protein S 100B have bad outcome."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tesis Membership  Universitas Indonesia Library
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Ingka Nila Wardani
Tata laksana nutrisi pada kasus cedera kepala sedang dan berat = Nutritional management in moderate and severe traumatic brain injury
"Tatalaksana nutrisi pada pasien cedera kepala sedang dan berat mencakup pemberian makronutrien mikronutrien nutrien spesifik pengelolaan cairan dan elektrolit serta pemantauan dan evaluasi Dukungan nutrisi yang adekuat perlu diberikan pada pasien cedera kepala agar meningkatkan perbaikan kondisi optimal pasien Sebagian besar pasien cedera kepala memiliki status gizi yang baik sebelum terjadinya trauma Pemenuhan nutrisi yang optimal dapat turut menunjang perbaikan inflamasi metabolisme dan menjaga tidak terjadi penurunan status gizi Pasien pada serial kasus ini seluruh pasien laki laki mempunyai rentang usia 19 sampai 49 tahun Adanya penyakit penyerta mempengaruhi luaran akhir pasien cedera kepala Terapi nutrisi diberikan sesuai dengan kebutuhan setiap pasien Kebutuhan energi total dihitung berdasarkan perkiraan kebutuhan energi basal menggunakan persamaan Harris Benedict dikalikan faktor stres 1 4 1 6 dan pemberiannya disesuaikan dengan kondisi klinis pasien Kebutuhan protein 1 5 2 g kg BB hari dan lemak 20 30 Pemantauan mencakup tanda klinis toleransi asupan makanan kapasitas fungsional keseimbangan cairan parameter laboratorium dan antropometri Pemberian nutrisi pada pasien cedera kepala berat dengan sakit kritis bersifat individual dan mencakup semua aspek Tatalaksana nutrisi yang baik dan dilanjutkan dengan edukasi pada pasien dan keluarga diharapkan dapat meningkatkan kualitas hidup pasien cedera kepala dengan meminimalkan komplikasi yang dapat terjadi
Nutrition therapy in patients with moderate and severe traumatic brain injury includes the provision of macronutrient micronutrient specific nutrition fluid and electrolyte management with monitoring and evaluation Adequate nutrition support should be given in traumatic brain injury to optmalyze outcome patient Three from four this case series have a normoweight before trauma Nutritional support can improve metabolism decrease inflammation and manage nutritional status Patients in this case series all male have an age range from 19 to 49 kg years Their comorbid condition influence outcome of traumatic brain injury patient Nutritional support is given according to each patient rsquo s requirement which is calculated with basal energy requirement using Harris Benedict equation with stress factor 1 4 1 6 and the administration starts with individual condition which gradually increased to reach the total energy expenditure Protein requirement 1 5 2 g kg day and lipid requirement is calculated 20 30 total energy requirement Patient rsquo s monitoring include clinical signs food intake tolerance functional capacity fluid balance laboratory and anthropometric parameter were taken With the management of good nutrition expected quality of life of patients with moderate and severe traumatic brain injury various comorbidities would be better "
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013
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UI - Tugas Akhir  Universitas Indonesia Library
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Patricia Amanda
Tatalaksana medik gizi pada pasien sakit kritis dengan cedera kepala sedang dan berat = Medical nutrition therapy in critically ill patients with moderate and severe traumatic brain injury
"Cedera kepala merupakan penyebab utama kematian dan kecacatan pada populasi dunia berusia di bawah 45 tahun. Cedera kepala sedang (CKS) dan berat (CKB) biasanya memerlukan perawatan intensif dan pendekatan medis-bedah. Pasien dengan cedera kepala mengalami peningkatan laju metabolisme sehingga memerlukan tatalaksana medik gizi yang sesuai. Pemenuhan kebutuhan energi yang tidak adekuat dapat menyebabkan peningkatan angka morbiditas, risiko infeksi, dan komplikasi lainnya. Pemberian nutrisi enteral dini dalam kurun 24-48 jam setelah masuk Intensive Care Unit (ICU) dapat memperbaiki luaran klinis pasca cedera.
Serial kasus ini bertujuan untuk melaporkan peran tatalaksana medik gizi pada status gizi, lama pemakaian ventilator, tingkat kesadaran dan kapasitas fungsional pada pasien kritis dengan CKS dan CKB. Empat pasien laki-laki dengan rentang usia 25-46 tahun diobservasi selama perawatan di ICU RS Cipto Mangunkusumo, dua pasien dengan diagnosis CKS dan sisanya dengan diagnosis CKB. Status gizi berdasarkan indeks massa tubuh, dua pasien memiliki berat badan (BB) normal, satu pasien BB lebih dan satu pasien obesitas II. Tingkat kesadaran berdasarkan skor Glascow Coma Scale (GCS) pasien pada saat masuk ICU adalah 6-11.
Selama perawatan keempat pasien mendapat nutrisi enteral dini dan pemberian nutrisi ditingkatkan bertahap. Pada seluruh pasien, kebutuhan energi dapat dipenuhi sesuai target 25-30 kkal/kg BB. Kebutuhan makronutrien dapat dipenuhi sesuai target, yaitu protein 1,2-2 g/kg BB, lemak 20-30%, dan karbohidrat minimal 100 g/hari. Pada dua pasien dengan CKB, diberikan nutrien spesifik berupa glutamin sebesar 0,2 g/kgBB/hari dan mikronutrien berupa vitamin C, vitamin B kompleks, asam folat, dan seng.
Hingga akhir pemantauan status gizi pada dua pasien CKS dapat dipertahankan, sedangkan dua pasien dengan CKB mengalami penurunan berat badan. Dua pasien CKS hanya menggunakan ventilator selama 4-5 hari, sedangkan dua pasien dengan CKB menggunakan ventilator lebih lama yaitu 12 dan 31 hari dengan disertai komorbiditas pneumotoraks dan ventilator-associated pneumonia. Tingkat kesadaran seluruh pasien mengalami perbaikan. Skor GCS pasien pada akhir perawatan di ICU adalah 7-15. Kapasitas fungsional berdasarkan Indeks Barthel juga mengalami perbaikan pada tiga pasien, yaitu dari ketergantungan total menjadi ketergantungan sedang atau berat.
Dapat disimpulkan bahwa tatalaksana medik gizi dapat berperan dalam mempertahankan status gizi, menurunkan lamanya pemakaian ventilator, memperbaiki tingkat kesadaran dan kapasitas fungsional pada pasien sakit kritis dengan CKB dan CKS. Tingkat keparahan cedera kepala dan komorbiditas dapat memengaruhi luaran klinis dan harus dipertimbangkan dalam memberi tatalaksana medik gizi.
Traumatic brain injury (TBI) is a leading cause of death and disability in the global population under 45 years old. Moderate and severe TBI usually require intensive care and a medical-surgical approach. Patients with TBI experience an increase in metabolic rate and therefore require appropriate medical nutrition therapy. Inadequate energy intake can cause an increase in morbidity, risk of infection, and other complications. Early enteral nutrition within 24-48 hours after ICU admission has been shown to improve clinical outcome.
This case series aims to report the role of medical nutrition therapy on nutritional status and clinical outcomes of critically ill patients with moderate and severe TBI. Four male patients aged 25-46 years were observed during their stay at the ICU of Cipto Mangunkusumo Hospital. Based on body mass index, two patients were normoweight, one patient was overweight and one patient was class II obese. The Glascow Coma Scale (GCS) scores of the patients on ICU admission were ranged 6-11.
Two of the four patients were classified as moderate TBI and the other two patients were as classified as severe TBI. On monitoring four patients received early enteral nutrition and the nutrition was gradually increased to reach the target of 25-30 kcal/kg body weight (BW). Enteral formula were targeted to achieve protein intake of 1.2-2 g/kgBW, fat intake of 20-30% of energy intake, and carbohydrate intake of at least 100 g/day. Two patients with severe TBI were given specific nutrients in the form of glutamine as much as 0.2 g/kgBW/day and micronutrients in the form of vitamin C, vitamin B complex, folic acid, and zinc. Two patients with moderate TBI received mechanical ventilation for 4 and 5 days, while two patients with severe TBI received mechanical ventilation for 12 and 31 days. In two patients with severe TBI, prolonged use of mechanical ventilation may be associated with the comorbidities of pneumothorax and ventilator-associated pneumonia.
At the end of monitoring, the levels of consciousness were improved in all patients. The patients GCS score at the end of treatment in the ICU were ranged 7-15. Functional capacity based on the Barthel Index also improved in three patients, from total dependence to moderate or severe dependence. Weight loss was experienced in two patients with severe TBI, possibly due to severe and prolonged catabolism in severe TBI. Patients with severe TBI may have higher energy requirements to maintain their nutritional status.
It can be concluded that medical nutrition therapy may play a role in improving the level of consciousness and functional capacity in critically ill patients with moderate and severe traumatic brain injury."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library
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Muhammad Farell Hwardaya Putraprasetyo
Radiological Findings of Moderate to Severe Traumatic Brain Injury and Its Association with The Mortality and Disability Rate at Cipto Mangunkusumo Hospital = Temuan Radiologi Cedera Otak Trauma Sedang hingga Berat dan Hubungannya dengan Angka Kematian dan Kecacatan Menggunakan Analisis Statistik pada Pasien RSUPN dr. Cipto Mangunkusumo pada tahun 2021
"Latar Belakang: Cedera Otak Traumatik (COT) mempengaruhi jutaan orang di seluruh dunia setiap tahunnya. Penelitian ini bertujuan untuk mengetahui hubungan temuan radiologi TBI dengan angka kecacatan dan kematian di RSUPN dr. Cipto Mangunkusumo. Metode: Penelitian ini merupakan penelitian deskriptif analitis, dilakukan secara retrospektif dengan menggunakan data sekunder yang diambil dari rekam medis dan arsip pasien yang disediakan oleh Departemen Neurologi FKUI-RSCM yang telah didiagnosis menderita COT sedang dan berat di RSUPN dr. Cipto Mangunkusumo dari Januari hingga Desember 2021. Hasil CT diklasifikasikan menggunakan skor CT Rotterdam. GOSE digunakan sebagai outcome prediktor dimana penilaian dilakukan pada hari ke 14, 30, dan 90. Analisis bivariat akan dilakukan dengan menggunakan uji Chi-square dan uji Mann-Whitney. Hasil: TBI sedang menjadi dominan (88,5%) dan SAH menjadi kelainan CT paling umum di RSCM (57,6%). Usia ditemukan menjadi faktor signifikan dalam perkembangan hasil yang lebih buruk pada hari ke-14 pasca-trauma (p= 0,026). Keparahan juga ditemukan sebagai faktor yang signifikan terlepas dari kapan skor GOSE diambil (hari ke-14 p= 0,004, hari ke-30 p= <0,001, hari ke-90 p=<0,001). SAH merupakan prediktor hasil yang signifikan pada hari ke-14 (p=0,030), hari ke-30 (p=0,010), dan hari ke-90 (p = 0,009). DAI (p= 0,048) dan edema serebral (p=0,009) memainkan peran penting terhadap hasil pada hari ke-90. Skor CT Rotterdam memiliki hubungan yang signifikan terhadap prediksi hasil pada hari ke-14 (p=0,009), hari ke-30 (p <0,001), dan hari ke- 90 (p <0,001). Kesimpulan: Tingkat keparahan COT, SAH, DAI, dan edema serebral mempunyai peran penting dalam prediksi hasil akhir penelitian.
Introduction: TBI affects millions of individuals around the world. This research aims to explore the relationship between radiological findings of TBI and the disability and mortality rate in Cipto Mangunkusumo Hospital Methods: This is a descriptive analytical research, done in a retrospective way by the usage of secondary data extracted from medical records of patients that had been diagnosed with TBI in Cipto Mangunkusumo hospital in 2021. GOSE was used as an outcome predictor in which assessment was done at the 14th, 30th, and 90th day. Analysis was done using Chi-square test and Mann-Whitney test Results: Moderate TBI to be predominant (88.5%) and SAH to be the most prevalent CT abnormality in Cipto Mangunkusumo hospital (57.6%). Age was found to be a significant factor in the development of worse outcomes in the 14th day post-trauma (p= 0.026). Severity was found to be a significant factor also regardless of when the GOSE score was taken (14th day p= 0.004, 30th day p= <0.001, 90th day p=<0.001). SAH was a significant predictor of outcome at the 14th day (p=0.030), 30th day (p=0.010), and 90th day (p = 0.009). DAI (p= 0.048) and cerebral edema (p=0.009) played a significant role on the outcome at the 90th day. Rotterdam CT score had a significant association in outcome prediction at the 14th day (p=0.009), 30th day (p < 0.001), and 90th day (p < 0.001). Conclusion: Severity, Rotterdam CT score, SAH, DAI, and cerebral edema had a significant role in prediction of outcome at the end of the study."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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Hendra Samanta
Protein S 100b sebagai prediktor tingkat keparahan cidera kepala = Protein S 100b as predictor severity traumatic brain injury
"[ABSTRAK
Nama Hendra SamantaProgram Studi Pendidikan Dokter Spesialis NeurologiJudul Protein S 100B sebagai prediktor tingkat keparahan cedera kepala Latar Belakang Cedera kepala merupakan salah satu masalah kesehatan masyarakat yang serius yang dapat menyebabkan kematian kecacatan fisik dan kecacatan mental Cedera kepala dapat menyebabkan sel astrosit rusak sehingga mengeluarkan protein S 100B yang dapat dideteksi didalam darah perifer sehingga dapat dipakai untuk memprediksi tingkat keparahan cedera kepala yang terjadi Penelitian ini bertujuan untuk mencari hubungan antara kadar protein S 100B dengan tingkat keparahan cedera kepala Metode Desain penelitian adalah potong lintang untuk mengetahui kadar protein S 100B pada pasien cedera kepala akut onset kurang dari 24 jam Subyek penelitian sejumlah 85 pasien yang datang berobat ke Instalasi Gawat Darurat RSCM sejak bulan maret ndash juni 2015 Dilakukan penilaian GCS lamanya tidak sadarkan diri lamanya amnesia pasca trauma dengan bantuan alat TOAG pemeriksaan CT Scan dan pemeriksaan serum protein S 100B Hasil Didapatkan kadar rerata protein S 100B serum 0 77 g L rerata durasi amnesia 21 22 jam rerata nilai GCS 13 Terdapat perbedaan kadar protein S 100B pada CKR rerata 0 4175 dibandingkan dengan pada CKS dan CKB 1 0722 p 0 020 nilai titik potong kadar protein S 100B pasien yang meninggal 0 765 g L p 0 002 Simpulan Kadar rerata protein S 100B pada cedera kepala ringan lebih rendah dibandingkan dengan kadar protein S 100B pada cedera kepala sedang dan berat semakin tinggi kadar protein S 100B akan semakin tidak baik keluaran pasien cedera kepala ABSTRACT Name Hendra SamantaStudy program Neurology Specialization Educational ProgrammedTitle Protein S 100B as Predictor Severity Traumatic Brain Injury Background Traumatic brain injury is still a serious community health problem can cause death physical and mental disability Protein S 100B release from destructive astrocyte from brain injury and detected in the peripheral blood so that protein S 100B can serve as predictor of severity traumatic brain injury This research aimed to find association between protein S 100B with traumatic brain injury severity Method This was a cross sectional study focusing to protein S 100B value from acute traumatic brain injury patients with onset 24 hours Eighty five patients were recruited from emergency room RSCM GCS value duration of post traumatic amnesia with TOAG tools duration loss of consciousness brain CT scan and concentration serum protein S 100B were record Results The mean concentration serum Protein S 100B were 0 77 mean PTA duration were 21 22 hours and the mean GCS were 13 There is a significant differentiation value of concentration protein S 100B from mild trumatic brain injury compare moderate and severe traumatic brain injury p 0 020 cut off point for death patients was 0 765 g LConclusion The mean serum Protein S 100 B from mild trumatic brain injury lower than moderate and severe traumatic brain injury higher consentration of protein S 100B have bad outcome ;ABSTRACT Name Hendra SamantaStudy program Neurology Specialization Educational ProgrammedTitle Protein S 100B as Predictor Severity Traumatic Brain Injury Background Traumatic brain injury is still a serious community health problem can cause death physical and mental disability Protein S 100B release from destructive astrocyte from brain injury and detected in the peripheral blood so that protein S 100B can serve as predictor of severity traumatic brain injury This research aimed to find association between protein S 100B with traumatic brain injury severity Method This was a cross sectional study focusing to protein S 100B value from acute traumatic brain injury patients with onset 24 hours Eighty five patients were recruited from emergency room RSCM GCS value duration of post traumatic amnesia with TOAG tools duration loss of consciousness brain CT scan and concentration serum protein S 100B were record Results The mean concentration serum Protein S 100B were 0 77 mean PTA duration were 21 22 hours and the mean GCS were 13 There is a significant differentiation value of concentration protein S 100B from mild trumatic brain injury compare moderate and severe traumatic brain injury p 0 020 cut off point for death patients was 0 765 g LConclusion The mean serum Protein S 100 B from mild trumatic brain injury lower than moderate and severe traumatic brain injury higher consentration of protein S 100B have bad outcome , ABSTRACT Name Hendra SamantaStudy program Neurology Specialization Educational ProgrammedTitle Protein S 100B as Predictor Severity Traumatic Brain Injury Background Traumatic brain injury is still a serious community health problem can cause death physical and mental disability Protein S 100B release from destructive astrocyte from brain injury and detected in the peripheral blood so that protein S 100B can serve as predictor of severity traumatic brain injury This research aimed to find association between protein S 100B with traumatic brain injury severity Method This was a cross sectional study focusing to protein S 100B value from acute traumatic brain injury patients with onset 24 hours Eighty five patients were recruited from emergency room RSCM GCS value duration of post traumatic amnesia with TOAG tools duration loss of consciousness brain CT scan and concentration serum protein S 100B were record Results The mean concentration serum Protein S 100B were 0 77 mean PTA duration were 21 22 hours and the mean GCS were 13 There is a significant differentiation value of concentration protein S 100B from mild trumatic brain injury compare moderate and severe traumatic brain injury p 0 020 cut off point for death patients was 0 765 g LConclusion The mean serum Protein S 100 B from mild trumatic brain injury lower than moderate and severe traumatic brain injury higher consentration of protein S 100B have bad outcome ]"
Fakultas Kedokteran Universitas Indonesia, 2015
SP-PDF
UI - Tugas Akhir  Universitas Indonesia Library
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Farid Yudoyono
Skoring prognostik cedera otak traumatika berat = Prognostic scoring severe traumatic brain injury patient single indonesian institution study
"[ABSTRAK
Latar Belakang: Cedera otak traumatika akibat kecelakaan lalu lintas masih merupakan salah satu penyebab kematian dan kecacatan utama pada kelompok usia produktif. Cedera otak sekunder dideskripsikan sebagai konsekuensi gangguan fisiologis, seperti iskemia, reperfusi, dan hipoksia pada area otak yang beresiko, beberapa saat setelah terjadinya cedera awal (cedera otak primer). Cedera otak sekunder sensitif terhadap terapi dan proses terjadinya dapat dicegah dan dimodifikasi. Metode: Penelitian kohort retrospektif dengan data primer rekam medis. Data yang terdiri dari beberapa variabel yang dikumpulkan secara retrospektif dari catatan medis pasien. RS. Hasan Sadikin, Bandung Jawa Barat, Indonesia. Pengambilan data dilakukan pada 2011-2014. Jumlah sampel yang diambil sebanyak 647 pasien. Analisis yang dilakukan meliputi analisis univariat, bivariat, dan analisis multivariate cox proportional hazard dengan model matematis yang
selanjutnya akan dibuat model skoring. Analisis roctab digunakan untuk menentukan nilai cut-off setiap variabel numerik. Hasil: Variabel perdarahan otak, tingkat kesadaran, dan edema serebri merupakan
faktor resiko outcome, sedangkan variabel peningkatan tekanan intrakranial, kadar elektrolit natrium dan klorida, serta terapi diuretik merupakan faktor resiko untuk terjadinya outcome kematian pada pasien ensefalitis anak. Berdasarkan hasil analisis multivariat skoring didapatkan urutan faktor prognostik yang dominan menyebabkan kematian, yaitu Variabel usia memilik HR sebesar 1,00, natrium
mempunyai HR 0,8, Perdarahan otak pada CT Scan kepala mempunyai HR sebesar 1,73, edema serebri mempunyai HR 2,53, hipoksia mempunyai HR sebesar 2,13, farktur maksillofascial mempunyai HR sebesar 0,6, hipotensi memiliki HR 0,7 dan pembedahan/trepanasi mempunyai HR 0,388 Berdasarkan analisis tersebut maka natrium, GCS, hipotensi, pembedahan dan MFS fraktur merupakan faktor proteksi outcome sedangkan usia, perdarahan otak pada CT Scan, edema serebri, hipoksia merupakan faktor resiko terjadinya outcome
kematian pada pasien cedera kepala berat. Dari hasil mulitvariat yang telah dilakukan sebelumnya apabila skor -69 s/d -47 mengalami resiko rendah untuk mengalami kematian, skor -46 s/d -20 mengalami resiko sedang untuk terjadinya kematian dan skor >-19 akan mengalami resiko tinggi terjadinya kematian. Kesimpulan: Model skoring prognosis yang telah terbentuk ini mampu memprediksi sebesar 84,75 % faktor faktor yang berhubungan dengan prognosis cedera otak traumatika berat. Apabila ada 100 pasien cedera kepala berat dengan adanya semua variabel maka 76 pasien akan meninggal dan bila 100 pasien
cedera kepala berat tanpa adanya semua variabel maka 25 pasien akan meninggal.
ABSTRACT
Background: Severe traumatic brain injury caused by traffic accidents is still one of the major causes of death and disability in the productive age group. Secondary brain injury is described as a physiological disorders, such as ischemia, reperfusion, and hypoxia in brain areas at risk, some time after the initial injury (primary brain injury). Secondary brain injury is sensitive to therapy it can be preventable and modifiable.
Methods: This cohort study with primary data medical records. The data consists of multiple variables collected retrospectively from patient medical records at Hasan Sadikin Hospital Bandung West Java, Indonesia. Data were collected in 2011-2014. The number of samples was 647 patients. Analysis was conducted on univariate, bivariate, and multivariate Cox proportional hazards analysis with a mathematical model which would then be created scoring models. Roctab analysis
is used to determine the cut-off value of any numeric variable.
Results: Variable brain hemorrhage, level of consciousness and cerebral edema is a risk factor outcomes, while variable increased intracranial pressure, electrolyte levels of sodium and chloride, as well as diuretic therapy is a risk factor for the occurrence of mortality outcomes in patients with severe traumatic brain injury. Based on the results of the multivariate analysis of prognostic factors scoring sequence obtained the dominant cause of death, the age variable having an HR of 1.00, sodium has HR 0.8, brain hemorrhage on CT scan head has a HR of 1.73, had a cerebral edema HR 2,53, hypoxia has a HR of 2.13, fracture maxillofascial have HR of 0.6 and hypotension have HR 0.7, surgery / trepanation HR 0.388, based on the analysis of the sodium, GCS, hypotension, MFS fracture, surgery and outcome protection factor whereas age, brain hemorrhage on a CT scan, cerebral edema, hypoxia is a risk factor for mortality outcomes in patients with severe head injury. From the results multivariate analysis has score of -69 s/d -47
experiencing low risk to experience death, a score of -46 s / d -20 experiencing moderate risk for the occurrence of death and a score of > -19 will experience a high risk of death. Conclusions: This Prognostic model scoring has capable to predict 84.75% factors related to the prognosis of severe traumatic brain injury. If there were 100 patients with severe traumatic brain injury in the presence of all variables and 76 patients will die and when 100 patients with severe traumatic brain injury in the absence of all variables that 25 patients will die., Background: Severe traumatic brain injury caused by traffic accidents is still one
of the major causes of death and disability in the productive age group. Secondary
brain injury is described as a physiological disorders, such as ischemia,
reperfusion, and hypoxia in brain areas at risk, some time after the initial injury
(primary brain injury). Secondary brain injury is sensitive to therapy it can be
preventable and modifiable.
Methods: This cohort study with primary data medical records. The data consists
of multiple variables collected retrospectively from patient medical records at
Hasan Sadikin Hospital Bandung West Java, Indonesia. Data were collected in
2011-2014. The number of samples was 647 patients. Analysis was conducted on
univariate, bivariate, and multivariate Cox proportional hazards analysis with a
mathematical model which would then be created scoring models. Roctab analysis
is used to determine the cut-off value of any numeric variable.
Results: Variable brain hemorrhage, level of consciousness and cerebral edema is
a risk factor outcomes, while variable increased intracranial pressure, electrolyte
levels of sodium and chloride, as well as diuretic therapy is a risk factor for the
occurrence of mortality outcomes in patients with severe traumatic brain injury.
Based on the results of the multivariate analysis of prognostic factors scoring
sequence obtained the dominant cause of death, the age variable having an HR of
1.00, sodium has HR 0.8, brain hemorrhage on CT scan head has a HR of 1.73,
had a cerebral edema HR 2,53, hypoxia has a HR of 2.13, fracture maxillofascial have HR of 0.6 and hypotension have HR 0.7, surgery / trepanation HR 0.388,
based on the analysis of the sodium, GCS, hypotension, MFS fracture, surgery
and outcome protection factor whereas age, brain hemorrhage on a CT scan,
cerebral edema, hypoxia is a risk factor for mortality outcomes in patients with
severe head injury. From the results multivariate analysis has score of -69 s/d -47
experiencing low risk to experience death, a score of -46 s / d -20 experiencing
moderate risk for the occurrence of death and a score of > -19 will experience a
high risk of death.
Conclusions: This Prognostic model scoring has capable to predict 84.75%
factors related to the prognosis of severe traumatic brain injury. If there were 100
patients with severe traumatic brain injury in the presence of all variables and 76
patients will die and when 100 patients with severe traumatic brain injury in the
absence of all variables that 25 patients will die]"
Depok: Universitas Indonesia, 2015
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Hubungan antara luka kekerasan tumpul di kepala dengan kerusakan otak = Correlation between blunt head trauma with traumatic brain injury
"[Pendahuluan: Trauma akibat benda tumpul pada kepala adalah salah satu trauma
yang dapat bersifat fatal, berkaitan dengan organ intrakranial yang bersifat vital
bagi kehidupan. Namun, luka kekerasan tumpul pada kepala tidak seluruhnya dapat
menyebabkan kerusakan organ intrakranial, berkaitan dengan berbagai faktor yang
menyebabkan luka, antara lain lokasi, besar gaya, arah gaya. Pada penelitian ini
akan dilihat hubungan antara luka kekerasan tumpul dengan adanya kerusakan otak.
Penelitian epidemiologi forensik ini digunakan untuk menunjang opini ahli dokter
forensik pada temuan luka akibat kekerasan tumpul di kepala dengan kerusakan
organ intrakranial. Metode: Penelitian ini merupakan penelitian cross-sectional
dengan data sekunder yang berasal dari visum et repertum pasien di Departemen
Forensik dan Medikolegal FKUI-RSCM. Hasil: Sebanyak 1% hubungan antara
memar pada kepala memiliki hubungan yang bermakna dengan kerusakan otak, 1%
hubungan antara ekskoriasi pada kepala memiliki hubungan yang bermakna dengan
kerusakan otak, sebanyak 82% hubungan antara laserasi pada kepala memiliki
hubungan yang bermakna dengan kerusakan otak, dan sebanyak 95,3% hubungan
antara fraktur pada kepala memiliki hubungan yang bermakna dengan kerusakan
otak. Diskusi: Hasil penelitian menunjukkan bahwa terdapat variasi hubungan
antara luka kekerasan tumpul dengan adanya kerusakan otak berdasarkan jenis serta
lokasi luka luar dan lokasi kerusakan intrakranialnya. Variasi hasil ini terjadi karena
luka kekerasan tumpul, yaitu memar, ekskoriasi, laserasi, dan fraktur, masingmasing
memiliki mekanisme yang berbeda, dan timbul akibat besar gaya yang
berbeda. Memar dan ekskoriasi, luka kekerasan tumpul yang disebabkan oleh gaya
yang kecil dan menyebabkan diskontinuitas jaringan luar hanya sedikit hanya
memiliki sedikit hubungan dengan kerusakan otak. Laserasi dan fraktur memiliki
banyak hubungan dengan kerusakan otak oleh karena gaya penyebab luka
kekerasan tumpul tersebut bersifat lebih besar, Introduction: Blunt head trauma had a high fatality rate, as the head protects
intracranial organs that are vital to the continuity of life. However, not all blunt
head trauma cause the same damage to intracranial organs, due to the various
factors such as location, the strength of the force, and the direction from which the
striking force came. This forensic epidemiological study is designed to support
expert opinions in forensic practice regarding the findings of blunt head trauma and
intracranial organ damage. In this study, the correlation between blunt head trauma
and traumatic brain injury were analyzed. Methods: This study is a cross-sectional
study with secondary data from patients’ visum et repertum in the Forensic and
Medicolegal Department of Cipto Mangunkusumo General Hospital. Results:
Results show that 1% of the correlations between bruise findings on the head had
significant association with traumatic brain injury, 1% of the correlations between
excoriation findings on the head had significant association with traumatic brain
injury, 82% of the correlations between laceration findings on the head had
significant association with traumatic brain injury, and 95,3% of the correlations
between fracture findings on the skull had significant association with traumatic
brain injury. Discussion: This study showed that the relationship between blunt
head injury with traumatic brain injury varied based on the location and type of the
external injury and the location of the intracranial organ. This variation in results
happened as external blunt head trauma such as bruise, excoriation, laceration, and
fracture each had different mechanisms, and were caused by various force intensity.
Bruising and excoriation, which were usually caused by smaller force and only
caused little damage externally, were found to have little correlation with traumatic
brain injury findings. On the other hand, laceration and fracture were found to have
more correlation with traumatic brain injury findings, since both traumas were
usually caused by a greater force.]"
[, Fakultas Kedokteran Universitas Indonesia], 2015
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Jeffri Harisman
Gambaran Status Epileptikus Non Konvulsif Pada Pasien Cedera Kepala Sedang-Berat dan Faktor-Faktor yang Mempengaruhi = Non Convulsive Status Epilepticus In Adult Moderate-Severe Traumatic Brain Injury Patients and Associated Factors
"Latar belakang: Status epileptikus non konvulsif (SENK) dapat ditemukan pada
cedera kepala sedang-berat (CKS-B). Timbulnya kejang pascatrauma dapat
memperberat cedera otak yang sudah terjadi, sehingga dapat mempengaruhi luaran.
Gejala klinis SENK tidak spesifik, sehingga membutuhkan pemeriksaan
elektroensefalografi (EEG) dalam penegakkan diagnosis. Penelitian ini bertujuan
mengetahui angka kejadian SENK, faktor yang mempengaruhi, gambaran demografi
(usia, jenis kelamin dan luaran), gejala klinis, gambaran pencitraan dan EEG pada
pasien CKS-B dengan SENK.
Metode penelitian: Penelitian ini menggunakan desain potong lintang dengan sampel
terdiri dari data primer, yaitu semua CKS-B dari bulan Juli-Desember 2019 secara
consecutive sampling dan data sekunder, yaitu subjek CKS-B dengan klinis kecurigaan
SENK dari bulan Januari 2017-Juni 2019 di Rumah Sakit Umum Pusat Nasional Cipto
Mangunkusumo (RSUPNCM), Jakarta. Penegakkan diagnosis SENK dilakukan melalui
kriteria modified salzburg consensus criteria for non convulsive status epilepticus
(mSCNC).
Hasil penelitian: Sebanyak 39 sampel CKS-B masuk ke dalam penelitian yang terdiri
dari 14 data primer dan 25 data sekunder. Sebanyak 19 dari 39 sampel terdiagnosis
SENK. Proporsi insiden SENK pada CKS-B dari Juli-Desember 2019 sebesar 21,4% (3
dari 14 sampel). Pada kelompok SENK didapatkan usia lebih tua, laki-laki lebih banyak
dari perempuan (3:1) dan kecelakaan lalu lintas sebagai mekanisme utama. Manifestasi
klinis SENK, antara lain penurunan kesadaran (23,1%), agitasi psikomotor (12,8%),
delirium (5,1%) dan gangguan persepsi (5,1%). Lobus frontal dan SAH merupakan
daerah lokasi cedera dan patologi terbanyak. Hanya didapatkan 2 sampel dengan kriteria
definit SENK dan selebihnya possible SENK. Sebagian besar bangkitan SENK berasal
dari lobus temporal. Analisis multivariat menunjukkan lokasi cedera lobus temporal
bermakna berhubungan dengan kejadian SENK (p = 0,036, OR 11,45 (95% IK 1,17-
111,6).
Kesimpulan: Proporsi insiden SENK pada CKS-B di RSUPNCM sebesar 21,4%.
Penurunan kesadaran merupakan gejala klinis SENK terbanyak. Lobus temporal
merupakan faktor yang berhubungan terhadap kejadian SENK.
Background: Non convulsive status epilepticus (NCSE) can be accounted by moderatesevere
traumatic brain injury (TBI). Posttraumatic seizure can aggravate the previous
injury and produce poor outcome. Electroecephalography (EEG) was employed as
diagnostic tool because unspecified clinical symptoms. This study was aimed to find
incidence proportion, associated risk factors, demographic profiles (age, gender,
outcome), clinical symptoms, imaging and EEG patterns of NCSE in moderate-severe
TBI patients.
Method: Cross-sectional design was applied ini this study. Data is consist of primary
data which include all moderate-severe TBI since July-December 2019 by consecutive
sampling and secondary data which include moderate-severe TBI since January 2017-
June 2019 with highly suspicious NCSE symptoms in Cipto Mangunkusumo Hospital,
Jakarta. EEG was employed as diagnostic tool by using modified salzburg consensus
criteria for non convulsive status epilepticus (mSCNC) as a criteria.
Result: Of 39 samples, 19 moderate-severe TBI samples (14 primary data, 25
secondary data) were diagnosed as NCSE. Incidence proportion of NCSE from July-
December 2019 is 21,4% (3 from 14 samples). Older age, man gender, traffic accident
and worse outcome are the most common NCSE demographic profiles. Loss of
consciousness (23,1%) is a main symptom, followed by psychomotor agitation (12,8%),
delirium (5,1%) dan perception disturbance (5,1%). Frontal lobe and SAH are
consecutively as the most common injury location and pathologic finding. Only 2
samples have definite NCSE diagnosis and the remaining as possible NCSE. Most of
NCSE discharges were originated from temporal lobe. Temporal lobe injury location
has significance relation toward SENK occurance (p = 0,036, OR 11,45 (95% CI 1,17-
111,6).
Conclusion: Incidence proportion of NCSE in moderate-severe TBI is 21,4%. Loss of
consciousness is the most finding symptoms. Temporal lobe is a factor relates to NCSE
occurance."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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Elisa Harlean
Pengaruh koagulopati dengan keluaran perawatan pasien cedera kepala sedang-berat : analisis kasus kontrol = The association of coagulopathy with outcome in patients with moderate severe traumatic brain injury a : case control analysis
"Latar Belakang: Cedera kepala dikaitkan dengan aktivasi kaskade koagulasi dapat menyebabkan koagulopati. Hal ini berhubungan dengan hasil akhir atau keluaran yang tidak baik pada pasien. Deteksi dini dan evaluasi berkala faktor hemostasis dibutuhkan pada pengelolaan pasien cedera kepala sedang dan berat dalam memperbaiki hasil keluaran perawatan pasien cedera kepala.
Tujuan: Diketahuinya angka kejadian prevalensi koagulopati pada pasien cedera kepala sedang berat dan hubungan gangguan hemostasis tersebut dengan hasil keluarannya.
Metode Penelitian: Penelitian ini merupakan studi ?nested case control?. Studi ini bersarang pada penelitian awal yang berupa studi komparasi potong lintang. Data hemostasis diperiksa pada hari pertama(<24 jam dari kejadian) saat di Instalasi Gawat Darurat(IGD) RSCM. Pasien cedera kepala sedang dan berat ini nantinya akan diikuti sampai akhir perawatan inap dan dinilai hasil keluaran perawatannya. Koagulopati adalah gangguan status koagulasi, dapat berupa hiperkoagulasi atau hipokoagulasi
Hasil: Terdapat 76 sampel, 38 sampel memiliki keluaran baik dan 38 sampel memiliki keluaran buruk. Pria(81,6%) lebih banyak dari wanita. Sebagian besar subjek berusia 18-50 tahun(81,6%). Koagulopati terjadi pada 34,2% pasien. Koagulopati merupakan faktor prediksi keluaran buruk pada cedera kepala (OR 4,429; 95%IK 1,569 ? 12,502; p=0,004). Hasil analisis multivariat menunjukkan urutan prioritas kemaknaan faktor yang mempengaruhi keluaran subjek cedera kepala yang terkuat berturut-turut di penelitian ini adalah usia (50,271), derajat cedera kepala (46,522), dan koagulopati (5,409). Terdapat hubungan bermakna antara beratnya derajat cedera kepala dengan terjadinya koagulopati p= 0,009.
Kesimpulan: Prevalensi koagulopati pada cedera kepala sedang berat cukup tinggi. Pasien dengan koagulopati memiliki keluaran yang lebih buruk
Background: Brain injury is associated with activation of the coagulation cascade, contributing to coagulopathy. This condition is correlated with unfavorable outcome. Early detection and evaluation of hemostatic factors are needed in treatment of moderate-severe traumatic brain injury (TBI) to improve patient outcome.
Objectives: To determined the number of prevelence coagulopathy in moderate severe TBI and the relationship of the hemostatic disorder with outcome.
Materials and Method: We did the nested case control study. Hemostatic parameters were recorded from emergency departement (ED) not exceeding 24 hours from onset of accident. Moderate-severe TBI patients were followed until the patients discharged and we assessed the outcome. Coagulopathy was defined as hypocoagulopathy or hypercoagulopathy.
Results: From 76 subjects, 38 subjects were favorable outcome and 38 subjects had unfavorable outcome. Men were higher than women (81,6%), mostly subjects were in range 18-50 years(81,6%). Coagulopathy occured in 36% of all patients. Coagulopathy was the predictor of unfavorable outcome for TBI (OR 4,429; 95%CI 1,569 ? 12,502; p=0,004). From the multivariate analysis, the priority level for TBI outcome, in order of strongest to weakest correlation, were age (50,271), severity of traumatic brain injury(46,522) and coagulopathy(5,409). There was significant correlation between severity of traumatic brain injury and coagulopathy (p= 0,009).
Conclusions: Our study confirmed a quite high prevalence of coagulopathy in patients with moderate-severe TBI. Patients with coagulopathy had poorer outcome compared to non-coagulopathy"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016
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