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"ABSTRAKLatar Belakang. Biomarker dapat digunakan untuk memprediksi derajat keparahan trauma kepala.Tujuan. Mengetahui hubungan antara kadar S100B dengan derajat keparahan trauma kepala dan kelainan CT scan kepala.Metode Penelitian. Penelitian potong lintang di IGD RSUPN Cipto Mangunkusumo, RSUP Fatmawati, dan RS Permata Cibubur selama Juli-Desember 2015. Subjek adalah anak usia 1-18 tahun yang mengalami trauma kepala dengan onset <24 jam. Setiap subjek dilakukan pemeriksaan skor Skala Koma Glasgow Pediatrik, pemeriksaan CT scan kepala bila terdapat indikasi, serta pemeriksaan kadar S100B dari serum.Hasil Penelitian. Subjek penelitian terdiri atas 20 subjek trauma kepala ringan dan 18 subjek trauma kepala sedang. Hasil penelitian menunjukkan terdapat perbedaan bermakna kadar S100B kelompok trauma trauma kepala sedang dan kepala ringan; median (rentang) 0,173 (0,054-0,812) μg/L dibandingkan 0,067 (0,039-0,084) μg/L, p<0,001. Selain itu juga terdapat perbedaan bermakna antara kelompok yang terdapat kelainan CT scan kepala dibandingkan dengan yang tidak ada kelainan; 0,124 (0,051-0,812) μg/L dan 0,067 (0,039-0,084) μg/L, p=0,001. Berdasarkan analisis ROC, kadar S100B serum sangat kuat untuk memprediksi trauma kepala sedang (AUC 0,818, p=0,001 dan IK95% 0,668-0,969) dengan nilai cut-off 0,083 μg/L.Simpulan. Kadar S100B serum pada trauma kepala sedang secara bermakna lebih tinggi dari trauma kepala ringan serta memiliki kemampuan diskriminasi sangat baik untuk memprediksi derajat keparahannya.

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ABSTRACT

Background. Biomarker has ability to predict the severity of TBI and abnormal CT scan.

Objectives. To determine the association between S100B level with the severity of pediatric TBI and intracranial injury.

Methods. A cross-sectional study at Emergency Department of RSUPN Cipto Mangunkusumo, RSUP Fatmawati, and Permata Cibubur Hospital on July- December 2015. Subjects were 1-18 year-old children with TBI, onset within 24 hours before admission. We measured Pediatric GCS score, serum S100B level, and performed cranial CT scan if indicated.

Results. Twenty subjects had mild TBI and 18 subjects had moderate TBI were included. S100B levels were higher in children with moderate TBI as compared to children with mild TBI; 0,173 (0,054-0,812) μg/L vs 0,067 (0,039-0,084) μg/L, p<0,001. S100B levels were significantly elevated in children following TBI with abnormal cranial CT scan as compared to children with a normal CT scan (0,124 (0,051-0,812) μg/L vs 0,067 (0,039-0,084) μg/L, p=0,001). AUC for S100B was also significant (0,818, p=0,001, CI95% 0,668-0,969) as prediction of moderate TBI with cut-off point 0,083 μg/L.

Conclusions. Children with moderate TBI had significantly higher S100B levels as compared to children with mild TBI. Cut-off point S100B level at 0,083 μg/L has good ability to predict the severity of TBI."

"ABSTRAKLatar Belakang Biomarker dapat digunakan untuk memprediksi derajat keparahan trauma kepala Tujuan Mengetahui hubungan antara kadar S100B dengan derajat keparahan trauma kepala dan kelainan CT scan kepala Metode Penelitian Penelitian potong lintang di IGD RSUPN Cipto Mangunkusumo RSUP Fatmawati dan RS Permata Cibubur selama Juli Desember 2015 Subjek adalah anak usia 1 18 tahun yang mengalami trauma kepala dengan onset

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ABSTRACTBackground Biomarker has ability to predict the severity of TBI and abnormal CT scan Objectives To determine the association between S100B level with the severity of pediatric TBI and intracranial injury Methods A cross sectional study at Emergency Department of RSUPN Cipto Mangunkusumo RSUP Fatmawati and Permata Cibubur Hospital on July December 2015 Subjects were 1 18 year old children with TBI onset within 24 hours before admission We measured SKG score serum S100B level and performed cranial CT scan if indicated Results Twenty subjects had mild TBI and 18 subjects had moderate TBI were included S100B levels were higher in children with moderate TBI as compared to children with mild TBI 0 173 0 054 0 812 g L vs 0 067 0 039 0 084 g L p;Background Biomarker has ability to predict the severity of TBI and abnormal CT scan Objectives To determine the association between S100B level with the severity of pediatric TBI and intracranial injury Methods A cross sectional study at Emergency Department of RSUPN Cipto Mangunkusumo RSUP Fatmawati and Permata Cibubur Hospital on July December 2015 Subjects were 1 18 year old children with TBI onset within 24 hours before admission We measured SKG score serum S100B level and performed cranial CT scan if indicated Results Twenty subjects had mild TBI and 18 subjects had moderate TBI were included S100B levels were higher in children with moderate TBI as compared to children with mild TBI 0 173 0 054 0 812 g L vs 0 067 0 039 0 084 g L p;Background Biomarker has ability to predict the severity of TBI and abnormal CT scan Objectives To determine the association between S100B level with the severity of pediatric TBI and intracranial injury Methods A cross sectional study at Emergency Department of RSUPN Cipto Mangunkusumo RSUP Fatmawati and Permata Cibubur Hospital on July December 2015 Subjects were 1 18 year old children with TBI onset within 24 hours before admission We measured SKG score serum S100B level and performed cranial CT scan if indicated Results Twenty subjects had mild TBI and 18 subjects had moderate TBI were included S100B levels were higher in children with moderate TBI as compared to children with mild TBI 0 173 0 054 0 812 g L vs 0 067 0 039 0 084 g L p;Background Biomarker has ability to predict the severity of TBI and abnormal CT scan Objectives To determine the association between S100B level with the severity of pediatric TBI and intracranial injury Methods A cross sectional study at Emergency Department of RSUPN Cipto Mangunkusumo RSUP Fatmawati and Permata Cibubur Hospital on July December 2015 Subjects were 1 18 year old children with TBI onset within 24 hours before admission We measured SKG score serum S100B level and performed cranial CT scan if indicated Results Twenty subjects had mild TBI and 18 subjects had moderate TBI were included S100B levels were higher in children with moderate TBI as compared to children with mild TBI 0 173 0 054 0 812 g L vs 0 067 0 039 0 084 g L p"

"Latar Belakang: Protein S100B merupakan protein yang berikatan dengan kalsium pada sel-sel astroglial jaringan otak. Peningkatan kadar protein S100B dalam serum disebabkan karena aktivasi kerusakan astrosit dan sel glial, dan kerusakan integritas sawar darah otak. Beberapa studi prospektif terakhir, para ahli menghubungkan protein S100B dengan prediksi keluaran pasien cedera kepala. Tujuan: Mengetahui hubungan kadar Protein S100B 6 jam pasca trauma terhadap skala keluaran GOSE 3 bulan pada penderita CKR dan CKS. Metode: Penelitian ini bersifat deskriptif analitik dengan data dikumpulkan secara prospektif pada pasien cedera kepala ringan dan sedang yang dirawat di UGD RSCM. Hasil: Dari 45 sampel, didapatkan kelompok yang paling banyak adalah laki-laki (65.7%), usia 15-20 tahun (45.7%), tingkatp endidikan SMA (48.6%), CT scan normal (54.3%), kadar protein S100B < 0.403 μg/L (54.3%) dan GOSE >= 7 (71.4%). Terdapat hubungan yang bermakna antara derajat cedera kepala dengan GOSE, CT scan dengan GOSE dan kadar protein S100B dengan GOSE. Kesimpulan: Protein S100B merupakan prediktor yang sensitif terhadap keluaran, dimana pasien dengan protein S100B tinggi memperlihatkan keluaran yang buruk dibandingkan pasien dengan kadar protein S100B rendah.

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Backgrounds: S100B protein is a protein that binds with calcium in brainastroglial cell. The increase in S100B serum level can be caused caused byastrocyte and glial cell damage and disturbance of blood brain barrier. Several prospective studies have elooked into the relationship of S100B protein with headinjury patents outcome.

Aim: To investigate the relationship between S100B protein level 6 hours aftertrauma and the outcome of patients with mild and moderate head injury using GOSE 3 months after trauma.

Method: This is an analytic descriptive study using data collected prospectivelyin mild and moderate head injury patients admitted to the emergency departmentof Cipto Mangunkusumo hospital.

Result: The majority of patients were male 65 7 aged between 15 20 yearsold 45 7 senior high school graduates 48 6 with normal CT scan 54 3 with S100B protein level 0 403 g L 54 3 and with GOSE 7 71 4. There was a significant relationship between the severity of head injury and GOSE CT scan finding and GOSE and S100B protein level and GOSE.

Conclusion: S100B protein level is a sensitive predictor for head injury patientoutcome in which patients with higher S100B protein level correlates with pooreroutcome."

"ABSTRAKTujuan : 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.

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ABSTRACTObjective: 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."

"PENDAHULUAN : Cedera kepala menjadi penyebab kematian paling umum pada usia kurang dari 40 tahun di negara maju dan berkembang, luaran setelah cedera kepala masih menjadi masalah dan sulit diprediksi. GCS telah ditetapkan sebagai prediktor luaran cedera kepala akibat trauma maupun non-trauma, namun prediktor luaran cedera kepala lain saat ini telah banyak dipakai salah satu adalah biomarker neuroinflamasi yaitu Rasio Neutrofil Limfosit (RNL) yang masih jarang diteliti.METODE : Penelitian prospektif ini didasarkan pada kasus cedera kepala sedang dan berat yang dilakukan operasi kraniotomi di multisenter rumah sakit pada November 2019-November 2020. Uji chi-square digunakan untuk mengetahui kemaknaan statistik dari hubungan antara demografi (usia dan jenis kelamin), gejala klinis serta hubungan RNL dan GCS sebagai prediktor luaran pada penelitian ini. Dilakukan analisis ROC untuk mendapatkan cut off RNL.HASIL : Dari 54 pasien cedera kepala sedang dan berat (GCS 7-13) pada November 2019-November 2020 didapatkan dominasi laki-laki 41 (75,9%) pasien dan perempuan 13 (24,1) pasien, usia (mean±SD) 27,6±15,3, GCS preoperasi (median; min-maks) 13 (7-13), gejala klinis pupil anisokor 33 (61,1), kejang 5(9,3), hemiparesis 1 (1,86), GCS pascaoperasi hari kelima dan ketujuh (median; min-maks) 14 (6-15). RNL Preoperasi 7,4 (1,9-26,2) dan untuk nilai cut off RNL 9,8 dengan spesisfisitas dan sensitifitas 87% yang signifikan dengan nilai p=<0,001.KESIMPULAN: Terdapat hubungan bermakna secara statistik RNL dan GCS preoperasi. Dimana dimana dengan nilai RNL yang rendah memiliki luaran fungsional yang baik sebaliknya pada pasien dengan RNL yang tinggi dengan luaran fungsional yang buruk.

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INTRODUCTION: Traumatic brain injury (TBI) is the most common cause of death on population less than 40 years old in developed and developing countries. The clinical outcome after TBI is still an issue and difficult to predict. GCS has been used to predict outcome after either traumatic or non-traumatic brain injury. But several other outcome factors also can predict outcome after TBI, such as neutrophil to lymphocyte ratio (NLR) as one of neuroinflammation biomarkers.

METHOD : This prospective study included moderate and severe TBI patients were performed craniotomy in a multicenter hospital, from November 2019 to November 2020. Chi-square analytic test was used to determine the relationship between demographics (age and sex), clinical symptoms, RNL and GCS as a predictors outcome of moderate and severe TBI.

RESULT : 54 patients moderate and severe TBI (GCS 7-13) consist of 41 (75.9%) male and 13 (24.1%) female patients, age (mean±SD) 27.6±15.3, preoperative GCS (median; min-max) 13 (7-13), with asymmetric pupil 33 (61.1%), seizures 5 (9.3%), hemiparesis 1 (1.86%), and GCS postoperative on the fifth and seventh day (median; min-max) 14 (6 - 15). Preoperative NLR was 7.4 (1.9-26.2) and the cut off for NLR as a predictor for improved GCS was at 9.8 with a specificity and sensitivity of 87% with signification of p=<0.001.

CONCLUSSION : There was a statistically significant relationship between preoperative RNL and GCS. Whereas with a low RNL value has a good functional outcome in contrast to patients with high RNL with poor functional outcome.

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"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

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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 "

"ABSTRAKLatar Belakang: Pasien cedera kepala sedang (CKS) dan cedera kepala berat (CKB) memerlukan perawatan di rumah sakit sehingga beresiko terkena infeksi nosokomial seperti pneumonia yang dapat memperburuk keluaran. Karena banyaknya faktor yang dapat mempengaruhi keluaran pasien cedera kepala dengan pneumonia, diperlukan suatu sistem skoring untuk menilai derajat keparahan pneumonia.Tujuan: Untuk mengetahui apakah sistem skoring CURB-65 dapat dipakai untuk memprediksi keluaran pasien CKS dan CKB yang mengalami pneumonia.Metode: Penelitian ini merupakan studi prospektif. Subjek penelitian adalah seluruh pasien CKS dan CKB yang dirawat di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta selama periode penelitian. Diagnosis pneumonia ditegakkan sesuai kriteria The Center for Disease Control (CDC). Penilaian derajat keparahan pneumonia dilakukan dengan skoring CURB-65. Keluaran yang dinilai adalah hidup atau meninggal.Hasil: Dari 176 pasien CKS dan CKB, terdapat 26 pasien yang menderita pneumonia. Rentang usia subjek penelitian adalah 15 - 71 tahun. Sebagian besar berjenis kelamin laki-laki dan berusia < 65 tahun. Nilai maksimal dari CURB-65 pada penelitian ini adalah 3. Sedangkan nilai yang terbanyak adalah 2. Nilai CURB-65 ditemukan tidak bermakna sebagai prediktor keluaran pasca cedera kepala. Keluaran pasien cenderung dipengaruhi variabel usia, penurunan kesadaran, peningkatan kadar BUN, dan peningkatan frekuensi napas. Diantara 5 pasien yang meninggal, ada 2 pasien yang memiliki nilai CURB-65 = 3, sehingga tampak adanya kecenderungan peningkatan mortalitas pada pasien-pasien dengan nilai CURB-65 = 3.Kesimpulan: Walaupun skoring CURB-65 tidak bermakna sebagai prediktor keluaran pada pasien CKS dan CKB dengan pneumonia, penelitian pendahuluan ini menemukan adanya kecenderungan pengaruh masing-masing komponen CURB-65 (penurunan kesadaran, frekuensi napas, kadar BUN, serta usia) terhadap resiko kematian pasien

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ABSTRACTBackground: Patients with moderate and severe traumatic brain injury (TBI) require hospitalization, therefore they have higher risk in developing nosocomial infections such as pneumonia which can worsen their outcomes. Since there are many factors that can affect outcome of head-injured patients with pneumonia, a scoring system for evaluating the severity of pneumonia is needed.Objective: To know whether the CURB-65 scoring system can be used to predict the outcome of moderate and severe TBI patients who developed pneumonia during hospitalization.Methods: This was a prospective study. The study subjects were all moderate and severe TBI patients who had been hospitalized in Cipto Mangunkusumo Hospital during the research period. Diagnosis of pneumonia was confirmed if the patient fulfiled the criteria from The Center for Disease Control (CDC). The severity of pneumonia was determined by using CURB-65 scoring system. The outcome would either be dead or alive.Results: Of 176 patients with moderate and severe TBI, there were 26 patients who developed pneumonia. The age of the subjects ranged between 15 to 71 years. Most of them were male and over the age of 65. The maximum score of CURB-65 was 3. The mode of CURB-65 score was 2. CURB-65 was shown to be not useful in predicting outcome of head-injured patients with pneumonia. The outcome was seemingly associated with age, loss of consciousness, BUN, and respiratory rate. Among 5 patients who were dead, there were 2 patients who had a CURB-65 score of 3, thus there was a trend of increasing mortality in patients with a CURB-65 score of 3.Conclusions: Although the CURB-65 scoring system was not found to be useful in predicting outcome of moderate and severe TBI patients, this preliminary study have found that there were a tendency that each component of CURB-65 (loss of consciousness, respiratory rate, BUN, age) have some effects on mortality. "

"Latar Belakang: Cedera kepala merupakan penyebab kematian paling sering pada orang dewasa muda, Dari penelitian perkiraan keluaran pasien cedera kepala sudah dapat diprediksi dalam 3 hari perawatan. Klasifikasi diffuse injury berdasarkan tomografi komputer kepala saat pertama kali datang dengan melihat sisterna mesensefalika, derajat midline shift dan ada atau tidak rnassa intrakranial operatif dapat memprediksi kematian pasien cedera kepala. Skala diffuse injury dibagi menjadi 4 subgrup, makin tinggi skala diffuse injury-nya, makin tinggi angka kematiannya.Tujuan: Menentukan derajat diffuse injury untuk memperkirakan kemungkinan kematian 3 hari pertama pasien dewasa cedera kepala sedang dan berat,Desain dan Metode: Studi dengan disain nested case control yang bersarang pada penelitian prospektif tanpa pembanding. Pasien dewasa cedera kepala derajat sedang dan berat yang mengalami kematian dini akan dimasukkan sebagai kelompok studi, sedangkan kelompok kontrol akan diambil secara random dari pasien-pasien yang tidak mengalami kematian dini.Hasil: Dari 103 subyek penelitian didapatkan 24 (23,3%) penderita mengalami CKB dan 79 (76,7%) penderita CKS. Terdapat 23 (22,3 %) penderita yang meninggal daiam 3 hari pertama. Faktor yang berpeng ruh terhadap kematian adalah SKG, diffuse injury, sisterna mesensefalika, mid/Inc shift 5 mm atau lebih, denyut nadi, frekuensi nafas, jumlah leukosit dan tekanan PC02. Hasil analisis muitivariat menunjukkan bahwa faktor resiko independen kematian 3 hari pertama adalah skala diffuse injury (p=0,005), midline shift 5 mm (p=0,000) dan denyut nadi (p=0,016).Kesimpulan: Skala diffuse injury unfavorable dapat memprediksi kematian dalam 3 hari pertama. Midline shift 5 mm sebagai komponen skala berperan sebagai faktor resiko terjadinya kematian pasien dewasa cedera kepala sedang dan berat.

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Background: Head injury is the most frequent cause of mortality in young adult. Previous studies showed that outcome of head injured patient could be predicted in the first 3 days from the on set. Classification of head injury based primarily on information gleaned from the initial computerized tomography (CT) is described. It utilizes the status of the mesencephalic cisterns, the degree ofmidiine shift in millimeters, and the presence of absence of one or more surgical masses could be predict mortality in trauma. The term `diffuse injury' is divided into four subgroups, and the higher mortality had a strong correlation with the higher scale,

Objective: To formulate prediction scale using `diffuse injury' to know the risk of moderate and severe head injury in the first 3 days.

Methods: It was cross sectional study and continued with nested case control without comparison between moderate and severe head injury patient. Patient who was died in the first 3 days were included as study group while control group has been consisted of patient who was not died in the first 3 days and selected randomly.

Result: from 103 subject, there were 24 (23,3%) severe head injury and 79 (76,7%) moderate head injury. There were 23 (22,3%) patients who was died in the first three days. Significant factor that had influence to the mortality were GCS, diffuse injury, mesencephalic cisterns, midline shift 5 mm or more, pulse rate, respiratory rate, leucocytes count and PCO2 . Multivariate analysis showed the independent risk factors to mortality in the first 3 days were diffuse injury (p=0,006), midline shift 5 mm or more (p=0,000) and pulse rate (p=0,016).

Conclusion: Diffuse injury could predict mortality in the first 3 days of head injury patient. Midline shift as one of diffuse injury components is the leading risk factor of mortality in moderate and severe head injury patients in this research."