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Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) merupakan sistem skoring yang memprediksi morbiditas dan mortalitas berdasarkan 12 parameter fisiologis dan 6 parameter pembedahan. American Society of Anesthesiologist’s Physical Status (ASA-PS), yang terdiri dari 6 tingkatan, adalah skoring prediksi risiko pembedahan yang pertama kali dikembangkan dan paling sering digunakan saat ini. Penelitian ini bertujuan untuk menilai apakah kemampuan prediksi in-hospital mortality skoring P-POSSUM lebih baik dibanding skoring ASA-PS. Penelitian kohort retrospektif di RSCM selama bulan Mei-Juli 2018. Sebanyak 230 rekam medis diambil sesuai pasien yang menjalani laparotomi emergensi pada periode 1 Januari 2016-31 Desember 2017. Penilaian status ASA dicatat sesuai rekam medis dan dilakukan penilaian P-POSSUM. Analisis data dilakukan dengan komparatif Area Under the Curve (AUC), Hosmer Lemeshow goodness of fit dan multivariat regresi logistik. Angka in-hospital mortality pasien pascalaparotomi emergensi periode Januari 2016-Desember 2017 adalah sebesar 21,3%. Nilai kalibrasi ASA-PS lebih baik dibanding dengan P-POSSUM (p 0,072 vs 0,043). Nilai diskriminasi P-POSSUM lebih baik dibanding dengan ASA-PS (AUC 87,9% vs 76,2%). Komponen P-POSSUM yang paling berhubungan dengan in-hospital mortality adalah usia, riwayat gangguan napas, GCS, hemoglobin, natrium, kontaminasi intraperitoneal dan EKG. Skor P-POSSUM lebih baik dibanding ASA-PS dalam memprediksi in-hospital mortality pasien pascalaparotomi emergensi.

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Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) is a scoring system which predicts morbidity and mortality based on 12 physiologic and 6 operative parameters. American Society of Anesthesiologist’s Physical Status (ASA-PS), consists of 6 categories, is the first scoring system predicting risk preoperatively and mostly use to this date. Our goals are to evaluate and compare the ability of these two scores in predicting mortality. This is a retrospective cohort taken place in RSCM within May to July 2018. There was 230 medical records taken as samples based on patient who underwent emergency laparotomy within period 1 January 2016 to 31 December 2017. ASA physical status was recorded and P-POSSUM score was assessed. Data were analyzed to compare Area Under the Curve (AUC), Hosmer Lemeshow goodness of fit and multivariate of logistic regression. In-hospital mortality of patient undergoing emergency laparotomy within period January 2016 to December 2017 is 21.3%.  Calibration performance of ASA-PS is better than P-POSSUM (p 0,072 vs 0,043). Discrimination performance of P-POSSUM is better than ASA-PS (AUC 87,9% vs 76,2%). Parameters of P-POSSUM, which most related with in-hospital mortality, are age, respiratory disorder, GCS, hemoglobin, sodium, intraperitoneal contamination and ECG. P-POSSUM is better than ASA-PS in predicting in-hospital mortality of patient undergoing emergency laparotomy.

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"ABSTRAKLatar belakang: Stratifikasi risiko terhadap pembedahan sangat membantu dalam pengambilan keputusan klinis perioperatif, edukasi, evaluasi, dan audit klinis. Kraniotomi pada tumor otak sebagai tindakan pembedahan berisiko tinggi belum memiliki stratifikasi risiko yang akurat di RSUPNCM karena masih menggunakan ASA yang bersifat subjektif dan kurang informatif. P-POSSUM terbukti tepat dalam prediksi mortalitas pascabedah kraniotomi di India dan Inggris, namun belum diketahui ketepatannya di Indonesia, khususnya di RSUPNCM. Tujuan: Penelitian ini bertujuan untuk mengetahui ketepatan P-POSSUM dalam prediksi mortalitas pascabedah kraniotomi pada tumor otak di RSUPNCM. Metode: Disain penelitian adalah deskriptif analitik retrospektif terhadap seluruh pasien dewasa dengan tumor otak yang menjalani kraniotomi di RSUPNCM selama periode Januari 2015 - Desember 2016. Hasil: Sebanyak 196 subjek dilibatkan dalam analisis risiko mortalitas. Didapatkan rasio O:E 1,68 secara keseluruhan dengan rasio O:E 1,91 pada jangkauan risiko 0-5 dan 1,69 pada jangkauan risiko 11-20 . Hasil uji Hosmer-Lemeshow menunjukkan perbedaan yang signifikan antara angka mortalitas prediksi dan aktual p=0,006 . Simpulan: P-POSSUM tidak tepat dalam prediksi mortalitas pascabedah kraniotomi di RSUPNCM. Diperlukan kajian dan penyesuaian lebih lanjut sebelum P-POSSUM dapat digunakan pada populasi bedah saraf di RSUPNCM.

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ABSTRACTBackground Risk stratification in surgery helps in perioperative clinical decision making, education, evaluation, and clinical audit. Craniotomy on brain tumor as a high risk surgery does not have an accurate risk stratification in RSUPNCM because they still use ASA, which is subjective and not informative. P POSSUM had been proven to be accurate in predicting postoperative mortality after craniotomy in India and England, but it has not been studied in Indonesia, especially in RSUPNCM. Aim This study was done to gain knowledge about the accuracy of P POSSUM for predicting mortality after craniotomy in brain tumor in RSUPNCM. Methods This was a retrospective descriptive analytic study on adults with brain tumor scheduled to have elective craniotomy in RSUPNCM between January 2015 ndash December 2016. Result 196 subjects were analyzed in this study. Overall O E ratio was 1.68 with O E ratio of 1.91 in the risk range of 0 5 and 1.69 in the risk range of 11 20 . Hosmer Lemeshow test showed significant difference between predicted and actual mortality rate p 0.006 . Conclusion P POSSUM was not accurate for predicting mortality after craniotomy in RSUPNCM. Further studies and adjustments are needed before P POSSUM can be used in neurosurgery population in RSUPNCM."

"Latar Belakang: Identifikasi risiko mortalitas pascabedah diketahui hanya pada 66 pembedahan dan 34 sisanya tidak teridentifikasi. Modalitas P-POSSUM dianggap lebih superior dibandingkan dengan modalitas ASA dalam memprediksi morbiditas dan mortalitas karena memperhitungkan beban pembedahan.Metode: Uji kesahihan ini dilakukan di RSUPN dr. Cipto Mangunkusumo. Dilakukan penelusuran data fisiologis dan operatif dari enam puluh delapan pasien bedah risiko tinggi elektif kemudian dilakukan perhitungan prediksi risiko dengan koefisien perhitungan skor P-POSSUM dalam situs internet http://www.riskprediction.org.uk dan dibandingkan dengan luaran mortalitas aktual. Kesahihan dinilai dengan penilaian kemampuan kalibrasi dan diskriminasi. Dilakukan analisis untuk mengetahui hubungan parameter-parameter P-POSSUM dengan mortalitas. Hipotesis penelitian ini adalah P-POSSUM sahih dalam memprediksi mortalitas 30 hari pasien bedah risiko tinggi dengan kemampuan prediksi lebih dari 80 .Hasil: Kemampuan diskriminasi didapatkan dengan menghitung luas AUC yaitu sebesar 89.2 IK 95 0,756 ndash;1,000; p=0,000 . Kemampuan kalibrasi dinilai baik dari analisis Hosmer-Lemeshow p=0,23 . Pada analisis bivariat hanya hemoglobin p=0,003 , tekanan darah sistolik p=0,031 dan leukosit p=0,007 yang berhubungan dengan mortalitas. Pada analisis regresi logistik didapatkan hanya tekanan darah sistolik p=0,043 dan leukosit p=0,010 yang berhubungan dengan mortalitas.Simpulan: P-POSSUM sahih dalam memprediksi mortalitas 30 hari pasien bedah risiko tinggi dengan kemampuan prediksi lebih dari 80 . Berdasarkan analisis bivariat didapatkan hemoglobin, tekanan darah sistolik dan leukosit yang berhubungan dengan mortalitas. Setelah analisis regresi logistik didapatkan hanya tekanan darah sistolik dan leukosit yang berhubungan dengan mortalitas. Kata Kunci: kesahihan, P-POSSUM, mortalitas, risiko tinggi

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BACKGROUND Postsurgery mortality risk identified only in 66 surgery and 34 remain unknown. P POSSUM considered more superior than ASA stratification in predicting morbidity and mortality since it calculates surgical risk.METHODS This research was performed in RSUPN dr. Cipto Mangunkusumo. Physiological and surgical parameter of sixty eight high risk patients were taken from medical record and then risk prediction was calculated by calculation coefficient of P POSSUM scoring from http www.riskprediction.org.uk. The comparison between predicted and actual mortality was performed. Validation is assessed by calibration and discrimination ability. The researchers also analyzed the correlation between P POSSUM parameters and mortality. We hypothesized that P POSSUM valid in predicting 30 days mortality high risk surgical patients with predicting ability more than 80.RESULTS Pada analisis regresi logistik didapatkan hanya tekanan darah sistolik p 0,043 dan leukosit p 0,010 yang berhubungan dengan mortalitas. Discrimination ability was assessed by calculating AUC area which is 89.2 CI 95 0,756 ndash 1,000 p 0,000 . Calibration ability is good based on Hosmer Lemeshow analysis p 0,23 . From bivariat analysis only hemoglobin p 0,003 , sistolic blood pressure p 0,031 and leukocyte p 0,007 have relationship with mortality. From multivariate logistic regression anylisis only sistolic blood pressure p 0,043 and leukocyte p 0,010 have relationship with mortality.CONCLUSION P POSSUM is valid in predicting 30 days mortality high risk surgical patients with predicting ability more than 80 . From bivariat analysis only hemoglobin, sistolic blood pressure and leukocyte have relationship with mortality. From multivariate logistic regression anylisis only sistolic blood pressure and leukocyte have relationship with mortality. Keywords validation, P POSSUM, mortality, high risk "

"Latar Belakang: Secara global diperkirakan terdapat 313 juta pembedahan yang dilakukan, dengan angka kematian 30 hari pascaoperasi mencapai 4.2 juta jiwa. Penilaian kondisi pasien preoperatif diperlukan untuk memprediksi morbiditas danmortalitas pasien pascabedah, maka modalitas yang digunakan dalam menilai risiko pembedahan sebaiknya memiliki akurasi dan objektivitas yang baik. Salah satu modalitas yang rutin digunakan di RSUPN Cipto Mangunkusumo (RSUPNCM) adalah skor ASA-PS. Namun skor ini sudah banyak ditinggalkan oleh negara maju dan beralih pada skor P-POSSUM yang dinilai lebih objektif, dan akurat. Studi ini menguji kesahihan skor P-POSSUM dalam memprediksi lama perawatan pasien pascabedah digestif mayor di ICU, yang mencerminkan keparahan morbiditaspascabedah. Tujuan: Studi ini menguji kemampuan kalibrasi dan diskriminasi skor P-POSSUM dalam memprediksi lama perawatan di ICU, dan menganalisis hubungan antar variabel skor P-POSSUM dengan lama perawatan di ICU pada pasien pasabedah digestif mayor. Metode: Studi ini merupakan studi kohort retrospektif di RSUPNCM selama Januari 2017 hingga Desember 2018. Sebanyak 289 subjek yang sesuai kriteria inklusi dianalisis dari data rekam medis. Lama perawatan pascabedah di ICU dan skor P-POSSUM subjek dicatat sesuai dengan data rekam medis. Variabel PPOSSUM yang berpengaruh terhadap lama perawatan subjek dianalisis dengan analisis bivariat dan regresi logistik multivariat. Kesahihan skor dinilai menggunakan uji kalibrasi Hosmer-Lemeshow dan uji diskriminasi dengan melihatnilai Area Under Curve. Hasil: Hasil analisis statistik menghasilkan bahwa skor P-POSSUM memiliki kemampuan kalibrasi yang baik (uji Hosmer-Lemeshow p=0.815) dan kemampuandiskriminasi yang cukup baik (AUC 77.8%, IK 95% 0.717-0.827). Variabel PPOSSUM yang secara statistik berpengaruh signifikan (p<0.05) terhadap lama perawatan di ICU adalah kadar natrium, jumlah perdarahan, laju jantung, dan EKG.Kesimpulan: Skor P-POSSUM sahih dalam memprediksi lama perawatan pasien pascabedah digestif mayor di ruang intensif (ICU).

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Background: It was estimated that there was 313 million surgery underwent worldwide, with the 30-days postoperative mortality rate reaching 4.2 million cases. The evaluation of preoperative patients’ conditions is encouraged to predict

postoperative morbidity and mortality, thus the modality used to assess surgery risk should be accurate and objective. RSUPN Cipto Mangunkusumo (RSUPNCM) routinely uses ASA-PS score to assess patients’ condition. Nonetheless, ASA-PS has

been regarded as subjective. Developed countries has started to replace this score with P-POSSUM score which was considered to be more accurate and objective. This study finds out the validity of P-POSSUM Score in predicting the length of

hospital stay in the ICU in patients who underwent digestive surgery, which reflects the severity of postoperative morbidity. Goals: This study investigated the calibration and discrimination ability of PPOSSUM score in predicting the length of stay in the ICU, and also explored the relationship between variables in P-POSSUM score and the length of stay in the ICU in patients who underwent digestive surgery.

Methods: This retrospective cohort study was conducted in RSUPNCM in January 2017 to December 2018 on 289 subjects who met the inclusion criteria. P-POSSUM score and the length of stay in the ICU unit were recorded, the data was taken from

medical record. Bivariate and multivariate logistic regression was used to investigate the relationship between P-POSSUM variables and the length of stay. The validity of P-POSSUM score was assessed by Hosmer-Lemeshow calibration

test and the measurement of the Area Under Curve (AUC).

Results: Statistical analysis showed that P-POSSUM had a good calibration ability (p=0.815 for Hosmer-Lemeshow test) and moderate discrimination ability (AUC 77.8%, CI 95% 0.717-0.827). Four P-POSSUM variables were found to be significantly associated with length of stay in the ICU (p<0.05), namely natrium level, total blood loss, heart rate and ECG. Conclusion: P-POSSUM score is valid in predicting the length of stay in the ICU in patients who underwent digestive surgery."

"ABSTRAKLatar belakang : Kunjungan dan angka mortalitas pasien di Instalasi Gawat Darurat (IGD) semakin meningkat dengan kondisi penyakit yang bervariasi, sehingga deteksi yang cepat dan tepat pada pasien dengan risiko mortalitas tinggi sangat penting. Skor Hypotension, Oxygen Saturation, Low Temperature, ECG Changes, and Loss of Independence (HOTEL) sangat baik dan penting untuk diterapkan pada pasien gawat darurat karena menggunakan variabel-variabel yang mudah dan cepat diperoleh. Namun demikian skor tersebut belum divalidasi di Indonesia.Tujuan : untuk menilai performa skor HOTEL dalam memprediksi mortalitas 24 jam pasien non bedah di IGD Rumah Sakit Cipto Mangunkusumo (RSCM).Metode: Penelitian ini merupakan studi kohort retrospektif. Subjek penelitian adalah pasien non bedah yang masuk ke IGD RSCM pada bulan Oktober hingga November 2012. Variabel bebas yang dinilai adalah tekanan darah sistolik, saturasi oksigen perifer, suhu tubuh, perubahan elektrokardiogram (EKG), dan kemampuan berdiri tanpa bantuan. Luaran yang dinilai adalah mortalitas dalam 24 jam setelah masuk IGD. Performa kalibrasi dinilai dengan uji Hosmer-Lemeshow. Performa diskriminasi dinilai dengan area under the curve (AUC).Hasil: Terdapat 815 pasien non bedah yang datang ke IGD RSCM selama bulan Oktober hingga November 2012. Sebanyak 804 (98,7%) subjek memenuhi kriteria inklusi dengan mortalitas 24 jam sebesar 30 (3,7%) subjek. Performa kalibrasi HOTEL dengan uji Hosmer-Lemeshow menunjukkan p = 0,753. Performa diskriminasi ditunjukkan dengan nilai AUC 0,86 (IK 95% 0,781; 0,931).Simpulan: Skor HOTEL memiliki performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 24 jam pada pasien non bedah yang masuk ke IGD RSCM.

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ABSTRACT

Background: The number of visit and mortality rate of emergency patients at Emergency Department (ED) have been increasing from time to time. Those patients have wide spectrum conditions. Appropriate identification of the patients with high mortality risk is crucial. The Hypotension, Oxygen Saturation, Low Temperature, ECG changes, and Loss of Independence (HOTEL) score is easy and important to be applied in the ED, however, the score has not been validated in Indonesia.

Objective: to evaluate performance of HOTEL score in predicting the 24-hour mortality non-surgical patients in ED of Sakit Cipto Mangunkusumo hospital.

Method: This was a retrospective cohort study. The research subjects were the non-surgical patients who admitted to ED of RSCM between October-November 2012. We collected systolic blood pressure, peripheral oxygen saturation, body temperature, ECG changes, and loss of independence. Those data were evaluated based on the HOTEL scoring system. The outcome were evaluated in 24- hour after admission (alive or dead). The calibration was evaluated with the Hosmer-Lemeshow test. The discrimination performance was evaluated with area under the curve (AUC).

Results: There were 815 non-surgical patients admitted to the ED between October until November 2012. There were 804 (98,7%) subjects included. The 24-hour mortality rate was 30 subjects (3,7%). The calibration performance with the Hosmer-Lemeshow test showed p = 0,753. The discrimination performance was shown with the AUC score 0,86 (95% CI 0.781; 0.931).

Conclusion: The HOTEL score has a good calibration and discrimination performance in predicting the 24-hour mortality of the non-surgical patients in ED of Cipto Mangunkusumo hospital."

"Pendahuluan: Skor TRISS menjadi salah satu alat yang paling umum digunakan mengukur keberhasilan pelayanan trauma. Saat ini belum ada data penggunaan Skor TRISS pada penanganan pasien politrauma di Instalasi Gawat Darurat (IGD) Rumah Sakit Cipto Mangunkusumo (RSCM). Penelitian ini disusun untuk mengetahui kemampuan skor TRISS memprediksi kematian pasien politrauma di IGD RSCM. Metode Penelitian: Penelitian ini adalah penelitian kohor retrospektif. Data diambil dari rekam medis pasien politrauma tahun 2011- 2014 yang datang di IGD RSCM. Analisis dilakukan untuk mengetahui hubungan skor TRISS dengan prognosis pasien. Dilakukan analisa bivariat dan multivariat dengan menggunakan program SPSS 18. Temuan Penelitian dan Diskusi: Terdapat 70 data pasien yang memenuhi inklusi pada pasien ini. Mayoritas pasien adalah laki-laki (65%) dan berusia muda. Terdapat 69 pasien yang mengalami trauma tumpul dengan kecelakaan lalu lintas menjadi penyebab terbanyak trauma paling banyak(94,3%). Sebanyak 26 pasien meninggal dunia dan 54 pasien survive setelah mendapat perawatan. Pada analisis bivariat dan multivariat didapatkan hubungan bermakna antara skor TRISS dengan prognosis pasien. Skor TRISS mampu memprediksi kuat mortalitas pasien politrauma (AUC = 0,899; IK95% 0,824-0,975). Skor TRISS mempunyai sensivitas 84,6% dan spesifivitas 81,8 % dengan titik potong optimal ≤90,5. Simpulan: Skor TRISS dapat memprediksi kematian pasien politrauma yang di rawat di RSCM.

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Introduction: TRISS score is one of the most commonly used trauma score. Currently there is no data about using TRISS score in the care of polytrauma patients at emergency department of Ciptomangunkusumo Hospital. This research is to determine whether TRISS score can predict the mortality of polytrauma patients at Ciptomangunkusumo Hospital.

Methods: It was a retrospective cohort study. Data was collected from medical records of polytrauma patients who was admitted to emergency department of Ciptomangunkusumo Hospital 2011-2014. From there, we analyze the relationship between TRISS score and patient?s prognosis. Furthermore, we conducted bivariate and multivariate analysis by SPSS 18 software.

Result and Discussion: Seventy medical records was included in this study. Majority of our patients was male (65%) in young age. There were 69 patients who experienced blunt trauma, with the majority of them (94,3%) was caused by motor vehicle accident. After receiving trauma care, there were 26 deaths, while other 54 patients survived. From bivariate and multivariate analysis, we found a significant association between TRISS score and patient?s prognosis. TRISS score strongly predicts polytrauma patient?s mortality (AUC 0,899; IK95% 0,824-0,975). TRISS score has 84,6% sensitivity and 81.8% specificity with optimal intersection point ≤90,5.

Conclusion: TRISS score can predict the mortality of polytrauma patients at Ciptomangunkusumo Hospital."

"Latar Belakang: Pasien yang datang ke IGD memiliki penyakit yang berbeda dan tingkat keparahan yang juga berbeda. Sistem skor dapat digunakan untuk menilai tingkat keparahan pasien IGD dan dapat memprediksi mortalitas pasien. Simple Model Score (SMS) yang merupakan sistem skor yang menggunakan data laboratorium dasar disertai umur sebagai variabelnya, telah terbukti memiliki performa yang baik. Namun untuk dapat digunakan pada karakteristik pasien yang berbeda, SMS perlu divalidasi.Tujuan: Menilai performa kalibrasi dan diskriminasi SMS dalam memprediksi mortalitas tujuh hari perawatan pasien gawat darurat non bedah yang masuk ke Instalasi Gawat Darurat Rumah Sakit Cipto Mangunkusumo (IGD RSCM).Metode: Penelitian ini merupakan studi kohort retrospektif dengan subjek pasien non bedah yang masuk ke IGD RSCM pada bulan Oktober-November 2012. Data usia, hemoglobin, trombosit, leukosit, ureum, natrium, dan glukosa saat pasien masuk ke IGD digunakan untuk penilaian SMS. Luaran dinilai pada tujuh hari perawatan (hidup atau meninggal). Performa kalibrasi dinilai dengan plot kalibrasi dan uji Hosmer-Lemeshow. Performa diskriminasi dinilai dengan area under the curve (AUC).Hasil: Terdapat 701 pasien yang memenuhi kriteria penelitian ini. Pasien yang meninggal sebanyak 92 pasien (13,12%). Plot kalibrasi SMS menunjukkan koefisien korelasi r=0,639 dan uji Hosmer-Lemeshow menunjukkan p = 0,749. Performa diskriminasi ditunjukkan dengan nilai AUC 0,665 (IK 95% 0,610; 0,719).Simpulan: Simple Model Score memiliki performa kalibrasi yang baik namun performa diskriminasi yang kurang baik untuk memprediksi mortalitas tujuh hari perawatan pasien non bedah yang masuk ke IGD RSCM.

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Background: Patients who came to emergency department (ED) had different diagnosis and severity spectrums. Scoring system could stratify the risk of ED patients and predict their mortality. Simple Model Score (SMS) utilizing age and laboratory data as variables was already proven as a instrument with good performance. Nevertheles, the application of SMS in different characteristic population, should be validated.

Objective: To evaluate calibration and discrimination of SMS in predicting seven day in hospital mortality of nonsurgical ED patients at Cipto Mangunkusumo Hospital.

Methods: This was a retrospective cohort study of nonsurgical patients who attended to ED of Cipto Mangunkusumo Hospital in October-November 2012. The data of age, hemoglobin, platelet count, white blood count, ureum, sodium and blood glucose level when the patient was admitted to emergency room used to perform the calculation of SMS. The primary outcome was seven day in hospital mortality. Calibration was evaluated with calibration plot and Hosmer-Lemeshow test while discrimination was evaluated with area under the curve (AUC).

Results: There were 701npatients who met the criteria were recruited to this study. Mortality was observed in 92 patients (13.12%). Calibration plot of SMS showed r = 0.639 and Hosmer-Lemeshow test showed p = 0.749. Discrimination was shown by ROC curve with AUC 0.665 (CI 95% 0.610; 0.719).

Conclusion: Simple Model Score showed a good calibration despites less satisfying discrimination in predicting seven day in hospital mortality of nonsurgical ED patients at Cipto Mangunkusumo Hospital."

"Latar Belakang: Identifikasi risiko mortalitas pasien non bedah yang masuk ke ruang gawat darurat sangat penting dilakukan karena banyaknya pasien yang datang dengan berat penyakit bervariasi. Rapid Emergency Medicine Score (REMS) dikembangkan untuk memprediksi mortalitas pasien secara cepat sehingga dapat membantu dokter membuat keputusan klinis berdasarkan data yang objektif. Perbedaan karakteristik pasien di Indonesia dapat memengaruhi performa skor tersebut, sehingga perlu dilakukan validasi sebelum sistem skor tersebut digunakan. Tujuan: Menilai performa kalibrasi dan diskriminasi REMS dalam memprediksi mortalitas pasien gawat darurat non bedah di Instalasi Gawat Darurat Rumah Sakit Cipto Mangunkusumo (IGD RSCM). Metode: Penelitian ini merupakan studi kohort prospektif dengan subjek pasien non bedah yang masuk ke IGD RSCM pada bulan Oktober-Desember 2012. Usia, suhu tubuh, mean arterial pressure, denyut jantung, frekuensi pernapasan, saturasi oksigen perifer, dan Glasgow coma scale dinilai saat pasien masuk ke IGD untuk penilaian REMS. Luaran dinilai saat pasien keluar dari RSCM (hidup atau meninggal). Performa kalibrasi dinilai dengan plot kalibrasi dan uji Hosmer-Lemeshow. Performa diskriminasi dinilai dengan area under the curve (AUC). Hasil: Sebanyak 815 pasien non bedah masuk ke IGD RSCM selama penelitian. Terdapat 741 (90,9%) pasien yang berhasil diikuti sampai terjadi luaran dengan angka mortalitas sebanyak 145 pasien (19,57%). Plot kalibrasi REMS menunjukkan koefisien korelasi r = 0,913 dan uji Hosmer-Lemeshow menunjukkan p = 0,665. Performa diskriminasi ditunjukkan dengan nilai AUC 0,77 (IK 95% 0,723; 0,817). Simpulan: Rapid Emergency Medicine Score memiliki performa kalibrasi dan diskriminasi yang baik untuk memprediksi mortalitas pasien non bedah yang masuk ke IGD RSCM.

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Background: Identifying the mortality risk of nonsurgical emergency department (ED) patients is essential as a consequence of increasing number of attendence with diverse severity of disease. Rapid Emergency Medicine Score (REMS) was developed to predict patient?s mortality rapidly, therefore it can help doctors to make clinical decision based on objective data. Difference in characteristic of patients in Indonesia may influence the score?s performance, therefore validation of REMS is needed before applying this scoring system in Indonesia.

Objective: To evaluate calibration and discrimination of REMS in predicting mortality of nonsurgical ED patients in Cipto Mangunkusumo Hospital.

Methods: This is a prospective cohort study of nonsurgical patients who attended to ED of Cipto Mangunkusumo Hospital in October-December 2012. Age, body temperature, mean arterial pressure, heart rate, respiratory rate, peripheral oxygen saturation, and Glasgow coma scale were obtained when the patient was arrived at emergency room to perform the calculation of REMS. Outcome was assessed when patients were discharge from the hospital (alive or dead). Calibration was evaluated with calibration plot and Hosmer-Lemeshow test. Discrimination was evaluated with area under the curve (AUC).

Results: A total of 815 nonsurgical patients attended to ED of Cipto Mangunkusmo Hospital during the study. As many as 741 (90.9%) patients were followed through the outcome. Mortality was observed in 145 patients (19.57%). Calibration plot of REMS showed r = 0.913 and Hosmer-Lemeshow test showed p = 0.665. Discrimination was shown by ROC curve with AUC 0.77 (95% CI 0.723; 0.817).

Conclusion: Rapid Emergency Medicine Score showed a good calibration and discrimination in predicting mortality of nonsurgical emergency department patients in Cipto Mangunkusumo Hospital."

"Latar Belakang: Hingga saat ini masih terjadi kerancuan penegakkan diagnosis sepsis pada praktik klinik sehari-hari. Belum diketahui performa seluruh kriteria diagnosis sepsis yang telah ada dan performa modifikasi kriteria diagnosis sepsis berdasarkan kenaikan sistem skor modified Sequential Organ Failure Assessment (MSOFA) sebagai pengganti sistem skor SOFA yang membutuhkan pemeriksaan laboratorium lengkap dalam memprediksi luaran pasien infeksi khususnya di negara berkembang termasuk Indonesia. Belum diketahui pula peran penambahan laktat vena pada performa kriteria diagnosis sepsis. Penelitian ini bertujuan menilai performa dan mengembangkan kriteria diagnosis sepsis dalam memprediksi luaran pasien infeksi dewasa di RS Cipto Mangunkusumo (RSCM). Metode: Penelitian kohort retrospektif dilakukan dengan menggunakan data rekam medik dan registri pasien infeksi Divisi Penyakit Tropik dan Infeksi Departemen Ilmu Penyakit Dalam RSCM pasien berusia lebih dari atau sama dengan 18 tahun yang mendapat perawatan di Unit Gawat Darurat (UGD) RSCM selama tahun 2017. Data yang dikumpulkan meliputi catatan karakteristik sampel, data pemeriksaan klinis dan laboratorium variabel bebas, luaran yang terjadi berupa mortalitas dalam perawatan rumah sakit selama 28 hari pengamatan. Hasil Subyek penelitian terdiri atas 1213 pasien. Sebagian besar (52,5%) merupakan pasien laki-laki, dengan median (rentang interkuartil) usia 51 tahun (38;60). Mortalitas terjadi pada 421 (34,7%) pasien. Performa kriteria diagnosis sepsis terbaik untuk memprediksi mortalitas dalam perawatan ditunjukkan oleh sepsis-3 (area under receiver operating characteristic curve [AUROC] 0,75; interval kepercayaan [IK]95% 0,72-0,78), sementara performa terburuk ditunjukkan oleh kriteria systemic inflammatory response syndrome (SIRS) (AUROC 0,56; IK95% 0,52-0,60). Performa kriteria kadar laktat vena baik (AUROC 0,76; IK95% 0,73-0,79) dalam memprediksi mortalitas dalam perawatan pasien infeksi dewasa di RSCM. Penambahan kriteria kadar laktat vena dapat meningkatkan performa kriteria diagnosis sepsis-3 (AUROC 0,80; IK95% 0,77-0,82) secara bermakna dalam memprediksi mortalitas dalam perawatan pasien infeksi dewasa di RSCM (p <0,0001). Simpulan: Performa kriteria diagnosis sepsis terbaik dalam memprediksi mortalitas dalam perawatan pasien infeksi dewasa di RSCM ditunjukkan oleh kriteria sepsis-3. Performa kriteria kadar laktat vena baik dalam memprediksi mortalitas dalam perawatan pasien infeksi dewasa di RSCM. Penambahan kriteria kadar laktat vena dapat meningkatkan performa kriteria diagnosis sepsis-3 dalam memprediksi mortalitas dalam perawatan pasien infeksi dewasa di RSCM.

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Introduction: There is uncertainty on the use of sepsis diagnostic criteria in daily clinical practice. The performance of all established sepsis diagnosis criteria and modified criteria using increase modified Sequential Organ Failure Assessment (MSOFA) score as a substitute for SOFA score system which need a complete laboratory test in prediciting in-hospital mortality in developing country, including Indonesia, is unknown. The added value of venous lactate concentration on sepsis diagnostic criteria is unknown as well. This study aim to assess the performance and improve sepsis diagnostic criteria in predicting infected adult patients mortality in Cipto Mangunkusumo Hospital. Methods: The retrospective cohort using medical record and infected adult patients (aged 18 years and older) registry of Division of Tropical and Infectious Diseases Internal Medicine Departement Cipto Mangunkusumo Hospital who were hospitalized in Emergency Room on 2017 was done. Sample's characteristics, clinical and laboratory data of independent variables, outcome i.e. 28 days in-hospital mortality were collected.Results: Subjects consist of 1213 patients, predominantly male (52.5%), with median (interquartile range) age of 51 (38;60) years old. Mortality developed in 421 (34.7%) patients. The best performance of sepsis diagnostic criteria in predicting mortality was shown by sepsis-3 criteria (area under receiver operating characteristic curve [AUROC] 0.75; 95% confidence interval [CI] 0.72-0.78). The worst performance of sepsis diagnostic criteria in predicting mortality was shown by systemic inflammatory response syndrome (SIRS) criteria (AUROC 0.56; 95CI% 0.52-0.60). Performance of lactate in predicting mortality was good (AUROC 0.76; 95CI% 0,73-0,79). The addition of lactate criteria significantly improved sepsis-3 criteria performance (AUROC 0.80; 95CI% 0.77-0.82, p <0,0001). Conclusions: The best performance of sepsis diagnostic criteria in predicting infected adult patients mortality in Cipto Mangunkusumo Hospital is shown by sepsis-3 criteria. Performance of lactate in predicting mortality is good. The addition of lactate criteria significantly improved sepsis-3 criteria performance."

"Latar Belakang: Mortalitas pasien UPI lebih tinggi dari pasien rawat lainnya. Instrumen prediktor mortalitas pada pasien UPI dapat membantu untuk melakukan stratifikasi risiko dan pengambilan keputusan klinis dalam tatalaksana pasien. Skor LODS merupakan salah satu instrumen yang terbukti memiliki keunggulan dibandingkan intrumen prediktor yang saat ini digunakan di UPI RSCM. Meskipun demikian, komponen skor LODS membutuhkan pemeriksaan yang tidak murah sehingga sulit diaplikasikan terutama pada pasien tanpa jaminan kesehatan. Bersihan laktat merupakan alternatif yang lebih murah dan ditemukan memiliki kemampuan prediktor mortalitas yang baik pada penelitian sebelumnya.Tujuan: Mengetahui perbandingan kemampuan prediktor bersihan laktat dengan skor LODS terhadap mortalitas pasien dalam 30 hari pasien yang dirawat di UPI RSCM.Metode: Penelitian ini adalah studi kohort retrospektif menggunakan data rekam medis pasien UPI RSCM yang dirawat pada rentang Agustus 2015 – April 2018. Data yang di ambil berupa karakteristik, skor LODS hari pertama, laktat inisial, laktat 6-24 jam serta terjadi atau tidaknya mortalitas dalam 30 hari. Hubungan antara skor LODS dengan mortalitas dianalisis dengan regresi logistik sederhana, sementara hubungan antara bersihan laktat dan mortalitas dinilai dengan uji chi square. Kemampuan diskriminasi keduanya dinilai dengan analisis kurva ROC sementara kemampuan kalibrasi dinilai dengan uji goodness of fit Hosmer-Lemeshow. Kemampuan diagnostik dinilai dengan menghitung sensitivitas, spesifisitas, PPV, NPV, LR positif, serta LR negatif. Kemampuan diskriminasi, kalibrasi, serta diagnostik diantara skor LODS dan bersihan laktat kemudian dibandingkan.Hasil: Dari 388 subjek yang dianalisis, didapatkan bersihan laktat memiliki diskriminasi lemah (AUC 0,597), kalibrasi lemah (Uji Hosmer-Lemeshow p<0,001), sensitivitas 65% (IK95% 48,3% - 79,3%), spesifisitas 54,3% (IK95% 48,9% - 59,6%), PPV 14,1% (IK95% 11,2% - 17,4%), NPV 93,1% (IK95% 89,7% - 95,4%), LR positif 1,420 (IK95% 1,10 – 1,84), dan LR negatif 0,640 (IK95% 0,42 – 0,99), dalam memprediksi mortalitas pasien dalam 30 hari di UPI RSCM. Sementara Skor LODS memiliki diskriminasi baik (AUC 0,79), kalibrasi baik (Uji Hosmer-Lemeshow p=0,818), sensitivitas 77,5% (IK95% 64,6% - 90,4%), spesifisitas 63,8% (IK95% 58,8% - 68,8%), PPV 19,7% (IK95% 13,4% - 25,9%), NPV 96,1% (IK95% 93,6% - 98,6%), LR positif 2,140 (IK95% 1,72 – 2,66), dan LR negatif 0,353 (IK95% 0,20 – 0,63), dalam memprediksi mortalitas pasien dalam 30 hari di UPI RSCM.Kesimpulan: Performa bersihan laktat dari segi kemampuan diskriminasi, kalibrasi, atau diagnostik tidak lebih baik dari skor LODS dalam memprediksi mortalitas pasien dalam 30 hari di UPI RSCM.

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Backgrounds: The mortality rate of ICU patients is higher than other inpatients. The mortality predicting tools of ICU patients can help a physician stratify the risk and make the clinical decision in patient management. The LODS score is one of the tools that has been proven better than predictor instruments currently used at RSCM ICU. However, the component of the LODS score requires an expensive examination, so it is difficult to apply, especially to patients without health insurance. Lactate clearance is a cheaper alternative and was found to have a good predictive ability of mortality in previous studies.

Objective: This study aimed to compare the predictor ability of LODS scores with lactate clearance on 30-days-patient-mortality treated at RSCM ICU.

Method: This was a cohort retrospective study using the medical records of RSCM ICU patients who were treated between August 2015 – April 2018. The data were demographic characteristics, first-day LODS score, initial lactate, lactate in 6-24 hours, and 30-days-patient-mortality. The relationship between LODS scores and mortality was analyzed with simple logistic regression, while the chi-square test assessed the relationship between lactate clearance and mortality. Discrimination ability was assessed by ROC curve analysis, while the Hosmer-Lemeshow goodness of fit test assessed calibration ability. Diagnostic ability was assessed by calculating sensitivity, specificity, PPV, NPV, positive LR, and negative LR. Discrimination, calibration, and diagnostic capabilities between LODS scores and lactate clearance were then compared between groups.

Results: From 388 subjects analyzed, lactate clearance was found to have weak discrimination (AUC 0.597), weak calibration (Hosmer-Lemeshow test p<0.001), sensitivity 65% ​​(CI 95% 48.3% – 79.3%), specificity 54 ,3% (95% CI 48.9% – 59.6%), PPV 14.1% (95% CI 11.2% – 17.4%), NPV 93.1% (95% CI 89.7% – 95 0.4%), positive LR 1.420 (95% CI 1.10 – 1.84), and negative LR 0.640 (95% CI 0.42 – 0.99), in predicting patient mortality within 30 days at RSCM ICU. Meanwhile, the LODS score had good discrimination (AUC 0.79), good calibration (Hosmer-Lemeshow test p=0.818), sensitivity 77.5% (95% CI 64.6% – 90.4%), specificity 63.8% (95% CI 58.8% – 68.8%), PPV 19.7% (95% CI 13.4% – 25.9%), NPV 96.1% (95% CI 93.6% – 98.6%), positive LR 2.140 (95% CI 1.72 – 2.66), and negative LR 0.353 (95% CI 0.20 – 0.63), in predicting patient mortality within 30 days at RSCM ICU.

Conclusion: Lactate clearance performance in terms of discriminatory ability, calibration, or diagnostic performance was not better than the LODS score in predicting patient mortality within 30 days at RSCM ICU."