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"ABSTRAKLatar belakang : Insomnia merupakan gangguan tidur yang sering dialami pascatraumakepala, tetapi faktor yang berhubungan dengan insomnia belum banyak diketahui.Penelitian ini bertujuan mengetahui prevalensi insomnia pascatrauma kepala dan faktoryang berhubungan.Metode penelitian: Desain penelitian potong lintang deskriptif menggunakan PittsburghSleep Quality Index (PSQI) versi Bahasa Indonesia pada pasien pascatrauma kepala diPoliklinik Neurologi RSUPN Ciptomangunkusumo, RSUD Pasar Rebo dan RSPADGatot Soebroto selama bulan Maret-Mei 2016 dengan onset minimal tiga bulan. Faktoryang dianalisis adalah derajat keparahan trauma kepala, gambaran CT-Scan kepala,derajat nyeri kepala, gangguan depresi dan ansietas. Derajat keparahan trauma kepaladinilai berdasarkan skala koma Glasgow, lamanya pingsan, lamanya amnesiapascatrauma dan CT-Scan kepala. Insomnia ditetapkan jika skor PSQI >8. Nyeri kepaladinilai dengan numeric rating scale, gangguan depresi dan ansietas dinilai dengan MiniInternasional Neuropsychiatric Interview Version ICD-10 (MINI ICD-10).Hasil : Diantara 70 orang subjek pascatrauma kepala, didapatkan prevalensi insomniasebesar 33%. Subjek cedera kepala berat (31%) memiliki risiko 3,4 kali mengalamiinsomnia dibandingkan cedera kepala ringan (42%) (IK 95% 1,072-10,806). Subjekdengan nyeri kepala sedang sampai berat (26%) memiliki risiko 5,78 kali mengalamiinsomnia dibandingkan subjek tanpa nyeri sampai nyeri kepala ringan (74%) (IK 95%1,730-19,315). Tidak didapatkan hubungan antara gangguan depresi (9%), ansietas (3%)dengan insomnia.Kesimpulan : Insomnia banyak dijumpai pascatrauma kepala. Keluhan nyeri kepalasedang sampai berat, dan cedera kepala berat merupakan faktor yang berhubungandengan insomnia

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ABSTRACTBackground : Insomnia is very common following traumatic brain injury (TBI), but therelated factors with insomnia is less known. This study was aimed to determine theprevalence of insomnia after TBI and related factors.Methods : Cross-sectional descriptive study using Pittsburgh Sleep Quality Index (PSQI)Indonesian version on patients with history of TBI, with a minimum of three months sinceonset, in Neurology clinic of Cipto Mangunkusumo general hospital, Pasar Rebo generalhospital and Gatot Soebroto Army hospital during March-May 2016. The analyzedfactors consisted of: severity of TBI, head CT-Scan findings, severity of headache,depression, and anxiety disorders. Severity of TBI was assessed on Glasgow coma scale,duration of loss of consciousness, duration of post traumatic amnesia and head CT-Scanfindings. Insomnia was determined if PSQI score > 8. Severity of headache was measuredby numeric rating scale, depression and anxiety disorders were assessed based on MiniInternasional Neuropsychiatric Interview Version ICD-10 (MINI ICD-10).Results : Prevalence of insomnia among 70 subjects after TBI was 33%. Severe TBIsubjects (31%) had 3.4 times the chance of developing insomnia compared to mild cases(42%) (CI 95% 1.072-10.806). Moderate-severe headache subjects (26%) had 5.78 timesthe risk of having insomnia compared to no headache-mild headache cases (74%) (CI95% 1.730-19.315). No significant relation could be established between depression(9%), anxiety disorders (3%) with insomnia.Conclusion : Insomnia is common after TBI. Moderate-severe headache and severe TBIare the related factors of insomnia."

"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."

"ABSTRAKCedera kepala traumatik merupakan penyebab kematian tersering pada kecelakaan. Trauma tumpul pada kepala dapat menimbulkan contusio cerebri berupa lesi coup dan contrecoup. Namun, mekanisme dari terjadinya lesi coup dan contrecoup belum diketahui dengan jelas. Penelitian ini dilakukan untuk mengetahui hubungan antara letak trauma tumpul pada kepala dengan terjadinya lesi coup dan contrecoup.Metode: Sampel penelitian diambil dari rekam medis jenazah dengan trauma tumpul pada kepala yang diotopsi di Departemen Forensik dan Medikolegal RSCM pada tahun 2012-2016. Peneliti kemudian mencari tahu mengenai letak trauma tumpul dan temuan contusio cerebri pada rekam medis jenazah.Hasil: Dari 97 sampel dengan trauma tumpul pada kepala, didapatkan proporsi lesi coup sebesar 5,2 , 11,3 , dan 2,1 , dan proporsi lesi contrecoup sebesar 1,0 , 15,5 , dan 2,1 pada trauma tumpul yang terjadi di depan, samping, dan belakang kepala secara berturut-turut. Hasil uji chi square menunjukkan hubungan yang bermakna antara trauma tumpul pada sisi depan p=0,005 dan samping p=0,002 kepala dengan lesi contrecoup.Pembahasan: Terjadinya lesi coup tidak selalu diikuti oleh terjadinya lesi contrecoup, dan berlaku juga sebaliknya. Hubungan bermakna antara trauma tumpul pada sisi samping kepala dengan lesi contrecoup secara teori dapat dikaitkan dengan teori sistem suspensori otak.Kesimpulan: Dari penelitian ini, dapat disimpulkan bahwa terdapat hubungan antara trauma tumpul pada sisi depan dan samping kepala dengan lesi contrecoup.

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ABSTRACTTraumatic brain injury remains the most common cause of mortality in accidents. Blunt trauma in the head may cause cerebral contusion, which includes coup and contrecoup contusion. However, the mechanism of coup and contrecoup contusion formation remains unknown. This research aims to know the relationship between the position of head blunt trauma with coup and contrecoup contusion.Methods Research samples were taken from corpse medical records with head blunt trauma who had undergone autopsy in Forensics and Medicolegal Department of Cipto Mangunkusumo Hospital from 2012 2016. The position of head blunt trauma and findings of cerebral contusions were recorded.Results Out of 97 samples with head blunt trauma, the proportions for coup contusion were 5,2 , 11,3 , and 2,1 , while the proportions for contrecoup contusion were 1,0 , 15,5 , and 2,1 in blunt trauma happening at the front, side, and back part of the head respectively. Chi square tests showed significant relationships between blunt trauma of front p 0,005 and side p 0,002 part of the head with contrecoup contusion.Discussion Coup contusion is not always followed by contrecoup contusion, and vice versa. The significant relationship between blunt trauma of the side part of the head and contrecoup contusion can be explained by the theory of brain suspensory system.Conclusion This research concludes that blunt trauma of the front and side part of the head is related to contrecoup contusion."

"Trauma kepala merupakan suatu istilah untuk salah satu jenis gangguan traumatis yang berdampak pada fungsionalitas otak. Trauma kepala dapat menyebabkan gangguan fungsi neurologis, gangguan fisik, gangguan fungsi kognitif, dan gangguan psikososial secara temporer ataupun permanen. Trauma kepala merupakan salah satu masalah global karena menjadi salah satu penyebab terbanyak kematian dan kecacatan di seluruh dunia. Penelitian ini telah memberikan gambaran secara faktual, sistematis, dan terbaru mengenai insidensi kasus trauma kepala dengan riwayat prosedur bedah di Rumah Sakit Dr. Cipto Mangunkusumo (RSCM) beserta karakteristik demografi yang diselidiki. Penelitian observasional dengan metode deskriptif dan analitik ini menggunakan desain potong lintang. Populasi penelitian adalah pasien trauma kepala dengan riwayat prosedur bedah di RSCM selama periode tahun 2016–2020 dengan besar sampel sebanyak 90 subjek yang pada data rekam medis didiagnosis mengalami trauma kepala dan diintervensi melalui prosedur bedah. Pengambilan sampel menggunakan teknik purposive sampling. Dari 90 subjek penelitian, didapatkan bahwa mayoritas pasien berasal dari kelompok usia <21 tahun (31,1%), laki-laki (84,4%), pengguna JKN (88,9%), kecelakaan sebagai etiologi (65,6%), bukan rujukan (48,9%), rujukan dari Jawa (45,6%), antrean non-cito (55,6%), dan domisili Jabodetabek (61,1%). Hipotesis nol diterima pada analisis bivariat. Karakteristik demografi dari pasien trauma kepala dengan riwayat prosedur bedah di RSCM mayoritas berusia <21 tahun, laki-laki, pengguna JKN, korban kecelakaan, pasien bukan rujukan, pasien rujukan terbanyak dari Jawa, antrean non-cito, dan berdomisili di Jabodetabek. Tidak ada perbedaan penggunaan jaminan kesehatan dan etiologi antara berbagai golongan usia pasien. Selain itu, tidak ada perbedaan etiologi trauma kepala antara pasien laki-laki dan perempuan.

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Head trauma is a traumatic disorder that impacts brain functionality. Head trauma can cause temporary or permanent neurological, physical, cognitive, and psychosocial dysfunction. Head trauma is a global problem because it is one of the leading causes of death and disability throughout the world. This research has provided a factual, systematic, and up-to-date description along with demographic characteristics of head trauma cases that underwent surgical procedures at RSUP Dr. Cipto Mangunkusumo (RSCM). This observational research with descriptive and analytical methods uses a cross-sectional design. The study population was head trauma patients with a history of surgical procedures at RSCM during 2016–2020 with a sample size of 90 subjects who were diagnosed with head trauma in medical record and were intervened through surgical procedures. Sampling used purposive sampling technique. Of the 90 subjects, the characteristics were majorly <21 years (31.1%), men (84.4%), JKN users (88.9%), accidents as the etiology (65.6% ), non-referral (48.9%), referral from Java (45.6%), non-cito queue (55.6%), and Jabodetabek domicile (61.1%). The null hypothesis was accepted in the bivariate analysis. The demographic characteristics of head trauma patients with a history of surgical procedures at RSCM were majorly <21 years old, male, JKN users, accident victims, non-referral patients, most referral patients were from Java, non-cito queues, and lived in Jabodetabek. There were no differences in the use of health insurance and etiology between various patient age groups. In addition, there was no difference in the etiology of head trauma between male and female patients."