Background For critically ill patients in the pediatric intensive care unit (PICU), a scoring system is helpful for assessing the severity of morbidity and predicting the risk of mortality. The Pediatric Index of Mortality (PIM) 3 score consists of ten easy simple variables, so that the probability of death can be assessed prior to undergoing advanced therapies. The PIM 3 score in inexpensive and comprised of routine laboratory variables performed in PICU patients. In Indonesia, studies to validate the PIM 3 score have been limited. Objective To evaluate the PIM 3 score for predicting the probability of death in the PICU, Dr. Mohammad Hoesin Hospital (MHH), Palembang. Methods A prospective, cohort study was performed in the PICU, MHH, Palembang, from February to April 2016. The PIM 3 score was calculated within 2 hours of patients admission to the PICU by an android calculator application. PIM3 score and mortality were analyzed by Mann-Whitney test; calibration was performed by Hosmer-Lameshow goodness of fit test, discrimination was done by receiver operating characteristic (ROC) curve analysis; and standardized mortality ratio (SMR) was calculated. Results During the study period there were 81 PICU patients, 69 children were included, ranging in age from 1,5 to 187 months. The overall mortality rate was 40,58%. The most common illnesses in our subjects were malignancy (17,4%), post non-thoracic surgery (14,5%), dengue shock syndrome (14,5%), respiratory disease (13%), and neurological disease (11,6%). Subjects' PIM3 scores ranged from 1,02% to 58,84%, with means of 26,08% in non-survivors and 13,05% in survivors. The SMR was 2,24, indicating that death was underpredicted. The AUC of 0,771 (95% CI of 0,651 to 0,891) indicated that the PIM3 score had good discrimination. Conclusion In Mohammad Hoesin Hospital, Palembang, South Sumatera, the PIM 3 can be used to predict mortality in PICU patients, but the score should be multiplied by a factor
Latar belakang. Rasio neutrofil dan limfosit (NLCR) memiliki potensi sebagai prediktor bakteremia pada pasien dengan infeksi yang didapat di masyarakat. Insidensi bakteremia, atau adanya bakteri hidup dalam darah, mencapai sekitar 1% kasus pada populasi. Angka kematian mencapai 25%-30% dan meningkat hingga 50% pada sepsis berat.Tujuan. Untuk mengetahui hubungan rasio neutrofil dan limfosit (NLCR) dengan kejadian infeksi bakteri.Metode. Sebuah studi kasus-kontrol dilakukan dengan meninjau rekam medis di RSUP Sanglah, Denpasar, pada periode Januari 2016 hingga Maret 2018. Data yang diambil adalah usia, jenis kelamin, kadar WBC, Neutrofil, limfosit, monosit, platelet, dan kultur darah. Kemudian dilakukan analisis hubungan antara rasio neutrofil dan limfosit terhadap infeksi aliran darah.Hasil. Selama periode studi didapatkan 98 pasien dengan hasil kultur positif dan 100 pasien dengan hasil kultur negatif. Dari total subjek yang dianalisis, didapatkan 116 (58,5%) subjek laki-laki dan 82 (40,9%) subjek perempuan. Median usia pada kelompok kasus adalah 12 bulan, sedangkan median usia pada kelompok kontrol adalah 24 bulan. Analisis kurva ROC menunjukkan nilai cut-off optimal untuk NLCR adalah 4,67. Rasio odd untuk hubungan antara NLCR dengan kejadian infeksi bakteri adalah 3,24 (95% IK 1,74 – 5,92) dan adjusted odds ratio sebesar 3,49 (95% IK 1,83-6,64).Kesimpulan. Nilai NLCR ≥4,67 merupakan faktor risiko untuk infeksi aliran darah yang berkembang. Hasil ini dapat digunakan sebagai titik potong untuk antibiotik yang awalnya diberikan untuk mencegah prognosis yang buruk (sepsis, kegagalan organ multipel, dan kematian).
Background The pediatric logistic organ dysfunction-2 (PELOD-2) score is recommended by the Indonesian Pediatric Society Emergency and Intensive Care Working Group as an indicator of life-threatening organ dysfunction for sepsis in children. However, The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) recommended the Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score in determining life-threatening organ dysfunction, which has not been adjusted for pediatric patients. Objective To assess the accuracy of the pediatric SOFA score in diagnosing sepsis in children admitted to the pediatric intensive care unit (PICU) at Mohammad Hoesin Hospital, Palembang, South Sumatera. Methods The study was conducted in children with organ dysfunction caused by infection admitted in PICU, from April to December 2019. Subjects were included by consecutive sampling, according to the following inclusion criteria: all patients aged 1 month to 18 years who met organ dysfunction and two SIRS criteria, with infection according to the 2005 PSCC criteria. Laboratory tests performed included complete blood count (CBC), blood gas analysis, measurement of C-reactive protein (CRP), liver and kidney function tests. In all patients, pSOFA and PELOD-2 scores were calculated within 24 hours of admission. We compared the accuracy of pSOFA score to PELOD-2 score ≥ 11. Results Of 108 subjects, there were 59 males and 49 females, with median age 11 (range 1-193) months. We compared the accuracy of pSOFA score to PELOD-2 score ≥ 11 and obtained a sensitivity of 93.3% and a specificity of 79.5%, for pSOFA cut-off score ≥ 8. Pediatric SOFA score cutoff ≥ 8 was determined by receiver operating curve (ROC). The area under the curve (AUC) for pediatric SOFA score was 93.9% (95%CI 89.7 to 98.0%). Conclusion Pediatric SOFA score ≥ 8 is the optimal cut-off for predicting life-threatening organ dysfunction in pediatric sepsis. Multicenter revalidation is needed to find the most optimal cut-off point for general use in Indonesia.
Salah satu kejadian yang menjadi masalah kesehatan dunia yang menyebabkan banyak musibah adalah kecelakaan lalu lintas. Peristiwa ini terbukti banyak mengakibatkan korban dan kerugian. Sebagai first responder, masyarakat perlu memiliki pengetahuan pertolongan pertama dan motivasi menolong korban kecelakaan untuk mengurangi kerugian tersebut. Angka kematian kecelakaan lalu lintas bisa diturunkan 85% dengan pengetahuan pertolongan dan motivasi yang baik. Tujuan penelitian untuk mengidentifikasi hubungan pengetahuan pertolongan pertama dengan motivasi menolong korban kecelakaan lalu lintas pada masyarakat di Jalan Prof. Dr. Ida Bagus Mantra, Bali. Penelitian ini merupakan penelitian kuantitatif, rancangan deskriptif korelatif dengan pendekatan cross-sectional. Sampel yang digunakan berjumlah 106 masyarakat dengan pemilihan teknik purposive sampling. Analisis hubungan menggunakan uji Spearman. Hasil penelitian ini didapatkan adanya hubungan antara pengetahuan pertolongan pertama dengan motivasi menolong dan kekuatan hubungan yang sedang. Peneliti merekomendasikan kepada masyarakat untuk mengikuti pelatihan pertolongan pertama sehingga lebih meningkatkan motivasi menolong.
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