NILAI DIAGNOSTIK TORONTO CLINICAL SCORING SYSTEM PADA NEUROPATI PERIFER

Abstract

Peripheral Neuropathy (PN) is a frequent complication of Diabetes Mellitus (DM) type 2. Patients (pts) DM with PN predispose to tissue damage and develop to diabetic foot, diabetic ulcer furthermore amputation of the toes and foot There were cause considerable morbidity and mortality. Early finding and treatment of the DN may decrease this incidence. The Toronto Clinical Scoring System (TCSS) should be performed simplify and easily method for evaluation to screening and diagnostic PN. The TCSS is quantitative test to properties sensory symptoms characteristic of neuropathy pain, sensory examination of the toes and lower-limb reflexes. The out-come; the clinical neuropathy score from a minimum of 0 (no neuropathy) to a maximum of 19 point. The objectives of the study was to evaluate the diagnostic value of the TCSS in pts with DM type 2. This study was conducted cross-sectional in Endocrinology out-patient of Or Kariadi General Hospital Semarang during August to December 2003. Electromyography was used as a gold standard. The best diagnostic cutt-off point we use Receiver Operating Characteristic ' (ROC) curve. Total study involve 92 pts of DM type 2, consists of 75 pts (81,5%) with PN and 17 pts (18,5%) non PN. The TCSS score 4 sensitivity was 96,0% (95% CI : 92 - 100 % ), the specificity was 58,8% (95% Cl : 49, 9%-68, 7%), with positive predictive value (ppv) of 91,1% (95% CI : 95,3-96,9%). negative predictive value (npv) of 76,7,1% ( 95% CI : 66,2% -87,3%) and an accurate value of 89,1% (95% C/ : 82,8%-95,4%). The TCSS score 5 sensinrity was 92,0% (95% CI : 86,5 - 97,5% ), the specificity was 70,6 % (95% CI : 61,3%-79,9%), with positive predictive value (ppv) of 93,2% (95% CI : 88,1-98,3%), negative predictive value (npv) of 66,6,1% ( 95% C/ : 52,2% -71,0%) and an accurate value of 88,0% (95% CI : 81,4%-94,5%). The TCSS score 6 sensitivity was 86,6% (95% CI : 79,3%-93,5%), the specificity was 94,1% (95% CI : 88,9%-99,3%), with positive predictive value (ppv) of 98,5% (95% CI : 96%-100%), negative predictive value (npv) of 94,1% ( 95% CI: 88,9% -99,3%) and an accurate value of 88,0% (95% CI : 81,4%- 94,6%). The conclusion that the TCSS had highly sensitivity and specificity. The score at 4 is• better to. screening. The score at 6 is better to diagnosis Neuropati Perifer (N?) merupakan komplikasi yang sering didapatkan pada pasien(ps) Diabetes Melitus (DM) tipe 2. Ps DM dengan NP lebih mudah terjadi kerusakan jaringan, berlanjut menjadi kaki diabetik, ulkus diabetik bahkan sampai amputasi kaki. Keadaan ini merupakan penyebab morbiditas dan mortalitas utama. Insiden ini dapat ditiirunkan bila NP dapat dideteksi pada stadium awal. Toronto Clinical Scoring System (TCSS) adalah metoda yang sederhana dan mudah dilakukan balk untuk skrining maupun diagnosis NP. TCSS adalah pemeriksaan kuantitatif terhadap keluhan khas neuropati, pemeriksan sensorik dan refleks tungkai. Ada tidaknya neuropati ditentukan dengan skor 0-19. Penelitian ini bertujuan untuk melakukan evaluasi nilai diagnostik TCSS pada ps DM tipe 2 dengan metoda cross-sectional. Pemeriksaan dilakukan pada ps yang datang pada bulan Agustus sampai Desember 2003 di Poliklinik Endokrinologi RS Dr Kariadi Semarang. Sebagai baku emas adalah Elektromiografi. Penentuan nilai diagnostic terbaik dengan kurva ROC (Receiver Operating Characteristic). Penelitian me'ndapatkan 92 ps DM tipe 2, terdiri 75 ps(81,5%) NP dan 17 ps (18,5%) bukan NP. Skor 4 didapatkan sensitifitas: 96,0% (95% CI :92%-100%),spesifisitas : 58,8% (95%Cl : 49,9%-68,7%), nilai ramal + : 91,1% (95% CI : 95,3%-96,9%), nilai Rama! - : 76,7% (95% CI : 66,2%-87,3 %) dan akurasi : 89,1% (95% CI : 82,8%- 95,4%).. Skor 5 didapatkan sensitifitas: 92,0% (95% CI :86,5 %-97,5%), spesifisitas: 70,6% (95%CI : 61,3%-79,9%), nilai ramal +: 93,2% (95% CI : 88,1%-98,3%), nilai ramal - : 66,6 % (95% CI : 52,2%-71,0%) dan akurasi : 88,0% (95% CI : 81,4%- 94,6%) Skor 6 didapatkan sensitifitas 86,6% (95% Cl : 79,3%-93,5%), spesifisitas 94,1% (95% CI : 88,9%-99,3%), nilai ramal positif 98,5% (95% Cl : 96%-100%), nilai ramal negatif 61,5% ( 95% C/ : 88,9% -99,3%) dan akurasi sebesar 88,0% (95% C/ : 81,4%-94,6%). Kesimpulan : TCSS mempunyai sensitifitas dan spesilisitas cukup tinggi. Skor 4 !mac untuk skrining. Skor 6 balk untuk diagnosis.