PENGARUH KOAGULOPATI TERHADAP GLASGOW OUTCOME SCALE PENDERITA CEDERA KEPALA BERAT DENGAN GAMBARAN CT SCAN DIFFUSE INJURY

Abstract

The influence of coagulopathy on Glasgow Outcome Scale severe head injury patients with CT scan result diffuse injury. Background : Coagulopathy in severe head injury is caused by thromboplastin which is released from parenchimal brain damage to the systemic circulation. This condition maybe influenced the outcome of severe head injury patient who suffered from coagulopathy with CT Scan resulted diffuse injury. Method : Cohort study was conducted in 50 adults patients diffuse injury GCS 5-8, injury severity score under 16, and hospitalized in Neurosurgery department Dr. Kariadi Hospital Semarang between November 2005 to June 2007. The detected coagulopathy parameters were PT, APTT, TT, thrombocyte, and fibrinogen plasma level. Then subjects were examined using Glasgow Outcome Scale (GOS) one month after injured. Data were analized using univariable , multivariable , relative risk ratio calculation (RR), and attributable risk calculation (AR). Result : The result showed a significantly prolonged of PT levels against GOS values (p=0,045), RR=6,102 (95% CI 1,040-35,791) and AR=35% in group of diffuse injury III and IV also in GCS 5 and 6. The influence prolonged APTT (p=0,178) and prolonged TT (p=0,548) on outcome were not statistically significant. Pengaruh koagulopati terhadap Glasgow Outcome Scale penderita cedera kepala berat dengan gambaran CT scan diffuse injury Latar belakang : Koagulopati pada cedera kepala berat disebabkan oleh pelepasan tromboplastin dari jaringan parenkim otak yang mengalami kerusakan parah ke sistemik. Kondisi ini mungkin mempengaruhi outcome pada pasien cedera kepala berat. Tujuan penelitian ini adalah mengetahui outcome penderita cedera kepala berat yang mengalami koagulopati dengan gambaran CT scan diffuse injury. Metode : Studi kohort pada 50 pasien diffuse injury GCS 5-8, usia dewasa, injury severity score kurang dari 16, yang dirawat di bagian Bedah Saraf RSUP Dr. Kariadi Semarang antara bulan November 2005 hingga Juni 2007. Parameter koagulopati diperiksa PT, APTT, TT, jumlah trombosit darah tepi, kadar fibrinogen. Pada penderita dinilai Glasgow Outcome Scale sebulan setelah cedera. Data dianalisis menggunakan analisis univariat dan untuk mengetahui pengaruh parameter koagulasi terhadap outcome penderita dengan analisis multivariat bersama variabel pengganggu, perhitungan rasio risiko relatif (RR) serta perhitungan attributable risk (AR) dengan memakai batas kebermaknaan p<0,05. Hasil : Hasil PT memanjang terhadap outcome bermakna secara statistik (p=0,045) RR=6,102 (95% CI 1,040-35,791) serta AR=35% pada kelompok diffuse injury III dan IV serta kelompok GCS 5 dan 6. Pengaruh APTT memanjang (p=0,178) dan TT memanjang (p=0,548) terhadap outcome tidak bermakna secara statistik.