VALIDITY OF RISK FACTORS AFFECTING MORTALITY WITHIN 14 DAYS IN SEVERE TRAUMATIC HEAD INJURY IN SANGLAH GENERAL HOSPITAL

TESIS

Abstract

By : dr. I Made Sukarya

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Faculties : Fakultas Kedokteran

Department : PS. ILMU BEDAH

ABSTRACT VALIDITY OF RISK FACTORS AFFECTING MORTALITY WITHIN 14 DAYS IN SEVERE TRAUMATIC HEAD INJURY IN SANGLAH GENERAL HOSPITAL Background: patients with traumatic head injury need early diagnosis and early detection of deteriorating factors, so the early appropriate therapy can be given to create a better prognosis. Prognosis is a part of consideration in clinical decision making process, information base in realistic inform consent to family, and as a consideration in allocating health care resources. The high mortality proportion in severe head injury occurs in the first 14 days after trauma. This mortality is affected by degree of severity of head injury, accompanying trauma in other body parts, and complication that occur during admission. The aims of the study is to develop a valid scoring system about risk factors affecting mortality within 14 days in severe traumatic brain injury. Method: We conducted a prospective cohort study with subjects of severe head injury patients (n=105) from 1st March to 31st October 2016. Samples treated with standard neurosurgery protocols and evaluate the outcome within 14 days. Variables included age, sex, Glasgow Coma Scale (GCS) score, hypotension, hypoxia, pupil reflex, preoperative time, Injury Severity Score (ISS), pneumonia, central hyperthermia, and Head CT Scan Profile. The relationship of risk factors and outcome were analyzed with bivariate and multivariate analysis with 95% confident interval. Furthermore, the prognostic score are developed and validated their ability in predicting mortality within 14 days in severe head injury patients. Results: In bivariate analysis we found ten significant variables, including: age, hypotension, hypoxia, GCS, bilateral mydriasis, ISS score, obliterated basal cistern, traumatic SAH, ICH, and SDH. In multivariate analysis we found five variable that significantly affecting mortality within 14 days, including: age > 60 years old (RR: 15.6, 95%CI: 1.88-129.95), hypoxia (RR: 17.78, 95%CI: 2.05-154.11), GCS 3-5 (RR: 34.71, 95%CI: 6.85-175.98), obliteration of basal cistern (RR: 12.71, 95%CI: 2.61-61.95), and traumatic SAH (RR:7,57 , 95%CI: 1,19-48,36). The prognostic score models are created by giving a different value according ods ratio, with the best cut-off point was 3. Low risk patient with sum score 0-3 (4.3% predicted mortality), and high risk patients with sum score 4-11 (95.7% predicted mortality). The prognostic score had a good predictive ability that proved by ROC analysis with AUC 0.954, 89.2% sensitivity and 90.3% specificity. Conclusion: Age more than 60 years old, hypoxia, GCS 3-5, obliteration of basal cistern, and traumatic SAH are independent risk factors affecting mortality within 14 days in severe head injury patients. The prognostic score model shows a good predictive ability. Keywords: Severe head injury, prognostic score, mortality risk factor in severe head injury, mortality within 14 days

Keyword : Keywords: Severe head injury, prognostic score, mortality risk factor in severe head injury, mortality within 14 days

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