BAB V. KESIMPULAN DAN SARAN
V.2. SARAN
1. perlu dilakukan penelitian lebih lanjut dengan jumlah sampel yang lebih banyak agar diperoleh hasil yang lebih akurat.
2. Pasien dengan trauma kapitis, terutama trauma kapitis berat dianjurkan untuk memeriksa marker koagulasi setelah terjadinya trauma, agar dapat diberikan penatalaksanaan yang memadai bila sudah dijumpai tanda suatu koagulopati sehingga dapat mencegah terjadinya outcome yang buruk.
3. Hasil penelitian ini diharapkan dapat menjadi acuan bagi para dokter dalam rangka penatalaksanaan dan rehabilitasi pasien trauma kapitis sebagai upaya peningkatan kualitas hidup pasien dengan trauma kapitis.
DAFTAR PUSTAKA
Affonseca, C., Carvalho, L.F.A., Guerra, S.S., Ferreira, A.R. 2007. Coagulation disorder in children and adolescents with moderate to severe traumatic brain injury. J Pediatr (Rio J). 83: 274-282.
Antovic J., Bakic M., Ignjatovic G., Milenkovic Z. 1998. Blood coagulation and fibrinolysis parameter changes after various type of brain damage. Med Biol. 5:44-49.
Bayir, A., Kalkan, E., Kocak, S., Ak, A., Cander, B., Bodur, S. 2006. Fibrinolytic markers and neurologic outcome in traumatic brain injury. Neurol India. 54,363-365.
Boto, G.R., Gomez, P.A., De La Cruz, J., Lobato, R.D. 2006. Severe head injury and the risk of early death. J Neurol Neurosurg Psychiatry. 77,1054-1059.
Brohi K., Cohen M.J., Ganter M.T., Matthay M.A., et al. 2007. Acute traumatic coagulopathy: initiated by hypoperfusion, modulated through the protein C pathway ? Ann Surg. 245:812-818.
Capruso, D.X., Levin, H. 1996. Neurobehavioral outcome of head trauma. In : Evans, RW. Neurology and trauma. pp. 210-219. W.B Saunders Company. Philadelphia.
Chiaretti, A., Pezzotti, P., Mestrovic, J., Piastra, M., et al. 2001. The influence of hemocoagulative disorders on the outcome of children with head injury. Pediatr neurosurg. 34:131-137.
Dawodu, S.T. 2007. Traumatic Brain Injury : definition, epidemiology, pathophysiology. Available from :
www.emedicine.com/pmr/topic212.htm
Engstrom, M., Romner, B., Schalen, W., Reinstrup, P. 2005. Thrombocyto- penia predicts progressive hemorrhage after head trauma. J Neurotrauma. 22,291-296.
Gilroy J. Basic Neurology. 2000. 3rd edtion. McGraw-Hill. New York.
Grenader, A., Bredbacka, S., Rydvall, A., Aroch, R., Edner, G., Koskinen, L.O.D., Olivecrona, M. 2001. Antithrombin treatment in patients with traumatic brain injury. A pilot study. J Neurosurg Anesthesiol. 13,49- 56.
Hartanto, H. (Ed). 2004. Tinjauan Klinis Hasil Pemeriksaan Laboratorium. Edisi 11. Penerbit Buku Kedokteran EGC.Jakarta.
Heesen, M., Winking, M., Kemkes-Matthes, B., Deinsberger, W. 1997. What neurosurgeon needs to know about the coagulation system. Surg Neurol.47,32-34.
Hoffmann, M.E., John, O., Gaddis, G. 2001. Utility of an initial D-dimer assay in screening for traumatic or spontaneous intracranial hemorrhage. Academic emergency medicine. 8,859-865.
Homma, M., Henmi, H., Otomo Y., Inuoe J. 1998. Coagulation and fibrinolysis after head injury. Crit care. 2:22.
Jones,RD.,Rizzo,M. 2004. Head Trauma and Traumatic Brain Injury. In : Rizzo, M.,Eslinger,P.J.(eds).Principles and Practice of Behavioral Neurology and Neuropsychology. Pp. 615-31. WB Saunders Company Philadelphia
Kaufman, H.H., Timberlake, G., Voelker, J. 1996. Medical complications of head injury. In : Evans RW. Neurology and Trauma. Pp.186-200. W.B. Saunders Company. Philadelphia.
Khan, F., Baguley, I.J., Cameron, I.D. 2003. Rehabilitation after traumatic brain injury. MJA. 178,290-295.
Kraus, J.F., McArthur, D.L. 1996. Epidemiology of Brain Injury. In : Evans RW. Neurology and Trauma. Pp.3-17. W.B. Saunders Company. Philadelphia.
Leon-Carrion, J. 2005. Methods and tools for the assessment of outcome after brain injury rehabilitation. In : Leon-Carrion J, Von Wild KRH, Zitnay GA. (eds). Brain injury treatment theories and practices. Pp. 331-353. Taylor & Francis. Great Brittain.
Lim, H.B., Smith, M. 2007. Systemic complications after head injury: a clinical review. Anesthesia. 62,474-482.
Madiyono, B,, Moeslichan, M.S., Sastroasmoro, S., Budiman, I., Purwanto, S.H. 2002. Perkiraan besar sampel. Dalam : Sastroasmoro S, Ismael S. (eds). Dasar-dasar metologi penelitian klinis, hal. 259-87. Sagung Seto. Jakarta.
Marik, P.E., Varon, J., Trask, T. 2002. Management of Head Trauma. Chest. 122:699-711.
Mayer, S.A., Rowland, L.P. 2000. Head Injury. In : Rowland LP. (ed). Merritt’s Neurology. 10th edition. Pp. 401-15. Lippincott Williams & Wilkins. Philadelphia.
Murray, G.D., Butcher, I., McHugh G.S., Lu, J. et al. 2007. Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study. J neurotrauma. 24:329-337.
Naalt, J., Zomeren, A.H., Sluiter, W.J., Minderhoud, J.M. 1999. One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work. J Neurol Neurosurg Psychiatry. 66,207-213.
Nekludov, M., Bellander, B.M., Blomblack, M., Wallen, H.N. 2007. Platelet dysfunction in patients with severe traumatic brain injury. J Neurotrauma. 24, 1699-1706.
Pathak, A., Dutta, S., Marwaha, N., Singh, D., Varma, N., Mathuriya, S.N. 2005. Change in tissue thromboplastin content of brain following trauma. Neurology India. 53,178-182.
PERDOSSI. Konsensus Nasional Penanganan Trauma Kapitis dan Trauma Spinal. PERDOSSI. Jakarta. 2006.
Piek, J., Chesnut, R.M., Marshall, L.F., Van berkum-Clark, M., Klauber, M.R. 1992. Extracranial complications of severe head injury. J Neurosurg. 77,901-907.
Preston F.E., Malia R.G., Swoen M.J., Timperley W.R, Blackburn E.K. 1974. Disseminated intravascular coagulation as a consequence of cerebral damage. JNNP. 37:241-248.
Rizzo, M.. 2002. Head Trauma, Brain Injury, and Postconcussional. In : Johnson RT, Griffin JW, McArthur JC. (eds). 2002. Current Therapy in Neurologic Disease. 6th edition. pp. 228-238. Mosby, St.Louis. Ropper, A.H., Brown, R.H. 2005. Adams and Victor’s Principles of
Neurology. 8th edition. McGraw-Hill. New York.
Sawaya, R., Kornblith, P.L. 1987. Brain tumors and thromboembolic complications. Surg Neurol. 28,163.
Signorini, D.F., Andrews, P.J.D., Jones, P.A., Wardlaw, J.M., Miller, J.D. 1999. Predicting Survival using simple clinical variables: a case study in traumatic brain injury. J Neurol Neurosurg Psychiatry. 6, 20-25. Spahn D.R., Rossaint R. coagulopathy and blood component transfusion
in trauma. 2005. Br J Anaesth. 95:130-139.
Stein, S.C., Chen, X.H., Sinson, G.P., Smith, D.H. 2002. Intravascular coagulation: a major secondary insult ini nonfatal traumatic brain injury. J Neurosurg. 97,1373-1377.
Takahashi, H., Urano, T., Takada, Y., Nagai, N., Takada, A. 1997. Fibrinolytic parameters as an admission prognostic marker of head injury in patients who talk and deteriorate. J Neurosurg. 86,768-772. Thomas, C.L. 1988. Taber’s Cyclopedic Medical Dictionary. FA Davis
Company. Philadelphia.
Thompson, H.J., McCormick, W.C., Kagan, S.H. 2006. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc. 54:1590-1595.
Ueda S., Fujitsu K., Fujino H., Sekino T., Kuwabara T. 1985. Correlation between plasma fibrin-fibrinogen degradation product values and CT findings in head injury. JNNP. 48:58-60.
Vandelli, A., Fabbri, A., Servadei, F., Marchesini, G. 2004. Coagulopathy and NICE recommendations for patients with mild head injury. J Neurol Neurosurg Psychiatry. 75,1787-1788.
Vavilala, M., Dunbar, P., Rivara, F.P., Lam, A.M. 2001. Coagulopathy predicts poor outcome following head injury in children less than 16 years of age. J Neurosurg Anesthesiol. 13,13-18.
Vecht C.J., Smit Sibinga T., Minderhoud J.M.. 1975. Disseminated intravascular coagulation and head injury. JNNP. 38:567-571.
Wardlaw, J.M., Easton, V.J., Statham, P. 2002. Which CT features help predict outcome after head injury ? J Neurol Neurosurg Psychiatry. 72:188-92.
Wartenberg, K.E., Mayer, S.A. 2007. Trauma. In : Brust JCM. (ed). Current diagnosis & treatment in neurology. pp 175-90. McGraw-Hill Company Inc. United States of America.
Widjajakusumah, M.D. (ed). 1995. Buku ajar fisiologi kedokteran (review of medical physiology) / William F Ganong. Edisi 17. Penerbit Buku Kedokteran EGC. Jakarta.
LAMPIRAN 1
SURAT PERSETUJUAN IKUT DALAM PENELITIAN
Saya yang bertanda tangan di bawah ini :
Nama :
Jenis Kelamin :
Umur :
Pekerjaan :
Alamat :
Setelah mendapatkan keterangan secara terperinci dan jelas mengenai penelitian “PERANAN MARKER KOAGULASI SEBAGAI PREDIKTOR
OUTCOME PADA PENDERITA TRAUMA KAPITIS” dan setelah mendapatkan kesempatan mengajukan pertanyaan mengenai segala sesuatu yang berhubungan dengan penelitian tersebut, maka dengan ini saya secara sukarela dan tanpa paksaan menyatakan kesediaan saya ikut dalam penelitian tersebut.
Tanggal,
LAMPIRAN 2
LEMBAR PENGUMPUL DATA PENELITIAN IDENTITAS PRIBADI No urut : No. MR : Tgl. MRS : Jam MRS : Nama : Umur : tahun
Jenis Kelamin : 1. Pria 2. Wanita
Suku bangsa :
Pendidikan :
Pekerjaan :
Status : 1. Kawin 2. Tidak Kawin
PEMERIKSAAN FISIK NEUROLOGIS Pemeriksa Umum : Kesadaran
SKALA KOMA GLASGOW (SKG)
Buka mata Spontan 4
Dengan perintah verbal 3
Dengan nyeri 2
Tidak ada respon 1
Respon Verbal Orientasi baik dan berbicara 5
Disorientasi dan berbicara 4
Kata- kata yang tidak tepat, menangis 3
Suara yang tidak berarti 2
Tak ada respon 1
Respon Motorik Menurut perintah 6
Dapat melokalisasi nyeri 5
Fleksi terhadap nyeri 4
Fleksi abnormal (dekortikasi) 3
Ekstensi (deserebrasi) 2
Tidak ada respon 1
STATUS PRESENS
Tekanan darah : mmHg
Suhu : °C
Denyut nadi : X / menit Pernafasan : X / menit
III. HASIL PEMERIKSAAN MARKER KOAGULASI
Jumlah hitung Trombosit : /mm3
Prothrombin Time (PT) : detik(C: detik)
Thrombine Time (TT) : detik(C : detik)
Partial Thromboplastin Time (PTT) : detik(C : detik)
Fibrinogen : mg/dL
D-dimer : ng/mL
IV. HASIL PEMERIKSAAN CT-SCAN KEPALA
……… ……… ……… ……… ……… ……… ……… KESAN : ……… ………. ……….
Gambaran HeadCT Scan : 1. Normal
2. Mild focal injury (dijumpai adanya kontusio kecil pada hanya satu area di otak).
3. Medium focal injury (dijumpai beberapa kontusio pada 1 atau 2 area yang berdekatan di otak atau dijumpai subdural hematoma epidural hematoma kecil).
4. Mild/moderate difuse (dijumpai beberapa kontusio kecil atau hematoma tapi tidak pada daerah yang berdekatan, tapi sebagian besar otak kelihatannya normal.
5. Massive focal injury (dijumpai epidural/subdural hematoma besar atau kontusio berat atau parenchymal hematomas).
6. Massive diffuse injury (dijumpai edema otak menyeluruh atau banyak kontusio dibeberapa area).
LAMPIRAN 3
GLASGOW OUTCOMES SCALE (GOS)
1. = Death
2. = Vegetative State
• Tidak dapat berinteraksi dengan lingkungan • Tidak ada respon
3. = Severe Disability
Dapat mengikuti perintah/tidak dapat hidup secara independent (perlu bantuan)
4 = Moderate Disability
Dapat hidup secara independent/tidak dapat kembali bekerja atau sekolah
5 = Good Recovery
Dapat kembali bekerja atau sekolah
Nilai GOS saat keluar rumah sakit =
Dikutip dari : Jones,RD.,Rizzo,M.2004.Head Trauma and Traumatic Brain Injury. In : Rizzo, M.,Eslinger,P.J.(eds).Principles and Practice of Behaviral Neurology and Neuropsychology. pp. 615-31. WB Saunders Company Philadelphia