BAB VI SIMPULAN DAN SARAN
6.2 Saran
1. Masalah penatalaksaan sektor prehospital perlu mendapatkan perbaikan yang melibatkan pemerintah dan manajemen rumah sakit.
2. Penerapan NISS untuk membantu dokter menentukan prioritas penanganan triage pasien di IGD rumah sakit.
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LAMPIRAN – LAMPIRAN
LAMPIRAN 4. Hasil Analisis Data
Case Processing Summary Cases
Valid Missing Total
N Percent N Percent N Percent
USIA (th) 50 100.0% 0 0.0% 50 100.0%
Descriptives
Statistic Std. Error
USIA (th)
Mean 30.42 1.956
95% Confidence Interval for Mean Lower Bound 26.49 Upper Bound 34.35 5% Trimmed Mean 29.36 Median 27.00 Variance 191.351 Std. Deviation 13.833 Minimum 16 Maximum 65 Range 49 Interquartile Range 22 Skewness .990 .337 Kurtosis .105 .662 Tests of Normality Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
USIA (th) .161 50 .002 .874 50 .000
Frequencies Statistics Prehospital Insult Transport Time >60mnt NISS>50 Syok Hipovolemik Koagulopati N Valid 50 50 50 50 50 Missing 0 0 0 0 0 Statistics
Durasi operasi >90mnt Blood Loss >1500cc Outcome
N
Valid 50 50 50
Missing 0 0 0
Frequency Table
Prehospital Insult
Frequency Percent Valid Percent Cumulative Percent Valid Ya 23 46.0 46.0 46.0 Tidak 27 54.0 54.0 100.0 Total 50 100.0 100.0 Transport Time >60mnt
Frequency Percent Valid Percent Cumulative Percent Valid Ya 36 72.0 72.0 72.0 Tidak 14 28.0 28.0 100.0 Total 50 100.0 100.0 NISS>50
Frequency Percent Valid Percent Cumulative Percent
Valid
Ya 15 30.0 30.0 30.0
Tidak 35 70.0 70.0 100.0
Syok Hipovolemik
Frequency Percent Valid Percent Cumulative Percent Valid Ya 28 56.0 56.0 56.0 Tidak 22 44.0 44.0 100.0 Total 50 100.0 100.0 Koagulopati
Frequency Percent Valid Percent Cumulative Percent Valid Ya 25 50.0 50.0 50.0 Tidak 25 50.0 50.0 100.0 Total 50 100.0 100.0 Durasi operasi >90mnt
Frequency Percent Valid Percent Cumulative Percent Valid Ya 8 16.0 16.0 16.0 Tidak 42 84.0 84.0 100.0 Total 50 100.0 100.0 Blood Loss >1500cc
Frequency Percent Valid Percent Cumulative Percent
Valid
Ya 30 60.0 60.0 60.0
Tidak 20 40.0 40.0 100.0
Outcome
Frequency Percent Valid Percent Cumulative Percent Valid Mati 22 44.0 44.0 44.0 Hidup 28 56.0 56.0 100.0 Total 50 100.0 100.0 Crosstabs
Case Processing Summary Cases
Valid Missing Total
N Percent N Percent N Percent
Prehospital Insult * Outcome 50 100.0% 0 0.0% 50 100.0% Transport Time >60mnt * Outcome 50 100.0% 0 0.0% 50 100.0% NISS>50 * Outcome 50 100.0% 0 0.0% 50 100.0% Syok Hipovolemik * Outcome 50 100.0% 0 0.0% 50 100.0% Koagulopati * Outcome 50 100.0% 0 0.0% 50 100.0% Durasi operasi >90mnt * Outcome 50 100.0% 0 0.0% 50 100.0% Blood Loss >1500cc * Outcome 50 100.0% 0 0.0% 50 100.0%
Prehospital Insult * Outcome Crosstab Outcome Total Mati Hidup Prehospital Insult Ya Count 22 1 23
% within Prehospital Insult 95.7% 4.3% 100.0%
Tidak
Count 0 27 27
% within Prehospital Insult 0.0% 100.0% 100.0%
Total
Count 22 28 50
% within Prehospital Insult 44.0% 56.0% 100.0%
Chi-Square Tests Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 46.118a 1 .000 Continuity Correctionb 42.318 1 .000 Likelihood Ratio 60.366 1 .000
Fisher's Exact Test .000 .000
Linear-by-Linear Association 45.196 1 .000 N of Valid Cases 50
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 10.12. b. Computed only for a 2x2 table
Risk Estimate
Value 95% Confidence Interval
Lower Upper
For cohort Outcome = Hidup .043 .006 .296 N of Valid Cases 50
Transport Time >60mnt * Outcome Crosstab Outcome Total Mati Hidup Transport Time >60mnt Ya Count 18 18 36
% within Transport Time >60mnt
50.0% 50.0% 100.0%
Tidak
Count 4 10 14
% within Transport Time >60mnt
28.6% 71.4% 100.0%
Total
Count 22 28 50
% within Transport Time >60mnt
44.0% 56.0% 100.0%
Chi-Square Tests
Value df Asymp. Sig. (2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 1.878a 1 .171 Continuity Correctionb 1.109 1 .292 Likelihood Ratio 1.935 1 .164
Fisher's Exact Test .215 .146
Linear-by-Linear Association 1.841 1 .175 N of Valid Cases 50
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 6.16. b. Computed only for a 2x2 table
Risk Estimate
Value 95% Confidence Interval
Lower Upper
Odds Ratio for Transport Time >60mnt (Ya / Tidak)
2.500 .661 9.461
For cohort Outcome = Mati 1.750 .718 4.263 For cohort Outcome = Hidup .700 .440 1.115 N of Valid Cases 50 NISS>50 * Outcome Crosstab Outcome Total Mati Hidup NISS>50 Ya Count 15 0 15 % within NISS>50 100.0% 0.0% 100.0% Tidak Count 7 28 35 % within NISS>50 20.0% 80.0% 100.0% Total Count 22 28 50 % within NISS>50 44.0% 56.0% 100.0% Chi-Square Tests Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 27.273a 1 .000 Continuity Correctionb 24.123 1 .000 Likelihood Ratio 33.565 1 .000
Fisher's Exact Test .000 .000
Linear-by-Linear Association 26.727 1 .000 N of Valid Cases 50
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 6.60. b. Computed only for a 2x2 table
Risk Estimate
Value 95% Confidence Interval
Lower Upper
For cohort Outcome = Mati 5.000 2.578 9.699 N of Valid Cases 50
Syok Hipovolemik * Outcome
Crosstab Outcome Total Mati Hidup Syok Hipovolemik Ya Count 16 12 28
% within Syok Hipovolemik 57.1% 42.9% 100.0%
Tidak
Count 6 16 22
% within Syok Hipovolemik 27.3% 72.7% 100.0%
Total
Count 22 28 50
% within Syok Hipovolemik 44.0% 56.0% 100.0%
Chi-Square Tests Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 4.461a 1 .035 Continuity Correctionb 3.331 1 .068 Likelihood Ratio 4.568 1 .033
Fisher's Exact Test .047 .033
Linear-by-Linear Association 4.372 1 .037 N of Valid Cases 50
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 9.68. b. Computed only for a 2x2 table
Risk Estimate
Value 95% Confidence Interval
Lower Upper
Odds Ratio for Syok Hipovolemik (Ya / Tidak)
3.556 1.071 11.808
For cohort Outcome = Mati 2.095 .986 4.453 For cohort Outcome = Hidup .589 .358 .970 N of Valid Cases 50 Koagulopati * Outcome Crosstab Outcome Total Mati Hidup Koagulopati Ya Count 15 10 25 % within Koagulopati 60.0% 40.0% 100.0% Tidak Count 7 18 25 % within Koagulopati 28.0% 72.0% 100.0% Total Count 22 28 50 % within Koagulopati 44.0% 56.0% 100.0% Chi-Square Tests Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 5.195a 1 .023 Continuity Correctionb 3.977 1 .046 Likelihood Ratio 5.295 1 .021
Fisher's Exact Test .045 .023
Linear-by-Linear Association 5.091 1 .024 N of Valid Cases 50
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 11.00. b. Computed only for a 2x2 table
Risk Estimate
Value 95% Confidence Interval
Lower Upper
Odds Ratio for Koagulopati (Ya / Tidak)
3.857 1.180 12.606
For cohort Outcome = Mati 2.143 1.058 4.338 For cohort Outcome = Hidup .556 .324 .952 N of Valid Cases 50
Durasi operasi >90mnt * Outcome Crosstab Outcome Total Mati Hidup Durasi operasi >90mnt Ya Count 6 2 8
% within Durasi operasi >90mnt
75.0% 25.0% 100.0%
Tidak
Count 16 26 42
% within Durasi operasi >90mnt
38.1% 61.9% 100.0%
Total
Count 22 28 50
% within Durasi operasi >90mnt
44.0% 56.0% 100.0%
Chi-Square Tests Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 3.714a 1 .054 Continuity Correctionb 2.368 1 .124 Likelihood Ratio 3.775 1 .052
Fisher's Exact Test .116 .062
Linear-by-Linear Association 3.640 1 .056 N of Valid Cases 50
a. 2 cells (50.0%) have expected count less than 5. The minimum expected count is 3.52. b. Computed only for a 2x2 table
Risk Estimate
Value 95% Confidence Interval
Lower Upper
Odds Ratio for Durasi operasi >90mnt (Ya / Tidak)
4.875 .875 27.149
For cohort Outcome = Mati 1.969 1.130 3.431 For cohort Outcome = Hidup .404 .119 1.373 N of Valid Cases 50
Blood Loss >1500cc * Outcome Crosstab Outcome Total Mati Hidup Blood Loss >1500cc Ya Count 16 14 30
% within Blood Loss >1500cc
53.3% 46.7% 100.0%
Tidak
Count 6 14 20
% within Blood Loss >1500cc
30.0% 70.0% 100.0%
Total
Count 22 28 50
% within Blood Loss >1500cc
44.0% 56.0% 100.0%
Chi-Square Tests Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square 2.652a 1 .103 Continuity Correctionb 1.789 1 .181 Likelihood Ratio 2.703 1 .100
Fisher's Exact Test .148 .090
Linear-by-Linear Association 2.598 1 .107 N of Valid Cases 50
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 8.80. b. Computed only for a 2x2 table
Risk Estimate
Value 95% Confidence Interval
Lower Upper
Odds Ratio for Blood Loss >1500cc (Ya / Tidak)
2.667 .807 8.814
For cohort Outcome = Mati 1.778 .841 3.758 For cohort Outcome = Hidup .667 .413 1.075 N of Valid Cases 50
Generalized Linear Models
Model Information Dependent Variable Outcome Probability Distribution Poisson Link Function Log
Case Processing Summary N Percent
Included 50 100.0%
Excluded 0 0.0%
Categorical Variable Information N Percent Factor Transport Time >60mnt Ya 36 72.0% 0 14 28.0% Total 50 100.0% NISS>50 Ya 15 30.0% 0 35 70.0% Total 50 100.0% Syok Hipovolemik Ya 28 56.0% 0 22 44.0% Total 50 100.0% Koagulopati Ya 25 50.0% 0 25 50.0% Total 50 100.0% Durasi operasi >90mnt Ya 8 16.0% 0 42 84.0% Total 50 100.0% Blood Loss >1500cc Ya 30 60.0% 0 20 40.0% Total 50 100.0%
Continuous Variable Information
N Minimum Maximum Mean Std. Deviation
Goodness of Fita
Value df Value/df
Deviance 21.055 43 .490
Scaled Deviance 21.055 43
Pearson Chi-Square 27.099 43 .630 Scaled Pearson Chi-Square 27.099 43
Log Likelihoodb -32.528 Akaike's Information
Criterion (AIC)
79.055
Finite Sample Corrected AIC (AICC)
81.722
Bayesian Information Criterion (BIC)
92.439
Consistent AIC (CAIC) 99.439
Dependent Variable: Outcome
Model: (Intercept), TransportTime60mnt, NISS50, SyokHipovolemik, Koagulopati, Durasioperasi90mnt, BloodLoss1500cca
a. Information criteria are in small-is-better form.
b. The full log likelihood function is displayed and used in computing information criteria. Omnibus Testa Likelihood Ratio Chi-Square df Sig. 15.068 6 .020
Dependent Variable: Outcome
Model: (Intercept), TransportTime60mnt, NISS50, SyokHipovolemik, Koagulopati, Durasioperasi90mnt, BloodLoss1500cca a. Compares the fitted model against the
Tests of Model Effects
Source Type III
Wald Chi-Square df Sig. (Intercept) 13.554 1 .000 TransportTime60mnt .718 1 .397 NISS50 15.505 1 .000 SyokHipovolemik .740 1 .390 Koagulopati 1.166 1 .280 Durasioperasi90mnt 2.009 1 .156 BloodLoss1500cc .528 1 .467
Dependent Variable: Outcome
Model: (Intercept), TransportTime60mnt, NISS50, SyokHipovolemik, Koagulopati, Durasioperasi90mnt, BloodLoss1500cc
Parameter Estimates
Parameter B Std. Error 95% Wald Confidence Interval Hypothesis Test
Lower Upper Wald Chi-Square (Intercept) -2.161 .7140 -3.561 -.762 9.166 [TransportTime60mnt=1] .456 .5380 -.599 1.510 .718 [TransportTime60mnt=0] 0a . . . . [NISS50=1] 1.407 .3574 .707 2.108 15.505 [NISS50=0] 0a . . . . [SyokHipovolemik=1] .260 .3026 -.333 .853 .740 [SyokHipovolemik=0] 0a . . . . [Koagulopati=1] .308 .2850 -.251 .866 1.166 [Koagulopati=0] 0a . . . . [Durasioperasi90mnt=1] .515 .3635 -.197 1.228 2.009 [Durasioperasi90mnt=0] 0a . . . . [BloodLoss1500cc=1] -.260 .3579 -.962 .441 .528 [BloodLoss1500cc=0] 0a . . . . (Scale) 1b
Parameter Estimates Parameter
Hypothesis Test
Exp(B) 95% Wald Confidence Interval for Exp(B)
df Sig. Lower Upper
(Intercept) 1 .002 .115 .028 .467 [TransportTime60mnt=1] 1 .397 1.578 .550 4.529 [TransportTime60mnt=0] .a . 1 . . [NISS50=1] 1 .000 4.084 2.027 8.228 [NISS50=0] .a . 1 . . [SyokHipovolemik=1] 1 .390 1.297 .717 2.348 [SyokHipovolemik=0] .a . 1 . . [Koagulopati=1] 1 .280 1.360 .778 2.378 [Koagulopati=0] .a . 1 . . [Durasioperasi90mnt=1] 1 .156 1.674 .821 3.413 [Durasioperasi90mnt=0] .a . 1 . . [BloodLoss1500cc=1] 1 .467 .771 .382 1.555 [BloodLoss1500cc=0] .a . 1 . . (Scale)
Dependent Variable: Outcome
Model: (Intercept), TransportTime60mnt, NISS50, SyokHipovolemik, Koagulopati, Durasioperasi90mnt, BloodLoss1500cc
a. Set to zero because this parameter is redundant. b. Fixed at the displayed value.
Generalized Linear Models
Model Information Dependent Variable Outcome Probability Distribution Poisson Link Function Log
Case Processing Summary N Percent
Included 50 100.0%
Excluded 0 0.0%
Total 50 100.0%
Categorical Variable Information
N Percent Factor Transport Time >60mnt Ya 36 72.0% 0 14 28.0% Total 50 100.0% Syok Hipovolemik Ya 28 56.0% 0 22 44.0% Total 50 100.0% Koagulopati Ya 25 50.0% 0 25 50.0% Total 50 100.0% Durasi operasi >90mnt Ya 8 16.0% 0 42 84.0% Total 50 100.0% Blood Loss >1500cc Ya 30 60.0% 0 20 40.0% Total 50 100.0%
Continuous Variable Information
N Minimum Maximum Mean Std. Deviation
Goodness of Fita
Value df Value/df
Deviance 29.484 44 .670
Scaled Deviance 29.484 44
Pearson Chi-Square 27.521 44 .625 Scaled Pearson Chi-Square 27.521 44
Log Likelihoodb -36.742 Akaike's Information
Criterion (AIC)
85.484
Finite Sample Corrected AIC (AICC)
87.438
Bayesian Information Criterion (BIC)
96.956
Consistent AIC (CAIC) 102.956
Dependent Variable: Outcome
Model: (Intercept), TransportTime60mnt, SyokHipovolemik, Koagulopati, Durasioperasi90mnt, BloodLoss1500cca a. Information criteria are in small-is-better form.
b. The full log likelihood function is displayed and used in computing information criteria. Omnibus Testa Likelihood Ratio Chi-Square df Sig. 6.639 5 .249
Dependent Variable: Outcome
Model: (Intercept), TransportTime60mnt, SyokHipovolemik, Koagulopati,
Durasioperasi90mnt, BloodLoss1500cca a. Compares the fitted model against the intercept-only model.
Tests of Model Effects
Source Type III
Wald Chi-Square df Sig. (Intercept) 17.583 1 .000 TransportTime60mnt 1.852 1 .174 SyokHipovolemik 1.718 1 .190 Koagulopati 1.359 1 .244 Durasioperasi90mnt 8.002 1 .005 BloodLoss1500cc .136 1 .712
Dependent Variable: Outcome
Model: (Intercept), TransportTime60mnt, SyokHipovolemik, Koagulopati, Durasioperasi90mnt, BloodLoss1500cc
Parameter Estimates
Parameter B Std. Error 95% Wald Confidence Interval Hypothesis Test
Lower Upper Wald Chi-Square (Intercept) -2.073 .5580 -3.167 -.979 13.800 [TransportTime60mnt=1] .531 .3900 -.234 1.295 1.852 [TransportTime60mnt=0] 0a . . . . [SyokHipovolemik=1] .535 .4081 -.265 1.335 1.718 [SyokHipovolemik=0] 0a . . . . [Koagulopati=1] .397 .3409 -.271 1.066 1.359 [Koagulopati=0] 0a . . . . [Durasioperasi90mnt=1] .769 .2719 .236 1.302 8.002 [Durasioperasi90mnt=0] 0a . . . . [BloodLoss1500cc=1] .136 .3674 -.584 .856 .136 [BloodLoss1500cc=0] 0a . . . . (Scale) 1b
Parameter Estimates Parameter
Hypothesis Test
Exp(B) 95% Wald Confidence Interval for Exp(B)
df Sig. Lower Upper
(Intercept) 1 .000 .126 .042 .376 [TransportTime60mnt=1] 1 .174 1.700 .792 3.652 [TransportTime60mnt=0] .a . 1 . . [SyokHipovolemik=1] 1 .190 1.707 .767 3.799 [SyokHipovolemik=0] .a . 1 . . [Koagulopati=1] 1 .244 1.488 .763 2.903 [Koagulopati=0] .a . 1 . . [Durasioperasi90mnt=1] 1 .005 2.158 1.266 3.677 [Durasioperasi90mnt=0] .a . 1 . . [BloodLoss1500cc=1] 1 .712 1.145 .557 2.353 [BloodLoss1500cc=0] .a . 1 . . (Scale)
Dependent Variable: Outcome
Model: (Intercept), TransportTime60mnt, SyokHipovolemik, Koagulopati, Durasioperasi90mnt, BloodLoss1500cc a. Set to zero because this parameter is redundant.
LAMPIRAN 5. Lembar Pengumpulan Data
No. Sampel :
PREHOSPITAL INSULT DAN NISS > 50 MEMPENGARUHI MORTALITAS PASIEN TRAUMA TUMPUL ABDOMEN DI RUMAH SAKIT SANGLAH PERIODE TAHUN 2015
Nama : MRS : No CM : OK : Jenis kelamin : KRS : Usia : Alamat : Prehospital insult : Transport time :
Regio Deskripsi Cedera AIS (Abbreviated
Injury Scale)
Square Top Three
Kepala dan Leher Wajah Thoraks Abdomen Ekstremitas Eksternal NISS Diagnosis : Tindakan operasi :
Syok : (tax : ° C; N : x/min)
Koagulopati : INR :
Durasi operasi :
Pendarahan durante op :
LAMPIRAN 6. Persetujuan Penelitian
PERSETUJUAN PENELITIAN
Bapak/Ibu Yth,
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Informasi umum
Tujuan dari penelitian ini adalah untuk mengetahui faktor-faktor risiko yang mempengaruhi mortalitas pasien trauma tumpul abdomen di Rumah Sakit Sanglah. Mortalitas akibat trauma abdomen paling sering disebabkan akibat perdarahan, dimana perdarahan menempati urutan kedua setelah trauma sistem saraf pusat sebagai penyebab kematian dengan kisaran 30-40%. Beberapa faktor-faktor risiko yang dianggap berperan dalam mortalitas pada pasien traum tumpul abdomen adalah tidak memberikan resusitasi cairan prehospital, transport tme lebih dari 60 menit, NISS lebih dari 50, syok hipovolemik, koagulopati, durasi operasi lebih dari 90 menit, dan jumlah darah yang hilang lebih dari 1500cc durante operasi. Diharapkan pengendalian terhadap faktor-faktor risiko tersebut mampu menekan angka mortalitas pasien trauma tumpul abdomen.
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