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7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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A new 2-step risk-stratification
clinical score for suspectedappendicitis in children
Yap T, Chen Y, Low W, Ong C, Nah S, Jacobsen A,
Shen L, Lowa Y
Journal of Pediatric Surgery 50 (2015) 2051–2055
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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PENDAHULUAN
• Diagnosis akurat appendisitis anak sulit
• Negative appendectomy rates !"
• Perforation rates #$"
• Overdiagnose appendisitis
– Skor Al%arado #&"
– Pediatric ppendicitis Score '(AS) #$"
1
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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PENDAHULUAN
• (enanda in*a+asi laboratoriu+
– e ↑ ke+ungkinan diagnosisappendisitis
• -o+binasi .u+lah leukosit,persentase netro/l dan C0( aplikasi pada anak '1)
2
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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TUJUAN PENELITIAN
e+buat alat prediksi klinis 2ang +udahdan sederhana untuk diaplikasikan,
disertai # penanda laboratoriu+ untuk
+en2ingkirkan appendisitis
(e+eriksaan 3S4 dan CT scan padapasien dengan diagnosa 2ang
tersa+ar
3
Disertaidengan
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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METODE 4
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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Kriteria Eksklusi
56
&6
#6
76
5
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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LUARAN 6
• 8istologis 9 terdapat in/ltratin*a+asi :okal dan trans+ural
'+ini+al in/ltrasi +ukosa)• Dite+ukan :aecolith
A((;ND<C<T<S
• 8istologis 9 per:orasi atau gangren• Saat operasi 9 abses atau +assa
in*a+asi
A((;ND<C<T<S dengan-O(L<-AS<
• (asien dengan tersangkaappendisitis diobser%asi di ruangansa+pai bebas n2eri sela+a &7 .a+
• Diagnosa belu+ .elas 3S4 atauCT Scan
=3-AN A((;ND<C<T<S
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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ANALIA TATITIK !
• Nilai nor+al titik potong
– Leukosit 9 > 5?6???@L
– Netro/l 9 > $"
– C0( 9 > $ g@L
• S(SS 5B dan 4raph(ad (ris+!
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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HAIL PENELITIAN "
Ta#el 1$ De%&'ra( )a* Karakteristik Kli*is
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HAIL PENELITIAN +
Ta#el 2$ Kete,ata* Dia'*&sis Leuk&sit- Netr&(l- .RP- )a*k&%#i*asi keti'a*/a
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HAIL PENELITIAN 10
Ta#el 3$ Pre)ikt&r )a* Raw Score
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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HAIL PENELITIAN 11
K&e(sie* A•
A ?
ketiga penanda laboratoriu+nor+al•A 5 salah satu penanda laboratoriu++e↑
.il)re* A,,e*)iitis &re .A koe/sien A .u+lah ra! score
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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HAIL PENELITIAN 12
a%#ar 1$ Distri#usi rekue*si .A )e*'a* 2titik ,&t&*'
e*siti7itas 8+"-29NP: 8 +"-"9
,esi(sitas8++-69PP: 8 +4-49
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HAIL PENELITIAN 13
a%#ar 2$Kur7a RO. u*tuk Dia'*&sis A,,e*)iitis)e*'a* .A )a* PA
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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HAIL PENELITIAN 14
AU. )ari .A Me*urut Usia•7 E F tahun ?,B?F•B E 5& tahun ?,F#•5# E 5! tahun ?,F$?
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HAIL PENELITIAN 15
a%#ar 3$ Dia'ra% Alur Pe%akaia* .il)re*A,,e*)iitis &re
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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HAIL PENELITIAN 16
Ta#el 4$ Per#a*)i*'a* Dia'*&sis Me%akai .A )a* PA
#er)asarka* Titik P&t&*'
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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DIKUI
• CAS
+en2ingkirkan !#" pasien tanpaappendicitis
• -eterbatasan C0(
– 0espon secara time"dependent &7 E 7F .a+
• Leukosit dan netro/l
– e↑ dala+ &7 .a+ setelah onset n2eri
1!
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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DIKUI
• CAS 7 ge.ala klinis G #laboratoriu+
• 4e.ala sub.ekti: pada (AS
– N2eri berpindah
– ual tidak digunakan
– untah
1"
7/25/2019 A New 2-Step Risk-stratification Clinical Score for Suspected
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KEIMPULAN
• CAS lebih superior dibandingkan (ASuntuk +en2ingkirkan appendicitis6
1+