Prediktor klinis subdural kronik pada pasien lanjut usia di instalasi gawat darurat
DOI:
https://doi.org/10.25170/djm.v23i3.5416Keywords:
hematoma subdural kronik, lansia, pencitraan, prediktor klinisAbstract
Pendahuluan: Subdural hematoma kronik (cSDH) merupakan salah kasus emergensi neurologi yang sering terjadi yang lebih sering terjadi pada lansia. Diagnosis cSDH memiliki kesulitan tersendiri pada pasien lansia. Studi ini bertujuan untuk mempelajari karakteristik klinis pasien lansia yang dapat menjadi prediktor adanya cSDH dan derajat keparahan gambaran cSDH yang ditemukan pada hasil CT-scan kepala.
Metode: Penelitian ini merupakan studi kasus-kontrol yang dilakukan di Instalasi Gawat Darurat Neurologi RSUP Prof. dr. I.G.N.G. Ngoerah dalam periode 3 tahun. Studi melibatkan 85 pasien lansia cSDH dan 85 kontrol yang terbukti tidak ada perdarahan intrakranial dari data imaging. Pengumpulan dan pengolahan data yang dilakukan meliputi variabel karakteristik demografi, faktor risiko, presentasi klinis, dan karakteristik cSDH pada gambaran computed-tomography scan (CT-scan) kepala.
Hasil: Studi ini menemukan pasien cSDH dengan rata-rata usia 72,9±8.1 tahun dan 75,3% laki-laki. Penurunan kesadaran dan defisit fokal merupakan presentasi klinis yang paling sering ditemukan dengan median onset 3 hari (rentang 1-30 hari). Usia lebih tua, laki-laki (RO=2,84, 95% IK 1,45-5,45, p=0,001), hipertensi (RO=3,66, 95% IK 1,89-7,06, p=0,000), dan gangguan ginjal kronik (RO=2,77, 95% IK 1,34-5,72, p=0,005) merupakan faktor risiko terjadinya cSDH yang signifikan. Efek massa dan Glasgow Coma Scale (GCS) yang rendah lebih sering terjadi pada cSDH dengan midline shift (MLS) >5mm.
Simpulan: Adanya cSDH perlu dipertimbangkan pada pasien lansia yang datang dengan onset manifestasi neurologis akut-subakut terutama pasien laki-laki, mengalami penurunan kesadaran dengan atau tanpa defisit fokal, disertai adanya komorbid hipertensi dan gangguan ginjal. Penurunan GCS dan efek massa dapat memperkirakan adanya MLS pada CT-scan kepala.
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