Tesis

Perbandingan Skor Wells, D-Dimer dan Kombinasi Skor Wells dan D-Dimer Dengan Venous Duplex Ultrasonography (VDUS) Dalam Penegakan Diagnosis Deep Vein Thrombosis (DVT) Akut Ekstremitas Bawah = Comparison of Wells Score, D-Dimer and Combination of Wells Score and D-Dimer with Venous Duplex Ultrasonography (VDUS) in Diagnosis of Acute Deep Vein Thrombosis (DVT) in Lower Extremity.

Latar Belakang. Penegakan diagnosis DVT akut ekstremitas bawah dengan sarana diagnostik yang ada termasuk venous duplex ultrasonography (VDUS) masih terkendala biaya, waktu dan tenaga operator. Penelitian ini bertujuan menilai efektivitas skor Wells, kadar D-Dimer atau skor kombinasi keduanya dibandingkan dengan VDUS dalam mendeteksi kasus-kasus DVT akut ekstremitas bawah. Metode. Dilakukan studi diagnostik dengan desain cross-sectional yang dilakukan di Divisi Bedah Vaskular dan Endovaskular Departemen Ilmu Bedah FKUI-RSCM pada semua pasien dewasa dengan dugaan DVT akut ekstremitas bawah yang dikonsultasikan ke Divisi Bedah Vaskular RSCM yang dikonfirmasi dengan pemeriksaan VDUS pada periode Januari 2014 – Desember 2015 yang memenuhi kriteria inklusi dan eksklusi. Sumber data diambil dari rekam medik (data sekunder). Analisis data berupa uji diagnostik dan diuji dengan SPSS version 17.0 for Windows Hasil. Studi melibatkan 85 orang. Didapatkan kejadian DVT akut ekstremitas bawah sebesar 65,88%. Sensitivitas dan nilai duga negatif tertinggi (100.00%) didapatkan pada skor kombinasi II dan IV. Sedangkan spesifisitas tertinggi (89,66%) dan nilai duga positif tertinggi (92,68%) diperoleh pada skor kombinasi III. Skor dengan nilai diagnostik berimbang (sensitivitas 87,50%; spesifisitas 72,41%) dijumpai pada skor Wells 3 level I. Simpulan. Skor Wells dan VDUS memiliki efektivitas sebanding dalam deteksi kasus-kasus kecurigaan DVT akut ekstremitas bawah.
Kata Kunci: DVT akut ekstremitas bawah, skor Wells, D-Dimer, venous duplex ultrasonography


Introduction. The diagnosis of acute lower extremity DVT with available resources including VDUS was still costly, time-consuming and power consumng. The purpose of this study was to evaluate effectivity of Wells score, D-Dimer and combination of both compared with VDUS in detecting lower extremity DVT. Methods. This was a cross-sectional diagnostic study that was carried out at Vascular and Endovascular Surgery Division of Surgery Department of FKUI-RSCM between by enrolling all adult patients with suspected acute DVT of lower extremity that was consulted to Vascular Surgery Division and confirmed with VDUS study between January 2014 and December 2015 that meet inclusion and exclusion criteria. Data source was taken from medical record. Data analysis in the form of diagnostic study was performed with SPSS version 17.0 for Windows Result. The study enrolled 85 subjects, of which 65,88% was found to have acute lower extremity DVT. The highest sensitivity and negative predictive value (100,00%) was discovered in combination score II and IV. The combination score III had the highest specificity (89,66%) and positive predictive value (92,68%). Whereas the most balanced diagnostic study score was the Wells score 3 Level I with sensitivity 87,50% and specificity 72,41%. Conclusion. Wells score and VDUS were equally effective in detection of lower extremity acute DVT cases.
Keywords: lower extremity acure DVT, Well score, D-Dimer, venous duplex ultrasonography