Tesis

Uji Validasi Skor A2 DS2 Sebagai Prediktor Timbulnya Pneumonia Pada Pasien Stroke Iskemik Akut = Validation of A 2 DS 2 score as Predictor of incidence of Pneumonia in Patients with Acute Ischemic Stroke who are hospitalized in Cipto Mangunkusumo National General Hospital.

LATAR BELAKANG: Pneumonia menjadi penyebab utama morbiditas dan mortalitas pada pasien-pasien stroke iskemik akut yang dirawat di RS, sehingga diperlukan suatu sistem skor yang valid dan mudah diterapkan sebagai alat untuk memprediksi dan menstratifikasi risiko timbulnya pneumonia pada pasien stroke iskemik akut. TUJUAN : Menilai kemampuan skor A 2 DS 2 dalam memprediksi timbulnya pneumonia pada pasien stroke iskemik akut yang dirawat di RSCM. METODE: Penelitian ini merupakan studi kohort retrospektif terhadap pasien stroke iskemik akut yang dirawat di RSCM. Usia, fibrilasi atrium, disfagia, jenis kelamin (laki-laki), dan tingkat keparahan stroke (dinilai dengan NIHSS), dinilai pada awal perawatan di RSCM kemudian diikuti hingga 7 hari sejak onset stroke iskemik untuk dilihat outcome-nya (pneumonia atau tidak). Performa kalibrasi skor A dinilai dengan uji Hosmer-Lemeshow dan plot kalibrasi. Performa diskriminasi skor A dinilai dengan Area Under The Curve (AUC). HASIL PENELITIAN: Sebanyak 281 subjek diikutsertakan dengan angka kejadian pneumonia dalam 7 hari sejak onset timbulnya stroke iskemik sebanyak 118 subjek (42%). Uji Hosmer-Lemeshow menunjukkan p = 0,222 dengan plot kalibrasi menunjukkan koefisien korelasi r=0,982. AUC sebesar 0,885 (IK95% 0,845; 0,924) SIMPULAN: Skor A 2 DS 2 memiliki performa kalibrasi dan diskriminasi yang baik dalam memprediksi timbulnya pneumonia pada pasien stroke iskemik akut yang dirawat di RSCM.
KATA KUNCI: stroke iskemik akut, skor A 2 DS 2 (Age, Atrial Fibrillation, Dysphagia, Sex (male), and Stroke Severity), validasi


BACKGROUND : Pneumonia is the leading cause of morbidity and mortality in acute ischemic stroke patients admitted to hospital. Thus required a valid scoring system which is easy to apply, to predict and stratify the risk of pneumonia in patients with acute ischemic stroke. OBJECTIVE : To assess the performance of calibration and discrimination of A 2 DS 2 score in predicting the incidence of pneumonia in patients with acute ischemic stroke who are hospitalized in Cipto Mangunkusumo National General Hospital. METHODS: This was a retrospective cohort study of adult acute ischemic stroke patients who are hospitalized in Cipto Mangunkusumo Hospital. Age, presence or absence of atrial fibrillation, presence or absence of dysphagia, Sex (male), and stroke severity (rated with NIHSS) were obtained at the beginning of admission. The subjects were followed up for up to 7 days after the onset of ischemic stroke to assess the outcome (pneumonia or not). Our study protocol was approved by the Ethics Committee of the Faculty of Medicine, University of Indonesia. Calibration properties of A 2 DS 2 score were assessed by Hosmer-Lemeshow test and calibration plot. Discrimination properties of A 2 DS 2 score were assessed by the area under the curve (AUC). RESULT: A total of 281 subjects were followed up. The incidence of pneumonia in acute ischemic stroke patients was observed in 118 patients (42%). Hosmer Lemeshow test of A 2 DS 2 score showed p=0,222 and calibration plot showed r=0,982. Discrimination of A 2 DS 2 score was shown by the AUC value of 0,885 (95%CI 0,845; 0,924). CONCLUSION: A 2 DS 2 score have a good calibration and discrimination performance in predicting incidence of pneumonia in patients with acute ischemic stroke who are hospitalized in Cipto Mangunkusumo National General Hospital.
KEYWORD: acute ischemic stroke, A 2 DS 2 score, (Age, Atrial Fibrillation, Dysphagia, Sex (male), and Stroke Severity), validation