Hubungan Skore Cognitive Test For Delirium (CTD) dengan Lamanya Masa Rawat Inap Penderita Trauma Kapitis Sedang-Berat di Rumah Sakit

Abstract

Background : Delirium is universal following coma caused by head injury, it is particularly likely to occur on recovery of consciousness following acute brain injury. Delirium is associated with increased mortality, longer lengths of hospital stay, increased utilization of hospital resources, and poorer functional and cognitive outcomes. The objective of this study was to determine the correlation between CTD score and lengths of hospital stay in moderate-severe head injury patients.

Methods : This is a cross sectional study with non random sampling using the consecutive method applied to moderate-severe head injury patients in neurology ward Haji Adam Malik Medan hospital between the periode of February until July 2007. Calculation of GCS score and Head CT scan were performed. Afterward, delirium identification was performed using the CTD instrument and length of hospital stay was noted. To determine the correlation between the CTD score and mean of lengths of hospital stay, t-independent test was used. The significance value is p < 0,05.

Result :The were 34 samples of moderate-severe head injury patients, consisted of 30 males (88.2%) and 4 females (11.8%). There were 20 patients (58.8%) who suffered delirium (CTD score <19). The mean of CTD score was 16.79 ± 5.17. The mean of CTD score in GCS score 3 – 8 group (10.29 ± 6.26) was lower than GCS score 9 – 12 group (18.48 ± 3.25) although the mean of CTH score in both groups showed that there were symptoms of deliium (p = 0.013). Overall, the mean of lengths of hospital stay was 17.50 ± 5.83 days with the shortest lengths of hospital stay was 10 days and the longest was 30 days. The mean of lengths of hospital stay in head injury patients with delirium was longer than those with not delirium (21.05 ± 4.61 days vs 12.43 ± 2.85 days, p = 0.000).

Conclusion : The mean of lengths of hospital stay in head injury patients with delirium was significantly longer than head injury patients without delirium.

Latar belakang : Delirium sering dijumpai setelah kejadian koma yang disebabkan oleh trauma kapitis, yang terutama muncul saat pemulihan kesadaran setelah trauma kapitis akut. Delirium berhubungan dengan peningkatan mortalitas, penambahan lamanya masa rawat inap di rumah sakit (lengths of hospital stay), peningkatan penggunaan fasilitas rumah sakit, dan semakin memperburuk outcome fungsional dan kognitif. Penelitian ini bertujuan untuk mengetahui hubungan antara skore Cognitive Test for Delirium (CTD) dengan lamanya masa rawat inap penderita trauma kapitis sedang-berat di rumah sakit.

Metode : Studi ini merupakan studi potong lintang dengan pengambilan sampel secara non random dengan metode konsekutif pada penderita trauma kapitis sedang-berat yang dirawat di ruang rawat inap RSUP H. Adam Malik Medan periode Februari sampai Juli 2007. Dilakukan perhitungan skore SKG dan dilakukan pemeriksaan CT scan kepala, selanjutnya dilakukan identifikasi delirium dengan menggunakan instrumen Cognitive Test for Delirium (CTD) dan dicatat lamanya masa rawat inap penderita di rumah sakit. Untuk melihat hubungan antara skore CTD dengan rerata lamanya masa rawat inap penderita di rumah sakit digunakan uji t-independent. Nilai kemaknaan p < 0,05.

Hasil : Didapati 34 sampel penderita trauma kapitis sedang-berat, yang terdiri dari 30 orang pria (88,2%) dan 4 orang wanita (11,8%). Dijumpai penderita trauma kapitis yang mengalami delirium (CTD < 19) sebanyak 20 orang (58,8%). Nilai rerata skore CTD pada penderita trauma kapitis sebesar 16,79 ± 5,17. Nilai rerata skore CTD pada kelompok SKG 3 – 8 (10,29 ± 6,26) lebih rendah dibanding pada kelompok SKG 9 – 12 (18,48 ± 3,25) meskipun rerata skore CTD pada kedua kelompok SKG sama-sama menunjukkan adanya gejala delirium (p = 0,013). Secara keseluruhan dijumpai rerata lamanya masa rawat inap penderita di rumah sakit yaitu selama 17,50 ± 5,83 hari dengan masa rawat inap paling singkat yaitu 10 hari dan paling lama yaitu 30 hari. Rerata lamanya masa rawat inap penderita di rumah sakit pada penderita trauma kapitis yang mengalami delirium dijumpai lebih panjang dibanding pada penderita tauma kapitis yang tanpa mengalami delirium (21,05 ± 4,61 hari vs 12,43 ± 2,85 hari; p = 0,000).

Kesimpulan : Rerata lamanya masa rawat inap penderita di rumah sakit pada penderita trauma kapitis yang mengalami delirium secara signifikan dijumpai lebih panjang dibanding pada penderita trauma kapitis yang tanpa mengalami delirium.