Skip to main content Skip to main navigation menu Skip to site footer

Akurasi crams scale sebagai prediktor mortalitas pada pasien multipel trauma di rumah sakit umum pusat Prof. Dr. I.G.N.G. Ngoerah

  • Muhammad Yusuf ,
  • I Ketut Wiargitha ,
  • Tjokorda Gde Bagus Mahadewa ,

Abstract

Background: CRAMS (circulation, respiration, abdominal/thoracic, motoric and speech) scale is scoring system that can determine the level of physiological decline in multiple trauma cases. This study was conducted to assess the accuracy of the CRAMS scale as a predictor of mortality in cases of multiple trauma at Prof IGNG Ngoerah Hospital.

Method: This cohort study was an observational analytic with a diagnostic test. Sample of the study was multiple trauma patients who came to emergency department from January to December 2021. Patients with comorbidities, onset of trauma ≥ 24 hours before admission, and refused treatment were excluded. We analyzed the ROC curve to find the best cut off point, area under the curve, sensitivity and specificity. The score classified into major trauma (<6.5) and minor trauma (≥6.5), with outcome of the study is mortality. Diagnostic tests were performed to get positive predictive value, negative predictive value and accuracy. We analyzed using Chi-Square test and p<0.05 considered statistically significant.

Result: Ninety eight samples were included in this study. The average CRAMS score was 7.21 ± 2.06. The ROC curve shows a score of 6.5 as the best cut-off value with a sensitivity of 80% and a specificity of 55.3%, and an area under the curve of 0.76 or 76% (p=0.000). The positive predictive value is 55.26% and the negative predictive value is 80%. The accuracy of the CRAMS scale in predicting mortality were obtained at 70.40%.

Conclusion: CRAMS scale with a cut off score of 6.5 indicates reliable accuracy in predicting mortality.

 

Latar belakang: Skala CRAMS (circulation, breathing, abdominal/thoracic, motoric and speech) adalah sistem skoring yang dapat menentukan tingkat penurunan fisiologis pada kasus trauma multipel. Penelitian ini dilakukan untuk menilai akurasi skala CRAMS sebagai prediktor mortalitas pada kasus trauma ganda di RS Prof IGNG Ngoerah.

Metode: Penelitian kohort ini merupakan penelitian observasional analitik dengan uji diagnostik. Sampel penelitian ini adalah pasien trauma multipel yang datang ke unit gawat darurat dari Januari hingga Desember 2021. Pasien dengan penyakit penyerta, onset trauma ≥ 24 jam sebelum masuk, dan menolak pengobatan dikeluarkan. Kami menganalisis kurva ROC untuk menemukan titik potong terbaik, area di bawah kurva, sensitivitas, dan spesifisitas. Skor diklasifikasikan menjadi trauma mayor (<6,5) dan trauma minor (≥6,5), dengan luaran penelitian adalah kematian. Uji diagnostik dilakukan untuk mendapatkan nilai prediksi positif, nilai prediksi negatif dan akurasi. Kami menganalisis menggunakan uji Chi-Square dan p<0,05 dianggap signifikan secara statistik.

Hasil: Sembilan puluh delapan sampel dimasukkan dalam penelitian ini. Skor rata-rata CRAMS adalah 7,21 ± 2,06. Kurva ROC menunjukkan skor 6,5 sebagai nilai cut-off terbaik dengan sensitivitas 80% dan spesifisitas 55,3%, dan area di bawah kurva 0,76 atau 76% (p=0,000). Nilai prediksi positif sebesar 55,26% dan nilai prediksi negatif sebesar 80%. Akurasi skala CRAMS dalam memprediksi mortalitas diperoleh sebesar 70,40%.

Kesimpulan: Skala CRAMS dengan skor cut off 6,5 menunjukkan akurasi yang dapat diandalkan dalam memprediksi kematian.

References

  1. Antara, I Komang Yose; Wiargitha, I Ketut; Mahadewa, Tjokorda G. B. Validitas New Injury Severity Score (NISS) dalam Mendeteksi Terjadinya Koagulopati pada Pasien Multiple Trauma. JBN (Jurnal Bedah Nasional) 2017; 1(1): 15–.
  2. Ramadiputra, G., Ismiarto, Y.D. and Herman, H. Survey Penyebab Kematian Berdasarkan Prosedur Advance Trauma Life Support (ATLS) pada Pasien Multiple Trauma di Instalasi Gawat Darurat (IGD) Bedah Rumah Sakit Hasan Sadikin Bandung Periode Januari–Juli 2014. Syifa'MEDIKA: Jurnal Kedokteran dan Kesehatan 2019; 9(1):10-15.
  3. Lecky, F.E., Bouamra, O., Woodford, M., Alexandrescu, R. and O’Brien, S.J. Epidemiology of polytrauma. In Damage control management in the polytrauma patient (pp. 13-24). Springer, New York, NY. 2010.
  4. World Health Organization. State of health inequality: Indonesia. World Health Organization. 2017.
  5. Liu, H., Yan, H., Christian, S., Gomez, S., Rosinia, F., Chen, M., … Kaye, A. D. Physiological Derangement of the Trauma Patient. Anesthesia for Trauma 2014; 45–65.
  6. Salim, C. Sistem penilaian trauma. Cermin Dunia Kedokteran 2015; 42(9):702-709.
  7. Ani, N.H.C. Comparison of Triage Revised Score and CRAMS Scale as predictors of outcome for adult trauma patient in Emergency Department, Hospital Universiti Sains Malaysia (Doctoral dissertation, Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia). 2017.
  8. Champion, H.R. Trauma scoring. Scandinavian Journal of Surgery 2002; 91(1):12-22.
  9. Jiang, X., Jiang, P. and Mao, Y. Performance of Modified Early Warning Score (MEWS) and Circulation, Respiration, Abdomen, Motor, and Speech (CRAMS) score in trauma severity and in-hospital mortality prediction in multiple trauma patients: a comparison study. PeerJ 2019; 7:e7227.
  10. Champion HR, Sacco WJ, COPES WS, GANN DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. Journal of Trauma and Acute Care Surgery. 1989; 29(5):6239
  11. Oprita, B., Aignatoaie, B. and Gabor-Postole, D.A. Scores and scales used in emergency medicine. Practicability in toxicology. Journal of medicine and life 2014; 7(Spec Iss 3):4.
  12. GE, W., LI, B., Ruan, H., Yang, J. and Huang, F. Value of CRAMS score for assessing prognosis in patients with acute trauma. Chinese Journal of Trauma 2014:807-810.

How to Cite

Yusuf, M., Wiargitha, I. K. ., & Mahadewa, T. G. B. . (2024). Akurasi crams scale sebagai prediktor mortalitas pada pasien multipel trauma di rumah sakit umum pusat Prof. Dr. I.G.N.G. Ngoerah. Intisari Sains Medis, 15(1), 325–330. https://doi.org/10.15562/ism.v15i1.2006

HTML
0

Total
0

Share

Search Panel

Muhammad Yusuf
Google Scholar
Pubmed
ISM Journal


I Ketut Wiargitha
Google Scholar
Pubmed
ISM Journal


Tjokorda Gde Bagus Mahadewa
Google Scholar
Pubmed
ISM Journal