CONTOH KASUS MENGGUNAKAN TRISS.docx

8/11/2019 CONTOH KASUS MENGGUNAKAN TRISS.docx

1/4

CONTOH KASUS MENGGUNAKAN TRISS

Background.Dalam sebuah penelitian department forensic medicine medikolegal dengan

menggunkan Desain penelitian cross sectional untuk menentukan nilai diagnostik dari

metode penilaian derajat luka TRISS sesuai dengan kualifikasi derajat luka dalam KUHP

pasal 351 dan 352. Penelitian ini menggunakan sampel visum et repertum definitifsebanyak 160 buah yang dipilih secara acak, yang dihilangkan bagian identitas dankesimpulan kecuali informasi tentang usia. Tiap sampel difotokopi sebanyak 2 kali dan

diberikan pada 2 orang dokter spesialis forensik. Penelitian ini terbagi menjadi 2 tahap.

Pada tahap pertama dilakukan kegiatan mencari nilai diagnostik metode penilaianperlukaan TRISS dan menghitung tingkat kesamaan persepsi metode penilaian derajat

luka standar (Kappa1). Pada tahap kedua dilakukan pembuatan buku pedoman penetapan

kualifikasi luka menggunakan TRISS yang diberikan pada kedua dokter spesialis forensik,

yang akan digunakan untuk menilai ulang derajat luka pada sampel, kemudian dihitungtingkat kesamaan persepsinya(Kappa 2).

Hasil Penelitian. Sampel didapatkan sebanyak 160 buah, yang terdiri dari luka akibatkekerasan tumpul sebesar 149 sampel(93,1%), luka akibat kekerasan tajam sebesar 11

sampel (6,9%), luka derajat ringan sebanyak 107 sampel (66,9%), dan luka derajat sedang

sebanyak 53 sampel (33,1%). Nilai cut-off pointTRISS pada luka akibat kekerasan tumpulkelompok usia kurang dari 15 tahun adalah 0,35. kelompok usia antara 15-55 tahun adalah

0,35, kelompok usia lebih dari 55 tahun sebesar 1,95. SedangkanNilai cut-off pointTRISS

pada luka akibat kekerasan tajam kelompok usia kurang dari 15 tahun adalah 0,35,kelompok usia antara 15-55 tahun adalah 0,65, kelompok usia lebih dari 55 tahun sebesar

1,90. Tingkat kesamaan persepsi metode penilaian derajat luka standar (Kappa l) sebesar

0,56 (kategori sedang) sedangkan tingkat kesamaan persepsi metode skoring perlukaan

TRISS (Kappa 2 ) sebesar 0,83 (kategori baik sekali).

Kesimpulan.Metode skoring perlukaan TRISS dapat digunakan untuk mengkuantifikasi

kualifikasi derajat luka sesuai dengan KUHP pasal 351 dan 352, metode skoring perlukaanTRISS baik sekali untuk digunakan menilai derajat luka ringan dan sedang, dalam hal

menilai derajat luka ringan dan sedang sesuai dengan kualifikasi derajat luka dalam KUHP

pasal 351 dan352, metode skoring perlukaan TRISS mampu memberikan tingkatkesamaan persepsi (Kappa) lebih tinggi dibandingkan metode penilaian derajat luka

standar.

Background:Most standard trauma score systems have been developed and validated in theUnited States. However, trauma differs between the United States and Germany. Thisprospective study tested the validity of eight current trauma scoring systems (Glasgow Coma

Scale, Trauma Score, Revised Trauma Score, Injury Severity Score, TRISSTS, TRISSRTS,

Prehospital Index, Polytraumaschluessel) in 612 patients in Cologne.

Methods: Between January 1, 1987, and December 31, 1987, 2,136 trauma relatedemergencies were seen by emergency physicians in the field. All trauma patients with a


2/4

Trauma Score below 16 and a random sample of 10% of patients with a Trauma Score of 16

were included in the study (n = 625). Follow-up was successfully completed for 612 patients

(97%). Their hospital outcome was correlated with their individual score result.

Results: All trauma score systems under study showed high accuracy rates. TRISSRTSand

TRISSTSperformed best with values of above 0.97 for the area under the receiver operatingcharacteristics curve.

Conclusion: We conclude that the standard trauma score systems are valid tools for patientclassification and support TRISSRTS as the international reference score system for the

assessment of injury severity. This validation will allow comparisons between different

trauma care systems.

Background:In this prospective study, the TRISS methodology is used to compare trauma

care at a University Hospital in Jakarta, Indonesia, with the standards reported in the MajorTrauma Outcome Study (MTOS).

Methods: Between February 24, 1999, and July 1, 1999, all consecutive patients with

multiple and severe trauma were included in the study (n = 105). Survival analysis wascompleted for 97 (92%) patients.

Results: The majority of patients were men (81%), and the average age was 28 years.Ninety-five patients (98%) sustained blunt trauma, with motor vehicle crashes being the

most common (68%). The predicted mortality was 14% and the observed mortality was

29%. The Z and M statistics were 7.87 and 0.843, respectively.

Conclusion: We conclude that in developing countries both institution-bound factors and

specific limitations in the TRISS methodology are responsible for the difference betweenpredicted and observed mortality, indicating the need for a regional database.


3/4

Between January 1996 and July 1996, 462 patients with multiple blunt injuries were

admitted to the emergency room of JLN Hospital, Ajmer. Ours is a tertiary level trauma care

centre and the facilities available here are a reflection of the facilities of trauma evaluation

and care at similar hospitals in developing countries. Emergency radiographs are available,but facilities for emergency ultrasonography and CT scan are only available at some

distance from the hospital. Facilities for emergency resuscitation and operation are alsoavailable.

Estimation of the probability of survival (Ps)

This was done by using the formula

Ps = 1/(1 + e-b)

where b = b0 + b1 (RTS) + b2 (ISS) + b3 (A). The constant e is equal to 2.718282. b0, b1,b2, b3 are coefficients derived from Walker-Duncan regression analysis applied to data from

thousands of patients analysed in the Major Trauma Outcome Study (MTOS) and are -1.2470, 0.9544, - 0.0768 and -1.9052 respectively. RTS (Revised Trauma Score), the

physiologic component of TRISS is :

RTS = 0.9368 (G) + 0.7326 (S) + 0.2908 (R)

G, S, and R are coded values for the Glasgow Coma Scale, systolic blood pressure and

respiratory rate respectively(5). ISS (Injury Severity Score) is the anatomic component ofTRISS and is based on the Abbreviated Injury Scale (AIS), 1985(6).

Each of the six body regions was scored with the highest AIS values given to any injury in

that area. The AIS values for the three highest scoring body regions were squared andsummed to form the ISS. "A" (age) is coded as 1 if the patient is at least 55 years old and 0,

if otherwise.

Trauma score (TS) was calculated by using the method described by Champion et al,

utilising the systolic blood pressure, capillary refill, respiratory rate and respiratoryexpansion combined with the Glasgow Coma Scale(2).

Statistical analysis

The number of deaths and survivals was noted. The sensitivity and specificity of the

methods was estimated by using a decision criterion that predicts survival for all patientscalculated to have a Ps of O 50% and predicts death for all those with a Ps of l 50%(4).

The Flora Z statistic(7)was used to quantitate the difference in the actual number of deathsin our institution and the predicted number of deaths based on the baseline MTOS norm.

When considering mortality, the formula for calculating Z is :
http://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5http://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5http://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5http://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5http://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5http://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5http://www.sma.org.sg/smj/4006/references/4006a2ref.htmlhttp://www.sma.org.sg/smj/4006/references/4006a2ref.htmlhttp://www.sma.org.sg/smj/4006/references/4006a2ref.htmlhttp://www.sma.org.sg/smj/4006/references/4006a2ref.htmlhttp://www.sma.org.sg/smj/4006/references/4006a2ref.htmlhttp://www.sma.org.sg/smj/4006/references/4006a2ref.htmlhttp://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5http://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5http://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5http://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5http://www.sma.org.sg/smj/4006/references/4006a2ref.htmlhttp://www.sma.org.sg/smj/4006/references/4006a2ref.htmlhttp://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5http://www.sma.org.sg/smj/4006/references/4006a2ref.html#4006a2ref5


4/4

An absolute value of Z exceeding 1.96 was required for a significance level of 0.05. Finally,

M statistic was calculated to evaluate the degree of match between the test and baseline

patient sets, the fraction of patients (f1 .... f6) falling into each of six increments of Ps for the

baseline group (MTOS) was compared with the corresponding fraction for the study sample(g1 .... g6). If Si is the smaller of the two values fi and gi, then S1 .... 6 were summed to

arrive at M, A value of M L 0.88 indicated a good match between the test and baseline

groups(4).

RESULTS

Out of 462 patients, 369 (79.9%) were males and 93 (20.1%) were females. Median age was

42.2 years (range 13 to 72 years). Table I shows the distribution of patients according to

trauma score (TS) along with the observed and expected deaths. As against 42 deathspredicted by TS, 63 deaths were observed, thus giving a sensitivity of 53.9% and a

specificity of 98.8%.Table IIshows the ISS value versus patient outcome. There was a steep

rise in mortality with ISS above 20.Table IIIshows the RTS value versus patient outcome.

There was a steep rise in mortality with decreasing RTS, with Ps dropping sharply from theRTS value of 6.6132 and reaching very low levels as RTS approached 5.0304. Table IV

shows the distribution of patients according to Ps using the TRISS method. The overallmortality was 13.6% as against a predicted mortality of 7.35% (Z = 4.17, p < 0.001), thusgiving a sensitivity of 46% and a specificity of 98.7%.
http://www.sma.org.sg/smj/4006/pics/tables/4006a2t1.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t1.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t2.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t2.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t2.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t3.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t3.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t3.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t4.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t4.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t4.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t3.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t2.gifhttp://www.sma.org.sg/smj/4006/pics/tables/4006a2t1.gif

Documents

CONTOH KASUS MENGGUNAKAN TRISS.docx