Research Article

Validitas modified Pediatric Early Warning System/Score di Rumah Sakit Umum Pusat Sanglah

I Made Karma Setiyawan , Dyah Kanya Wati, I Nyoman Budi Hartawan, Ida Bagus Gede Suparyatha, Made Pande Lilik Lestari

I Made Karma Setiyawan
Program Pendidikan Dokter Spesialis Anak, Fakultas Kedokteran Universitas Udayana, Bali, Indonesia. Email: karmasetiyawan88@gmail.com

Dyah Kanya Wati
Departemen Ilmu Kesehatan Anak, Universitas Udayana, Bali, Indonesia

I Nyoman Budi Hartawan
Departemen Ilmu Kesehatan Anak, Universitas Udayana, Bali, Indonesia

Ida Bagus Gede Suparyatha
Departemen Ilmu Kesehatan Anak, Universitas Udayana, Bali, Indonesia

Made Pande Lilik Lestari
Staf Keperawatan Anak, RSUP Sanglah, Bali, Indonesia
Online First: December 01, 2020 | Cite this Article
Setiyawan, I., Wati, D., Hartawan, I., Suparyatha, I., Lestari, M. 2020. Validitas modified Pediatric Early Warning System/Score di Rumah Sakit Umum Pusat Sanglah. Intisari Sains Medis 11(3): 1443-1450. DOI:10.15562/ism.v11i3.808


Background: Early identification of patient at risk influence the chance of appropriate management and thus patient’s outcome. Pediatric Early Warning System/Score (PEWS) was developed to evaluate patient clinical development while hospitalized. Sanglah General Hospital has implemented PEWS to evaluate early clinical deterioration since 2015 in accordance with quality control program, even though it is not validated yet.

Methods: A single-center, cross-sectional analytic observational study was conducted in pediatric ward Sanglah General Hospital in 2019. The scores ranged from 0 to 9 and were assessed in the 6 to 8 hours prior to unplanned intensive care transfer. Cut-off point, sensitivity, and specificity of modified PEWS was obtained in terms of unplanned intensive care transfer.

Results: Amongst 200 children at pediatric ward, 22 children (11%) had unplanned intensive transfer. The most common intensive consultation problems were respiratory failure (63.6%), followed by decrease of consciousness (22.8%) and shock (13.6%). Median of time to clinical deterioration occured within 6 days of hospitalization (range, 1- 41). Majority clinical deterioration event was found in hematology oncology group.  The AUC score  was 0,99 (95% CI, 0,99 - 1) with the optimal cut-off point on score ? 4 (sensitivity 95,5% and spesificity 100%).

Conclusion: Modified PEWS at Sanglah General Hospital is a valid instrument in identifying early clinical deterioration in children. Prospective clinical evaluation of modified Sanglah General PEWS is needed to determine improvement quality of care and patient outcomes.

 

 

Latar Belakang: Identifikasi pasien yang berisiko mengalami perburukan klinis sejak dini dapat mempengaruhi pemberian tatalaksana yang akan meningkatkan luaran. Instrumen Pediatic Early Warning System/Score (PEWS) disusun untuk mengetahui perkembangan klinis dari pasien selama perawatan di rumah sakit. RSUP Sanglah menerapkan deteksi dini perburukan klinis menggunakan instrumen PEWS yang dimodifikasi sejak tahun 2015 dalam menjalankan Gugus Kendali Mutu (GKM), namun belum tervalidasi.

Metode: Penelitian observasi analitik, single-center, menggunakan desain potong lintang yang dilakukan di ruang perawatan anak RSUP Sanglah pada tahun 2019. Skor memiliki rentang 0 sampai 9 dan dinilai saat 6-8 jam sebelum terjadinya pemindahan ke perawatan intensif yang tidak terencana. Titik potong, sensitivitas dan spesifisitas skor modified PEWS didapatkan terkait perburukan klinis yang memerlukan perawatan intensif tidak terencana.

Hasil: Sebanyak 22 anak (11%) dari 200 anak yang dirawat di ruang perawatan memerlukan perawatan ruang intensif tidak terencana. Penyebab terbanyak dilakukannya konsultasi untuk perawatan intensif adalah gagal napas (63,6%) diikuti oleh penurunan kesadaran (22,8%) dan syok (13,6%). Median waktu terjadinya perburukan klinis didapatkan setelah 6 hari perawatan (rentang, 1- 41). Mayoritas perburukan klinis didapatkan pada kelompok diagnosis hematologi onkologi. Nilai AUC skor modified PEWS RSUP Sanglah didapatkan sebesar 0,99 (IK 95%, 0,99-1) dengan titik potong optimal pada skor ? 4 (sensitivitas 95,5%, spesifisitas 100%).

Kesimpulan: Skor modified PEWS RSUP Sanglah merupakan instrumen yang valid dalam mengenali perburukan klinis pada anak sejak awal. Evaluasi klinis secara prospektif menggunakan skor PEWS tersebut diperlukan untuk melihat perbaikan dalam hal kualitas perawatan dan luaran pada pasien.

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