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"[ABSTRAKPendahuluan:Pada traumatic brain injury (TBI) dapat terjadi peningkatan metabolisme sehingga pasien rentan mengalami malnutrisi. Tatalaksana nutrisi yang adekuat sesuai dengan kondisi klinis dan komorbiditas berperan dalam mencegah terjadinya malnutrisi, menurunkan morbiditas dan mortalitas, serta mengoptimalkan outcome neurologis.Presentasi Kasus:Keempat pasien dalam serial kasus ini adalah laki-laki berusia antara 31?60 tahun dengan TBI dan berbagai faktor penyulit. Pasien pertama dengan obesitas dan mengalami hiponatremia berulang selama perawatan, pasien kedua memiliki status gizi malnutrisi, pasien ketiga dengan riwayat kemoradiasi pada astrositoma, amiloid angiopati dan disfagia, sementara pasien keempat dengan hipertensi dan fibrilasi atrium. Skrining gizi dengan MST pada keempat pasien menunjukkan skor dua. Pemberian energi pada keempat pasien adalah sebesar 140?150% dari kebutuhan energi basal yang dihitung dengan Harris-Benedict, dengan target pemberian protein sebesar 1,5?1,9 g/kg BB/hari atau setara dengan 20% energi. Selama pemantauan asupan protein pada keempat pasien adalah sebesar 0,55?1,67 g/kg BB/hari atau setara dengan 13,1?19,5% energi. Restriksi cairan dilakukan pada pasien pertama sebagai tatalaksana hiponatremia yang diperkirakan terjadi akibat SIADH. Pemberian natrium pada pasien keempat tidak direstriksi meskipun pasien mengalami hipertensi karena hipertensi adalah salah satu mekanisme kompensasi pada TBI. Pasien ketiga mengalami disfagia jika mengasup air putih sehingga dilakukan latihan menelan. Asupan per oral dimulai pada hari ke 6?15 pasca trauma.Hasil:Keempat pasien menunjukkan perbaikan outcome neurologis yang tampak berdasarkan peningkatan skor GCS disertai peningkatan kapasitas fungsional. Kesimpulan: Tatalaksana nutrisi yang adekuat pada pasien TBI dengan mempertimbangkan komorbiditas pasien diperlukan untuk menunjang penyembuhan dan memperbaiki outcome pasien.

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ABSTRACTBackground:Hypermetabolism in traumatic brain injury (TBI) increase the risk of malnutrition. Adequate nutritional management based on clinical status and comorbidity reduces the risk of malnutrition, therefore reduces morbidity and mortality rate and improves neurological outcomes.Case Presentation:The four patients included in this serial case were male, 31?60 years old. All patients were diagnosed with TBI complicated by various comorbidities.The first patient was obese with reccurrent episode of hyponatremia during hospitalization, the second patient was malnourished, the third patient had history of chemoradiation due to astrocytoma and was diagnosed with angiopathy amyloid and dysphagia, while the fourth patient was diagnosed with hypertension and atrial fibrilation. The MST scores in all four patients were two. Target of energy provision were between 140?150% of predicted basal energy requirement and target of protein provision were 1,5?1,9 g/kg BW/day or equal to 20% of energy. The protein intake during monitoring were 0,55?1,67 g/kg BW/day or equal to 13,1?19,5% energy. The fluid intake was restricted in first patient due to SIADH- related hyponatremia. Sodium intake was not restricted for the forth patient eventhough the patient was diagnosed with hypertension. In TBI, hypertension could occur due to compensational mechanism. The third patient was having difficulties consuming water due to dysphagia, and was conducted to multiple swallowing therapy exercises. Oral intake in four patients were initiated in day 6? 15 post trauma.Result:There were improvement of neurological outcome shown by the higher GCS score and improvement of the functional capacity in all four patients Conclusion: Adequate nutritional management in TBI patient can support the recovery and improve patient?s outcome. Nutritional management should consider patient?s comorbidities.;Background:Hypermetabolism in traumatic brain injury (TBI) increase the risk of malnutrition. Adequate nutritional management based on clinical status and comorbidity reduces the risk of malnutrition, therefore reduces morbidity and mortality rate and improves neurological outcomes.Case Presentation:The four patients included in this serial case were male, 31–60 years old. All patients were diagnosed with TBI complicated by various comorbidities.The first patient was obese with reccurrent episode of hyponatremia during hospitalization, the second patient was malnourished, the third patient had history of chemoradiation due to astrocytoma and was diagnosed with angiopathy amyloid and dysphagia, while the fourth patient was diagnosed with hypertension and atrial fibrilation. The MST scores in all four patients were two. Target of energy provision were between 140–150% of predicted basal energy requirement and target of protein provision were 1,5–1,9 g/kg BW/day or equal to 20% of energy. The protein intake during monitoring were 0,55–1,67 g/kg BW/day or equal to 13,1–19,5% energy. The fluid intake was restricted in first patient due to SIADH- related hyponatremia. Sodium intake was not restricted for the forth patient eventhough the patient was diagnosed with hypertension. In TBI, hypertension could occur due to compensational mechanism. The third patient was having difficulties consuming water due to dysphagia, and was conducted to multiple swallowing therapy exercises. Oral intake in four patients were initiated in day 6– 15 post trauma.Result:There were improvement of neurological outcome shown by the higher GCS score and improvement of the functional capacity in all four patients Conclusion: Adequate nutritional management in TBI patient can support the recovery and improve patient’s outcome. Nutritional management should consider patient’s comorbidities., Background:Hypermetabolism in traumatic brain injury (TBI) increase the risk of malnutrition. Adequate nutritional management based on clinical status and comorbidity reduces the risk of malnutrition, therefore reduces morbidity and mortality rate and improves neurological outcomes.Case Presentation:The four patients included in this serial case were male, 31–60 years old. All patients were diagnosed with TBI complicated by various comorbidities.The first patient was obese with reccurrent episode of hyponatremia during hospitalization, the second patient was malnourished, the third patient had history of chemoradiation due to astrocytoma and was diagnosed with angiopathy amyloid and dysphagia, while the fourth patient was diagnosed with hypertension and atrial fibrilation. The MST scores in all four patients were two. Target of energy provision were between 140–150% of predicted basal energy requirement and target of protein provision were 1,5–1,9 g/kg BW/day or equal to 20% of energy. The protein intake during monitoring were 0,55–1,67 g/kg BW/day or equal to 13,1–19,5% energy. The fluid intake was restricted in first patient due to SIADH- related hyponatremia. Sodium intake was not restricted for the forth patient eventhough the patient was diagnosed with hypertension. In TBI, hypertension could occur due to compensational mechanism. The third patient was having difficulties consuming water due to dysphagia, and was conducted to multiple swallowing therapy exercises. Oral intake in four patients were initiated in day 6– 15 post trauma.Result:There were improvement of neurological outcome shown by the higher GCS score and improvement of the functional capacity in all four patients Conclusion: Adequate nutritional management in TBI patient can support the recovery and improve patient’s outcome. Nutritional management should consider patient’s comorbidities.]"

"Cedera kepala merupakan penyebab utama kematian dan kecacatan pada populasi dunia berusia di bawah 45 tahun. Cedera kepala sedang (CKS) dan berat (CKB) biasanya memerlukan perawatan intensif dan pendekatan medis-bedah. Pasien dengan cedera kepala mengalami peningkatan laju metabolisme sehingga memerlukan tatalaksana medik gizi yang sesuai. Pemenuhan kebutuhan energi yang tidak adekuat dapat menyebabkan peningkatan angka morbiditas, risiko infeksi, dan komplikasi lainnya. Pemberian nutrisi enteral dini dalam kurun 24-48 jam setelah masuk Intensive Care Unit (ICU) dapat memperbaiki luaran klinis pasca cedera. Serial kasus ini bertujuan untuk melaporkan peran tatalaksana medik gizi pada status gizi, lama pemakaian ventilator, tingkat kesadaran dan kapasitas fungsional pada pasien kritis dengan CKS dan CKB. Empat pasien laki-laki dengan rentang usia 25-46 tahun diobservasi selama perawatan di ICU RS Cipto Mangunkusumo, dua pasien dengan diagnosis CKS dan sisanya dengan diagnosis CKB. Status gizi berdasarkan indeks massa tubuh, dua pasien memiliki berat badan (BB) normal, satu pasien BB lebih dan satu pasien obesitas II. Tingkat kesadaran berdasarkan skor Glascow Coma Scale (GCS) pasien pada saat masuk ICU adalah 6-11. Selama perawatan keempat pasien mendapat nutrisi enteral dini dan pemberian nutrisi ditingkatkan bertahap. Pada seluruh pasien, kebutuhan energi dapat dipenuhi sesuai target 25-30 kkal/kg BB. Kebutuhan makronutrien dapat dipenuhi sesuai target, yaitu protein 1,2-2 g/kg BB, lemak 20-30%, dan karbohidrat minimal 100 g/hari. Pada dua pasien dengan CKB, diberikan nutrien spesifik berupa glutamin sebesar 0,2 g/kgBB/hari dan mikronutrien berupa vitamin C, vitamin B kompleks, asam folat, dan seng. Hingga akhir pemantauan status gizi pada dua pasien CKS dapat dipertahankan, sedangkan dua pasien dengan CKB mengalami penurunan berat badan. Dua pasien CKS hanya menggunakan ventilator selama 4-5 hari, sedangkan dua pasien dengan CKB menggunakan ventilator lebih lama yaitu 12 dan 31 hari dengan disertai komorbiditas pneumotoraks dan ventilator-associated pneumonia. Tingkat kesadaran seluruh pasien mengalami perbaikan. Skor GCS pasien pada akhir perawatan di ICU adalah 7-15. Kapasitas fungsional berdasarkan Indeks Barthel juga mengalami perbaikan pada tiga pasien, yaitu dari ketergantungan total menjadi ketergantungan sedang atau berat. Dapat disimpulkan bahwa tatalaksana medik gizi dapat berperan dalam mempertahankan status gizi, menurunkan lamanya pemakaian ventilator, memperbaiki tingkat kesadaran dan kapasitas fungsional pada pasien sakit kritis dengan CKB dan CKS. Tingkat keparahan cedera kepala dan komorbiditas dapat memengaruhi luaran klinis dan harus dipertimbangkan dalam memberi tatalaksana medik gizi.

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Traumatic brain injury (TBI) is a leading cause of death and disability in the global population under 45 years old. Moderate and severe TBI usually require intensive care and a medical-surgical approach. Patients with TBI experience an increase in metabolic rate and therefore require appropriate medical nutrition therapy. Inadequate energy intake can cause an increase in morbidity, risk of infection, and other complications. Early enteral nutrition within 24-48 hours after ICU admission has been shown to improve clinical outcome.

This case series aims to report the role of medical nutrition therapy on nutritional status and clinical outcomes of critically ill patients with moderate and severe TBI. Four male patients aged 25-46 years were observed during their stay at the ICU of Cipto Mangunkusumo Hospital. Based on body mass index, two patients were normoweight, one patient was overweight and one patient was class II obese. The Glascow Coma Scale (GCS) scores of the patients on ICU admission were ranged 6-11.

Two of the four patients were classified as moderate TBI and the other two patients were as classified as severe TBI. On monitoring four patients received early enteral nutrition and the nutrition was gradually increased to reach the target of 25-30 kcal/kg body weight (BW). Enteral formula were targeted to achieve protein intake of 1.2-2 g/kgBW, fat intake of 20-30% of energy intake, and carbohydrate intake of at least 100 g/day. Two patients with severe TBI were given specific nutrients in the form of glutamine as much as 0.2 g/kgBW/day and micronutrients in the form of vitamin C, vitamin B complex, folic acid, and zinc. Two patients with moderate TBI received mechanical ventilation for 4 and 5 days, while two patients with severe TBI received mechanical ventilation for 12 and 31 days. In two patients with severe TBI, prolonged use of mechanical ventilation may be associated with the comorbidities of pneumothorax and ventilator-associated pneumonia.

At the end of monitoring, the levels of consciousness were improved in all patients. The patients GCS score at the end of treatment in the ICU were ranged 7-15. Functional capacity based on the Barthel Index also improved in three patients, from total dependence to moderate or severe dependence. Weight loss was experienced in two patients with severe TBI, possibly due to severe and prolonged catabolism in severe TBI. Patients with severe TBI may have higher energy requirements to maintain their nutritional status.

It can be concluded that medical nutrition therapy may play a role in improving the level of consciousness and functional capacity in critically ill patients with moderate and severe traumatic brain injury."

"Traumatic Brain Injury merupakan penyebab kematian utama dan morbiditas pada pasien dengan trauma kepala. Dikarenakan Traumatic Brain Injury mempunyai angka prevalensi yang sangat tinggi dan mortalitas yang tinggi, maka perlu suatu alat bantu berupa cedera bagian luar (cedera scalp) untuk ketahui kemungkinan adanya traumatic brain injury yang di sebabkan oleh sebab mati pada mayat tersebut. Penelitian ini menggunakan desain studi cross sectional analitik. Sampel dalam penelitian ini berupa data sekunder yang diambil dari laporan pemeriksaan mayat pada Departemen Forensik RS Cipto Mangunkusumo yang memenuhi kriteria inklusi dan eksklusi bejumlah 100 sampel. Data yang diambil berupa umur, jenis kelamin, cedera scalp, fraktur tulang tengkorak, perdarahan epidural, perdarahan subdural, perdarahan serebral didata dari hasil pemeriksaan luar dan pemeriksaan dalam. Dari penelitian ini didapatkan bahwa tidak ada hubungan yang bermakna antara cedera scalp dengan traumatic brain injury dengan nilai p sebesar 0,09. Hal ini menguatkan teorinya bahwa hanya gold standard yang bisa mendiagnosis adanya traumatic brain injury, yaitu pemeriksaan dalam pada otopsi.

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Traumatic Brain Injury is the leading cause of death and morbidity in the world. Due to a very high prevelance rate of traumatic brain injury, a diagnostic tool that is able to quickly identify the presence of traumatic brain injury is needed. Injuries to the scalp can be used as a diagnostic tool to determine the presence of Traumatic Brain Injury.

This study uses an analytical cross sectional study design. The sample in this research wassecondary data taken from autopsy reports to the Department of Forensic Cipto Mangunkusumo that meet the inclusion and exclusion criteria, which was 100 samples. Data taken the form of age, gender, scalp injury, brain bone fracture, epidural hemorrhage, subdural hemorrhage, cerebral hemorrhage recorded from external examination results and examination.

From this study it was found that there was no significant correlation between scalp injury with traumatic brain injury with p value of 0.09. It supported the theory that only internal autopsy can diagnose the presence of traumatic brain injury."

"This book is a concise guide designed for neurologists, primary care, and sports physicians and other medical providers, psychologists and neuropsychologists, and athletic trainers who may evaluate and care for patients with TBI. The book features summaries of the most pertinent areas of diagnosis and therapy, which can be readily accessed by the busy clinician/professional. "

"In order to reduce the number of deaths from severe head injuries, systematic management is essential. This book is a practical, comprehensive guide to the treatment of patients (both adults and children) with such injuries, from the time of initial contact through to the rehabilitation center. Sections are devoted to prehospital treatment, admission and diagnostics, acute management, and neurointensive care and rehabilitation. Evidence-based recommendations are presented for each diagnostic and therapeutic measure, and tips, tricks, and pitfalls are highlighted. Throughout, the emphasis is on the provision of sound clinical advice that will maximize the likelihood of an optimal outcome. Helpful flowcharts designed for use in daily routine are also provided. The authors are all members of the Scandinavian Neurotrauma Committee and have extensive practical experience in the areas they write about."

"A comprehensive introduction to evaluating and treating patients with traumatic brain injuries, this second edition of a bestseller features new information regarding the epidemiology and pathophysiology of brain injury as well as structural and functional imaging in the assessment of traumatic brain injury, including functional MRI, PET scanning, and magnetic resonance spectroscopy. With expanded discussions of brain-injury malingering and family dynamics, this revised and updated text gives an overview of state-of-the-art techniques and discusses new pharmacological treatments, acquired psychopathy, and test instruments for assessing behavior."

"ABSTRAKLatar Belakang. Pasien pasca cedera kepala seringkali mengalami gangguan kognitif. Instrumen komputer “Stimulasi Kognitif” (STIMKOG) adalah salah satu bentuk intervensi terapetik kognitif eksternal yang dapat diberikan pada pasien cedera kepala. STIMKOG memiliki tujuh stimulus yang mencakup lima domain kognitif. Tujuan dari penelitian adalah mengetahui fungsi kognitif pada pasien cedera kepala setelah distimulasi dengan STIMKOG.Metode. Penelitian menggunakan desain eksperimental. Subyek penelitian adalah pasien cedera kepala ringan-sedang yang dibagi atas kelompok intervensi dan kelompok kontrol. Kelompok intervensi diberikan latihan STIMKOG selama 12 hari berturut-turut sedangkan kelompok kontrol hanya diberikan di hari 1, 6 dan 12. Evaluasi perubahan fungsi kognitif menggunakan pemeriksaan neuropsikologi Skrining tes Luria Nebraska.Hasil. Sebanyak 60 subyek ikut dalam penelitian, terbagi atas 30 subyek di tiap kelompok. Rasio jumlah laki-laki dan perempuan adalah 2:1. Usia dari subyek penelitian berkisar antara 17-45 tahun, sebagian besar berusia 20-40 tahun (63.3%). Berdasarkan tingkat pendidikan, sebagian besar berpendidikan tamat SMU (51.6 %). Sebanyak 80% subyek adalah cedera kepala sedang sedangkan 20% adalah cedera kepala ringan. Perbaikan nilai STIMKOG kelompok intervensi lebih besar dari kelompok kontrol pada kecepatan waktu, keberhasilan, kegagalan dan persentase jawaban benar. Pada Skrining Tes Luria Nebraska di awal penelitian terdapat gangguan terutama pada tes Kalkulasi 3, Abstraksi dan Bahasa, Working Memory, New Learning Ability, Immediate memory dan atensi. Pasca latihan STIMKOG terjadi penurunan jumlah subyek yang mengalami gangguan kognitif pada kelompok intervensi sebesar 46.7% lebih besar dibandingkan kelompok kontrol (23.3%).Kesimpulan. Instrumen STIMKOG dapat meningkatkan fungsi kognitf pada pasien cedera kepala ringan-sedang.

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ABSTRACTBackground. Patients with traumatic brain injury were frequently had cognitive disfunction. Computer instrument “Stimulasi Kognitif” (STIMKOG) is one of external therapeutic intervention which can be applied to traumatic brain injury patients. STIMKOG has seven stimulus which include five cognitive domains. The objectives of the study were to obtain cognitive function in traumatic brain injury patients after being stimulated by STIMKOG.Method. An experimental study was conducted. Participants were mild-moderate traumatic brain injury patients which classified into intervention and control group. Intervention group were trained for 12 days consecutively whereas the control group only in day 1, 6 and 12 with level of difficulty 2. Cognitive evaluation was conducted using neuropsychology examination Screening Test Luria Nebraska.Result. A total of 60 subjects participated in this study, divided into 30 subjects in each group. The ratio of man and woman was 2:1. The age of the subjects was between 17 and 45 years, with age majority between 20-40 years (63,3%). Based on level of education, 51.6% subjects were secondary high school graduates. The subjects consisted of 80% moderate traumatic brain injury and 20% mild traumatic brain injury. The improvement of STIMKOG score in intervention group was greater than control group in time response velocity, success rate, failure rate and correct answer persentage. Post STIMKOG training, number of subjects with cognitive disfunction had decreased 46,7% in intervention group greater than control group (23,3%).Conclusion. STIMKOG instrument could improve cognitive function in light-moderate traumatic brain injury patients."

"ABSTRAKTujuan : Mengetahui hubungan kadar protein S100 pada pasien cedera otak ringan dan sedang yang diukur secara bertahap pada saat pasien tiba di rumah sakit, beberapa jam pasca trauma, dan sekian hari perawatan di rumah sakit, sehingga dapat digunakan sebagai petanda kerusakan otak.Latar belakang : Cedera otak menjadi masalah kesehatan masyarakat di seluruh dunia karena dapat menyebabkan kecacatan dan kematian. Diagnosis cedera otak ditegakkan berdasarkan pemeriksaan klinis neurologi, dan CT scan atau MRI untuk melihat kerusakan anatomi. Pemeriksaan kadar protein S100 pada pasien cedera otak ringan dan sedang dengan menggunakan bahan serum diperlukan untuk mendeteksi dan dapat untuk mengevaluasi adanya kerusakan otak pasca traumatik.Metode : Subyek penelitian adalah orang sehat dan pasien cedera otak ringan dan sedang berdasarkan nilai SKG, pemeriksaan klinis neurologi, dan CT scan, yang diambil darahnya untuk pemeriksaan kadar protein S100 pada saat tiba di rumah sakit, 6 jam pasca trauma, 24 jam pasca trauma, dan hari terakhir perawatan. Pemeriksaan kadar protein S100 dalam serum menggunakan Elecsys S100 dengan prinsip ECLIA.Hasil : Terdapat perbedaan bermakna (p = 0,001) pada semua kadar protein S100 yang diukur saat tiba di rumah sakit, 6 jam pasca trauma, 24 jam pasca trauma, dan hari terakhir perawatan, baik pada pasien cedera ringan maupun sedang. Puncak kadar protein S100 tercapai pada 6 jam pasca trauma pada pasien cedera otak ringan dan sedang. Kadar protein S100 pada pasien cedera otak sedang saat tiba di rumah sakit lebih tinggi secara bermakna dibandingkan pasien cedera otak ringan (median 0,259 μg/L rentang 0,207 – 0,680 μg/L vs median 0,150 μg/L rentang 0,051 – 0,289 μg/L, p = 0,001) dan kadar protein S100 pasien cedera otak ringan saat tiba di rumah sakit lebih tinggi secara bermakna dibandingkan kadar protein S100 orang sehat (median 0,150 μg/L rentang 0,051 – 0,289 μg/L vs rerata 0,065 ± 0,017μg/L, p = 0,001).Kesimpulan : Pada pasien cedera otak ringan dan sedang saat tiba di rumah sakit sudah terdapat peningkatan kadar protein S100 secara bermakna dibandingkan dengan orang sehat. Protein S100 dapat digunakan sebagai petanda untuk deteksi dan evaluasi kerusakan otak pasca traumatik.

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ABSTRACTObjective: To identify the relation of protein S100 level in mild and moderate brain injury patient, which is measured repeatedly at admission, few hours post trauma, and few days of hospitalization, thus it can be used as brain injury biomarker.Background: Brain injury becomes worldwide public health issue since it may cause disability and mortality. The diagnosis of brain injury is made based on clinical neurology examination, and CT scan or MRI, to observe anatomical impairment. Serum S100 protein examination in mild and moderate brain injury patients is needed to detect and evaluate the presence of post traumatic brain injury.Method: This research subject is healthy people and patients with mild and moderate brain injury, based on their GCS grade, clinical neurologic examination, and CT scan. On these patients, the blood for S100 protein examination is taken at admission, 6 hours post trauma, 24 hours post trauma, and last day of hospitalization. Examination of a serum S100 protein is conducted using Elecsys S100 with ECLIA method.Result: There is significant difference (p = 0,001) in mild or moderate brain injury patients in all serum S100 protein which is measured at admission, 6 hours post trauma, 24 hours post trauma, and the last day of hospitalization. The peak level of serum S100 protein reached at 6 hours post trauma. Serum S100 protein in moderate brain injury patients at admission is significantly higher than the mild ones (median 0, 259 μg/L range 0,207 – 0,680 μg/L vs median 0,150 μg/L range 0,051 – 0,289 μg/L, p = 0,001), and serum S100 protein in mild brain injury patients is also significantly higher than healthy people (median 0,150 μg/L range 0,051 – 0,289 μg/L vs mean 0,065 ± 0,017μg/L, p = 0,001).Conclusion: In mild and moderate brain injury patients, serum S100 protein is already significantly increased at admission, compared to healthy people. Serum S100 protein can be used as brain injury biomarker to detect and evaluate the presence of post traumatic brain injury."

"Latar Belakang: Cedera kepala dikaitkan dengan aktivasi kaskade koagulasi dapat menyebabkan koagulopati. Hal ini berhubungan dengan hasil akhir atau keluaran yang tidak baik pada pasien. Deteksi dini dan evaluasi berkala faktor hemostasis dibutuhkan pada pengelolaan pasien cedera kepala sedang dan berat dalam memperbaiki hasil keluaran perawatan pasien cedera kepala.Tujuan: Diketahuinya angka kejadian prevalensi koagulopati pada pasien cedera kepala sedang berat dan hubungan gangguan hemostasis tersebut dengan hasil keluarannya.Metode Penelitian: Penelitian ini merupakan studi ?nested case control?. Studi ini bersarang pada penelitian awal yang berupa studi komparasi potong lintang. Data hemostasis diperiksa pada hari pertama(<24 jam dari kejadian) saat di Instalasi Gawat Darurat(IGD) RSCM. Pasien cedera kepala sedang dan berat ini nantinya akan diikuti sampai akhir perawatan inap dan dinilai hasil keluaran perawatannya. Koagulopati adalah gangguan status koagulasi, dapat berupa hiperkoagulasi atau hipokoagulasiHasil: Terdapat 76 sampel, 38 sampel memiliki keluaran baik dan 38 sampel memiliki keluaran buruk. Pria(81,6%) lebih banyak dari wanita. Sebagian besar subjek berusia 18-50 tahun(81,6%). Koagulopati terjadi pada 34,2% pasien. Koagulopati merupakan faktor prediksi keluaran buruk pada cedera kepala (OR 4,429; 95%IK 1,569 ? 12,502; p=0,004). Hasil analisis multivariat menunjukkan urutan prioritas kemaknaan faktor yang mempengaruhi keluaran subjek cedera kepala yang terkuat berturut-turut di penelitian ini adalah usia (50,271), derajat cedera kepala (46,522), dan koagulopati (5,409). Terdapat hubungan bermakna antara beratnya derajat cedera kepala dengan terjadinya koagulopati p= 0,009.Kesimpulan: Prevalensi koagulopati pada cedera kepala sedang berat cukup tinggi. Pasien dengan koagulopati memiliki keluaran yang lebih buruk

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Background: Brain injury is associated with activation of the coagulation cascade, contributing to coagulopathy. This condition is correlated with unfavorable outcome. Early detection and evaluation of hemostatic factors are needed in treatment of moderate-severe traumatic brain injury (TBI) to improve patient outcome.

Objectives: To determined the number of prevelence coagulopathy in moderate severe TBI and the relationship of the hemostatic disorder with outcome.

Materials and Method: We did the nested case control study. Hemostatic parameters were recorded from emergency departement (ED) not exceeding 24 hours from onset of accident. Moderate-severe TBI patients were followed until the patients discharged and we assessed the outcome. Coagulopathy was defined as hypocoagulopathy or hypercoagulopathy.

Results: From 76 subjects, 38 subjects were favorable outcome and 38 subjects had unfavorable outcome. Men were higher than women (81,6%), mostly subjects were in range 18-50 years(81,6%). Coagulopathy occured in 36% of all patients. Coagulopathy was the predictor of unfavorable outcome for TBI (OR 4,429; 95%CI 1,569 ? 12,502; p=0,004). From the multivariate analysis, the priority level for TBI outcome, in order of strongest to weakest correlation, were age (50,271), severity of traumatic brain injury(46,522) and coagulopathy(5,409). There was significant correlation between severity of traumatic brain injury and coagulopathy (p= 0,009).

Conclusions: Our study confirmed a quite high prevalence of coagulopathy in patients with moderate-severe TBI. Patients with coagulopathy had poorer outcome compared to non-coagulopathy"

"Latar belakang. Laktat awalnya dianggap sebagai produk berbahaya dari metabolisme anaerobik, namun bukti terbaru menunjukkan laktat dapat melindungi neuron dan memperbaiki luaran. Dalam studi ini, kami mencari korelasi antara kadar laktat darah dan luaran pascaoperasi pasien dengan cedera otak traumatika (traumatic brain injury, TBI). Metode. Studi kohort prospektif ini mengambil sampel dari pasien dengan TBI terisolasi yang menjalani operasi di Departemen Bedah Saraf RSUPN dr. Cipto Mangunkusumo dari April 2020 hingga Juni 2021. TBI dikategorikan menjadi ringan (GCS 13-15), sedang (GCS 9-12), dan berat (GCS 3-8). Kadar laktat darah diambil dari vena perifer sebelum dan pada hari ke-3 pascaoperasi. Luaran klinis dievaluasi berdasarkan perubahan (D) GCS pada hari ke-7 pascaoperasi dengan preoperasi, lalu dibagi menjadi 3 kelompok: membaik, tidak berubah, dan memburuk. Hasil. Dari 72 subjek dalam penelitian ini, ditemukan terdapat korelasi yang signifikan (p = 0,019, r = 0,275) antara kadar laktat preoperatif dengan D GCS, dimana semakin tinggi kadar laktat preoperatif maka D GCS akan semakin positif. Berdasarkan analisis dengan kurva receiver operating characteristics (ROC) dan Chi-square, ditemukan bahwa subjek dengan kadar laktat >=2,35 mmol/L memiliki kemungkinan 1,64 kali lebih besar untuk mengalami peningkatan GCS pascaoperasi. Kesimpulan. Laktat dapat dijadikan suatu faktor prognostik luaran baik pascaoperasi pasien TBI.

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Background. Lactate was initially thought to be a harmful product of anaerobic metabolism, but recent evidence suggests it can protect neurons and improve outcomes. Therefore, we sought a correlation between blood lactate levels and the postoperative outcome of patients with traumatic brain injury (TBI). Method. This prospective cohort study took samples from patients with isolated TBI who underwent surgery at the Department of Neurosurgery, Cipto Mangunkusumo National Hospital from April 2020 to June 2021. Blood lactate levels were taken from peripheral veins before surgery and on the 3rd postoperative day. The clinical outcome was evaluated based on the change (D) of GCS from before surgery and on the 7th postoperative day, then categorized into 3 groups: improved, unchanged, and worsen. Results. From 72 subjects in this study, significant correlation (p = 0.019, r = 0.275) was found between preoperative lactate levels and D GCS, where the higher preoperative lactate levels, the more positive D GCS would be. Based on the analysis using ROC curve and Chi-square, subjects with lactate levels >=2.35 mmol/L were 1.64 times more likely to experience an increase in postoperative GCS. Conclusion. Lactate can be used as a favorable prognostic factor in TBI patients."