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Modified Lindberg’s Score dalam Diagnosis Appendisitis Akut pada Anak
Retrospektif
Oleh :
Agung Prasetyo, Suwardi
RSUD Dr MOEWARDI SURAKARTA
Appendisitis akut prevalensi tinggi akut abdomen
Morbiditas dan mortalitas cukup tinggi
Keterlambatan diagnosa dan penanganan akan timbul komplikasi
Modified Lindberg’s Score
Sistem scoring dalam diagnosis appendisitis
Variable indicator score
Sex Male +8
Female -8
WBC (x 10.000mm³) < 12,0 -15
12,0 – 20,0 +2
>20,0 +10
Progresion of pain Yes +3
No -4
Temperature (ºC) > 37,5 +7
< 37,5 - 9
Vomit Yes +7
No -5
Variable indicator score
Duration of Pain (h) < 24 +3
24 - 48 0
> 48 -12
Migration of pain Yes +4
No -11
Rebound tenderness Yes +5
No -10
Rigidity Yes +15
No -4
Tenderness outside RLQ Yes -6
No +4
Constant -10
Nilai score Score ≥-2 : Emergency surgery Score (-3) – (-18) : Observasi 24 jam Score ≤ -19 : Rawat jalan
Jenis Penelitian deskriptif retrospektif
Subyek penelitian :Pasien Appendisitis Akut post appendektomi di RSUD dr. Moewardi Surakarta(Januari 2008 – Desember 2010)
40 pasien umur 4 -15 tahun
Variable Frekwensi Prosentase %
Sex Male 20 50
Female 20 50
WBC x 1.000/mm³ <12,0 6 15
12,0-20,0 34 85
>20,0 - -
Duration of pain
(h)
<24 35 87,5
24-48 5 12,5
>48 - -
Variable Frekwensi Prosentase %
Progression of pain Yes 35 87,5
No 5 12,5
Temperatur >37,5 ⁰C Yes 37 92,5
No 3 7,5
Vomit Yes 36 90
No 4 10
Migration of pain Yes 38 95
No 2 5
Variable Frekwensi Prosentase %
Rebound tenderness Yes 37 92,5
No 3 7,5
Rigidity Yes 14 35
No 26 65
Tenderness outside
RLQ
Yes 4 10
No 36 90
Hasil histopatologisAppendicitis positif : 67,5 %Appendicitis negatif : 32,5 %
Hasil scoring Score ≥-2 : 65% Score (-3) – (-18) : 35% Score ≤ -19 : -
Appendisitis Positif
Appendisitis Negatif
Modified Lindberg’s score
≥ -224 (A) 2 (B)
Modified Lindberg’s score
(-3) – (-18)3 (C) 11 (D)
Sensitivity : A/A+C Specificity : D/B+DPPV : A/A+B NPV : D/C+D
Sensitivitas 88,8% Spesifitas 84,6%PPV 92,3% NPV 78,5%
G.Dado et al (2000) 197 pasien dengan Modified Lindenberg’s Score :Sensitifitas 86% Spesifitas 87% PPV 96% NPV 65%
Madan Samuel (1170 pasien) Pediatric Appendicitis Score (PAS) :Sensitifitas 100% Spesifitas 92%PPV 96% NPV 99%
Dari sistem scoring penelitian ini Hasil penelitian sesuai dengan
penelitian sebelumnya (Dado) Sensitifitas dan spesifitas < 90%
Akurasi diagnosis Appendicitis
Modified Linberg’s Score < PSA
Terima Kasih