Value of coma scale in prediction of mortality in non-traumatic coma in 1-12 years old children

2021 ◽  
Vol 19 (3) ◽  
pp. 63-66
Author(s):  
Stalin Ramprakash ◽  

Background: Acute non-traumatic coma is a common problem in pediatric practice accounting for 10-15% of all hospital admissions and is associated with significant mortality. Assessment of the severity of coma is essential to comment on the likelihood of survival in comatose children. In the last three decades, various scores have been used to assess the severity of coma and to predict its outcome. Glasgow Coma Scale (MGCS) in spite of its various drawbacks has been widely used for assessing pediatric coma, though only few studies are available to support its use in pediatric coma as a whole. Hence the study was undertaken to evaluate the usefulness of coma scale in prediction of mortality in children between 1-12 years old admitted with coma of non-traumatic origin. Methods: A prospective study was conducted at Inpatient services of intensive medical care unit and general medical wards of Institute of child Health and Hospital for children, Egmore, Chennai, between October 2018 to November 2019. A Study Population consisting of children in the age group 1-12 years admitted in intensive care unit and medical wards with alteration in sensorium as one of the predominant complaints and admitted within 7 days of onset of coma were included. Sample size was 148. Chi-square test was used to study the association between the scores at Various times points and outcome. Results: It was observed that when the scores were between 3‐ 5 mortality rate was 67.0%, it was 17% when the minimal observed score was between 6-8. The group in which the minimal score never decreased be1ow 9 had no mortality. As the score increases the proportion of death decreases and the proportion having good recovery increases and vice versa. This type of association has been observed at different time points (Initial, 24 hrs, 48 hrs and 72 hrs). The significance of this association increases with the progression of time since admission. P value for the degree of association at various time points are: At presentation P < 0.00001, 24hrs - P < 0.000001, 48 hrs - P < 0.000001 and 72 hrs P < 0.00000001. Conclusion: There is highly statistically significant association between the GSC score levels and outcome. As the score increases the proportion of death decreases and the proportion having good recovery increases and vice versa.

2019 ◽  
Vol 6 (4) ◽  
pp. 1524
Author(s):  
A. Manikanteswara Reddy ◽  
G. Sreedhar ◽  
Gangadhar B. Belavadi

Background: Non-traumatic coma is the problem of pediatric group, accounts 10-15% in hospital admissions. Assessment of the severity of coma is useful to speculate the survival. The aim was to assess outcome in pediatric non-traumatic coma with role of Glasgow coma scale and modified Glasgow coma scale.Methods: Total of 80 cases of non-traumatic coma between 1 month to 12 years, coma severity was assessed by using Glasgow coma scale. A score of less than 8 and more than 8 were used for analysis of outcome.Results: The maximum number of patents with non-traumatic coma were in the age group of 1 month-5 years, 40 children (50%). On neurological examination 42 (52.5%) children has GCS score of >8, 38 cases (47.5%) has GCS <8, 20 children had meningeal signs, 7 children had cranial nerve deficit (7th nerve), 9 children had decebrate posture. Out of 80 cases, 8 cases expired (10%), 4 cases were discharged against medical advice (4%), 68 cases were improved and discharged (85%), among these, 8 cases were discharged with complication (11.7%). Overall mortality was (10%) (8/80), males outnumbered females in frequency with ratio of 1.28:1. CNS infection accounted for almost about 66%.Conclusions: Children with GCS and MGCS scores of less than 8 have poor prognosis and a very high probability of death. Those with GCS score of more than 8 have good prognosis. Identification of these cases at the outset can help prepare the treating physician to plan critical care referral and to give a preliminary assessment of outcome to the family.


2015 ◽  
Vol 22 (07) ◽  
pp. 887-895
Author(s):  
Santosh Kumar ◽  
Muhammad Aslam ◽  
Maria Maria ◽  
Saleem Saleem

Stroke is one of the leading factors of morbidity and mortality worldwide. Toreduce the incidences of stroke, it is essential to identify and modify the risk factors for stroke.Risk factors can be modifiable and non modifiable. The aim of study was to ascertain theoutcome of stroke patient admitted in all Medical Wards in Liaquat University Hospital HyderabadObjective: To see the mortality, morbidity, disability and co-infection in stroke patients. StudyDesign: Prospective study. Period: One year. Setting: Medical Wards of Liaquat UniversityHospital Hyderabad / Jamshoro. Material and Methods: 200 Patients were enrolled in ourstudy to see the excepted outcome like mortality, Disability, Bed Sores, UTI & Pneumonia andDehydration in Stroke patients. All the patients were Young Adults, greater than 12 years inage and old aged patients, with Ischemic & Hemorrhagic stroke. On categorical variable suchas sex, mortality, morbidity chi-square test was applied at 95% confidence interval and the P-value ≤0.05 was considered as statically significant while the mean ±SD will be calculated forquantitative variables. Results: Mean age of the patient in our study was 57.03 years with thestandard deviation of ±7.35 years. Gender distribution shows most of the patients in our studywere male, i.e. 75% while, only 25% of the patients were female. Ischemic Stroke was foundin 126(63%) patients while, hemorrhagic stroke was found in 74(37%) patients. Regardingoutcome, mortality was found in 5% patients, disability 2%, UTI 2%, pneumonia 15%, Coinfection4%, Bed Sores 21.5% and dehydration was present in 50.5% patients. Conclusion:The study concludes that maximum patients had Ischemic Stroke. Among these patientsdehydration was the most common entity followed by bed Sores, pneumonia, mortality, Coinfection,disability and UTI.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Gala ◽  
G Venkatesan ◽  
M Mohsin ◽  
M Abdelkarim ◽  
S Murali ◽  
...  

Abstract Background Acute cholecystitis accounts for 20% of Emergency General Surgical admissions. The concept of seasonal variation is still a developing concept in surgical literature. Whether acute cholecystitis also follows a seasonal trend remains to be established. Aim Given the struggle healthcare system has been facing towards resource and staff allocation to deliver best possible patient care, we thought this may be a step forward to predict North Wales demand of resources seasonally and make appropriate arrangements ahead of time. Method We performed a retrospective analysis of patients across North Wales who had a discharging diagnosis of acute cholecystitis from January 2010 to December 2019. Chi-square goodness-of-fit test was used to analyse seasonality of acute cholecystitis adjusting for variation in number of days between seasons. The number of days for seasons were taken as 92, 92, 91, and 90.25 for spring, summer, fall, and winter, respectively. Results Overall, 4100 patients presented to the three hospitals across North Wales with acute cholecystitis during the study period. The frequency of hospital admissions varied between months (minimum February n = 302, maximum July n = 373) and seasons (minimum winter n = 971, maximum spring n = 1067). After applying chi-square goodness-of-fit test to check significant seasonality, we did not find any significant seasonal variation in acute cholecystitis (p-value = 0.262). Conclusions Our data failed to show any significant seasonal variation in patients presenting with acute cholecystitis in North Wales. We recommend prospective collection of data at national level to validate our results.


2020 ◽  
Vol 11 (03) ◽  
pp. 381-384
Author(s):  
Jitin Bajaj ◽  
Sanjay Rathore ◽  
Vijay Parihar ◽  
Pawan Agarwal ◽  
Yad Ram Yadav ◽  
...  

Abstract Objective Glasgow Coma Scale (GCS) assessment is vital for the management of various neurological, neurosurgical, and critical care disorders. Learning GCS scoring needs good training and practice. Due to limitation of teachers, the new entrants of the clinical team find it difficult to learn and use it correctly. Training through videos is being increasingly utilized in the medical field. This study aimed to evaluate the efficiency of video teaching of GCS scoring among general surgery residents. Materials and Methods A prospective study was done utilizing the freely available video at glasgowcomascale.org. The participants (general surgery residents, 1st–3rd year) were asked to assess and record their responses related to GCS both before and after watching the video. A blinded neurosurgeon recorded the correct responses separately. Statistical Analysis The difference between correct responses of the residents before and after watching the video was calculated using the “chi-square test.” p-Value ≤ 0.05 was taken as significant. Results There was a significant improvement in GCS scoring by residents after watching the videos (p < 0.05). On estimating the responses separately, all the three responses (eye, verbal, and motor) improved significantly for 1st-year residents while only the motor response improved significantly for 2nd- and 3rd-year residents. The mode subjective improvement for the 1st-, 2nd-, and 3rd-year residents was 5, 4, and 3, respectively. Conclusion Training GCS scoring through videos is an effective way of teaching the surgery residents with maximum benefit to the junior-most ones.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1364.2-1365
Author(s):  
A. Combier ◽  
S. Wanono ◽  
L. Poiroux ◽  
C. Frantz ◽  
E. Descamps ◽  
...  

Background:The COVID-19 pandemic requires measures to reduce patient exposure to the risk of contamination, in particular by limiting hospital admissions and promoting lockdown. In order to respond to these healthcare measures, patients were offered to replace intravenous infusions (IV) of abatacept (ABT) and tocilizumab (TCZ) to subcutaneous injections (SC).Objectives:To assess the outcome of patients who switched from IV ABT or TCZ to SC during the COVID-19 pandemic.Methods:A survey was conducted in December 2020 in partnership with the national AFP-RIC patient association to assess the outcome and satisfaction of patients who switched from ABT or TCZ IV to SC during the first wave of COVID-19 pandemic.We also analysed the outcome of patients who switched from IV ABT or TCZ to SC in the rheumatology department of Cochin Hospital during the lockdown in April/may 2020. Articular activity parameters (swollen joint count, pain joint count, visual analogic pain scale, CRP, DAS-28 activity score) were assessed at medical visits before and 6 months after switching from IV to SC.The data collected from the AFP-RIC patient association and the rheumatology department of Cochin Hospital were then aggregated and analyzed by Chi-square and Wilcoxon tests.Results:81 patients responded to the survey carried out by AFP-RIC patient association, including 29 treated with IV ABT (n=15, 52%) or TCZ (n=14, 48%). 17/29 (59%) were offered to switch from IV to SC, 14/17 patients (82%) accepted and 7 patients were still receiving ABT or TCZ SC injections in December 2020. In the rheumatology department of Cochin hospital, 71 patients were scheduled in April/May 2020 to receive IV ABT or TCZ, and 27 (38%) switched to SC. After 6 months, 19 patients (70%) had maintained SC injections, were satisfied with this injection route of administration and their articular activity parameters were unchanged (Table 1).Table 1.Course of Disease parameters evaluated in the 19 patients who maintained abatacept or tocilizumab SC injections in the Rheumatology department of Cochin HospitalParameter, mean(SD)Inclusion visitSwitch to SC(n=19)6 month visit (n=19)P-valueDAS282.3 (1.2)2.3 (0.7)0.62Tender joint count2.5 (3.5)1.3 (1.7)0.49Swollen joint count1.3 (2.5)0.9 (0.6)0.35Patient Global Health (cm)3.2 (1.9)2.6 (1.8)0.60CRP (mg/L)3.2 (4.1)5.2 (4.9)0.56CRP: C-Reactive Protein, SD: Standard DeviationThe combined analysis of these two populations included 41 patients (33 rheumatoid arthritis, RA, 7 juvenile idiopathic arthritis, JIA and 1 polymyalgia rheumatica) who switched to SC ABT or TCZ. 26/41 (63.5%) patients maintained SC injections and IV was re-established in 15/41 (36.5%). Reasons for returning to IV were poor tolerance of SC injections (n=6, 40%), worsening symptoms (n=11, 73%), patient preference to see a rheumatologist in hospital (n=10, 67%) and the high number of SC injections (n=2, 13%). The proportion of patients returning to IV was higher in RA patients compared to patients with JIA (42% vs. 14%, p = 0.08). Age and disease duration were not significantly different between patients who maintained SC injections and those who returned to IV (respectively p=0.97 and p=0.63).Conclusion:Our study suggests that switching from IV ABT or TCZ to SC is an acceptable procedure during the COVID-19 pandemic, especially for patients with JIA.Acknowledgements:Association AFP-RIC (Angélique Hochedé, Cyrielle Beller, Sandrine Rollot) and the members of the association for their help in the conduction of the surveyDisclosure of Interests:None declared.


2020 ◽  
Vol 8 (2) ◽  
pp. 105-114
Author(s):  
Ainul Mardhiah ◽  
Nova Hasbani Prima Dewi ◽  
Aminy Aminy

The family planning program also aims to improve the quality of the family in order to generate a sense of security, peace and hope of a better future in realizing the prosperity of birth and inner happiness. Allegedly the factor causing EFA participation in the family planning program is characteristic. The purpose of this research is to know the relationship of attitude and characteristic of Elderly Age Couple (PUS) with participation in family planning program at UPT Puskesmas Sungai Raya Sungai Raya District, East Aceh regency 2018. The research design used was analytic survey with cross sectional design. The population of this study is all Pairs Age of Fertile located in Work Area UPT Sungai Raya Public Health Service Center in January to December 2017 which amounted to 1897 people. Sampling using Slovin formula, obtained as many as 95 samples. The study was conducted from 7-17 July 2018 using questionnaires by interview. Statistical test using chi-square test. Result of research indicate that majority of fertile couple couples (PUS) participate in family planning program as much as 67 respondents (70,5%). Statistically there is relationship of attitude and characteristic of Elderly Age Couple (EFA) with non participation in family planning program in Working Area of UPT Puskesmas Sungai Raya Sungai Raya District of East Aceh Regency 2018 with p value <0,1. It is recommended that the family planning program holders in UPT Puskesmas Sungai Raya Sungai Raya District of East Aceh District to invite cross-sectoral figures to hold meetings to create mini workshop plans at least once a month to increase the participation of the Elderly Age Couple (PUS) in family planning programs. Keyword : Family Planning Program, Attitudes, CharacteristicsABSTRAKProgram KB juga bertujuan untuk meningkatkan kualitas keluarga agar dapat timbul rasa aman, tentram, dan harapan masa depan yang lebih baik dalam mewujudkan kesejahteraan lahir dan kebahagiaan batin. Diduga faktor yang menyebabkan ketidakikutsertaan PUS dalam program KB adalah karakteristik. Tujuan penelitian ini untuk mengetahui hubungan sikap dan karakteristik Pasangan Usia Subur (PUS) dengan keikutsertaan dalam program KB di Wilayah Kerja UPT Puskesmas Sungai Raya Kecamatan Sungai Raya Kabupaten Aceh Timur tahun 2018. Desain penelitian yang digunakan adalah survei analitik dengan rancangan bedah lintang. Populasi dari penelitian ini adalah seluruh Pasangan Usia Subur yang berada di Wilayah Kerja UPT Puskesmas Sungai Raya pada bulan Januari sampai dengan Desember tahun 2017 yang berjumlah 1.897 orang. Pengambilan sampel menggunakan rumus Slovin, didapatkan sebanyak 95 sampel. Penelitian dilaksanakan dari tanggal 7-17 Juli tahun 2018 menggunakan kuesioner dengan cara wawancara. Uji statistik menggunakan uji chi-square. Hasil penelitian menunjukkan bahwa mayoritas Pasangan Usia Subur (PUS) ikut serta dalam program KB yaitu sebanyak 67 responden (70,5%). Secara statistik ada hubungan sikap dan karakteristik Pasangan Usia Subur (PUS) dengan ketidakikutsertaan dalam program KB di Wilayah Kerja UPT Puskesmas Sungai Raya Kecamatan Sungai Raya Kabupaten Aceh Timur tahun 2018 dengan p value < 0,1. Sebaiknya pemegang program KB di UPT Puskesmas Sungai Raya Kecamatan Sungai Raya Kabupaten Aceh Timur agar mengajak tokoh lintas sektor agar mengadakan pertemuan untuk membuat rencana loka karya mini setidaknya satu bulan sekali untuk meningkatkan keikutsertaan Pasangan Usia Subur (PUS) dalam program KB.Kata Kunci : Program KB, Sikap, Karakteristik


2020 ◽  
Vol 1 (2) ◽  
pp. 9
Author(s):  
Yunita Mansyah Lestari ◽  
Suzy Yusna Dewi ◽  
Aulia Chairani

ABSTRAK   Alexithymia ditandai dengan ketidakmampuan dalam mengenali dan mengekpresikan emosi serta pemikiran yang berorientasi eksternal sehingga mereka memiliki hubungan interpersonal yang buruk. Remaja dengan alexithymia cenderung menjadi kecanduan media sosial.Penelitian ini bertujuan untuk mengetahui hubungan antara Alexithymia terhadap kecanduan media sosial pada remaja di Jakarta Selatan. Subjek penelitian adalah remaja yang berusia 13-19 tahun dan tinggal di Jakarta selatan. Pengambilan data menggunakan metode consecutive sampling dan snowball sampling dengan menyebar kuesioner menggunakan link googleform. Jumlah subjek penelitian sebanyak 207 orang (41 = laki-laki, 166 = perempuan). Skala yang digunakan adalah Toronto Alexithymia Scale (TAS-20) dan Social Media Disorder (SMD). Analisa data menggunakan metode chi-square pada SPSS 25. Hasil penelitian didapatkan 85 orang mengalami alexithymia, 88 mengalami kecanduan dan 62 orang mengalami alexithymia dan kecanduan media sosial. p-value didapatkan 0,000. Hal ini berarti terdapat hubungan antara Alexithymia dengan Kecanduan Media Sosial pada remaja di Jakarta Selatan. Kata Kunci :Alexithymia, Kecanduan Media Sosial, Remaja     ABSTRACT   Alexithymia is characterized by an inability to recognize and express emotions and have external oriented thoughts so that they have poor interpersonal relationships. Teenagers with alexithymial tend to become addicted to social media. This study aims to determine the relationship between Alexithymia towards social media addiction in adolescents in South Jakarta. The research subjects were adolescents aged 13-19 years and lived in south Jakarta. Retrieval of the data was using consecutive sampling and snowball sampling method by distributing questionnaires using the googleform link. The number of research subjects was 207 people (41 = men, 166 = women). The scale was used is the Toronto Alexithymia Scale (TAS-20) and Social Media Disorder (SMD). Data analysis using the chi-square method in SPSS 25. The results showed that 85 people had alexithymia, 88 were addicted and 62 people had alexithymia and were addicted to social media. p-value obtained is 0,000. This means that there is a relationship between Alexithymia and Social Media Addiction in adolescents in South Jakarta. Keyword : Adolescents, Alexithymia, Social Media Addiction


2019 ◽  
Vol 6 (1) ◽  
pp. 19-28
Author(s):  
Rakhmie Rafie ◽  
Yusmaidi Yusmaidi ◽  
Mira Fitriyani

Berdasarkan Permenkes 585/1989 dikatakan bahwa informed consent adalah persetujuan yang diberikan oleh pasien atau keluarganya atas dasar penjelasan mengenai tindakan medis yang akan dilakukan terhadap pasien tersebut. Peran dan tanggung jawab dokter terhadap pelaksanaan tindakan medis berdasarkan imformed consent sangat penting untuk mencegah kemungkinan yang akan terjadi kepada pasien nantinya. Pemahaman terhadap informasi yang diberikan dipengaruhi oleh beberapa faktor, diantaranya karakteristik orang tersebut. Survey analitik dengan desain cross sectional dengan wawancara terpimpin menggunakan kuesioner terhadap 100 responden, dan diolah menggunakan analisa univariat dan bivariat dengan uji Chi-Square. Hasil penelitian menunjukkan bahwa: yang berusia dewasa 84 responden (84%) dan yang berusia muda sebanyak 16 responden (16%), laki- laki 63 responden (63%) dan perempuan 37 responden (37%), yang berpendidikan rendah 41 responden (41%) dan yang berpendidikan tinggi 59 responden, yang tidak bekerja 24 responden (24%) sedangkan yang bekerja 76 responden (76%), yang mempunyai pemahaman baik 58 responden (58%) dan yang tidak baik sebanyak 42 responden (42%). Variabel yang terdapat hubungan bermakna dengan pemahaman terhadap persetujuan tindakan medis pada tindakan bedah di RSPBA pada bulan Maret 2015 adalah umur (nilai p value = 0,037) OR = 3.761 dengan nilai Confidence Interval (1.195-11.835)dan pendidikan (nilai p value = 0,00) OR = 8.551 dengan Confidence Interval (3.436-21.285). Sedangkan variabel yang tidak terdapat hubungan bermakna dengan pemahaman persetujuan tindakan medispada tindakan bedah di RSPBA pada bulan Maret 2015 adalah jenis kelamin (nilai p value = 0,987) dan pekerjaan (p value = 0,251). Terdapat hubungan bermakna antara umur dan pendidikan dengan pemahaman terhadap persetujuan tindakan medis pada tindakan bedah di RS Pertamina Bintang Aamin (RSPBA) pada bulan Maret 2015.  


2019 ◽  
Vol 7 (04) ◽  
pp. 215-224
Author(s):  
Kristin Yuliati Sayori ◽  
Astrid Novita
Keyword(s):  
P Value ◽  

Wanita hamil termasuk golongan yang rentan untuk terkena malaria karena berhubungan dengan penurunan imunitas di masa kehamilan. Tujuan penelitian ini adalah untuk mengetahui hubungan usia kehamilan, kebiasaan keluarga, lingkungan tempat tinggal, dan penggunaan kelambu dengan kejadian malaria pada ibu hamil. Jenis penelitian ini adalah observasional analitik dengan desain Cross sectional. Populasi pada penelitian ini adalah semua ibu hamil trimester 1 dan 2 di wilayah kerja Puskesmas Masni dari bulan Juli-Desember Tahun 2017 dengan teknik pengambilan sampel secara Total Sampling yaitu sebanyak 112 orang. Penelitian ini dilakukan pada bulan Januari tahun 2018. Penelitian ini menggunakan data primer dan sekunder yaitu kuesioner dan data status pasien sebagai alat ukur. Teknik pengolahan dan analisis data mengunakan uji Chi-square. Hasil penelitian menunjukan ada hubungan usia kehamilan dengan kejadian malaria (p-value=0,025), ada hubungan kebiasaan keluarga dengan kejadian malaria (p-value=0,011), ada hubungan lingkungan tempat tinggal dengan kejadian malaria (p-value=0,022), dan ada hubungan penggunaan kelambu dengan kejadian malaria (p-value=0,030). Kesimpulannya ada hubungan usia kehamilan, kebiasaan keluarga, lingkungan tempat tinggal, dan penggunaan kelambu dengan kejadian malaria. Saran bagi tenaga kesehatan agar dapat melakukan perbaikan prosedur distribusi kelambu berinsektisida gratis bagi masyarakat sehingga lebih tepat sasaran, dan perlu memaksimalkan sosialisasi cara penggunaan dan pemeliharaan kelambu berinsektisida.


2019 ◽  
Vol 18 (1) ◽  
pp. 33-36
Author(s):  
Feva Tridiyawati ◽  
Anisa Ayu Riska Handoko
Keyword(s):  
P Value ◽  

ABSTRAK Tujuan Penelitian: Untuk mengetahui hubungan antara Status sosial ekonomi dan pengetahuan ibu dengan kejadian gizi kurang pada balita di Wilayah Kerja Puskesmas Kelurahan Jatibening tahun 2018.  Metode Penelitian:Sampel dalam penelitian ini adalah seluruh balita yang mengalami gizi kurang di Wilayah Kerja puskesmas Kelurahan Jatibening yang sejumlah 35 orang. Jadi metode yang digunakan dalam pengambilan sampel adalah total sampling. Hasil Penelitian:Dari variabel yang ditelitidan di dugaberhubungandengankejadiangizikurang, seluruhvariabelterbuktimempunyaihubungandenganmelihathasil chi-square, semuahasil p value < 0,05. Kesimpulan dan Saran :Kader/penguruscakupan Wilayah KerjaPuskesmasKelurahanJatibeningsupayamemperhatikan status gizipadabalitadikarenakanmasihbanyaknya status gizikurangpadabalita, memberikankonselingpadaibu-ibu tentang gizi pada balita dan memberikan makanan tambahan pada balita yang memiliki status gizi kurang. Kata kunci : gizi kurang, balita


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