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Indonesian Journal of Critical and Emergency Medicine Vol 1 No.3 July-September 2014 / ISSN : 2355-4584

Profil Klinis dan Luaran Pasien Gawat Darurat Medis Dewasa di Rumah Sakit Cipto Mangunkusumo, Jakarta


Gurmeet Singh
Martin Winardi, Cleopas M Rumende

ABSTRACT
Background:
Cipto Mangunkusumo Hospital (CMH) is a national referral center in Indonesia. Most of the patients come with multiple and complicated diagnosis.
Objective: To describe clinical profiles and in-hospital prognosis in adult medical patients admitted to Emergency Room in CMH.
Methods: A prospective cohort study was performed on adult medical patients in Emergency Department (ED) of CMH between October and December 2012. Acute presenting symptoms and diagnosis were made by in-charge resident of Internal Medicine Department. Outcome was assessed when the patients were discharge from the hospital (alive or dead). Patients’ confidentiality was maintained throughout the study.
Results: A total of 815 non-surgical patients attended the study (51.7% were male). Mean age was 47.3 (SD 15.2) year old, mean arterial pressure was 91.7 (22.0) mmHg, mean heart rate was 101.3 (SD 23.4) bpm, mean respiratory rate was 25.0 (SD 6.8) bpm, mean body temperature was 36.9 (SD 1.1)oC, mean peripheral O2 saturation 96.2 (SD 4.2)%, median Glasgow Coma Scale was 15 (3–15). The most frequent chief complaints were shortness of breath (25.1%), general weakness (16.2%) and loss of consciousness (12.7%). Frequent diagnosis found included pneumonia (35.6%), dyspepsia (33.2%), hypertension (28.5%), renal failure (27.7%), malignancy (24.7%), sepsis (23.1%), anemia (22.0%) and diabetes mellitus (17.3%). Median length of stay was 5 (0–63) days. Mortality was observed in 145 patients (17.8%). The causes of death were irreversible septic shock (53.8%), respiratory failure (24.8%), cardiac arrest (11.0%), cardiogenic shock (6.9%) and pulmonary embolism (3.4%).
Conclusions: Clinical profile and outcome of adult medical emergency patients in Cipto Mangunkusumo Hospital differ from those of other hospitals in Indonesia. Long length of stay and high mortality was observed. Further research in CMH care system must be done for future improvements.
Key words: Clinical profile, outcome, medical emergency patients
 

ABSTRAK
Latar belakang:
Rumah Sakit Cipto Mangunkusumo (RSCM) merupakan rumah sakit rujukan nasional di Indonesia. Sebagian besar pasien datang dengan kasus sulit dan lebih dari satu diagnosis.
Tujuan: Menggambarkan profil klinis dan prognosis selama perawatan pada pasien gawat darurat medis dewasa di RSCM.
Metode: Penelitian kohort prospektif dilakukan di Instalasi Gawat Darurat RSCM dalam kurun Oktober sampai Desember 2012. Gejala dan diagnosis awal dicatat oleh residen Ilmu Penyakit Dalam yang bertugas. Luaran dinilai saat pasien keluar dari rumah sakit (hidup atau meninggal). Rahasia pasien tetap terjaga selama penelitian.
Hasil: Selama penelitian didapatkan 815 pasien gawat darurat medis (51,7% di antaranya laki-laki). Rerata usia pasien adalah 47,3 (SB 15,2) tahun, rerata tekanan arterial 91,7 (22,0) mmHg, rerata denyut jantung 101,3 (SB 23,4) kali/menit, rerata frekuensi pernapasan 25,0 (6,8) kali/menit, rerata suhu tubuh 36,9 (SB 1,1)oC, rerata
saturasi O2 perifer 96,2 (4,2)%, median Glasgow Coma Scale 15 (3–15). Keluhan utama yang banyak ditemukan adalah sesak napas (25,1%), kelemahan umum (16,2%), dan penurunan kesadaran (12,7%). Diagnosis yang banyak ditemukan adalah pneumonia (35,6%), dispepsia (33,2%), hipertensi (28,5%), gagal ginjal (27,7%), keganasan (24,7%), sepsis (23,1%), anemia (22,0%), dan diabetes melitus (17,3%). Median lama rawat 5 (0–63) hari. Mortalitas dijumpai pada 145 pasien (17,8%). Penyebab kematian pasien adalah renjatan sepsis ireversibel (53,8%), gagal napas (24,8%), henti jantung (11,0%), renjatan kardiogenik (6,9%), dan emboli paru (3,4%).
Simpulan: Profil klinis dan luaran pasien gawat darurat medis di RSCM berbeda dengan rumah sakit lain di Indonesia. Dijumpai durasi perawatan yang panjang dan mortalitas yang tinggi di RSCM. Penelitian lebih lanjut mengenai sistem perawatan di RSCM harus dilakukan untuk perbaikan di masa depan.
Kata kunci: Profil klinis, luaran, gawat darurat medis


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