Journal Reading
Diferences Upon Admission and in Hospital Course o Children Hospitalized with Community-Acquired Community-Acquired Pneumonia with or without Radiologically-Conrmed Pneumonia! a Retrospecti"e Cohort #tudy
Oleh:
Syena Damara Riza Gsutam M. Tata Suharta
04084821517083 04084821618193
Pembimbing: dr. z!ar ru"# S$.
DEPARTEMEN DEPARTEMEN ILMU KESEHATAN KESEHATAN ANAK FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA RSUP DrMOHAMMAD HOESIN PALEM!AN" #$%&
HALAMAN PEN"ESAHAN
Journal Reading
Differences Upon Admission and in Hospital Course of Children Hospitalized with Community Acquired Pneumonia with or without Radiologically-Confirmed Pneumonia: a Retrospectie Cohort !tudy Oleh:
Syena Damara Riza Gsutam M. Tata Suharta
04084821517083 04084821618193
Te%ah diterima se&a'ai sa%ah satu syarat da%am men'i(uti )e$aniteraan )%ini( Seni*r di De$artemen +%mu )esehatan na( ,a(u%tas )ed*(teran -niersitas Sri!i/aya RS- Dr.M*hammad *esin a%em&an' $eri*de 30 uni 2016 12 Se$tem&er 2016.
a%em&an'# u%i 2016
em&im&in'
dr. z!ar ru"# S$.
KATA PEN"ANTAR
u/i dan syu(ur $enu%is ua$(an (e$ada Tuhan an' Maha sa# (arena atas rahmat dan (aruniaya# $enu%is da$at menye%esai(an "ournal reading yan' &er/udu% Differences Upon Admission and in Hospital Course of Children Hospitalized with Community-Acquired Pneumonia with or without Radiologically-Confirmed Pneumonia: a Retrospectie Cohort !tudy : #ournal reading ini disusun da%am ran'(a memenuhi sa%ah satu syarat untu( men'i(uti )e$aniteraan +%mu )esehatan na( di RSM a%em&an'. ada (esem$atan ini# $enu%is in'in menyam$ai(an terima (asih (e$ada dr. z!ar ru"# S$. atas &im&in'an yan' te%ah di&eri(an. Da%am menye%esai(an $enu%isan ini# $enu%is tida( %u$ut dari (esa%ahan dan (e(uran'an &ai( dari se'i materi dan &ahasa yan' disa/i(an. -ntu( itu $enu%is mem*h*n maa" atas se'a%a (esa%ahan dan (e(uran'an# serta men'hara$(an (riti( dan saran demi (esem$urnaan tu%isan ini. (hirnya# $enu%is &erhara$ sem*'a tu%isan ini da$at &erman"aat &a'i $enu%is $ada (hususnya# serta semua $iha( yan' mem&utuh(an.
a%em&an'# u%i 2016
enu%is
DAFTAR ISI
;M -D-; ................................................................................................................. ;M GS.................................................................................................. ii )T GTR ............................................................................................................iii D,TR +S+ ..........................................................................................................................i RT+); S;+........................................................................................................................1 +<= >+.................................................................................................................................9
#im$alista et al. BMC Pediatrics %&'()* ()!(++ D, ('.((/+0s(&//1-'()-'2/)-+
R 3#3 AR C H A R 4 C 53
,pen Access
Diferences upon admission and in hospital course o children hospitalized with communityacquired pneumonia with or without radiologically-conrmed
pneumonia! a retrospecti"e cohort study 1
2
2
!
Raquel Simbalista , Dafne C. Andrade , Igor C. Borges , Marcelo Araúo and Cristiana M. "ascimento#Car$al%o
1,2,&'
A$stract
6ac7ground! (%e use of c%est radiogra)% *C+R for t%e diagnosis of c%ild%ood communit-#acquired )neumonia *CA is contro$ersial. /e assessed if c%ildren 0it% CA diagnosed on clinical grounds, 0it% or 0it%out radiologicall-#confirmed )neumonia on admis sion, e$ol$ed differentl-. 8ethods! C%ildren aged 9 2 mont%s, %os)italied 0it% CA diagnosed on clinical grounds, treated 0it% 2, I34 5g4da- of aqueous )enicillin 6 for 9 &7 % and 0it% C+R ta8en u)on admission, 0it%out )leural effusion, 0ere included in t%is retros)ecti$e co%ort. 9ne researc%er, blinded to t%e radiological diagnosis, collected data on demogra)%ics, clinical %istor- and )%-sical e:amination on admission, dail- %os)ital course during t%e first 2 da-s of treatment, and outcome, all from medical c%arts. Radiological confirmation of )neumonia 0as based on )resence of )ulmonar- infiltrate detected b- a )aediatric radiologist 0%o 0as also blinded to clinical data. ;ariables 0ere initiall- com)ared b- bi$ariate anal-sis. M ulti#$ariable logistic regression anal-sis assessed in de)endent association bet0een radiologicall-#confirmed )neumonia and factors 0%ic% significantl- differed during %os)ital course in t%e bi$ariate anal-sis. (%e multi#$ariable anal-sis 0as )erformed in a model adusted for age and for t%e same factor )resent u)on admission. Results! 1< *!7.= > c%ildren %ad radiologicall-#confirmed )neumonia, 1&! *=.= > %ad n ormal C+R and !1 *11. > %ad atelectasis or )eribronc%ial t%ic8ening. C%ildren 0it%out radiologicall-#confirmed )neumonia 0ere -ounger t%an t%ose 0it% radiologicall-#confirmed )neumonia *median ?I@R 1& ?:27 mont%s versus 21 ?12:&& mont%s P E .1. "one died. (%e subgrou) 0it% radiologicall-#confirmed )neumonia )resented fe$er on D1 *!!. vs. 1<.1 P E .1= and on D2 *!1.F > vs. 1F.2 > P E .& more frequentl-. (%e subgrou) 0it%out radiologicall-#confirmed )neumonia %ad c%est indra0ing on D1 *22.& > vs. 11.< > P E .2 more often detected. B- multi#$ariable anal-sis, Ge$er on D2 *9R ?<= > CI 2.1F ?1.1=#&.F 0as directl- and inde)endentl- associated 0it% radiologicall-#confirmed )neumonia u)on admission.
Conclusion! (%e com)ared subgrou)s e$ol$ed differentl-.
' Corres)ondence nascimentocar$al%oH%otmail.com 1 ostgraduate rogram in at%olog-, Gederal 3ni$ersit- of Ba%ia Sc%ool of Medicine, Sal$ador, Brail 2 ostgraduate rogram in ealt% Sciences, Gederal 3ni$ersit- of Ba%ia Sc%ool of Medicine, Sal$ador, Brail Gull list of aut%or information is a$ailable at t%e end of t%e article J 21= Simbalista et al. ,pen Access (%is article is distributed under t%e terms of t%e Creati$e Commons Attribution &. International Kicense *%tt)44creati$ecommons.org4licenses4b-4&.4, 0%ic% )ermits unrestricted use, distribution, and re)roduction in an- medium, )ro$ided -ou gi$e a))ro)riate credit to t%e original aut%or*s and t%e source, )ro$ide a lin8 to t%e Creati$e Commons license, and indicate if c%anges 0ere made. (%e Creati$e Commons ublic Domain Dedication 0ai$er *%tt)44creati$ecommons.org4)ublicdomain4ero41.4 a))lies to t%e data made a$ailable in t%is article, unless ot%er0ise stated.
6ac7ground <*mmunity a?uired $neum*nia @<A is the %eadin' ause *" m*rta%ity in hi%dren a'ed %ess than 5 years# a*untin' "*r 1.1 mi%%i*n hi%dh**d deaths eery year : m*re than +DS# meas%es and ma%aria a%% t*'ether B 1C. <*nsiderin' < *ntr*% a "undamenta% ste$ t* ahiee the Mi%%ennium Dee%*$ment G*a% 4 *" ;reduin' &y t!* thirds# &et!een 1990 and 2015# the under"ie m*rta%ity rate< B2C# the *r%d ea%th =r'anizati*n @=A $r* $*sed in 1990 a standardized asemana'ement $r*t**% "*r <# &ased s*%e%y *n sym$t*ms and si'ns B3C. +n 2005# a standardized manua% "*r $neum*nia re*'niti*n *n
hest radi*'ra$h @
=" n*te# the ediatri +n"eti*us Diseases S*iety and the +n"eti*us Diseases S*iety *" meria =s 'uide%ines state that
treated suess"u%%y a massie ma/*rity *" hi%dren h*s$i ta%ized !ith < B14C. +n this *nteFt# the aim *" this study !as t* assess i" there !ere di""erenes in h*s$ita% *urse and in *ut*me &et!een 'r*u$s *" hi%dren h*s$ita%ized !ith <# dia' n*sed *n %inia% 'r*unds# treated !ith a?ue*us $enii%%in G# !ith *r !ith*ut radi*%*'ia%%y*n"irmed $neum*nia *n admissi*n.
8ethods This retr*s$etie *h*rt in%uded hi%dren a'ed 9 2 m*nths h*s$ita%ized !ith < and t reated intraen*us%y !ith 200#000 +-I)'Iday *" a?ue*us $enii%%in G "*r at %east 48 h# and !ith
nasa% "%arin'# 'runtin'# seizureA# and *ut*me !ere *% %eted "r*m the media% harts and re*rded *n a $re de"ined "*rm. ,*r aFi%%ary tem$erature and res$irat*ry rate @RRA# the hi'hest re'istered 'rade !as *%%eted. ,eer !as de"ined as aFi%%ary tem$erature 9 37.5 J< B16C
and tahy$n*ea as RR 9 50 &reathsImin in hi%dren a'ed 2:11 m*nths# RR 9 40 &reathsImin in hi%dren "r*m 12 t* 59 m*nths *" a'e B 17C# and RR 9 30 in hi% dren a'ed 9 60 m*nths B18C. utriti*na% ea%uati*n !as $er"*rmed usin' the s*"t!are nthr*# ersi*n 1.02
>ig. ( Glo0#c%art of t%e ste)#b-#ste) selection of c%ildren %os)italied 0it% communit-#acquire d )neumonia diagnosed on clinical grounds
@
*r ina&i%ity t* drin( !ere %assi"ied as ery seere < B 17C. +" a hi%d had hest indra!in' a%*n' !ith any item that !*u%d %assi"y himIher as ery seere <# the "ina% %assi"i ati*n !as ery seere <. e *m$ared the "re?ueny *" dem*'ra$hi and %in ia% "indin's deteted u$*n admissi*n and *n eah day *" nd
h*s$ita% *urse u$ t* the 2 day &et!een $atients !ith radi*%*'ia%%y*n"irmed $neum*nia and th*se !ith n*r ma%
4a$le ( Baseline and clinical c%aracteristics of c%ildren %os)italied 0it% communit-#acquired )neumonia diagnosed on clinical grounds Radiologicall-#confirmed )neumonia
C%aracteristics
e
Les *n E 1<
"ormal C+R *n E 1&!
P
"o *n E 1&
P
*F&.2,
*=!.7,
.<7
7 *=.,
.1<
2#11 mont%s
27 *2=.,
F! *&&.1,
.!
! *&2.,
.=
1#& -ears
F *F1.=,
F7 *&.F,
.27
7 *=.,
.=<
9 = -ears
1& *12.7,
12 *7.&,
.2=
1& *7.,
.177
1 *<1.,
112 *7.!,
.&
1& *7.=,
.1
n E <
n E 7
= *!:,D 1#!
&*2 :F,D 1#2
.
&*2:,D1#2
.2<<
<2 *7&.&,
12! *7F.,
.2
1=2 *7.&,
.&7!
n E =<
n E 7
*&:<,D 1#&=
&.= *! :,D 1#!1
.22
=*!:.=,D1#!1
.=!
F *F1.=,
1& *2.,
.=7
12& *1.!,
.7
n E &F
n E
2 *1:F,D 1#!
! *1 :&.=,D 1#!
.7<&
!*1:=,D1#!
F747= *7.
d
<41F *&.=
d
.!2
<741!1 *&.7
d
.!
d
d
d
6ender male Age strata
a
a, b
istor- of current illness fe$er
a
duration of fe$er
c
a
coug%
duration of coug%
c
a
breat%lessness
duration of breat%lessness
c
n E 1=
n E
n E
%-sical e:amination findings tac%-)noea fe$er
a
a a
crac8les
a
0%eeing
c%est retraction
a
Se$erit- according to /9 a
non#se$ere a
se$ere
a
$er- se$ere
c%est indra0ing
a
=24<< *=2.=
F24121 *=1.2
.7&<
<41&7 *=!.&
.7<=
&2 *!7.=,
7F *F.1,
.1
1 *=.=,
.2
!2 *2<.&,
7F *F.1,
.1
<< *=F.<,
.1
!7 *!&.<,
=! *!.1,
.1<
F< *!<.,
.&17
F *F<.,
F *=!.1,
.7
< *==.,
.1<
22 *2.2,
& *!2.<,
.2=
== *!1.F,
.!F
11 *1.1,
2 *1&.,
.!=1
22 *12.F,
.=1=
! *2.=,
=7 *&.F,
.!2
F *!7.=,
.=7
b
nasal flaring
a
*F.&,
1 *11.<,
.1&!
1< *1.<,
.22
somnolence
a
1 *.<,
1 *.,
1.
1 *.F,
1.
1 *.<,
1 *.,
1.
1 *.F,
1.
2 *1.7,
1 *.,
.=7
1 *.F,
.=F1
a
seiure
a
c-anosis
C@R indicates chest radiograph H, indicates orld Health ,rganization a Data are shown as n %B* $ 4he requencies in each age stratum or in the se"erity groups according to H, were compared as dichotomic "aria$les c Data are shown as median %R* minimum-maEimum d Diferent denominators are due to missing data e ncludes normal C@R plus C@R with atelectasis or peri$ronchial thic7ening
This %ast 'r*u$ *m$rised $atients !ith n*rma%
Results Durin' the study $eri*d# 921 ases !ere deteted and 456 $atients "u%"i%%ed the in%usi*n riteria. "ter eF%ud in' 132 @29.0 HA ases due t* under%yin' de&i%itatin' i%%nesses# a "urther 39 @8.5 HA !ith $%eura% e""usi*n deteted *n the
4a$le & Significant differences during %os)ital course of c%ildren %os)italied 0it% communit-#acquired )neumonia diagnosed on clinical grounds C%aracteristics
Radiologicall-#confirmed )neumonia "ormal C+R
Les
D1
a
n
b
E 12< c
n E 1&!
P
b
c
"o
d
P
n E 1&
Ge$er
2<47F *!!.
141 *1=.<
.&
2=41!1 *1<.1
.1=
C%est indra0ing
1! *11.<,
!1 *21.,
.&!
!< *22.&,
.2
D2
a
n
b
E 12< c
n E 1&!
b
c
!14<7 *!1.F
1F411< *1!.&
.1
2&41&7 *1F.2
.&
Ge$er
2F4F2 *&1.<
<4&F *1<.F
.1&
1&4=< *2!.
.!!
C%est indra0ing
F4 *.7
<4= *1=.7
.1&
124= *1F.
.11
274F< *&.F,
14= *2.,
.1
1=4F7 *22.1,
.2
Ge$er
/it%out 0%eeers D1
D2
a
a
Ge$er
Data are shown as n %B* C@R indicates chest radiograph a D1 is the rst day ater aqueous penicillin F has $een initiated %&2 h o treatment*G D2 is the second day ater aqueous penicillin F has $een initiated %2/ h o treatment* $ n num$er o e"aluated patients in each su$group on the respecti"e day o hospital course c Diferent denominators due to missing data d ncludes normal C@R plus C@R with atelectasis or peri$ronchial thic7ening
ate%etasis @2.8 HA and $eri&r*nhia% thi(enin' @3.7 HA. The &ase%ine harateristis are *m$ared in Ta&%e 1.
4 days B+RL 3 :6C versus n* radi*%*'ia%%y*n"irmed $neum*niaL median 4 days B+RL 3 :6CN P O 0.402A. =er a%%# a?ue*us $enii%%in G !as su&stituted &y *ther anti&i*tis in 29 @10.2 HA ases.
4a$le I S-m)toms and signs 0 it%out significant differences during %os)ital course of c%ildren %os )italied 0it% communit-# acquired )neumonia diagnosed on clinical grounds C%aracteristics
Radiologicall-#confirmed )neumonia "ormal C+R
Les
D1
a
n
E 12<
b
c
n E 1&!
P
b
c
"o
d
P
n E 1&
b
c
(ac%-)noea
=&4< *F.
=141 *&.
.7&
F=41!2 *&<.2
.11=
C-anosis
#
#
C%est retraction
21 *1<.!,
2< *2.!,
.7&2
! *21.!,
.F7=
Somnolence
1 *.<,
1 *.,
1.
1 *.F,
1.
"asal flaring
& *!.,
& *2.7,
.!
= *2.<,
.!
6runting
1 *.,
1.
1 *.F,
1.
Seiure
#
#
Coug%
&1 *!.F,
&& *!.7,
.2==
== *!1.F,
.2<<
Breat%lessness
17 *1F.=,
.1<<
&2 *2&.1,
a
D2
n= 1< c
!! *2!.1, b
n E 1&! c
b
n= 1&
.12 b
c
(ac%-)noea
&=4
=2411< *&!.
.&
F41&= *&F.2
.&2
C-anosis
1 *.<,
.&!!
.!7=
C%est indra0ing
11 *1.1,
1& *<.7,
.
1< *1.<,
.72F
C%est retraction
1& *12.7,
1F *11.2,
.F77
2 *11.=,
.!&
Somnolence
2 *1.7,
.17F
.1&7
"asal flaring
1 *.<,
1 *.,
1.
1 *.F,
1.
6runting
1 *.,
1.
1 *.F,
1.
Seiure
#
#
Coug%
&& *&.&,
F= *&=.=,
.&1<
< *&=.&,
.&F
Breat%lessness
2= *22.<,
27 *1<.F,
.=1
!& *1<.=,
.&<&
Data are shown as n %B* C@R indicates chest radiograph a D1 is the rst day ater aqueous penicillin F has $een initiated %&2 h o treatment*G D2 is the second day ater aqueous penicillin F has $een initiated %2/ h o treatment* $ n num$er o e"aluated patients in each su$group on the respecti"e day o hospital course c Diferent denominators due to missing data d ncludes normal C@R plus C@R with atelectasis or peri$ronchial thic7ening
4a$le 2 Multi#$ariable anal-sis of factors associated 0it% radiologicall-#confirmed )neumonia during %os)ital course in bi$ariate anal-sis, adusted for age and for t%e same factor u)on admission, among c%ildren %os)italied 0it% communit-#acquired )neumonia diagnosed on clinical grounds Com)ared subgrou) C+R 0it%out )neumonia
"ormal C+R
/it%out 0%eeers
9R *<= > CI,
P
9R *<= > CI,
P
9R *<= > CI,
P
2.17 *1.#&.&!,
.!1
1.= *.<2#!.!&,
.<1
2. *.7<#&.&7,
.<&
1. *1.#1.,
.F2
1. *1.#1.,
.2!
1. *.<<#1.,
.7<
&.1 *1.=.&2,
.&
!.& *1.!=#7.<&,
.1
1.= *.=7#=.2!,
.!1
.F= *.!1#1.!,,
.2=<
.F *.2<#1.22,
.1F
.F *.2#1.,
.!=&
Age
1. *1.#1.,
.!!
1. *1.#1.,
.2&
1. *1.#1.,
.2
C%est indra0ing u)on admission
.F *.!7#1.1<,
.1&
.& *.&!#1.27,
.271
.F *.!#1.&F,
.!11
2.FF *1.!2#=.!F,
.F
2.1F *1.1=#&.F,
.1F
2.2& *1.&#&.<,
.!<
Age
1. *1.#1.,
.7F
1. *1.#1.,
.&&
1. *.<<#1.,
.11F
Re)ort of fe$er u)on admission
&.1= *1.F1#1.F,
.!
!.F= *1.&&#<.2!,
.F
2.1 *.F<#=.7!,
.1<<
C%aracteristics
Ge$er on D1
a
Age Re)ort of fe$er u)on admission C%est indra0ing on D1
Ge$er on D2
a
a
8ulti-"aria$le analysis $y logistic regression C@R indicates chest radiograph C@R without pneumonia includes normal C@R plus C@R with atelectasis or peri$ronchial thic7ening a D1 is the rst day ater aqueous penicillin F has $een initiated %&2 h o treatment*G D2 is the second day ater aqueous penicillin F has $een initiated %2/ h o treatment*
Discussion This study $r*ides eidene that hi%dren h*s$ita%ized !ith < dia'n*sed *n %inia% 'r*unds treated !ith a?ue*us $enii%%in G# $resent di""erenes durin' h*s$ita% *urse !hen radi*%*'ia%%y*n"irmed $neum*nia ases are *m$ared t* *thers !ith*ut radi*%*'ia%%y*n"irmed $neum*nia *r !ith n*rma%
B20C. dditi*na%%y# it has &een dem*nstrated that the in %usi*n *" "eer in the = riteria "*r the %inia% dia'n*sis *" < su&stantia%%y inreases its s$ei"iity# $artiu%ar%y in hi%dren !ith !heezin' B21C. The hist*ry *" "eer has a%s* &een re*'nized as the sym$t*m !ith the 'reatest sensitiity "*r the $resene *" $u%m*nary in "i%trates B22C. =ur data $r*ide eidene that $ersistene *" "eer u$ t* the se*nd day *" treatment is a%s* m*re "re?uent am*n' h*s$ita%ized hi%dren !ith radi*%*'ia%%y *n"irmed $neum*nia. +n a $rei*us inesti'ati*n !hih *m$ared the $r*'res si*n *" sym$t*ms am*n' hi%dren !ith n*nseere aute %*!er res$irat*ry trat in"eti*n !ith and !ith*ut a radi* %*'ia% dia'n*sis *" $neum*nia# tahy$n*ea $ersisted %*n'er durin' treatment am*n' th*se !ith radi*%*'ia%%y *n"irmed $neum*nia B12C. erein# this "indin' !as n*t "*und# $*ssi&%y due t* sam$%e size.
The eidene that there is n* e""et *" an admissi*n
Conclusions This is the "irst study t* dem*nstrate the di""erenes in h*s$ita% *urse &et!een h*s$ita%ized hi%dren !ith < di a'n*sed *n %inia% 'r*unds !ith *r !ith*ut radi*%*'ia%%y *n"irmed $neum*nia. e hi'h%i'ht di""erenes *n the h*s$ita% *urse &et!een the studied su&'r*u$s. The $er "*rmane *"
&.
=.
.
F.
.
7.
<.
1.
11.
Competing interests (%e aut%ors declare t%at t%e- %a$e no com)eting interests. 12.
Authors= contri$utions CM"#C designed t%e stud-, RS re$ie0ed t%e medical c%arts, collected and entered t%e data, MA read t%e c%est radiogra)%s, DCA and ICB anal-ed t%e data. All aut%ors contributed to t%e inter)retation of t%e results. RS drafted t%e manuscri)t. DCA, ICB and MA contributed to t%e 0riting and CM"#C )roofread t%e manuscri)t. All aut%ors read and a))ro$ed t%e final manuscri)t.
1!.
Ac7nowledgments (%ere 0as no funding for t%is in$estigation. (%e aut%ors t%an8 t%e medical c%art unit of t%e Gederal 3ni$ersit- of Ba%ia os)ital, in Sal$ador, Brail for t%eir coo)eration in getting t%e medical c%arts to be re$ie0ed.
1=.
Author details 1 ostgraduate rogram in at%olog-, Gederal 3ni$ersit- of Ba%ia Sc%ool of 2 Medicine, Sal$ador, Brail. ostgraduate rogram in ealt% Sciences, ! Gederal 3ni$ersit- of Ba%ia Sc%ool of Medicine, Sal$ador, Brail. Image Diagnosis, Image Memorial 3nit and Ba%ia os)ital, Sal$ador, Brail. & De)artment of aediatrics, Gederal 3ni$ersit- of Ba%ia Sc%ool of Medicine, Sal$ador, Brail.
1&.
1F. 1.
17.
Recei"ed! (+ January &'() Accepted! (I ,cto$er &'() 1<.
References 1. a%(er <;# Rudan +# ;iu ;# air # The*d*rat*u # hutta K# et
2.
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a%. G%*&a% &urden *" hi%dh**d $neum*nia and diarrhea. ;anet. 21!D!711&=:1F. *r%d ea%th =r'anizati*n. The -nited ati*ns
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.
ediatris. 2009N124Le29 :36.
2&. # asiment*
PI'O(VIA 1. r*&%em L )e%*m$*( sam$e% terdiri dari 283 $asien ra!at ina$ dari &u%an =(t*&er 2002 =(t*&er 2005 di -niersitas e'eri RS ahia# Sa%ad*r# razi% yan' didia'n*sis seara (%inis den'an $neum*nia dan di%a(u(an $emeri(saan hest F ray saat masu( RS
2. +nterenti*n ene%itian ini meru$a(an suatu $ene%itian (*h*rt retr*s$e(ti" den'an men''una(an re(am medi( $asien$asien yan' didia'n*sa den'an < seara (%inis den'an atau tan$a (*n"irmasi $emeri(saan radi*%*'is.
3. <*m$aris*n )e%*m$*( (*ntr*% L $asien yan' didia'n*sis den'an $neum*nia den'an r*nt'en th*ra(s n*rma% dan $asien den'an dia'n*sis radi*%*'is %ainnya# (eua%i T. )e%*m$*( (asus L $asien yan' didia'n*sis den'an $neum*nia den'an (*n"irmasi r*nt'en th*ra(s &erdasar(an in"i%trat $ada $aru
4. =utame erdasar(an hasi% $ene%itian dem*'ra"i (e%*m$*( (asus memi%i(i usia yan' %e&ih muda# demam# r*n(hi# !heezin'# dan termasu( (%asi"i(asi $neum*nia &erat &erdasar(an = di&andin'(an (e%*m$*( (*ntr*%. Se%ama $era!atan# (e%*m$*( (asus demam dan retra(si dindin' dada %e&ih &anya( di&andin'(an (e%*m$*( (*ntr*%.
5. >a%idity L a. $a(ah "*(us $ene%itian ini sesuai den'an tu/uan $ene%itian a# "*(us $ene%itian ini sesuai den'an tu/uan $ene%itian. Tu/uan $ene%itian ini ada%ah untu( men'etahui dem*'ra"i dan $r*'n*sis $asien yan' didia'n*sis den'an $neum*nia# den'an atau tan$a (*n"irmasi radi*%*'is. &. $a(ah su&/e( $ene%itian diam&i% den'an ara yan' te$at
a# su&/e( $ene%itian terdiri dari 283 $asien ra!at ina$ dari &u%an =(t*&er 2002 =(t*&er 2005 di -niersitas e'eri RS ahia# Sa%ad*r# razi% yan' memenuhi (riteria in(%usi dan e(s(%usi. . $a(ah data yan' di(um$u%(an sesuai den'an tu/uan $ene%itian a# data yan' di(um$u%(an sudah sesuai den'an tu/uan $ene%itian. Data men'enai (ara(teristi( $asien untu( mem&andin'(an dem*'ra"i dan $r*'n*sis $asien < den'an (*n"irmasi radi*%*'is dan tan$a (*n"irmasi radi*%*'is atau n*rma% hest Fray d. $a(ah $ene%itian ini mem$unyai /um%ah su&/e( yan' u(u$ untu( meminima%isir (e&etu%an a# $ene%itian ini men''una(an /um%ah su&/e( yan' u(u$ &anya( untu( meminima%isir (e&etu%an. ene%itian /u'a &ersi"at d*u&%e&%ind dimana $emeri(sa (%inis dan radi*%*'is tida( men'etahui dia'n*sis sam$e%.
e. $a(ah ana%isa data di%a(u(an u(u$ &ai( a# ana%isis sudah di%a(u(an den'an u(u$ &ai( den'an men''una(an ana%isis &iariate dan mu%tiariate. Mem&andin'(an (ate'*ri aria&e% den'an hi s?uare atau "isher eFat test# distri&usi n*n$arametri
men''una(an
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u
test.
na%isis
mu%tiariate men''una(an ana%isis re'resi %*'isti untu( meni%ai hu&un'an antara $asien < den'an (*n"irmasi radi*%*'is dan "a(t*r "a(t*r yan' seara si'ni"i(an &er&eda di ana%isis &iariate. @O0.05A
6. +m$*rtany ene%itian ini dini%ai $entin' untu( men/adi suatu $ed*man a%ur $enata%a(sanaan $neum*nia# dimana $ada $asien den'an dia'n*sis $neum*nia namun hasi% r*nt'en tida( menun/u((an 'am&aran $neum*nia# &e%um $er%u di&eri(an anti&i*ti(# namun harus teta$ di "*%%*! u$ %e&ih %an/ut.
7. $$%ia&i%ity ene%itian ini da$at ditera$(an di RSM (arena di RSM ada $asien den'an 'e/a%a (%inis $neum*nia dan /u'a memi%i(i "asi%itas $emeri(saan radi*%*'i.
