Nilai Diagnostik Indikator Fisik Dibandingkan Baku Emas untuk Menegakkan Diagnosis Terduga Kretin pada Batita

ABSTRACT Iodine severe deficiency is a major cause of impairment due to iodine deficiency disorders. Cretinism is a consequence of iodine deficiency in the womb with clinical signs that stand out among others is mental retardation. In Indonesia, there were many cases of endemic goiter and cretinism. Diagnosis of cretinism can be established more accurately by laboratory tests, but it is expensive and less practical when conducted the field. Currently there are available tools for early detection for hypothiroid in neonates (NHI, Quebec) less expensive and easier to implement however it can not be used for older children. The instrument need to be developed for older children that was easy, deap and can provide a reliable diagnostic result. This diagnostic test research studied the diagnostic value of physical indicators for the diagnosis of suspected cretinism in infants and toddlers. The research was conducted in Magelang, Wonosobo, Wonogiri and Ponorogo Districts, for 10 months. Subject were infants and children under three years old. The information generated in the form of cretinism suspected early detection instrument (DDSK) for infant and toddler at the community level. The proportion of subjects with high TSH and low FT4 (hypothyroid) were 4.6% and 98.8%. The proportion of subjects experiencing developmental disorder were 36.4% (Denver test); impaired function of hearing were 2.7% and impaired motor function were 5.5%. The result of diagnosis using DDSK form, subjects detected cretinism suspected of 11.9%, and the diagnostic gold standard (the combined test results of Denver, Bayley, clinical examination and laboratory) of 11.3%. There is a significant relationship (p< 0.001) between the presence of positive test results with cretinism suspected; grades Se= 47.1%, Sp= 92.5%. Compare with gold standard, physical indicators of diagnostic test (DDSK) could diagnosed suspected cretinism among children under three years. Revising components and scoring in the indicators of cretinism suspected early detection instrument (DDSK) for infant and toddler were necessary. Keywords: diagnostic tests, physical indicators, gold standard, cretinism, IDD. ABSTRAK Kekurangan asupan iodium yang berat merupakan penyebab utama terjadinya gangguan akibat kekurangan iodium. Kretin merupakan akibat lanjut dari kekurangan iodium sejak dalam kandungan, ditandai antara lain dengan retardasi mental. Di Indonesia banyak dijumpai daerah endemik gondok dan kasus kretin. Diagnosis kretin dapat ditegakkan lebih akurat dengan pemeriksaan laboratorium, namun biayanya mahal dan kurang praktis dikerjakan di lapangan. Saat ini telah tersedia alat deteksi dini hipotiroid untuk usia neonatus (NHI, Quebec) yang lebih murah dan mudah diterapkan tetapi belum tersedia untuk usia di atasnya. Perlu dikembangkan instrumen untuk usia tersebut yang mudah, murah dan memberikan hasil diagnostik yang bisa diandalkan. Penelitian dengan diagnostic test ini dilakukan untuk mempelajari nilai diagnostik indikator fisik untuk menegakkan diagnosis anak terduga kretin pada usia bayi dan batita. Penelitian ini dilakukan di Kabupaten Magelang, Wonosobo, Wonogiri, dan Ponorogo, selama 10 bulan. Subyek penelitian adalah bayi dan anak batita. Informasi yang dihasilkan berupa instrumen deteksi dini suspek kretin (DDSK) usia batita di tingkat masyarakat. Hasil penelitian menunjukkan proporsi subyek dengan TSH tinggi sebesar 4.6% dan FT4 rendah (hipotiroid) sebesar 98.8%. Proporsi subyek dengan gangguan perkembangan sebesar 36.4% (test Denver); gangguan fungsi pendengaran 2.7% dan gangguan fungsi motorik sebesar 15.5%. Hasil diagnosis DDSK menunjukkan subyek terduga kretin sebesar 11.9%, sedangkan hasil diagnosis baku emas (gabungan hasil tes Denver, Bayley, pemeriksaan klinis dan laboratorium) sebesar 11.3%. Terdapat hubungan bermakna (p<0.001) antara hasil uji positif dengan terdapatnya anak terduga kretin dengan nilai Se=47.1% dan Sp=92.5%. Dibandingkan baku emas, uji diagnostik indikator fisik dapat menegakkan diagnosis terduga kretin pada anak usia bawah tiga tahun. Perlu dilakukan beberapa perbaikan pada komponen dan skrining instrumen DDSK. Kata kunci: uji diagnostik, indikator fisik, baku emas, kretin, GAKI.

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