Feng Xue, Wang Meng, Zhang Ya, Liu Qian, Guo Mingyang, Liang Hongyin
Department of General Surgery, General Hospital of Western Theater Command (Chengdu Military General Hospital), Chengdu, China.
Department of Traditional Chinese Medicine, General Hospital of Western Theater Command (Chengdu Military General Hospital), Chengdu, China.
Int J Nurs Sci. 2022 Sep 24;9(4):438-444. doi: 10.1016/j.ijnss.2022.09.010. eCollection 2022 Oct.
This study aimed to develop a nomogram for predicting the risk of pressure injury (PI) in adult patients undergoing abdominal surgery and validate its effectiveness among these patients.
This study retrospectively included 11,247 adult patients, who underwent abdominal surgery and postoperative supervision in ICU, in a tertiary care hospital in western China between January 2017 and December 2020. All datasets were extracted from the patient's medical records and randomly divided into the training cohort (8,997) and the validation cohort (2,250) by 8:2. The univariable logistic regression was used to select potentially relevant features. Then, multivariable logistic regression was also conducted and utilized to establish the nomogram. The nomogram was compared with the Braden scale for predicting PI in the validation cohort through the area under the curve (AUC) of the receiver operator characteristic (ROC) curve, Hosmer-Lemeshow (H-L) test, and decision curve analysis (DCA).
873 (7.8%) patients suffered PIs. Logistic regression analysis showed that time of operation, weight, type of operation, albumin, and Braden scale score were independent risk factors for PI. A nomogram integrating five selected characteristics was constructed. The AUC of the ROC curve for the nomogram was 0.831, with a specificity of 85.2% and sensitivity of 63.7%. The AUC of the ROC curve for the Braden scale was 0.567, with a specificity of only 33.0%. The -values of the H-L test were 0.45 (nomogram) and 0.22 (Braden scale), both indicating good calibration. The DCA also displayed that the nomogram had better predictive validity.
Compared with the Braden scale, the nomogram showed a better predictive performance. This nomogram is informative and has the potential to better guide caregivers for risk stratification and prevention of PI, although it requires further validation.
本研究旨在开发一种列线图，用于预测接受腹部手术的成年患者发生压力性损伤（PI）的风险，并在这些患者中验证其有效性。
本研究回顾性纳入了2017年1月至2020年12月在中国西部一家三级医院接受腹部手术并在重症监护病房（ICU）接受术后监护的11247例成年患者。所有数据集均从患者病历中提取，并按8:2随机分为训练队列（8997例）和验证队列（2250例）。采用单变量逻辑回归选择潜在相关特征。然后，进行多变量逻辑回归并用于建立列线图。通过受试者操作特征（ROC）曲线的曲线下面积（AUC）、Hosmer-Lemeshow（H-L）检验和决策曲线分析（DCA），将列线图与Braden量表在验证队列中预测PI的能力进行比较。
873例（7.8%）患者发生了PI。逻辑回归分析显示，手术时间、体重、手术类型、白蛋白和Braden量表评分是PI的独立危险因素。构建了一个整合五个选定特征的列线图。列线图的ROC曲线AUC为0.831，特异性为85.2%，敏感性为63.7%。Braden量表的ROC曲线AUC为0.567，特异性仅为33.0%。H-L检验的P值分别为0.45（列线图）和0.22（Braden量表），均表明校准良好。DCA也显示列线图具有更好的预测效度。
与Braden量表相比，列线图显示出更好的预测性能。尽管该列线图需要进一步验证，但它具有参考价值，有可能更好地指导护理人员进行风险分层和预防PI。
