Department of Operation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Department of Nursing of Chongqing Medical University, Chongqing, China.
Int Wound J. 2023 Aug;20(6):2250-2259. doi: 10.1111/iwj.14106. Epub 2023 Feb 13.
This study aimed to investigate the clinical features and incidence of Intraoperatively Acquired Pressure Injuries (IAPIs) of brain tumours in children, to screen the risk factors and to establish a nomogram model for making prevention strategies against the development of IAPIs. Clinical data of 628 children undergoing brain tumour surgery from August 2019 to August 2021 were extracted from the adverse events and the electronic medical systems. They were randomly divided into a training cohort(n = 471) and a validation cohort(n = 157). The univariate and multivariate analysis was performed to identify the risk factors in training cohort; R software was used to construct a nomogram model; the area under the receiver operator characteristic curve (AUC) and calibration plots were used to judge the predictive performance of the nomogram model; decision curve analysis (DCA) was used to assess the clinical usefulness of the nomogram model. Age, haemorrhage, use of vasopressor, temperature, operation time and operation position were considered as significant risk factors, and enrolled to construct a nomogram model. The results of AUC showed satisfactory discrimination of the nomogram; the calibration plots indicated favourable consistency between the prediction of the nomogram and actual observations in both the training and validation cohorts; DCA showed better net benefit and threshold probability of the nomogram model. The nomogram model illustrates significant predictive ability, which can provide scientific and individual guidance for preventing development of IAPIs.
本研究旨在探讨儿童脑肿瘤术中获得性压疮（IAPIs）的临床特征和发生率，筛选风险因素，并建立一个列线图模型，以制定预防 IAPIs 发展的策略。从不良事件和电子病历系统中提取了 2019 年 8 月至 2021 年 8 月期间接受脑肿瘤手术的 628 名儿童的临床数据。他们被随机分为训练队列（n = 471）和验证队列（n = 157）。在训练队列中进行单因素和多因素分析，以确定风险因素；使用 R 软件构建列线图模型；使用接收者操作特征曲线（AUC）和校准图来判断列线图模型的预测性能；决策曲线分析（DCA）用于评估列线图模型的临床实用性。年龄、出血、使用血管加压药、体温、手术时间和手术体位被认为是显著的风险因素，并被纳入构建列线图模型。AUC 的结果表明该列线图具有良好的区分能力；校准图表明在训练和验证队列中，列线图的预测与实际观察之间具有良好的一致性；DCA 显示该列线图模型具有更好的净获益和阈值概率。该列线图模型具有显著的预测能力，可以为预防 IAPIs 的发生提供科学和个体化的指导。
