老年脆性髋部骨折患者术后谵妄的风险预测模型：系统评价和批判性评估。
Risk prediction models for postoperative delirium in elderly patients with fragility hip fracture: A systematic review and critical appraisal.
机构信息
Tianjin University of Traditional Chinese Medicine, 301610, Tianjin, China.
Tianjin Hospital Trauma Upper Extremity Ward I, 300211, Tianjin, China.
出版信息
Int J Orthop Trauma Nurs. 2024 Feb;52:101077. doi: 10.1016/j.ijotn.2023.101077. Epub 2023 Dec 10.
BACKGROUND
Elderly patients with fragility hip fracture continue to experience a high rate of postoperative delirium (POD), which has a significant negative impact on prognosis and imposes a huge economic burden. A number of risk prediction models have been developed to detect POD early. However, the risk of bias and clinical applicability of the models remain unclear. The aim of this study was to systematically evaluate risk prediction models for POD.
METHODS
CNKI, WanFang DATA, Vip Database, SinoMed, PubMed, Web of Science, Embase, and the Cochrane Library were searched for studies published by July 2023. The literature was screened independently by two investigators. The Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS) and the Prediction Model Risk of Bias Assessment Tool (PROBAST) were respectively used for data extraction, risk of bias, and applicability assessment.
RESULTS
A total of 16 studies on the construction of POD risk prediction models were included. The area under the ROC curve of the models ranges from 0.670 to 0.957. The most common predictors of POD included age, history of dementia, history of delirium, ASA classification, preoperative waiting time, and preoperative albumin level. All models had a high risk of bias, mainly due to inadequate sample size, inappropriate handling of missing data, a lack of model performance evaluation, and overfitting of the models.
CONCLUSIONS
Overall, risk prediction models for POD in fragility hip fracture patients are still in the development stage. The majority of POD prediction models have substantial bias risks, attributable primarily to poor reporting of analysis and evaluation of model performance. In future research, it is recommended to conduct validation of the models or develop localized prediction models with demonstrated high performance, with the aim of benefiting POD screening.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42023449153.
背景
患有脆性髋部骨折的老年患者仍会经历高术后谵妄（POD）发生率，这对预后有重大负面影响，并造成巨大的经济负担。已经开发了许多风险预测模型来早期检测 POD。然而，这些模型的偏倚风险和临床适用性仍不清楚。本研究的目的是系统地评估 POD 的风险预测模型。
方法
检索 2023 年 7 月前发表的研究，数据库包括中国知网、万方数据知识服务平台、维普期刊资源整合服务平台、中国生物医学文献服务系统、PubMed、Web of Science、Embase 和 Cochrane 图书馆。由两名研究者独立筛选文献。分别使用预测模型研究的批判性评价和数据提取清单（CHARMS）和预测模型风险偏倚评估工具（PROBAST）进行数据提取、偏倚风险和适用性评估。
结果
共纳入 16 项关于 POD 风险预测模型构建的研究。模型的 ROC 曲线下面积范围为 0.670 至 0.957。POD 的最常见预测因子包括年龄、痴呆史、谵妄史、ASA 分级、术前等待时间和术前白蛋白水平。所有模型都存在高偏倚风险，主要原因是样本量不足、缺失数据处理不当、缺乏模型性能评估以及模型过度拟合。
结论
总体而言，脆性髋部骨折患者 POD 的风险预测模型仍处于开发阶段。大多数 POD 预测模型存在较大的偏倚风险，主要归因于分析和评估模型性能的报告欠佳。在未来的研究中，建议对模型进行验证，或开发具有高性能的本地化预测模型，以期有助于 POD 的筛查。
系统评价注册
PROSPERO CRD42023449153。
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