Wu Ruhong, Liu Chunbo, Shi Jia, Jia Geng, Qin Huaping
Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, China.
Medicine (Baltimore). 2024 Dec 6;103(49):e40739. doi: 10.1097/MD.0000000000040739.
The purpose of this study was to investigate the risk factors for in-hospital death in elderly patients with surgically treated traumatic acute subdural hematoma (ASDH) and to construct a nomogram model for in-hospital death risk prediction. We analyzed 104 elderly patients who underwent decompressive craniotomy (DC) for isolated traumatic ASDH between May 2013 and May 2021 in our department. Independent factors for in-hospital death were identified via univariate and multivariate logistic regression analyses, and a nomogram model was constructed and validated. The overall in-hospital mortality rate was 58.7% (61/104). Sex (odds ratio [OR] = 11.94), dilated pupils (bilateral vs absent; OR = 194.16) and subarachnoid hemorrhage (SAH) (OR = 16.01) were independent risk factors for in-hospital death. A nomogram model for in-hospital death risk prediction was constructed based on these variables. Statistical analysis revealed that this model had good predictive performance, and receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of the nomogram model was 0.916 (95% confidence interval [CI] = 0.861-0.970). The calibration plot, which compared the predicted effective rate and observed effective rate, revealed the accurate predictive ability of the model. The model was internally validated via 200 bootstrap samples to calculate the discrimination accuracy, and the concordance index was 0.891. Decision curve analysis (DCA) demonstrated that the nomogram was clinically beneficial. The most important risk factors for in-hospital death in elderly patients with surgically treated traumatic ASDH were sex, dilated pupils, and SAH. The nomogram constructed from these data could be a promising and convenient tool to predict in-hospital death risk, but further external validation is needed.
本研究旨在探讨手术治疗创伤性急性硬膜下血肿（ASDH）老年患者院内死亡的危险因素，并构建用于预测院内死亡风险的列线图模型。我们分析了2013年5月至2021年5月期间在我科因单纯创伤性ASDH接受去骨瓣减压术（DC）的104例老年患者。通过单因素和多因素逻辑回归分析确定院内死亡的独立因素，并构建和验证列线图模型。总体院内死亡率为58.7%（61/104）。性别（比值比[OR]=11.94）、瞳孔散大（双侧与无；OR=194.16）和蛛网膜下腔出血（SAH）（OR=16.01）是院内死亡的独立危险因素。基于这些变量构建了院内死亡风险预测的列线图模型。统计分析显示该模型具有良好的预测性能，受试者工作特征（ROC）曲线分析显示列线图模型的曲线下面积（AUC）为0.916（95%置信区间[CI]=0.861 - 0.970）。校准图比较了预测有效率和观察有效率，显示了模型准确的预测能力。通过200个自助抽样对模型进行内部验证以计算判别准确性，一致性指数为0.891。决策曲线分析（DCA）表明列线图在临床上是有益的。手术治疗创伤性ASDH老年患者院内死亡的最重要危险因素是性别、瞳孔散大和SAH。根据这些数据构建的列线图可能是预测院内死亡风险的一种有前景且便捷的工具，但需要进一步的外部验证。
