PDF(Pubmed)
Abstract：
BACKGROUND: We aimed to develop and validate a nomogram for predicting the risk of intraoperatively acquired pressure injuries (IAPIs) in children undergoing cardiac surgery with cardiopulmonary bypass (CPB).
METHODS: This study retrospectively included 208 children aged 21 days to 8 years who underwent cardiac surgery with CPB in a tertiary hospital in China between January 2020 and October 2023. All patients\' data were collected from the hospital\'s medical record system and randomly divided into the training (n = 146) and validation (n = 62) cohorts by a ratio of 7:3. Logistic regression analysis was conducted in the training cohort to identify independent risk factors and establish the nomogram. Finally, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) were performed in both cohorts to validate the predictive ability of the nomogram.
RESULTS: 43 (14.7%) children developed IAPIs. Multivariate analysis showed that low Braden Q scores, use of steroids, skin abnormalities, and low intraoperative SpO2 were independent risk factors for IAPIs. A nomogram integrating the 4 factors was established. The areas under the curve (AUCs) of the nomogram were 0.836 and 0.903 in the training and validation cohorts, respectively. Furthermore, calibration curves and DCA demonstrated good calibration and clinical applicability of the nomogram.
CONCLUSIONS: We constructed a reliable nomogram based on specific risk factors for children undergoing cardiac surgery with CPB, which could be used as an effective and convenient tool for prevention of IAPIs.
METHODS: This study retrospectively included 208 children aged 21 days to 8 years who underwent cardiac surgery with CPB in a tertiary hospital in China between January 2020 and October 2023. All patients\' data were collected from the hospital\'s medical record system and randomly divided into the training (n = 146) and validation (n = 62) cohorts by a ratio of 7:3. Logistic regression analysis was conducted in the training cohort to identify independent risk factors and establish the nomogram. Finally, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) were performed in both cohorts to validate the predictive ability of the nomogram.
RESULTS: 43 (14.7%) children developed IAPIs. Multivariate analysis showed that low Braden Q scores, use of steroids, skin abnormalities, and low intraoperative SpO2 were independent risk factors for IAPIs. A nomogram integrating the 4 factors was established. The areas under the curve (AUCs) of the nomogram were 0.836 and 0.903 in the training and validation cohorts, respectively. Furthermore, calibration curves and DCA demonstrated good calibration and clinical applicability of the nomogram.
CONCLUSIONS: We constructed a reliable nomogram based on specific risk factors for children undergoing cardiac surgery with CPB, which could be used as an effective and convenient tool for prevention of IAPIs.
摘要：
背景：我们旨在开发和验证一个列线图，用于预测接受体外循环（CPB）心脏手术的儿童术中获得性压力损伤（IAPI）的风险。
方法：本研究回顾性纳入了2020年1月至2023年10月在中国一家三级医院接受CPB心脏手术的208名21天至8岁儿童。所有患者的数据均从医院的病历系统收集，并按7:3的比例随机分为训练组（n=146）和验证组（n=62）。在训练队列中进行Logistic回归分析以确定独立危险因素并建立列线图。最后,校正曲线,接收机工作特性(ROC)曲线，在两个队列中进行了决策曲线分析(DCA),以验证列线图的预测能力.
结果：43（14.7%）儿童发展了IAPI。多因素分析显示，布雷登Q得分较低，使用类固醇，皮肤异常,术中低SpO2是IAPI的独立危险因素。建立了整合4个因素的列线图。在训练和验证队列中，列线图的曲线下面积（AUC）分别为0.836和0.903，分别。此外，校准曲线和DCA证明了列线图的良好校准和临床适用性。
结论：我们根据CPB心脏手术患儿的特定危险因素构建了可靠的列线图，它可以用作预防IAPI的有效和方便的工具。
方法：本研究回顾性纳入了2020年1月至2023年10月在中国一家三级医院接受CPB心脏手术的208名21天至8岁儿童。所有患者的数据均从医院的病历系统收集，并按7:3的比例随机分为训练组（n=146）和验证组（n=62）。在训练队列中进行Logistic回归分析以确定独立危险因素并建立列线图。最后,校正曲线,接收机工作特性(ROC)曲线，在两个队列中进行了决策曲线分析(DCA),以验证列线图的预测能力.
结果：43（14.7%）儿童发展了IAPI。多因素分析显示，布雷登Q得分较低，使用类固醇，皮肤异常,术中低SpO2是IAPI的独立危险因素。建立了整合4个因素的列线图。在训练和验证队列中，列线图的曲线下面积（AUC）分别为0.836和0.903，分别。此外，校准曲线和DCA证明了列线图的良好校准和临床适用性。
结论：我们根据CPB心脏手术患儿的特定危险因素构建了可靠的列线图，它可以用作预防IAPI的有效和方便的工具。
