老年骨科创伤病人医院感染风险预测列线图模型的建立与验证  

Establishment and validation of Nomogram model for predicting the risk of nosocomial infection in elderly orthopedic trauma patients

作　　者：黄铭杰[1] 区智凤[1] 曾嘉欢 谭志韵[1] 张静玲 刘育敏 HUANG Mingjie;OU Zhifeng;ZENG Jiahuan;TAN Zhiyun;ZHANG Jingling;LIU Yumin(Foshan Hospital of TCM,Guangdong 528200 China)

机构地区：[1]佛山市中医院,广东528200

出　　处：《护理研究》2022年第13期2315-2320,共6页Chinese Nursing Research

摘　　要：目的:分析老年骨科创伤病人医院感染的危险因素,建立风险预测模型,并对模型的准确度进行验证。方法:回顾性分析2018年1月—2020年11月在佛山市中医院住院的74例骨科创伤老年病人的基本资料,采用单因素及Logistic多因素回归分析筛选老年骨科创伤病人医院感染的独立危险因素。并基于筛选得到的独立危险因素构建风险列线图模型,并验证模型的精准度。结果:Logistic多因素分析显示,住院时间>2周(OR=3.647)、合并基础疾病(OR=3.077)、未应用抗菌药物(OR=4.402)、侵入性操作(OR=2.583)及意识障碍(OR=2.563)为老年骨科创伤病人医院感染的独立危险因素。基于住院时间、合并基础疾病、未应用抗菌药物、侵入性操作及意识障碍5项独立危险因素建立的预测老年骨科创伤病人医院感染风险的列线图模型的预测能力较好;同时使用Bootstrap内部验证法对老年骨科创伤病人医院感染风险的列线图模型进行验证,C⁃index指数为0.815[95%CI(0.797,0.837)],说明本研究列线图模型具有良好的精准度和区分度。结论:对于因骨科创伤住院的老年病人,应个体化分析住院时间、合并基础疾病、未应用抗菌药物、侵入性操作及意识障碍等因素,评估老年骨科创伤病人医院感染的发生率,进而采取针对性措施保护易感病人,以降低医院感染发生率。Objective:To analyze the risk factors of nosocomial infection in elderly orthopedic trauma patients,to establish a risk prediction model,and to verify the accuracy of the model.Method:Univariate and Logistic multivariate regression analysis were used to analyze the risk factors of trauma in 74 elderly patients who were hospitalized in Foshan Hospital of TCM from January to November in 2018.Then,based on the independent risk factors screened,the risk Nomogram model was constructed,and the accuracy of the model was verified.Results:Logistic multivariate analysis showed that,hospitalization time>2 weeks(OR=3.647),combined with underlying diseases(OR=3.077),no use of antibiotics(OR=4.402),invasive operation(OR=2.583)and consciousness disorder(OR=2.563)were independent risk factors of nosocomial infection in elderly orthopedic trauma patients.A Nomogram model established based on five independent risk factors of nosocomial infection in elderly orthopedic trauma patients,such as length of stay,combined with underlying diseases,no use of antibiotics,in⁃vasive operation and disturbance of consciousness,to predict the risk of nosocomial infection in elderly orthopedic trauma patients had good pre⁃dictive ability.At the same time,bootstrap internal validation method was used to verify the Nomogram model of nosocomial infection risk of elderly orthopedic trauma patients,and the C⁃index was 0.815,95%CI(0.797,0.837),which indicated that the Nomogram model had good accuracy and discrimination.Conclusions:For the elderly patients with orthopedic trauma,it is necessary to evaluate the incidence of nosocomial infection in elderly patients with orthopedic trauma by individual analysis of hospitalization time,combined with underlying diseases,no use of antibiotics,invasive operation and disturbance of consciousness,so as to help medical staff take targeted measures to protect vulnerable patients,so as to reduce the incidence of nosocomial infection.

关 键 词：老年人 骨科创伤 医院感染 危险因素 列线图 预测 

分 类 号：R473.6[医药卫生—护理学]