老年股骨转子间骨折术后患者跌倒恐惧风险预测模型的构建与验证  

Construction and verification of a fall fear risk prediction model for elderly patients after operation for intertrochanteric fracture offemur

作　　者：查玉梅[1] 单雪 李慢慢 韩倩 李飞 李敏[1] 孔娜 Zha Yumei;Shan Xue;Li Manman;Han Qian;Li Fei;Li Min;Kong Na(Department of Traumatic Orthopaedics,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院创伤骨科,济宁272029

出　　处：《中国实用护理杂志》2024年第14期1097-1104,共8页Chinese Journal of Practical Nursing

摘　　要：目的调查老年股骨转子间骨折术后患者跌倒恐惧的现状, 分析影响因素并构建预测模型。方法采用前瞻性队列研究, 2021年1月至2022年12月便利抽样法选取济宁医学院附属医院骨科老年股骨转子间骨折术后患者303例作为建模组研究对象, 根据首次下床活动时跌倒恐惧得分分为跌倒恐惧组211例和非跌倒恐惧组92例。以多因素Logistic回归分析老年股骨转子间骨折术后发生跌倒恐惧的影响因素, 建立风险预测评分模型, 采用受试者工作特征曲线(ROC曲线)评价模型的区分度, 校准图评价模型的校准度, 利用Bootstrap法进行内部验证。收集2023年1-5月收治的81例老年股骨转子间骨折术后患者资料作为验证集对模型进行外部验证。结果老年股骨转子间骨折术后患者跌倒恐惧风险模型预测共纳入6个影响因素:性别(OR = 3.229, 95%CI 1.629~6.401)、共存疾病数量(OR = 9.578, 95%CI 4.532~20.245)、疼痛(OR = 1.684, 95%CI 1.074 ~ 2.643)、抑郁(OR = 1.719, 95%CI 1.371~2.155)、社会支持(OR = 0.859, 95%CI 0.784~0.942)以及日常生活活动能力(OR = 0.960, 95%CI 0.932~0.989)(均P<0.05)。预测模型ROC曲线下面积0.853, 灵敏度为0.896, 特异度为0.663;外部验证的ROC曲线下面积为0.766, 灵敏度为0.800, 特异度为0.645。模型预测中校准曲线接近参考曲线, 提示该模型有很好的预测效果。结论该模型预测效果良好, 在临床上能够快速预测老年股骨转子间骨折术后患者跌倒恐惧的发生风险, 为医务人员及时提供干预措施提供依据。Objective To investigate the current situation of fall fear in elderly patients after operation of intertrochanteric fracture,analyze the influencing factors and build a prediction model.Methods A prospective cohort study and convenient sampling method were used to select 303 elderly patients with intertrochanteric fracture after surgery in the Department of Orthopedics,Affiliated Hospital of Jining Medical University from January 2021 to December 2022 as the modeling group.According to the scores of fall fear when getting out of bed for the first time,they were divided into 21l cases in the fall fear group and 92 cases in the non-fall fear group.Multivariate Logistic regression was used to analyze the influencing factors of fall fear after operation of femoral intertrochanteric fracture in elderly patients,and a risk prediction score model was established.ROC curve was used to evaluate the differentiation of the model,calibration chart was used to evaluate the calibration degree of the model,and Bootstrap method was used for internal verification.Data of 81 elderly patients with intertrochanteric fracture treated from January to May 2023 were collected as a validation set for external verification of the model.Results A total of 6 influencing factors were included in the prediction of fall fear risk model for elderly patients after operation of intertrochanteric fracture:gender(OR=3.229,95%CI 1.672-6.401),number of co-existing diseases(OR=9.578,95%CI 4.532-20.245),pain(OR=1.684,95%CI 1.074-2.463),depression(OR=1.719,95%CI 1.371-2.155),social support(OR=0.859,95%CI 0.784-0.942),and ability to perform activities of daily living(OR=0.960,95%CI 0.932-0.989)(all P<0.05).The area under ROC curve of the prediction model was 0.853,the sensitivity was 0.896,and the specificity was 0.663.The area under the externally verified ROC curve was 0.766,the sensitivity was 0.800,and the specificity was 0.645.The calibration curve was close to the reference curve in the model prediction,indicating that the model hasd a good predic

关 键 词：老年人 股骨转子间骨折 跌倒恐惧 影响因素 预测模型 

分 类 号：R473.6[医药卫生—护理学]