创伤性四肢骨折患儿术后急性中重度疼痛预测模型的构建与验证  

Construction of prediction model for acute moderate to severe pain in children with traumatic limb fracture after surgery and its verification

作　　者：朱丽[1] 张芳[1] 梁培荣[1] 林娟娟[1] 王新华[1] ZHU Li;ZHANG Fang;LIANG Peirong;LIN Juanjuan;WANG Xinhua(Children's Hospital of Soochow University,Suzhou 215000,Jiangsu,China)

机构地区：[1]苏州大学附属儿童医院,江苏苏州215000

出　　处：《护士进修杂志》2024年第18期1952-1957,共6页Journal of Nurses Training

基　　金：苏州大学附属儿童医院院内课题(编号:A02)。

摘　　要：目的构建并验证创伤性四肢骨折患儿术后急性中重度疼痛预测模型。方法采用便利抽样法,选取2022年1-6月在苏州大学附属儿童医院骨科进行手术的300例创伤性四肢骨折患儿作为建模组,通过单因素和logistic回归分析确定危险因素并构建预测模型,使用R软件绘制列线图,采用受试者操作特征(receiver operating characteristic,ROC)曲线下面积和Hosmer-Lemeshow检验评价模型的区分度和校准度。将2022年7-12月创伤性四肢骨折手术患儿110例作为验证组,验证模型的临床应用效果。结果logistic回归分析显示,肢体肿胀程度、术前疼痛程度、儿童术前焦虑3项差异具有统计学意义(P<0.05),且纳入其作为预测因子构建预测模型。所构建模型的ROC曲线下面积为0.906(95%CI:0.854~0.957),最大约登指数为0.617时,最佳临界值为0.779,敏感度为69.5%,特异度为92.2%,Hosmer-Lemeshow检验P=0.971。模型验证结果:ROC曲线下面积为0.838(95%CI:0.8~0.875),最大约登指数为0.571时,最佳临界值为0.640,敏感度为61.0%,特异度为96.1%。校准曲线图显示列线图在验证组中发生的风险同实际情况较为一致。结论本研究构建的列线图模型具有较好的区分度和校准度,能较好地预测创伤性四肢骨折患儿术后急性中重度疼痛的发生风险,可为医护人员实施预防性疼痛管理措施提供参考。Objective To establish and verify the prediction model of acute moderate to severe pain in children with traumatic limb fracture after surgery.Methods A total of 300 children with traumatic limb fracture who underwent surgery in the department of Orthopedics,Children's Hospital Affiliated to Soochow University from January to June 2022 were selected as the modeling group by convenience sampling method,and the risk factors were determined by univariate and logistic regression analysis and the prediction model was constructed,and the nomograph was drawn by R software,and the area under receiver operating characteristic(ROC)curve and Hosmer-Lemeshow test were used to evaluate the differentiation and calibration of the model.A total of 110 children with traumatic limb fracture surgery from July to December 2022 were selected as the verification group to verify the clinical application effect of the model.Results The results of logistic regression analysis showed that there were statistically significant differences in the degree of limb swelling,preoperative pain,and preoperative anxiety in children(P<0.05),and they were included as predictive factors to construct a predictive model.The area under ROC curve of the constructed model was 0.906(95%CI was 0.854-0.957),the maximum Youden index was 0.617,the optimal critical value was 0.779,the sensitivity was 69.5%,the specificity was 92.2%,and the Hosmer-Lemeshow test was P=0.971.The results of model verification showed that the optimal critical value was 0.640,the sensitivity was 61.0%,and the specificity was 96.1%,when the area under ROC curve was 0.838(95%CI was 0.8-0.875)and the maximum Youden index was 0.571.The calibration curve shows that the risk of the nomogram in the validation group was consistent with the actual situation.Conclusion The nomogram model established in this study has a good degree of differentiation and calibration,and can better predict the risk of acute moderate to severe pain in children with traumatic limb fracture after surgery,which can pr

关 键 词：儿童 创伤性骨折 术后疼痛 预测模型 列线图 护理 

分 类 号：R473.72[医药卫生—护理学]