Chinese Journal of Nursing ›› 2020, Vol. 55 ›› Issue (6): 811-816.DOI: 10.3761/j.issn.0254-1769.2020.06.002

• Research Paper • Previous Articles     Next Articles

Construction of risk prediction model of delirium occurrence in patients with severe trauma

JI Yunlan,XU Xujuan(),SHAN Jun,NI Hua,TANG Dandan,WU Yaqin,XUE Huiping,JIANG Daishan   

  1. Department of Emergency Medicine,Affiliated Hospital of NanTong University,NanTong,226001,China
  • Received:2019-10-28 Online:2020-06-15 Published:2020-06-05
  • Contact: Xujuan XU

严重创伤患者谵妄发生风险预测模型的构建

吉云兰,徐旭娟(),单君,倪花,汤丹丹,吴亚琴,薛慧萍,姜岱山   

  1. 226001 南通市 南通大学附属医院急诊医学科(吉云兰,倪花,汤丹丹,吴亚琴,薛慧萍,姜岱山),护理研究所(徐旭娟); 南通大学医学院(单君)
  • 通讯作者: 徐旭娟
  • 作者简介:吉云兰:女,本科(硕士在读),副主任护师,护士长,E-mail:ntjiyunlan@sina.com
  • 基金资助:
    南通市基础科学研究项目(JC2018050)

Abstract:

Objective To explore the risk factors of delirium in patients with severe trauma and develop a nomogram model to predict the occurrence of delirium. Methods 437 patients with severe trauma in ICU from a tertiary hospital were selected by Richmond Agitation-Sedation Scale(RASS). The delirium group(n=142) and the non-delirium group(n=295) were compared to explore the independent risk factors of delirium through single factor analysis and multivariate logistic regression model. According to the selected independent risk factors,a risk prediction model was established and incorporated into the nomogram,and Bootstrapping method was adopted to verify the prediction effect of the model. Results After multivariate Logistic regression analysis,5 factors were included in the final regression model,including Injury Severity Score(ISS)(>21 points)(OR=39.718),Acute Physiology and Chronic Health Evaluation(APACHEⅡ) score (>13 points)(OR=20.921),hospital stay in ICU(>9 days)(OR=4.331),RASS score(1 point for each increase)(OR=1.823) and dexmedetomidine(OR=0.367). According to the above 5 risk factors,the prediction ability of delirium occurrence nomogram model of patients with severe trauma was useful,with the C-index of 0.936,the sensitivity of 88.73%,the specificity of 85.42% and the Youden index of 0.742. The results of the external model validation were C-index of 0.917,the sensitivity of 100%,and the specificity of 84.37%. Conclusion The nomogram can effectively predict the occurrence of delirium in patients with severe trauma during hospitalization. The model is valuable for predicting the risk of delirium.

Key words: Severe Trauma, Delirium, Intensive Care, Risk Prediction Model, Nomogram

摘要:

目的 探讨严重创伤患者发生谵妄的危险因素,构建列线图模型,以预测谵妄的发生。方法 应用损伤严重程度评分量表,选取某三级甲等医院ICU收治的严重创伤患者437例,将谵妄组(n=142)和非谵妄组(n=295)的各项指标进行对比,通过单因素分析和多因素Logistic回归分析探索谵妄发生的独立危险因素,建立风险预测模型并构建列线图,采用Bootstrapping法验证模型预测效果。结果 多因素Logistic回归分析显示,损伤严重程度评分>21分(OR=39.718)、急性生理与慢性健康状况评分>13分(OR=20.921)、ICU入住时间>9 d(OR=4.331)、Richmond躁动-镇静评分(每增加1分)(OR=1.823)和未使用右美托咪啶(OR=0.367)是谵妄发生的独立危险因素。根据上述5项危险因素构建的严重创伤患者谵妄发生列线图模型一致性指数为0.936,灵敏度为88.73%,特异度为85.42%,约登指数为0.742;外部模型验证结果,一致性指数为0.917,灵敏度为100%,特异度为84.37%。 结论 本研究构建的列线图能有效预测严重创伤患者住院期间谵妄的发生。

关键词: 严重创伤, 谵妄, 重症监护, 风险预测模型, 列线图