Construction of a nomogram prediction model for delirium in patients with open and comminuted fractures of the limbs after trauma
Objective To analyze the risk factors for delirium in patients with open and comminuted fractures of the limbs after trauma,and to construct and validate a risk prediction model.Methods A retrospective analysis was conducted on the medical records of 108 patients with open and comminuted fractures of the limbs after trauma admitted to Xi'an Gaoxin Hospital from March 2021 to March 2023.Among them,there were 76 males and 32 females,aged(54.17± 14.62)years.According to the 80/20 law,they were randomly divided into a training set(86 cases)and a verification set(22 cases).The occurrence of delirium within one month after surgery was recorded,and the patients were divided into a delirium group and a non-delirium group based on whether delirium occurred postoperatively.The risk factors for delirium in patients with open and comminuted fractures of the limbs after trauma were screened,and a risk prediction model was constructed and validated.t test,x2 test,logistic regression model,receiver operating characteristic curve(ROC),and Hosmer-Lemeshow test were used.Results Among the 86 patients with open and comminuted fractures of the limbs after trauma,18 patients developed delirium after surgery,with an incidence of 20.93％(18/86).The age,proportion of stroke history,proportion of intraoperative hypoxemia,and serum soluble tumor necrosis factor 1(sTNFR1)level in the delirium group were higher than those in the non-delirium group(all P＜0.05).Age(OR=3.187,95％CI 1.176-8.633),stroke history(OR=3.684,95％CI 1.359-9.979),intraoperative hypoxemia(OR=4.958,95％CI 1.830-13.431),and serum sTNFR1(OR=4.591,95％CI 1.695-12.435)were identified as risk factors for postoperative delirium in patients with open and comminuted fractures of the limbs after trauma(all P＜0.05).The risk prediction model showed a sensitivity of 0.825(95％CI 0.741-0.922),specificity of 0.829(95％CI 0.753-0.906),and area under the curve of 0.892(9 5％CI 0.808-0.915)for predicting postoperative delirium in 86 patients with open and comminuted fractures of the limbs after trauma of the training set.The risk prediction model showed a sensitivity of 0.799(95％CI 0.706-0.881),specificity of 0.732(95％CI 0.658-0.827),and area under the curve of 0.839(95％CI 0.791-0.915)for predicting postoperative delirium in 22 patients with open and comminuted fractures of the limbs after trauma of the verification set.Conclusions Age,history of stroke,intraoperative hypoxemia,and serum sTNFR1 are associated with postoperative delirium in patients with open and comminuted fractures of the limbs after trauma.Constructing a risk prediction model helps to predict the risk of postoperative delirium early.
LimbsOpen fractureComminuted fractureDeliriumRisk factorsRisk prediction model
万方数据
维普
