目的 老年髋部骨折患者急性尿潴留(acute urinary retention,AUR)问题容易被忽视,通过建立老年髋部骨折患者AUR发生风险的临床预测模型,帮助临床医师能早期识别高风险患者,尽早干预,减少AUR的发生.方法 回顾性收集2023年7月1日至2023年8月31日就诊于本院急诊的老年髋部骨折患者313例,根据是否发生AUR将患者分为AUR组(45例)和非AUR组(268例),比较两组患者的基本特征、实验室化验指标、膀胱体积,通过Logistic分析影响AUR发生的独立危险因素,建立老年髋部骨折患者AUR发生风险的列线图预测模型,并对模型进行内部验证.结果 合并痴呆精神行为症状(behavioral and psychological symptoms of dementia,BPSD)(OR=3.334,95％CI 1.258～8.839,P=0.015)、使用催眠镇静药(OR=6.758,95％CI 2.184～20.912,P=0.001)、心率增快(OR=1.041,95％CI 1.013～1.070,P=0.004)、膀胱体积增大(OR=1.005,95％CI 1.004～1.007,P＜0.001)是老年髋部骨折患者发生AUR的独立危险因素,基于上述因素构建列线图预测模型,采用Bootstrap法进行内部验证显示预测曲线与标准模型曲线拟合度较高,平均绝对误差为0.021.受试者工作曲线(ROC)结果显示AUC为0.083,95％CI为0.767～0.909.结论 合并BPSD、使用催眠镇静药、心率增快、膀胱体积增大是老年髋部骨折患者发生AUR的独立危险因素,构建列线图预测模型可直观地评估老年髋部骨折患者AUR发生风险,为急诊医生提供参考.
Evaluation of a prediction model for the risk of acute urinary retention in elderly hip fracture patients in the Emergency Care
Objective To establishing a clinical prediction model can assist clinicians in identifying at-risk patients early and intervening promptly to decrease AUR incidence.Methods A retrospective collection of 313 elderly patients with hip fracture treated between 1st July and 31st August 2023 at the Emergency Department of our hospital.Patients were categorised into two groups:The AUR group(45 patients)and the non-AUR group(268 patients)based on the presence or absence of AUR.Basic characteristics,laboratory indicators and bladder volume were compared between the two groups.Factors independently associated with the incidence of AUR were analysed using Logistic regression.Analysis of the independent risk factors impacting the occurrence of AUR,development of a clinical prediction model for the risk of AUR in elderly patients with hip fractures,and internal validation of the model.Results Comorbid psycho-behavioural symptoms of dementia(OR=3.334,95％CI 1.258-8.839,P=0.015),use of hypnotic sedatives(OR=6.758,95％CI 2.184-20.912,P=0.001),increased heart rate(OR=1.041,95％CI 1.013-1.070,P=0.004),and increased bladder volume(OR=1.005,95％CI 1.004-1.007,P＜0.01)were all identified as risk factors.The study identified independent risk factors for AUR in elderly patients who suffered a hip fracture.Based on these factors,the research team developed a prediction model which underwent internal validation using the Bootstrap method.The analysis indicated that the model's prediction curves aligned closely with the standard model curves.The average absolute error was 0.021.The study's ROC results showed an AUC of 0.083 and a 95％CI of 0.767-0.909.Conclusions Comorbid psycho-behavioural symptoms of dementia,the use of hypnotic sedative drugs,an increased heart rate,and an increased bladder volume are independent risk factors for the occurrence of AUR in elderly patients who have suffered a hip fracture.The creation of a chart prediction model using columns allows for a visual evaluation of the likelihood of AUR in elderly patients with hip fractures.This model provides important reference material for emergency physicians.
Elderly hip fractureAcute urinary retentionBladder volumeSedative hypnoticsDementia psychobehavioral symptomsRisk predictionMultivariate analysisNomogram model
NETL
NSTL
万方数据
