Network calculator for predicting the postoperative risk of hospital-acquired stress injuries of the elderly orthopaedic patients in the intensive care unit
Objective To analyze the risk factors for hospital-acquired stress injury(HAPI)of the elderly orthopaedic patients in the intensive care unit(ICU)and construct a nomogram diagram to publish a web-based calculator for HAPI management decisions.Methods Elderly orthopedic patients who were admitted to the ICU for postoperative treatment between January 2020 and December 2022 in our hospital were selected.Patients'risk factors for HAPI were analyzed using multifactorial logistic regression models,and risk factors were used as predictors for constructing nomogram diagrams.Internal data were used to validate the performance of the nomogram,decision curve analysis was used to assess the net clinical benefit of the nomogram,and the DynNom package was used to publish the nomogram to the web and develop a web-based calculator for HAPI.Results The incidence of HAPI in 218 elderly ICU patients was 19.3%(42/218).Multifactorial logistic regression analysis showed that age(OR:1.862,95%CI:1.267-4.563),proportion of peripheral vascular disease(OR:1.750,95%CI:1.201-4.656),Braden score(OR:0.553,95%CI:0.238-0.863),ALB(OR:0.742,95%CI:0.538-0.964),and LAC(OR:2.639,95%CI:1.265-5.684)were HAPI independent risk factors(P<0.05).The results of receiver operating characteristic(ROC)curve analysis showed that the area under the ROC curve(AUC)for age,peripheral vascular disease,Braden score,ALB,and LAC were 0.666(0.599-0.728),0.606(0.537-0.671),0.707(0.642-0.767),0.755(0.692-0.811),and 0.815(0.757-0.864),respectively;the nomogram correction curve showed a C-index of 0.837,which provided a significant clinical benefit when the nomogram predicted a risk threshold of 0.097-0.802 for HAPI.For Simple model prediction of 1000 patients,risk stratification showed increasing risk thresholds and progressively closer nomogram prediction accuracy to actual observations.Conclusions In this study,a nomogram of HAPI risk in elderly postoperative hip fracture ICU patients is constructed on the basis of age,peripheral vascular disease,Braden score,ALB,and LAC.A web-based calculator is developed,allowing for the early identification of high-risk patients and the implementation of more aggressive interventions.
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