Development and validation of a newly developed nomogram for predicting the risk of deep vein thrombosis after surgery for lower limb fractures in elderly patients.
Development and validation of a newly developed nomogram for predicting the risk of deep vein thrombosis after surgery for lower limb fractures in elderly patients.
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DOI：
10.3389/fsurg.2023.1095505
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发表时间：
2023
影响因子：
1.8
通讯作者：
Li, Kai
中科院分区：
文献类型：
--
作者：
Han, Shuai;Bai, Yunpeng;Jiao, Kun;Qiu, Yongmin;Ding, Juhong;Zhang, Jun;Hu, Jingyun;Song, Haihan;Wang, Jiaqi;Li, Shufeng;Feng, Dapeng;Wang, Jian;Li, Kai
预防深静脉血栓形成(DVT)是围手术期治疗下肢骨折不可缺少的环节。这项研究旨在开发和验证一种新的模型来预测老年患者在接受下肢骨折矫形手术后发生深静脉血栓的风险。这项观察性研究包括2016年1月至2018年12月手术治疗的576例老年下肢骨折患者。通过最小绝对收缩和选择算子回归分析，对影响DVT的11个因素进行了优化。多变量Logistic回归分析用于构建包含所选特征的预测模型。采用C指数评价辨别能力。用决策曲线分析来确定该模型的临床有效性，并用校准图来评价该诺模图的校准。该模型的内部验证采用自举验证方法进行评估。在该模型中，影响深静脉血栓发生率的预测因素包括吸烟、从受伤到手术的时间、手术时间、输血、髋关节置换术和术后D-二聚体水平。诺模图显示出显著的区分度，C指数为0.919(95%可信区间：0.893-0.946)，校正良好。在区间验证中仍可达到可接受的C指标值。决策曲线分析表明，DVT风险诺模图在所有可能的阈值内都是有用的。这一新开发的诺模图可以用来预测老年下肢骨折患者围手术期发生深静脉血栓的风险。
Prevention of deep vein thrombosis (DVT) is indispensable in the treatment of lower limb fractures during the perioperative period. This study aimed to develop and validate a novel model for predicting the risk of DVT in elderly patients after orthopedic surgeries for lower limb fractures. This observational study included 576 elderly patients with lower limb fractures who were surgically treated from January 2016 to December 2018. Eleven items affecting DVT were optimized by least absolute shrinkage and selection operator regression analysis. Multivariable logistic regression analysis was performed to construct a predictive model incorporating the selected features. C-index was applied to evaluate the discrimination. Decision curve analysis was employed to determine the clinical effectiveness of this model and calibration plot was applied to evaluate the calibration of this nomogram. The internal validation of this model was assessed by bootstrapping validation. Predictive factors that affected the rate of DVT in this model included smoking, time from injury to surgery, operation time, blood transfusion, hip replacement arthroplasty, and D-dimer level after operation. The nomogram showed significant discrimination with a C-index of 0.919 (95% confidence interval: 0.893–0.946) and good calibration. Acceptable C-index value could still be reached in the interval validation. Decision curve analysis indicated that the DVT risk nomogram was useful within all possibility threshold. This newly developed nomogram could be used to predict the risk of DVT in elderly patients with lower limb fractures during the perioperative period.
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影响因子：
6.7
作者：
Chan, Noel C.;Stehouwer, Alexander C.;Eikelboom, John W.
通讯作者：
Eikelboom, John W.
影响因子：
1.9
作者：
Hamper, Ulrike M.;DeJong, M. Robert;Scoutt, Leslie M.
通讯作者：
Scoutt, Leslie M.
影响因子：
4
作者：
Heit, John A.;Spencer, Frederick A.;White, Richard H.
通讯作者：
White, Richard H.
影响因子：
5.7
作者：
Hill, Jennifer;Treasure, Tom
通讯作者：
Treasure, Tom
DOI：
10.1016/j.arthro.2019.03.054
发表时间：
2019-08-01
影响因子：
4.7
作者：
Khazi, Zain M.;An, Qiang;Westermann, Robert W.
通讯作者：
Westermann, Robert W.