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Development and Validation of a Clinical Nomogram for Predicting Complications From Pediatric Multiple Magnet Ingestion: A Large Retrospective Study. 儿科多发性磁铁摄入并发症临床预测提名图的开发与验证:一项大型回顾性研究
Pub Date : 2024-07-30 DOI: 10.14309/ajg.0000000000002983
Yizhen Luo,Xiongjian Cui,Jianli Zhou,Yijiang Zhuang,Chenrui Zheng,Qiru Su,Yungen Gan,Zhiyong Li,Hongwu Zeng
INTRODUCTIONThis study aimed to develop and validate a reliable nomogram based on clinical factors to predict complications associated with pediatric multiple magnet ingestion, addressing the urgency and controversy surrounding its management.METHODSPatients aged 0-18 years with multiple magnet ingestion diagnosed at the Shenzhen Children's Hospital between January 2017 and December 2023 were enrolled. Clinical data were analyzed using least absolute shrinkage and selection operator regression and multifactor logistic regression analyses to screen for risk factors. A model was constructed, and a nomogram was plotted. Model performance was evaluated and internally validated using the area under the curve (AUC), Hosmer-Lemeshow test, calibration curve, decision curve analysis, and 1,000 bootstraps. We calculated the optimal cutoff value, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the prediction model.RESULTSOf the 146 patients, 57 (39.0%) experienced complications. The nomogram included age, multiple ingestions, vomiting, abdominal pain, and abdominal tenderness. The AUC was 0.941, and the internally validated AUC was 0.930. The optimal cutoff value selected as a predictive value was 0.534, with a sensitivity of 82.5%, specificity of 93.3%, positive predictive value of 88.7%, negative predictive value of 89.3%, and accuracy of 89.0%. The Hosmer-Lemeshow test yielded a P value of 0.750. The calibration plot exhibited high consistency in prediction, and decision curve analysis showed excellent net benefits.DISCUSSIONOur nomogram demonstrates excellent discrimination, calibration, and clinical utility and may thus help clinicians accurately assess the risk of complications from pediatric multiple magnet ingestion.
简介:本研究旨在开发和验证基于临床因素的可靠提名图,以预测小儿多发性磁铁摄入相关并发症,解决围绕其管理的紧迫性和争议。采用最小绝对缩减和选择运算回归以及多因素逻辑回归分析对临床数据进行分析,以筛查风险因素。构建了一个模型,并绘制了一个提名图。使用曲线下面积(AUC)、Hosmer-Lemeshow 检验、校准曲线、决策曲线分析和 1,000 次引导对模型性能进行了评估和内部验证。我们计算了预测模型的最佳临界值、灵敏度、特异性、阳性预测值、阴性预测值和准确性。结果 在 146 名患者中,有 57 人(39.0%)出现并发症。提名图包括年龄、多次摄入、呕吐、腹痛和腹部压痛。AUC为0.941,内部验证的AUC为0.930。选定的最佳预测截断值为 0.534,灵敏度为 82.5%,特异性为 93.3%,阳性预测值为 88.7%,阴性预测值为 89.3%,准确率为 89.0%。Hosmer-Lemeshow 检验的 P 值为 0.750。我们的提名图显示了出色的辨别能力、校准能力和临床实用性,因此可以帮助临床医生准确评估小儿摄入多种磁铁引起并发症的风险。
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The American Journal of Gastroenterology
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