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Development and validation of a nomogram model for central venous access device-related thrombosis in hospitalized
Lingyun Tian1,2, Yanan Su3, Huimin Gao4
1Department of Nursing, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Insights
A new nomogram model effectively predicts central venous access device-related thrombosis (CRT) in hospitalized children. This tool aids in reducing missed diagnoses and CRT incidence, improving patient outcomes.
Area of Science:
- Pediatric Thrombosis
- Medical Informatics
- Clinical Risk Prediction
Background:
- Central venous access device-related thrombosis (CRT) is often asymptomatic in hospitalized children, leading to frequent missed diagnoses.
- Currently, no established risk prediction nomogram model exists for CRT in this pediatric population.
Purpose of the Study:
- To develop and validate a nomogram model for predicting central venous access device-related thrombosis (CRT) in hospitalized children.
- To identify key risk factors associated with CRT in pediatric patients.
Main Methods:
- A nomogram model was developed using logistic regression on a training set of 503 hospitalized children.
- The model was validated internally (7:3 split) and externally using data from 85 additional pediatric patients.
- Model performance was assessed using discrimination (AUC), calibration, and decision curve analysis.
Main Results:
- The nomogram incorporated seven independent risk factors: blind catheterization, abnormal liver function, central line-associated bloodstream infection, infection, number of catheter lines, leukemia, and prolonged bed rest (>72h).
- The model demonstrated good discrimination with AUCs of 0.74 (training), 0.71 (internal validation), and 0.76 (external validation).
- Accuracy rates were 79% (training), 72% (internal), and 71% (external), with excellent calibration across all datasets.
Conclusions:
- The developed nomogram model serves as a valuable risk assessment tool for CRT in hospitalized children.
- Implementation of this model can help decrease the rate of missed diagnoses and the overall incidence of CRT.
Abstract:
This study aimed to develop and validate a nomogram model of central venous access device-related thrombosis (CRT) for hospitalized children. A total of 503 consecutive cases from a hospital in Changsha City, Hunan Province were stochastically classified into the training set and internal validation set at a ratio of 7:3, and 85 consecutive cases in two hospitals in Urumqi City, Xinjiang Uygur Autonomous Region were collected as an external validation set. Univariate analysis and multivariate analysis on CRT-related risk factors of hospitalized children were conducted, a logistic regression model was employed to establish the nomogram, and the discrimination, calibration, and decision curve analysis was performed to assess the proposed nomogram model. The nomogram model involved seven independent risk factors, including blind catheterization, abnormal liver function, central line-associated bloodstream infection, infection, number of catheter lines, leukemia, and bed rest > 72 h. The discrimination results showed that the area under the receiver operating characteristic curve of the training set, internal validation set, and external validation set was 0.74, 0.71, and 0.76 respectively, and the accuracy rates of the proposed nomogram model were 79%, 72%, and 71% in the training set, internal validation set, and external validation set. The calibration results also showed that the calibration curve had great fitness for each dataset. More importantly, the decision curve suggested that the proposed nomogram model had a prominent clinical significance.
Conclusion:
The nomogram model can be used as a risk assessment tool to reduce the missed diagnosis rate and the incidence of CRT in hospitalized children.
What Is Known:
• Central venous access device-related thrombosis is generally asymptomatic for hospitalized children, causing the missed diagnosis of central venous access device-related thrombosis easily. • No risk prediction nomogram model for central venous access device-related thrombosis in hospitalized children has been established.
What Is New:
• A visual and personalized nomogram model was built by seven accessible variables (blind catheterization, abnormal liver function, central line-associated bloodstream infection, infection, number of catheter lines, leukemia, and bed rest > 72 h). • The model can effectively predict the risk of central venous access device-related thrombosis for hospitalized children.
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