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Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock
Published on: November 3, 2023
A nomogram for predicting hemorrhagic shock in pediatric patients with multiple trauma
Nan Lin1, Jingyi Jin1, Sisi Yang1
1Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China.
Insights
This study developed a nomogram to predict hemorrhagic shock in pediatric trauma patients. The tool uses key indicators for early identification and improved clinical management of children with multiple injuries.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Clinical Prediction Modeling
Background:
- Hemorrhagic shock in pediatric trauma requires timely detection and management.
- Existing methods may lack accuracy or efficiency for early identification in this population.
Purpose of the Study:
- To develop and validate a nomogram for predicting hemorrhagic shock in pediatric patients with multiple trauma.
- To provide a tool for early identification and facilitate timely clinical intervention.
Main Methods:
- Retrospective study of 325 pediatric trauma patients, with external validation on 144 patients.
- Least Absolute Shrinkage and Selection Operator (LASSO) regression for predictor selection.
- Multivariable logistic regression and nomogram construction, validated with C-index, ROC, calibration, and DCA.
Main Results:
- Systolic blood pressure (ΔSBP), platelet count, activated partial thromboplastin time (APTT), and injury severity score (ISS) were identified as independent predictors.
- The nomogram achieved a high area under the curve (AUC) of 0.963, indicating robust predictive performance.
- The model demonstrated good calibration and improved clinical utility via decision curve analysis, confirmed by external validation.
Conclusions:
- A reliable nomogram for predicting hemorrhagic shock in pediatric multiple trauma patients has been successfully developed.
- This tool can aid clinicians in the timely and effective management of pediatric trauma patients at risk of hemorrhagic shock.
Abstract:
The timely detection and management of hemorrhagic shock hold paramount importance in clinical practice. This study was designed to establish a nomogram that may facilitate early identification of hemorrhagic shock in pediatric patients with multiple-trauma. A retrospective study was conducted utilizing a cohort comprising 325 pediatric patients diagnosed with multiple-trauma, who received treatment at the Children's Hospital, Zhejiang University School of Medicine, Zhejiang, China. For external validation, an additional cohort of 144 patients from a children's hospital in Taizhou was included. The model's predictor selection was optimized through the application of the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Subsequently, a prediction nomogram was constructed using multivariable logistic regression analysis. The performance and clinical utility of the developed model were comprehensively assessed utilizing various statistical metrics, including Harrell's Concordance Index (C-index), receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA). Multivariate logistic regression analysis identified systolic blood pressure (ΔSBP), platelet count, activated partial thromboplastin time (APTT), and injury severity score (ISS) as independent predictors for hemorrhagic shock. The nomogram constructed using these predictors demonstrated robust predictive capabilities, as evidenced by an impressive area under the curve (AUC) value of 0.963. The model's goodness-of-fit was assessed using the Hosmer-Lemeshow test (χ2 = 10.023, P = 0.209). Furthermore, decision curve analysis revealed significantly improved net benefits with the model. External validation further confirmed the reliability of the proposed predictive nomogram. This study successfully developed a nomogram for predicting the occurrence of hemorrhagic shock in pediatric patients with multiple trauma. This nomogram may serve as an accurate and effective tool for timely and efficient management of children with multiple trauma.
