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Nomogram for intraoperatively acquired pressure injuries in children undergoing cardiac surgery with cardiopulmonary
He Lin1, Haiyan Chen1, Jiehui Wang1
1Department of Operating Room, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
Insights
A new nomogram predicts intraoperatively acquired pressure injuries (IAPIs) in pediatric cardiac surgery patients. This tool identifies children at high risk, aiding in the prevention of IAPIs during cardiopulmonary bypass (CPB).
Area of Science:
- Pediatric Cardiac Surgery
- Medical Device Development
- Patient Safety
Background:
- Intraoperatively acquired pressure injuries (IAPIs) are a concern in pediatric cardiac surgery.
- Developing predictive tools for IAPIs in this vulnerable population is crucial.
Purpose of the Study:
- To develop and validate a nomogram for predicting IAPI risk in children undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Main Methods:
- Retrospective study of 208 children (21 days to 8 years) undergoing cardiac surgery with CPB.
- Data analyzed using logistic regression to identify risk factors and build a nomogram.
- Nomogram validated using calibration curves, ROC curves, and DCA in training and validation cohorts.
Main Results:
- 14.7% of children developed IAPIs.
- Independent risk factors identified: low Braden Q scores, steroid use, skin abnormalities, and low intraoperative SpO2.
- The nomogram demonstrated strong predictive ability (AUCs 0.836 and 0.903) and good clinical applicability.
Conclusions:
- A reliable nomogram was developed to predict IAPI risk in pediatric cardiac surgery patients.
- The nomogram integrates key risk factors and serves as an effective tool for IAPI prevention.
Background:
We aimed to develop and validate a nomogram for predicting the risk of intraoperatively acquired pressure injuries (IAPIs) in children undergoing cardiac surgery with cardiopulmonary bypass (CPB).
Methods:
This study retrospectively included 208 children aged 21 days to 8 years who underwent cardiac surgery with CPB in a tertiary hospital in China between January 2020 and October 2023. All patients' data were collected from the hospital's medical record system and randomly divided into the training (n = 146) and validation (n = 62) cohorts by a ratio of 7:3. Logistic regression analysis was conducted in the training cohort to identify independent risk factors and establish the nomogram. Finally, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) were performed in both cohorts to validate the predictive ability of the nomogram.
Results:
43 (14.7%) children developed IAPIs. Multivariate analysis showed that low Braden Q scores, use of steroids, skin abnormalities, and low intraoperative SpO2 were independent risk factors for IAPIs. A nomogram integrating the 4 factors was established. The areas under the curve (AUCs) of the nomogram were 0.836 and 0.903 in the training and validation cohorts, respectively. Furthermore, calibration curves and DCA demonstrated good calibration and clinical applicability of the nomogram.
Conclusion:
We constructed a reliable nomogram based on specific risk factors for children undergoing cardiac surgery with CPB, which could be used as an effective and convenient tool for prevention of IAPIs.
