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Development and Validation of a Clinical Nomogram for Predicting Complications From Pediatric Multiple Magnet
Yizhen Luo1, Xiongjian Cui2, Jianli Zhou3
1Department of Radiology, Shenzhen Children's Hospital, Affiliated to Shantou University Medical College, Shenzhen, China.
Insights
A new nomogram accurately predicts complications from pediatric multiple magnet ingestion. This tool helps clinicians assess risks for better management of this urgent pediatric condition.
Area of Science:
- Pediatric Gastroenterology
- Clinical Risk Prediction
- Medical Device Safety
Background:
- Pediatric multiple magnet ingestion presents urgent management challenges.
- Existing strategies for predicting complications are controversial.
- A reliable clinical prediction tool is needed.
Purpose of the Study:
- To develop and validate a clinical nomogram for predicting complications in pediatric multiple magnet ingestion.
- To identify key clinical risk factors associated with adverse outcomes.
- To provide clinicians with a tool for accurate risk assessment.
Main Methods:
- Retrospective analysis of 146 pediatric patients with multiple magnet ingestion (2017-2023).
- Development of a nomogram using logistic regression and least absolute shrinkage and selection operator (LASSO) regression.
- Validation using area under the curve (AUC), calibration plots, and decision curve analysis.
Main Results:
- The nomogram incorporated age, multiple ingestions, vomiting, abdominal pain, and tenderness.
- The model achieved an AUC of 0.941 (internal validation: 0.930).
- High accuracy (89.0%), sensitivity (82.5%), and specificity (93.3%) were observed.
Conclusions:
- The developed nomogram demonstrates excellent predictive performance and clinical utility.
- It aids clinicians in accurately assessing complication risk in pediatric magnet ingestion.
- This tool can guide timely and appropriate management decisions.
Introduction:
This 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.
Methods:
Patients 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.
Results:
Of 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.
Discussion:
Our nomogram demonstrates excellent discrimination, calibration, and clinical utility and may thus help clinicians accurately assess the risk of complications from pediatric multiple magnet ingestion.
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