A Predictive Nursing Tool for Patient Positioning Safety in Hybrid Digital Subtraction Angiography Operating Rooms

The aim of this study was to develop and internally validate a phase-updating nursing predictive assessment tool based on baseline patient-surgical risk and modifiable nursing processes for use before surgery and after positioning in the hybrid digital subtraction angiography operating room. This single-center retrospective cohort included inpatient adults undergoing their first procedure in the hybrid operating room, with surgery as the unit of analysis and follow-up to 72 h postoperatively. The outcome was a composite endpoint of position-related complications. Missing predictor data were handled using multiple imputation (m = 10), and extraction consistency was assessed with Cohen κ and intraclass correlation coefficients. Candidate variables from univariable screening plus prespecified variables entered least absolute shrinkage and selection operator regression, followed by multivariable logistic modeling and nomogram construction with threshold-based risk stratification. Model performance was evaluated by area under the curve, calibration intercept and slope, Brier score, bootstrap internal validation, and decision curve analysis. A total of 1,936 cases were analyzed, and the composite outcome occurred in 10.23%. Maximum missingness of key variables was 3.25%, and extraction consistency was good (κ ≥ 0.86, intraclass correlation coefficient ≥ 0.89). Twelve predictors were retained; pressure-point protection and intraoperative position checks were protective (odds ratio 0.68-0.71). The baseline model had an area under the curve of 0.74/0.72 (apparent/corrected), and the full model achieved 0.79/0.77. The optimism-corrected calibration slope was 0.947, the intercept was 0.004, and the Brier score was 0.085. This tool showed stable discrimination, calibration, and net benefit on internal validation. Nursing process variables added value, and the tool may support preoperative assessment and post-positioning risk updating, pending external validation.