预测ICU患者痴呆症风险模型:系统审查和批判性评估
Wen-Hua Chen1, Lei Ding1, Yue Sha1
1Department of Critical Care Medicine, Nantong Haimen People's Hospital, Nantong, 226100, China.
BMC anesthesiology
|December 13, 2025
概括
这次审查发现,虽然重症监护病房的许多妄想风险预测模型显示出良好的歧视性,但大多数都存在重大方法缺陷. 这些问题限制了它们在现实世界的临床应用和通用性.
科学领域:
- 关键护理医学 关键护理医学
- 流行病学 流行病学
- 医疗信息学 医疗信息学
背景情况:
- 妄想是重症监护室 (ICU) 中常见的并发症.
- 需要准确的风险预测模型来识别患有 Delirium 高风险的患者.
- 现有的模型需要对其质量和适用性进行严格的评估.
研究的目的:
- 系统地审查和评估成年ICU患者痴呆风险预测模型的方法质量.
- 评估这些模型的预测性能和临床适用性.
主要方法:
- 在PubMed,Embase,Web of Science和Cochrane图书馆进行系统搜索,截至2025年4月8日.
- 包括观察性队列研究,开发或验证ICU Delirium的多变量预测模型.
- 使用预测模型偏差风险评估工具 (PROBAST) 评估偏差风险和适用性.
主要成果:
- 包括27项研究,其中包括26个 Delirium 风险预测模型.
- 模型显示了与年龄,镇静和APACHE-II分数等预测因素的良好歧视 (AUC 0.67-0.932).
- 由于分析缺陷,过拟合和有限的外部验证,发现存在偏差的高风险;只有4个模型具有内部和外部验证.
结论:
- 尽管有良好的区别,但方法上的弱点阻碍了当前ICU Delirium预测模型的临床适用性和通用性.
- 未来的研究需要强大的外部验证和改进的方法严格性.
- 在例行采用之前,实施研究对于评估现实世界的实用性至关重要.
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