Establishment And Validation Of A Nomogram Prediction Model For Predicting Operative Management In Patients With Hepatic Trauma

Objective: Explore the predictive factor of operative management in patients with hepatic trauma,establishment and validation of a nomogram prediction model for predicting operative management in patients with hepatic trauma based on predictive factors,and evaluate and verify the model’s predictive efficacy and clinical applicability.Provide an objective basis for clinicians to use this predictive model to screen high-risk patients with hepatic trauma requiring surgical intervention,and to formulate more reasonable diagnosis and treatment strategies.Methods: Collect clinical data of patients with hepatic trauma admitted in our hospital from November 2011 to November 2020.Perform univariate and multivariate logistic regression analyses,and use of the lasso regression method to screen variables.Use the selected independent influencing factors as predictors to construct a nomogram prediction model.Evaluate the predictive performance of the model discrimination and calibration,draw the decision curve analysis and clinical impact curve of the model to evaluate the clinical applicability of the model.Finally,the Boot-strap method is used to repeatedly sample 1000 times to internally verify the model to evaluate the repeatability and stability of the model.Results: The study finally included a total of 188 patients,144 non-operative management of patients and 44 operative management of patients.Multivariatelogistic regression analysisshowed that: open injury(OR=32.9,95%Ci:5.49-261,P<0.001),severe injuries(OR=80.3,95%CI:8.92-1970,P<0.001),hematoperitoneum was classified as moderate(OR=16.3,95%CI:1.99-243,P=0.018),hematoperitoneum was classified as severe(OR=27.2,95%CI:3.63-384,P=0.004)、 Have blood transfusion within 24 hours of admission(OR=13.3,95%CI:2.97-74.5,P=0.001)were independent risk factors for operative management in patients with hepatic trauma。Injury type,injury scale,hematoperitoneum,blood transfusion within 24 hours of admission were used as predictors to establish a nomogram prediction model.The discrimination evaluation index AUC was 0.959,KS value was 0.74.Calibration evaluation index: Mc Fadden R~2 was 0.643,Brier score was 0.058,Hosmer Lemeshow goodness of fit test P value was 0.789.The decision curve analysis and clinical impact curve of the model show that the model has good clinical applicability.In the internal validation of the model AUC was 0.940,KS value was 0.69,Mc Fadden R~2 was 0.602,Brier score was 0.07.Conclusions: Injury type,injury scale,hematoperitoneum,blood transfusion within 24 hours of admission are independent influencing factors for operative management in patients with hepatic trauma.The nomogram prediction model for predicting operative management in patients with hepatic trauma constructed in this study has good predictive performance and clinical application value.