Construction And Application Of The Risk Assessment Scale Of Hypertrophic Scar After Thyroid Surgery

Objective:To analyze the risk factors of hypertrophic scar after thyroid surgery,construct the risk assessment scale of hypertrophic scar after thyroid surgery,and explore the predictive value of the risk assessment scale of hypertrophic scar after thyroid surgery.Methods:Part 1:The clinical data and the information related hypertrophic scar of 385 patients with thyroid cancer who underwent surgery in a third-class hospital in Chongqing from November 2018 to March 2019 were analyzed retrospectively.The case-control study was conducted.Patients with hypertrophic scar were included in the case group,while patients without hypertrophic scar were included in the control group.Univariate analysis and binary Logistic regression analysis were used to analyze the independent risk factors of hypertrophic scar after thyroid surgery.Part 2:Set up a research group,and the members compiled the expert consultation questionnaire through literature review and preliminary research data.By using the method of purposive sampling,21 experts were selected nationwide for expert consultation,and the indexes of the scale were preliminarily screened.According to the results of expert consultation,the initial score scale was constructed.The researcher scored the 175 patients with thyroid cancer who underwent surgery in a third-class hospital in Chongqing from May to July 2019 with the initial score scale.The indexes were screened again by frequency analysis and the critical ratio value method.After determining the weight of the scale by factor analysis,a secondary score scale was formed.The reliability and validity of the secondary scale were tested.Part 3:362 patients were selected from the patients in the first part of the study and scored by the researcher with a secondary score scale.The predictive ability of the scale was evaluated by ROC curve and Kappa consistency test.A formal scale was formed after determining the diagnostic threshold and the risk degree of the scale.Results:Part 1:121 out of 385 patients developed hypertrophic scar,with an incidence rate of 31.4%.Univariate analysis showed that there were significant differences in sex,age,postoperative infection,history of abnormal wound healing,history of pathological scar,family history of pathological scar and scar prevention measures between the two groups(P<0.05).Binary logistic regression analysis indicated that age ≤ 45 years old(OR=1.815),history of abnormal wound healing(OR=4.247),history of pathological scar(OR=9.840),family history of pathological scar(OR=5.708)and absence of preventive scar measures(OR=5.566)were independent risk factors of the hypertrophic scar after thyroid surgery.Part 2 : Two rounds of expert consultation were conducted.The positive degree of experts in both rounds were 100%.The authority degree of experts was 0.87 and 0.89 respectively.Kendall’s harmony coefficients was 0.313 and 0.472 respectively.In the first round,1 index was added,7indexes were deleted,and 5 indexes were adjusted.In the second round,6indexes were deleted.After frequency analysis and critical ratio value analysis,6 indexes were deleted,and 9 indexes were retained(age,BMI,allergic constitution,history of abnormal wound healing,history of pathological scar,family history of pathological scar,continuous use of hormones(> 2 months),I131 radiotherapy,postoperative infection).The results of factor analysis showed that : KMO=0.560>0.5,df=274.447,P<0.001.According to the standard that the eigenvalue is greater than 1,a total of 4 common factors were extracted.The cumulative contribution rate was 62.489%.88.9%(8/9)of the factors had a maximum load coefficient greater than 0.4.The normalized weight range of the scale index was0.066-0.191.The scale had good construct validity and content validity.The Spearman correlation coefficient of test-retest reliability was 0.983,P<0.001.Part 3:In ROC analysis,the AUC was 0.886,P<0.001.When the Youden index was at the highest of 0.72,the sensitivity was 77% and the specificity was 95%.The value of 25 points was determined as the diagnostic threshold.The risk rating of the scale score was as follows:low risk(25-28 points),medium risk(29-38 points),high risk(39-61 points).In the Kappa consistency test,the Kappa value was 0.731,P<0.001.ConclusionIn the study,the independent risk factors of hypertrophic scar after thyroid surgery were identified,and the risk assessment scale of hypertrophic scar after thyroid surgery was constructed with 9 indexes.The scale had good reliability,validity,and predictive ability.The scale provided a rapid and reliable quantitative evaluation tool for clinical medical workers to identify high-risk population of hypertrophic scar after thyroid surgery.It is suggested that doctors and nurses apply the scale to patients undergoing thyroid surgery to screen the high-risk population of hypertrophic scar.