| Objective:To understand the risk factors for medical device related pressure injury in ICU patients,construct and validate a predictive model for the risk of medical device related pressure injury in ICU patients,and provide a reference basis for nursing staff to identify the risk group of medical device related pressure injury at an early stage.Methods:The literature on risk factors for medical device related pressure injury in ICU patients was searched from the establishment of the database to June 2022,and the literature was screened and evaluated for quality to gain a preliminary understanding of risk factors for medical device related pressure injury in ICU patients and to form a data collection form from this.Model construction Part of the modeling group selected 280ICU patients who were admitted to a tertiary care hospital in Urumqi from June 2021 to December 2021 and met the inclusion and exclusion criteria as study subjects,and used multi-factor logistic regression analysis to screen independent influencing factors and construct a prediction model with the occurrence of medical device-related pressure injury as the independent variable.The area under the subject working characteristic curve AUC,calibration curve and decision curve analysis were used to evaluate the discrimination,calibration and clinical usefulness of the model,respectively.A total of123 ICU patients admitted to the hospital from April 2022 to June 2022 were selected as the verification group,and the model was externally verified.Results:(1)After a systematic review of the literature,a questionnaire on risk factors of medical device-related pressure injury in patients with ICU was formed.Low Braden score,enteral nutrition,internal ICU patients,overweight,mechanical ventilation,respiratory diseases,APACHEII score,age,male,average length of stay,use of vasoactive drugs,low albumin level,gastric tube use time,hemoglobin,surgery,use of sedatives and cardiovascular diseases were the possible influencing factors of device-related pressure injury in ICU patients.(2)Of the 403 ICU patients included,74 had medical device related pressure injury,with an incidence of 18.36%.Multivariate Logistic regression analysis showed that age,operation,prone position,APACHEII score and use of non-invasive ventilation mask were independent risk factors for MDRPI,while hemoglobin was a protective factor.Based on the above influencing factors,the risk prediction model of medical device-related pressure injury in ICU patients is constructed.The area under the ROC curve is 0.953,sensitivity is 94.5%,and the specificity is 88.9%,H-L testχ~2=6.347,P=0.608.The model calibration chart shows that the prediction probability is consistent with the actual observed probability.The decision curve shows that when the threshold probability of the patient is 0～0.85,the net benefit of using the nomogram prediction model to predict the risk of medical device-related pressure injury is higher.(3)The external verification of the model shows that the area under the ROC curve of the verification group is 0.880,sensitivity is 94.7%,and specificity is 81.0%,H-L testχ~2=8.597,P=0.377.The model calibration chart shows that the prediction probability is consistent with the actual probability,and the fit is good.The decision curve shows that the model still has good practicability.Conclusion:The incidence of medical device-related pressure injury in patients with ICU was 18.36%.Age,operation,prone position,APACHEII score and use of non-invasive ventilation mask were independent risk factors for MDRPI,while hemoglobin was a protective factor.The nomogram risk prediction model based on the above independent influencing factors has good differentiation,calibration and clinical practicability.Through external verification,the prediction model has good portability and repeatability.It can be used as a risk prediction tool for medical device-related pressure injury in ICU patients,and provides a reference for clinical nurses to identify high-risk groups. |
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