التفاصيل البيبلوغرافية
| العنوان: |
A recalibrated prediction model can identify level-1 trauma patients at risk of nosocomial pneumonia |
| المؤلفون: |
Kobes, T., Terpstra, A. M., IJpma, F. F.A., Leenen, L. P.H., Houwert, R. M., van Wessem, K. J.P., Groenwold, R. H.H., van Baal, M. C.P.M. |
| المساهمون: |
Zorgeenheid Traumatologie, Cancer, Researchgr. Systems Radiology, Infection & Immunity, Other research (not in main researchprogram), Epi Methoden Team 1 |
| سنة النشر: |
2023 |
| مصطلحات موضوعية: |
External validation, Nosocomial pneumonia, Prediction model, Recalibration, Trauma patients, Surgery, Orthopedics and Sports Medicine |
| الوصف: |
INTRODUCTION: Nosocomial pneumonia has poor prognosis in hospitalized trauma patients. Croce et al. published a model to predict post-traumatic ventilator-associated pneumonia, which achieved high discrimination and reasonable sensitivity. We aimed to externally validate Croce's model to predict nosocomial pneumonia in patients admitted to a Dutch level-1 trauma center. MATERIALS AND METHODS: This retrospective study included all trauma patients (≥ 16y) admitted for > 24 h to our level-1 trauma center in 2017. Exclusion criteria were pneumonia or antibiotic treatment upon hospital admission, treatment elsewhere > 24 h, or death < 48 h. Croce's model used eight clinical variables-on trauma severity and treatment, available in the emergency department-to predict nosocomial pneumonia risk. The model's predictive performance was assessed through discrimination and calibration before and after re-estimating the model's coefficients. In sensitivity analysis, the model was updated using Ridge regression. RESULTS: 809 Patients were included (median age 51y, 67% male, 97% blunt trauma), of whom 86 (11%) developed nosocomial pneumonia. Pneumonia patients were older, more severely injured, and underwent more emergent interventions. Croce's model showed good discrimination (AUC 0.83, 95% CI 0.79-0.87), yet predicted probabilities were too low (mean predicted risk 6.4%), and calibration was suboptimal (calibration slope 0.63). After full model recalibration, discrimination (AUC 0.84, 95% CI 0.80-0.88) and calibration improved. Adding age to the model increased the AUC to 0.87 (95% CI 0.84-0.91). Prediction parameters were similar after the models were updated using Ridge regression. CONCLUSION: The externally validated and intercept-recalibrated models show good discrimination and have the potential to predict nosocomial pneumonia. At this time, clinicians could apply these models to identify high-risk patients, increase patient monitoring, and initiate preventative measures. Recalibration of Croce's model improved ... |
| نوع الوثيقة: |
article in journal/newspaper |
| وصف الملف: |
application/pdf |
| اللغة: |
English |
| تدمد: |
0936-8051 |
| Relation: |
https://dspace.library.uu.nl/handle/1874/449025 |
| الاتاحة: |
https://dspace.library.uu.nl/handle/1874/449025 |
| Rights: |
info:eu-repo/semantics/OpenAccess |
| رقم الانضمام: |
edsbas.F39D1325 |
| قاعدة البيانات: |
BASE |