颅脑损伤患者肺炎发生风险预测模型的系统评价
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女,硕士在读,护师

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贵州省科技计划项目(黔科合支撑[2021]一般039)


Systematic review of risk prediction models for pneumonia in patients with traumatic brain injury
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    摘要:

    目的 系统地评价、分析颅脑损伤患者肺炎发生风险预测模型,为临床实践提供参考。方法计算机检索PubMed、Web of Science、Cochrane图书馆、Embase、万方数据库、中国知网、维普数据库、中国生物医学文献数据库中有关颅脑损伤患者肺炎发生风险预测模型的文献,检索时限为建库至2021年8月2日。由2名研究者独立筛选文献和提取数据,并使用预测模型研究的偏倚风险评估工具PROBAST分析纳入研究的偏倚风险和适用性。结果共纳入6项颅脑损伤患者肺炎发生风险预测模型开发研究;模型的受试者工作特征曲线下面积为0.806~0.949;GCS评分、机械通气、术后白蛋白水平、APACHE Ⅱ评分是纳入的6个模型中包含最多的预测因子。6项研究存在一定的偏倚风险,适用性尚不清楚,主要是因为未报告盲法、样本量不足、模型过度拟合、未报告或未处理缺失数据、模型性能缺乏评估。结论颅脑损伤患者肺炎发生风险预测模型的研究尚处于发展阶段,今后可开展多中心、大样本研究,结合大数据分析方法,开发预测性能优良、使用简便的预测模型,在使用过程中不断更新校正,为临床提供实际可用的模型。

    Abstract:

    Objective To systematically evaluate and analyze the risk prediction models for pneumonia in patients with traumatic brain injury (TBI), so as to provide references for clinical practice. Methods We searched Pubmed, Web of science, Cochrane library, EMBASE, Wanfang database, CNKI, VIP database, CBM to collect studies published during the period from database inception to August 2nd, 2021, on risk prediction models for pneumonia in TBI patients. Two researchers independently screened the literature,extracted information,and assessed the risk of bias and applicability of the included literature by using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Results Six relevant studies totaling 6 risk prediction models for pneumonia in TBI patients were included. The area under the ROC curve of the models ranged from 0.806 to 0.949. The most commonly reported predictive factors in all included models encompassed GCS score, mechanical ventilation, post-operative albumin level, and APACHE Ⅱscore. All included studies were subjected to a certain level of bias, and the applicability was unclear, which was mostly due to such shortcomings as not reporting blinding method, insufficient sample size, overfitting of model , not reporting or not handling missing data, and lack of model performance assessment. Conclusion The research on risk prediction models for pneumonia in TBI patients is still in the development stage. In the future, researchers could conduct multi-center and large sample research, and in conjunction with big data processing technique, develop easy-to-use risk prediction models with excellent performance. Researchers should continue to update and correct the models during use, in an effort to provide a solid predictive model for clinical settings.

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向黔灵,江智霞,胡汝均,袁晓丽,杨晓玲,张芳,张习莹.颅脑损伤患者肺炎发生风险预测模型的系统评价[J].护理学杂志,2022,27(14):97-100

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  • 收稿日期:2022-01-17
  • 最后修改日期:2022-03-22
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  • 在线发布日期: 2023-08-29