Song Yinghua

Zhao Junhong

Wang Lu

Wei Danna

Chen Jinrong

Department of Fourth Neurosurgery,First Affiliated Hospital of Xinjiang Medical University

Abstract:Objective To construct a nomogram model for individualized prediction of the risk of intraoperative acquired pressure injury(IAPI) in children with intracranial tumors, and to validate and evaluate the model. Methods Clinical data were collected from 224 children with intracranial tumors who underwent pediatric neurosurgery in the Fourth Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University from June 2022 to January 2025.The occurrence of IAPI was statistically analyzed. Binary logistic regression was used to analyze the influencing factors of IAPI, and a nomogram prediction model was constructed. Receiver operating characteristic(ROC) curve analysis was used to evaluate the predictive value of the nomogram model, and a decision curve was plotted to analyze the net benefit rate. Results Among the 224 children with intracranial tumors who underwent surgical treatment, 19 cases(8.48%) developed IAPI, including 18 cases(94.74%) at stage Ⅰ and 1 case(5.26%) at stage Ⅱ. Prolonged anesthesia time, increased intraoperative blood loss, intraoperative hypothermia, prone position during surgery, and the use of milling cutters and drill bits during the operation were all independent risk factors for IAPI in children with intracranial tumors [OR(95%CI) = 4.525(2.914-7.028),5.143(2.885-9.167), 5.563(3.429-9.025), 5.472(3.082-9.714), 5.928(3.517-9.992)]. Age ≥12 months and elevated Braden Q score were protective factors against the occurrence of IAPI in children with intracranial tumors [OR(95%CI) =0.072(0.942-5.471), 0.326(0.183-0.581)]. The nomogram model established based on the above influencing factors demonstrated good accuracy and effectiveness in predicting IAPI in children with intracranial tumors. ROC curve analysis showed that the AUC of the nomogram model for predicting IAPI in children with intracranial tumors was 0.969, with a 95%CI of0.919-0.986, a sensitivity of 89.47%, and a specificity of 95.06%. Decision curve analysis indicated that when the risk threshold ranged from 0 to 0.83, the nomogram model provided improved clinical benefits. Conclusion The nomogram prediction model for IAPI in children with intracranial tumors, constructed based on age, Braden Q score, anesthesia time, intraoperative blood loss, intraoperative hypothermia, surgical position, and the use of milling cutters and drill bits during surgery, can effectively predict the risk of IAPI in these patients and facilitates early clinical identification of children at high risk for IAPI.

Keyword:Intracranial tumorIntraoperative acquired pressure injuryInfluencing factorsNomogramChildren

Fund:

Authors:*陈金荣,E-mail:472142542@QQ.com;