Wan Chengliang,Bai Qiang,Zhang Chuanbo,et al.Establishment and validation of an early nomogram for predicting prolonged length of stay in children with perforated appendicitis[J].Journal of Clinical Pediatric Surgery,,():882-887.[doi:10.3760/cma.j.cn101785-202312066]
Establishment and validation of an early nomogram for predicting prolonged length of stay in children with perforated appendicitis
- Keywords:
- Child; Perforated Appendicitis; Nomogram; Prediction Model; Length of Stay
- Abstract:
- Objective To establish an early nomogram model for predicting prolonged length of stay in children with perforated appendicitis (PA).Methods The relevant clinical data were retrospectively reviewed for 818 PA children undergoing laparoscopic appendectomy at the Department of General Surgery,Kunming Children’s Hospital from January 2019 to December 2022.All patients were randomized at a ratio of 7∶3 into a derivation cohort (n=575) and a validation cohort (n=243).The 75th percentile of hospitalization duration (≥11 days) was set as a cut-off value for assigning them into two sub-groups of normal hospitalization and prolonged length of stay.Univariate analysis was performed for comparing the clinical and surgical parameters between two subgroups.Parameters with statistical significance were included in multivariate forward stepwise Logistic regression to screen independent risk factors for prolonged length of stay.R 3.6.3 software was utilized for constructing a nomogram based upon regression outputs.Receiver operating characteristic (ROC) curve was plotted for assessing discrimination capacity; Bootstrap resampling for internal validation and external validation conducted with the independent validation cohort.Results Univariate analysis of derivation cohort demonstrated significant intergroup differences (P＜0.05) in time from symptom onset to admission,preoperative ultrasonographic peritoneal effusion,preoperative C-reactive protein (CRP),preoperative antibiotic therapy,intraoperative peritoneal lavage,intraoperative abdominal drainage placing,intraoperative volume of blood loss and operative duration.Multivariate Logistic regression eliminated three non-significant confounding factors of preoperative antibiotic therapy,intraoperative drainage tubing and intraoperative volume of blood loss (P>0.05).Five independent risk factors were identified as time from symptom onset,preoperative peritoneal effusion on ultrasound,preoperative CRP,intraoperative peritoneal lavage and operative duration (P<0.05).The area under ROC curve (AUC) of derivation cohort was 0.915(95%CI:0.889-0.942) while AUC of validation cohort reached 0.926(95%CI:0.892-0.961),indicating satisfactory discrimination performance.Internal Bootstrap validation presented a mean absolute error of 0.021.A favorable fitting between predicted calibration curve and ideal curve verified reliable predictive accuracy of the model.Conclusions Time from symptom onset,preoperative peritoneal effusion,preoperative CRP,intraoperative peritoneal lavage and operative duration are independently correlated with prolonged length of stay among PA children.The nomogram constructed by these routinely available parameters exhibits excellent discrimination and calibration.Thus it enables early identification of high-risk children and facilitates targeted clinical interventions.
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Memo
收稿日期:2023-12-28。
基金项目:2026年度昆明市卫生科研课题（2026-06-02-006）； 云南省院士专家工作站(202605AF3 50095);云南省教育厅科学研究基金项目(2024J0382)； 2022 年度昆明市卫生科研课题（2022-06-02-002）
通讯作者:海波,Email:1hbspring@163.com