老年髋部骨折患者术后谵妄风险预测模型的系统评价

doi:10.16460/j.issn1008-9969.2023.07.048

摘要/Abstract

摘要： 目的系统评价老年髋部骨折术后谵妄风险预测模型。方法检索PubMed、Embase、Web of Science、The Cochrane Library、中国知网、万方、维普数据库关于老年髋部骨折术后谵妄风险预测模型的研究,检索时限为建库至2022年5月。由2名研究者独立筛选文献和提取数据,采用PROBAST评估工具对纳入文献进行质量评价。结果共纳入11项研究,ROC曲线下面积为0.67~0.94。常见的术后谵妄易感因素为年龄、ASA分级和认知功能储备减少;促发因素为术前等待时间症、低蛋白血症。11个模型的预测性能较好,但均存在一定的偏倚,主要为未报告数据缺失处理方法,大部分模型预测因子筛选未结合临床专业知识,且缺少模型外部验证,部分研究术后谵妄评估工具、时间存在差异。结论现有模型整体预测性能较好,适用性风险较低,但偏倚风险较高,仍需完善变量筛选、缺失数据处理及模型效能评价等统计分析细节,开展前瞻性研究,对现有模型进行外部验证。

关键词: 髋部骨折, 术后谵妄, 预测模型, 系统评价

Abstract: Objective To systematically evaluate the risk prediction model for postoperative delirium in elderly patients with hip fracture. Methods We searched the databases of PubMed, Embase, Web of Science, The Cochrane Library, China knowledge Network, Wanfang and VIP from the inception to May 2022 for eligible literature. Two researchers independently extracted the data and PROBAST was used for quality evaluation. Results Eleven studies were included and the area under the ROC curve was 0.67~0.94. The most common predisposing factors of postoperative delirium were age, ASA grading and decreased cognitive reserve, and the promoting factors were waiting time for operation and hypoproteinemia before operation. The prediction performance of 11 models was good, but there was certain bias, mainly ignoring the missing data processing. Most of the predictive factor screening was not combined with clinical professional knowledge, lacking external verification. There were differences in the evaluation tools and time of postoperative delirium in some studies. Conclusion Good prediction performance, low risk of applicability and high risk of bias of the existing models are found. It is still necessary to improve the statistical analysis details such as variable screening, missing data processing, and model performance evaluation, and carry out prospective studies to conduct research on existing models.

Key words: hip fracture, postoperative delirium, risk prediction model, systematic review

中图分类号:

R473.6

叶磊, 张爱琴, 荣芸, 夏广惠. 老年髋部骨折患者术后谵妄风险预测模型的系统评价[J]. 护理学报, 2023, 30(7): 48-52.

YE Lei, ZHANG Ai-qin, RONG Yun, XIA Guang-hui. Risk prediction models for postoperative delirium in elderly patients with hip fracture: a systematic review[J]. Journal of Nursing, 2023, 30(7): 48-52.

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