两种小儿肺炎临床预测模型的外部验证。

IF 3 3区 医学 Q1 PEDIATRICS
Sriram Ramgopal, Melissa Neveu, Douglas Lorenz, Jillian Benedetti, Jack Lavey, Todd A Florin
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引用次数: 0

摘要

目的从外部验证儿科放射性肺炎的两个预测模型:我们前瞻性地评估了两个预测模型(肺炎风险评分 [PRS] 和 CARPE DIEM 模型)的性能,样本来自 2022 年 1 月 1 日至 2023 年 12 月 31 日期间在儿科急诊室接受胸部放射摄影检查的 90 天至 18 岁疑似肺炎患儿。我们使用原始截距和系数对模型性能进行了评估,并在执行重新校准和重新估计程序时对性能变化进行了评估:我们纳入了 202 名患者(中位年龄 3 岁,IQR 1-6 岁),其中 92 人(41.0%)发现了放射性肺炎。PRS模型的接收者操作特征曲线下面积为0.72(95%置信区间[CI] 0.64-0.79),高于CARPE DIEM(0.59;95% CI 0.51-0.67)(PC结论:在预测放射性肺炎方面,PRS模型的表现优于CARPE DIEM模型。在肺炎发病率较高的儿童中,这些模型的性能水平不足以独立于临床判断。这些发现凸显了进一步验证和改进模型以提高其实用性的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
External validation of two clinical prediction models for pediatric pneumonia.

Objective: To externally validate two prediction models for pediatric radiographic pneumonia.

Methods: We prospectively evaluated the performance of two prediction models (Pneumonia Risk Score [PRS] and CARPE DIEM models) from a prospective convenience sample of children 90 days - 18 years of age from a pediatric emergency department undergoing chest radiography for suspected pneumonia between January 1, 2022, to December 31st, 2023. We evaluated model performance using the original intercepts and coefficients and evaluated for performance changes when performing recalibration and re-estimation procedures.

Results: We included 202 patients (median age 3 years, IQR 1-6 years), of whom radiographic pneumonia was found in 92 (41.0%). The PRS model had an area under the receiver operator characteristic curve of 0.72 (95% confidence interval [CI] 0.64-0.79), which was higher than the CARPE DIEM (0.59; 95% CI 0.51-0.67) (P<0.01). Using optimal cutpoints, the PRS model showed higher sensitivity (65.2%, 95% CI 54.6-74.9) and specificity (72.7%, 95% CI 63.4-80.8) compared to the CARPE DIEM model (sensitivity 56.5 [95% CI 45.8-66.8]; specificity 60.9 [95% CI 50.2-69.2]). Recalibration and re-estimation of models improved performance, particularly for the CARPE DIEM model, with gains in sensitivity and specificity, and improved calibration.

Conclusion: The PRS model demonstrated better performance than the CARPE DIEM model in predicting radiographic pneumonia. Among children with a high rate of pneumonia, these models did not reach a level of performance sufficient to be used independently of clinical judgement. These findings highlight the need for further validation and improvement of models to enhance their utility.

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来源期刊
Academic Pediatrics
Academic Pediatrics PEDIATRICS-
CiteScore
4.60
自引率
12.90%
发文量
300
审稿时长
60 days
期刊介绍: Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.
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