Hong Zhang, Jing Li, Shan Deng, Chan Liu, Mei-Mei Liu, Shi-Yao Hu, Shi-Chun Wang, Ming-Yuan Fan
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The Prediction Model Risk of Bias Assessment Tool (PROBAST) was employed to evaluate both the risk of bias and the clinical applicability of the included models.</p><p><strong>Results: </strong>A total of 17 articles, encompassing 29 prediction models, were included. The incidence of aspiration was 9.45%-57.00%. Meta-analysis of high-frequency predictors identified the following significant predictors of aspiration: history of aspiration, depth of endotracheal intubation, impaired consciousness, sedation use, nutritional risk, mechanical ventilation and gastric residual volume (GRV). The area under the curve (AUC) was 0.771-0.992. Internal validation was performed in 12 studies, while both internal and external validation were conducted in 5 studies. 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引用次数: 0
摘要
目的：系统识别和评价现有成人住院患者EN误吸风险预测模型。数据来源：系统检索PubMed、Web of Science核心合集、Embase、Cochrane Library、CINAHL、中国知网（CNKI）、万方数据库、中国生物医学文献库（CBM）、维普数据库（VIP Database），检索时间为建库至2025年3月1日。研究设计：对观察性研究进行系统评价。回顾方法：两名研究人员使用预测模型研究系统回顾关键评价和数据提取清单（CHARMS）独立进行文献筛选和数据提取。采用预测模型偏倚风险评估工具（PROBAST）对纳入模型的偏倚风险和临床适用性进行评估。结果：共纳入17篇文献，29个预测模型。误吸发生率为9.45% ~ 57.00%。高频预测因素荟萃分析确定了以下重要的误吸预测因素：误吸史、气管插管深度、意识受损、镇静使用、营养风险、机械通气和胃残留体积（GRV）。曲线下面积（AUC）为0.771 ~ 0.992。12项研究进行了内部验证，5项研究进行了内外验证。所有研究均存在高偏倚风险，主要原因是回顾性设计、地理偏倚（均来自中国不同地区）、数据分析不足、验证策略不足以及研究过程缺乏透明度。结论：目前肠内营养相关误吸的风险预测模型具有中等至高的判别准确性，但存在关键的方法学局限性，包括回顾性设计、地理偏差（所有模型均来自中国队列，限制了全球的可推广性）和结果定义不一致。临床实践意义：认识到现有模型的高偏倚，需要前瞻性多中心数据和标准化诊断来开发更准确和临床适用的肠内营养吸收不良预测模型。患者或公众捐款：不适用。试验注册：PROSPERO: CRD420251016435。
Risk Prediction Models for Enteral Nutrition Aspiration in Adult Inpatients: A Systematic Review and Critical Appraisal.
Objective: To systematically identify and appraise existing risk prediction models for EN aspiration in adult inpatients.
Data sources: A systematic search was conducted across PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biomedical Literature Database (CBM) and VIP Database from inception to 1 March 2025.
Study design: Systematic review of observational studies.
Review methods: Two researchers independently performed literature screening and data extraction using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). The Prediction Model Risk of Bias Assessment Tool (PROBAST) was employed to evaluate both the risk of bias and the clinical applicability of the included models.
Results: A total of 17 articles, encompassing 29 prediction models, were included. The incidence of aspiration was 9.45%-57.00%. Meta-analysis of high-frequency predictors identified the following significant predictors of aspiration: history of aspiration, depth of endotracheal intubation, impaired consciousness, sedation use, nutritional risk, mechanical ventilation and gastric residual volume (GRV). The area under the curve (AUC) was 0.771-0.992. Internal validation was performed in 12 studies, while both internal and external validation were conducted in 5 studies. All studies demonstrated a high risk of bias, primarily attributed to retrospective design, geographic bias (all from different parts of China), inadequate data analysis, insufficient validation strategies and lack of transparency in the research process.
Conclusion: Current risk prediction models for enteral nutrition-associated aspiration show moderate to high discriminative accuracy but suffer from critical methodological limitations, including retrospective design, geographic bias (all models derived from Chinese cohorts, limiting global generalisability) and inconsistent outcome definitions.
Implications for clinical practice: Recognising the high bias of existing models, prospective multicentre data and standardised diagnostics are needed to develop more accurate and clinically applicable predictive models for enteral nutrition malabsorption.
期刊介绍：
The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice.
JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice.
We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.
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