Key result
A six-factor clinical nomogram effectively predicted the location of neonatal gastrointestinal perforation before surgery, achieving an AUC of 0.876 in the training cohort and 0.900 in external validation.
Why the study?
Information on the localization of gastrointestinal perforation is crucial for subsequent surgical procedures, prompting the need to identify key indicators and develop a preoperative prediction model in neonates.
Does a nomogram based on clinical and laboratory factors accurately predict the location of gastrointestinal perforation in neonates before surgery?
Observational (n=270)
Yes
Does a nomogram based on clinical and laboratory factors accurately predict the location of gastrointestinal perforation in neonates before surgery?
A novel nomogram incorporating six clinical and laboratory factors demonstrated high accuracy in preoperatively predicting the location of neonatal gastrointestinal perforation, which may aid in surgical planning.
Answers are grounded in this paper and cite their sources.
May inform preoperative planning in neonatal GI perforation; leaves open prospective validation before clinical adoption.
Background: Information regarding the localization of gastrointestinal perforation is crucial for the following surgical procedure. This study was to determine the key indicators and develop a prediction model for the localization in neonates with gastrointestinal perforation. Methods: A nomogram to predict the location of neonatal gastrointestinal perforation was developed using a cohort of patients who underwent surgery between July 2009 and May 2021. Baseline variables were analyzed using logistics regression and nomogram developed using significant predictors. The predictive performance of the nomogram was assessed by the concordance index (C-index), calibration curve, and area under the receiver operating characteristic (ROC) curve (AUC). The nomogram was further validated in an integrated external cohort. Results: We investigated the data of 201 patients, of which 65 (32.3%) were confirmed with upper gastrointestinal perforation by surgery. Multivariate logistic regression analysis identified the following as independent predictors: preterm [OR: 5.014 (1.492–18.922)], time of onset [OR: 0.705 (0.582–0.829)], preoperative hemoglobin [OR:1.017 (1.001–1.033)], bloody stool: No [OR: 4.860 (1.270–23.588)], shock [OR: 5.790 (1.683–22.455)] and sepsis: No [OR 3.044 (1.124–8.581)]. Furthermore, the nomogram was effective in predicting the perforation site, with an AUC of 0.876 [95% confidence interval (CI): 0.830–0.923]. Internal validation showed that the average AUC was 0.861. Additionally, the model achieved satisfactory discrimination (AUC, 0.900; 95% CI, 0.826–0.974) and calibration (Hosmer-Lemeshow test, P = 0.4802) in external validation. Conclusions: The nomogram based on the six factors revealed good discrimination and calibration, suggesting good clinical utility. The nomogram could help surgeons predict the location of gastrointestinal perforation before surgery to make a surgical plan.
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Huang et al. (2021) conducted an observational in Neonatal gastrointestinal perforation (n=270). Six-factor clinical nomogram was evaluated on Prediction of upper gastrointestinal perforation (AUC) (AUC 0.876, 95% CI 0.830-0.923). A six-factor clinical nomogram effectively predicted the location of neonatal gastrointestinal perforation before surgery, achieving an AUC of 0.876 in the training cohort and 0.900 in external validation.
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